Left atrial emptying fraction predicts recurrence of atrial fibrillation after radiofrequency catheter ablation
Chung‐Chuan ChouHui‐Ling LeePo‐Cheng ChangHung-Ta WoMing‐Shien WenSan‐Jou YehFen-Chiung LinYi‐Ting Hwang
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Background Compared with left atrial (LA) dimension, LA emptying fraction (LAEF) has received less emphasis as a predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). In addition, patients experiencing post-RFCA AF recurrence may respond to previously ineffective antiarrhythmic drugs (AADs). Classifying these patients into a third RFCA outcome category is recommended. Objective To identify predictors of RFCA outcome classified into three categories, and to build proportional odds logistic regression models for clinical applicability to predict AF recurrence. Methods Data were retrospectively collected from 483 consecutive patients with drug-refractory AF undergoing RFCA (328 men; age 58.4 ± 11.5 years; 383 paroxysmal). Patients were classified into 3 groups based on the last RFCA outcome: group 1, free from AF without AADs; group 2, free from AF with AADs; and group 3, recurrence of AADs-refractory atrial tachyarrhythmia. Results After a mean follow-up duration of 64.5 ± 43.2 months and mean ablation procedure number of 1.37 ± 0.68, the RFCA outcome showed 76.0%, 9.5% and 14.5% of patients in groups 1, 2, and 3, respectively. In multivariate analysis, LAEF was the most stable and important predictor of AF recurrence, followed by body mass index, stroke, AF duration, mitral regurgitation, and LA linear ablation. For patients undergoing repeat RFCA, LAEF was the only independent predictor (cutoffs: 43% and 35% for groups 1 and 3, respectively). Conclusion LAEF provides optimal prognostic information regarding the risk stratification of AF patients undergoing RFCA.Cardiac Ablation
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Atrial fibrillation globally affects roughly 33.5 million people, making it the most common heart rhythm disorder. It is a crucial arrhythmia, as it is linked with a variety of negative outcomes such as strokes, heart failure and cardiovascular mortality. Atrial fibrillation can reduce quality of life because of the potential symptoms, for instance exercise intolerance, fatigue, and palpitation. There are different types of treatments aiming to prevent atrial fibrillation and improve quality of life. Currently, the primary treatment for atrial fibrillation is pharmacology therapy, however, these still show limited effectiveness, which has led to research on other alternative strategies. Catheter ablation is considered the second line treatment for atrial fibrillation when the standard treatment has failed. Moreover, catheter ablation continues to show significant results when compared to standard therapy. Hence, this review will argue that catheter ablation can show superiority over current pharmacological treatments in different aspects. It will discuss the most influential aspects of the treatment of atrial fibrillation, which are recurrence and burden of atrial fibrillation, quality of life, atrial fibrillation in the setting of heart failure and mortality and whether catheter ablation can be the first line treatment for patients with atrial fibrillation.
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Cardiac Ablation
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In recent years, radio-frequency catheter ablation has emerged as an effective treatment option for patients with paroxysmal and chronic atrial fibrillation (AF). Based on advances in the understanding of the pathogenesis of AF, catheter ablation has evolved primarily into two general approaches: (1) ablation strategies that create a predetermined set of lesions usually at or around specific anatomical landmarks (anatomically guided ablation) and (2) ablation strategies that attempt to identify and eliminate specific mechanisms that initiate and perpetuate AF (tailored ablation). A tailored ablation strategy also has been combined with anatomically guided ablation. In this chapter, anatomically guided ablation is discussed.
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Catheter ablation of ventricular tachycardia (VT) is demanding and time consuming. Robotically controlled catheter ablation reduces operator fatigue and exposure to X-rays, and provides greater precision and stability of the catheter. A new flexible, integrated robotic sheath and ablation catheter has recently been introduced (Lynx(TM)) and used in atrial ablation procedures. We describe the first VT substrate modification ablation in the world with the Lynx(TM) robotic radio frequency ablation catheter.
Rf ablation
Cardiac Ablation
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The advent of catheter ablation technology has changed the treatment strategy for atrial fibrillation, and the efficacy of catheter ablation is accurate with small surgical trauma. Catheter ablation treatment of atrial fibrillation is significantly better than pharmacologic therapy of anti-arrhythmia and rate control. However, the clinic data of catheter ablation of atrial fibrillation show that the recurrence rate is high. The risk factors for recurrence after catheter ablation include age, sex, body mass index, related primary disease, left atrial volume, pulmonary vein volume, gene, atrial fibrillation types, surgery and so on. Regulation of the above factors is crucial in improving the clinical efficacy and prognosis of catheter ablation of atrial fibrillation.导管消融技术改变了心房颤动的治疗策略，且其疗效确切，手术创伤小。导管消融术治疗房颤结局显著优于抗心律失常及控制心室率等药物的治疗方案，但其术后心房颤动的复发率高，其复发的影响因素包括年龄、性别、体重指数、基础疾病、左心房体积、肺静脉容积、基因、房颤类型、手术方式等。针对这些因素进行相应调整，对改善导管消融术后的临床疗效及预后至关重要。.
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Atrial fibrillation and obesity are interlinked epidemics and both impair quality of life. As the prevalence of both conditions in the US continues to rise, so will the number of obese patients with atrial fibrillation referred for catheter ablation. Catheter ablation has already been shown to significantly improve quality of life in patients with atrial fibrillation. Until recently, there has been little attention to the effects of catheter ablation on quality of life specifically in obese patients with atrial fibrillation. This paper will review what is known about the effects of atrial fibrillation and obesity on quality of life and how quality of life is affected by catheter ablation for atrial fibrillation in obese patients.
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Ablation of papillary muscles (PMs) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting.Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50 W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 g. Ablation lesions were sectioned and underwent quantitative morphometric analysis.A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared with ablation with the catheter parallel to PM tissue (75.26 ± 8.40 mm3 vs. 34.04 ± 2.91 mm3 , p < .001) and (3.33 ± 0.18 mm vs. 2.24 ± 0.10 mm, p < .001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33 ± 0.28°C vs. 40.28 ± 0.24°C, p = .003), yet, there were no steam pops in either group.For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths.
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