Invasive treatment of atrial arrhythmias, insight in mechanisms and outcome of different techniques

Contains fulltext : 191595.pdf (publisher's version ) (Open Access)Radboud University, 14 juni 2018Promotores : Royen, N. van, Crijns, H.J.G.M. Co-promotores : Elvan, A., Ramdat Misier, A.R

Catheter ablation of symptomatic postoperative atrial arrhythmias after epicardial surgical disconnection of the pulmonary veins and left atrial appendage ligation in patients with atrial fibrillation

OBJECTIVES: Minimally invasive thoracoscopic epicardial pulmonary vein isolation (MIPI) has an important role in the surgical treatment of atrial fibrillation (AF). However, the management of recurrent atrial arrhythmias after MIPI and long-term success rate of catheter ablation have not been well studied. METHODS: Electrophysiological study was performed in 23 patients, 378 +/- 282 days after MIPI surgery, because of recurrent symptomatic atrial arrhythmias. RESULTS: A total of 20 patients presented with paroxysmal and persistent AF, 2 patients had a combination of AF and atrial tachycardia (AT) and 1 patient had a combination of AF and atrial flutter. All patients showed pulmonary vein (PV) reconnection. ATs were micro-re-entry PV-related ATs and atrial flutter was cavotricuspid isthmus dependent. Eighteen of 23 patients (78.3%) were free of atrial arrhythmias after one catheter ablation procedure at a mean follow-up of 50 +/- 16 months. Three patients underwent a second ablation procedure for recurrent AF and macro-re-entry left atrial flutter. Eventually 20 of 23 patients (87%) remained free of atrial arrhythmias after a mean of 1.1 +/- 0.3 ablation procedures. CONCLUSIONS: Catheter ablation of recurrent atrial arrhythmias following MIPI for paroxysmal and persistent AF is a feasible and effective treatment with a good long-term success rate. Reconnection of PVs accounts for most recurrences

Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature

Item does not contain fulltextAIMS: Focal atrial tachycardia successfully ablated from the non-coronary cusp (NCC) is rare. Our aim was to describe the characteristics of mapping and ablation therapy of NCC focal atrial tachycardias and to provide a comprehensive review of the literature. METHODS AND RESULTS: Seven patients (age 40 +/- 9 years) with symptomatic, drug-refractory atrial tachycardia were referred for electrophysiological study. Extensive right and left atrial mapping revealed atrial tachycardia near His in all patients but either failed to identify a successful ablation site or radiofrequency applications only resulted in temporary termination of the tachycardia. Mapping and ablation of the NCC were performed retrogradely via the right femoral artery. Mapping of the NCC demonstrated earliest atrial activation during atrial tachycardia 38 +/- 14 ms (ranging 17-56 ms) before the onset of the P-wave. Earliest atrial activation in the NCC was earlier than earliest activation in the right atrium and left atrium in all patients. The P-wave morphology was predominantly negative in the inferior leads and biphasic in leads V1 and V2. The tachycardia was successfully terminated by radiofrequency application in 10 +/- 6 s (2-16 s), without complications. All patients were free of symptoms during a follow-up of 19 +/- 9 months. Literature search revealed 18 reports (91 patients) describing NCC focal atrial tachycardia, with 99% long-term ablation success with a 1% complication rate. CONCLUSION: Symptomatic focal atrial tachycardia near His may originate from the NCC and can be treated safely and effectively with radiofrequency ablation

Randomized Controlled Trial of Surgical Versus Catheter Ablation for Paroxysmal and Early Persistent Atrial Fibrillation

Contains fulltext : 200354.pdf (Publisher’s version ) (Closed access)BACKGROUND: Current guidelines recommend both percutaneous catheter ablation (CA) and surgical ablation in the treatment of atrial fibrillation, with different levels of evidence. No direct comparison has been made between minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation (surgical MIPI) versus percutaneous CA comprising of pulmonary vein isolation as primary treatment of atrial fibrillation. We, therefore, conducted a randomized controlled trial comparing the safety and efficacy of these 2 treatment modalities. METHODS: Eighty patients were enrolled in the study and underwent implantable loop recorder implantation. Twenty-eight patients did not reach randomization criteria. A total of 52 patients with symptomatic paroxysmal or early persistent atrial fibrillation were randomized, 26 to CA and 26 to surgical MIPI. The primary end point was defined as freedom of atrial tachyarrhythmias, without the use of antiarrhythmic drugs. The safety end point was freedom of complications. RESULTS: Median age was 57 years (range, 37-75), and 78% were men. Paroxysmal atrial fibrillation was present in 74%. Follow-up duration was >/=2 years in all patients. CA was noninferior to MIPI in terms of single-procedure arrhythmia-free survival after 2 years of follow-up (56.0% versus 29.2%; HR, 0.56; 95% CI, 0.26-1.20; log-rank P=0.059). Procedure-related major adverse events occurred significantly more often in MIPI than CA (20.8% versus 0%; P=0.029). CONCLUSIONS: Percutaneous pulmonary vein isolation was noninferior to MIPI in terms of efficacy and resulted in less complications. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00703157

Second-generation cryoballoon ablation for recurrent atrial fibrillation after an index cryoballoon procedure: a staged strategy with variable balloon size

Contains fulltext : 201240.pdf (publisher's version ) (Open Access

Quality of life after catheter and minimally invasive surgical ablation of paroxysmal and early persistent atrial fibrillation: results from the SCALAF trial

Contains fulltext : 229201.pdf (Publisher’s version ) (Closed access)AIMS: In the SCALAF trial, catheter-based pulmonary vein isolation (PVI) was as effective in long-term prevention of atrial fibrillation (AF) as minimally invasive thoracoscopic PVI and left atrial appendage ligation (MIPI). Catheter ablation (CA) resulted in significantly less major complications as compare to MIPI. We report quality of life (QOL) outcome in these patients. METHODS: In this study, 52 patients with symptomatic paroxysmal or early persistent AF were randomized to either MIPI or CA. QOL was assessed at baseline, 3, 6, and 12 months follow-up using the SF-36 Health Survey Questionnaire. AF-related symptoms were quantified at each follow-up visit using the European Heart Rhythm Association (EHRA) score. RESULTS: Median age was 57 years and 78% was male. Paroxysmal AF was present in 74%. At 3 months follow-up, physical role limitations (88.2 +/- 29.5; versus 40.9 +/- 44.0; P = 0.001, respectively) and bodily pain scores (95.5 +/- 8.7; versus 76.0 +/- 27.8; P = 0.021, respectively) were significantly higher after CA compared to MIPI, indicating less limitation in daily activity caused by physical problems and less pain after CA than after MIPI. AF symptoms assessed by the EHRA scores improved significantly at 3, 6, 12, and 24 months compared to baseline in both treatment groups (P < 0.001), with no significant differences between treatment groups. CONCLUSIONS: CA and MIPI ablation of AF both resulted in an improvement in several QOL measurements, although CA resulted in significantly less physical problems and bodily pain 3 months after treatment compared to MIPI. CLINICAL TRIAL NUMBER: ClinicalTrials.gov identifier: NCT00703157