Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

Objectives: To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters. Methods: Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and the analgesics were recorded. Patients were followed for at least 3 months. Results: The acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144±48 min for RF, vs 158±49 min for cryo). More applications were given with RF than with cryo (26±17 vs. 18±10, p<0.05). Fluoroscopy time was longer with RF (29±15 vs. 19±12 min, p<0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly less analgesia (p<0.01), and no use of long sheaths (p<0.005). The isthmus tended to be longer in the failed procedures (p=0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success. Concl

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Unusual haemorrhage complication after carotid endarterectomy.

An unusual case of haemorrhage complication after carotid endarterectomy caused by vein patch perforation is presented

Early appearance of an edematous tissue reaction during left atrial linear ablation using intracardiac echo imaging

Images in cardiovascular medicineRukshen Weerasooriya, Pierre Jaïs, Prashanthan Sanders, Christophe Scavée, Li-Fern Hsu, Mélèze Hocini, Jacques Clementy, Michel Haïssaguerr

Pulmonary vein ablation using a 3D catheter tracking system

Images in cardiovascular medicineRukshen Weerasooriya, Pierre Jaîs, Christophe Scaveé, Mélèze Hocini, Laurent Macle, Li-Fern Hsu, Prashanthan Sanders, Michel Haîssaguerr

Ablation of auricular fibrillation: Experiment of a center of reference [Ablation de la fibrillation auriculaire: Experience d'un centre de reference]

Copyright © 2004 Louvain Medical AssociationScavée, C.; Jaïs, P.; Weerasooryia, R.; Macle, L.; Hocini, M.; Hsu, L.F.; Sanders, P.; Haïssaguerre, M

Catheter ablation of pulmonary vein atrial fibrillation: segmental and limited linear ablation

Copyright © 2004 by Futura, an imprint of Blackwell PublishingLi-Fern Hsu, Pierre Jaïs, Prashanthan Sanders, Mélèze Hocini, Christophe Scavée, Rukshen Weerasooriya, Stéphane Garrigue, Jacques Clémenty, Michel Haïssaguerr

Effect of catheter ablation on quality of life of patients with paroxysmal atrial fibrillation

© 2007 Elsevier B.V. All rights reserved.BackgroundAlthough improved quality of life is one of the primary aims of catheter ablation for paroxysmal atrial fibrillation, there is a paucity of published data on this topic.ObjectivesThe purpose of this study was to determine the effect of curative catheter ablation on the quality of life of patients with symptomatic, drug-refractory paroxysmal atrial fibrillation.MethodsThis was a prospective nonrandomized study of 63 consecutively enrolled patients (49 men and 14 women, age 56 +/- 7 years). Patients were excluded from the study if they had significant structural heart disease. The ablation strategy consisted of systematic isolation of all pulmonary veins, followed by limited linear ablation in the atria comprising left isthmus ablation (between the left inferior pulmonary vein and lateral mitral annulus) and cavotricuspid isthmus ablation. Patients completed quality-of-life questionnaires comprising the SF-36 and Symptom Checklist at baseline and 3 and 12 months following ablation.ResultsFifty-four patients (86%) were free of symptomatic recurrence at 12-month follow-up. Successful ablation resulted in a significant improvement of all eight subscales of the SF-36 and of symptom frequency and severity scores of the symptom checklist at 3 months. This improvement was maintained at 12 months.ConclusionsCombined pulmonary vein isolation and linear atrial ablation has a high success rate for cure of paroxysmal atrial fibrillation. Successful curative catheter ablation of paroxysmal atrial fibrillation significantly and persistently improved quality of life during long-term follow-up. This improvement in quality of life was accompanied by a significant reduction in arrhythmia symptom frequency and severity.Rukshen Weerasooriya, Pierre Jaïs, Mélèze Hocini, Christophe Scavée, Laurent MacLe, Li Fern Hsu, Prashanthan Sandars, Stephane Garrigue, Jacques Clémenty and Michel Haïssaguerr

Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter

BackgroundRadiofrequency (RF) ablation of cavotricuspid isthmus (CTI) dependent flutter can be performed using different types of ablation catheters. It has been proposed that irrigated and large-tip catheters are capable of creating larger lesions, resulting in greater efficacy. This prospective, randomised clinical study compared the efficacy of irrigated and large-tip catheters of different designs.MethodsEighty patients (69 men, 66+/-11 years) undergoing de novo RF ablation of CTI-dependent flutter were randomised to ablation using one of the following catheters: (i) externally-irrigated 20), (ii) internally-cooled (n=20), (iii) single sensor, 8-mm tip (n=20), or (iv) double sensor, 8-mm tip (n=20). The study endpoint was the demonstration of bidirectional CTI conduction block within 12 min of cumulative RF delivery. Crossover to the externally-irrigated catheter was permitted if this was not achieved. The ablation and procedural parameters, safety and efficacy were compared.ResultsThe primary endpoint was achieved in 64 patients (80%), including all 20 patients randomised to the externally-irrigated catheter. Crossover was required in 16 patients: 9 initially using the internally-cooled catheter (45%), 3 using single-sensor, 8-mm-tip (15%), and 4 using double-sensor, 8-mm-tip (20%) catheters. The higher initial failure rate with the internally-cooled-tip catheter was significant compared to the externally-irrigated (p = 0.001) and single-sensor, 8-mm-tip (p = 0.04) catheters. The externally-irrigated catheter achieved the study endpoint more frequently with fewer RF applications of shorter duration compared to the internally-cooled-tip catheter and 8-mm-tip catheters, the difference being significant compared with internally cooled ablation. No major complications were observed.ConclusionAmong commonly used ablation catheters, the externally-irrigated catheter has a higher efficacy for rapid achievement of CTI block.Christophe Scavée, Pierre Jaïs, Li-Fern Hsu, Prashanthan Sanders, Meleze Hocini, Rukshen Weerasooriya, Laurent Macle, Florence Raybaud, Jacques Clementy and Michel Haïssaguerr