212 research outputs found
How to perform left atrial transseptal access and catheter ablation of atrial fibrillation from a superior approach
The standard technique for percutaneous catheter ablation of atrial fibrillation (AF) involves obtaining left atrial access and catheter manipulation from an inferior transfemoral venous access. However, in patients with inferior vena cava interruption, a standard transfemoral venous approach is not possible. In these cases, a percutaneous approach from a superior central vein, such as the internal jugular vein or the axillary/subclavian vein can be considered. In this article, we describe the details of our technique to obtain left atrial catheterization and perform catheter ablation of AF from a superior approach. Our technique involves the use of steerable sheaths, dedicated radiofrequency wires, and intracardiac echocardiography guidance.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153672/1/jce14294_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153672/2/jce14294.pd
Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it?
Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies
Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it?
Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies
Atrial Fibrillation Ablation without Interruption of Anticoagulation
Atrial fibrillation
(AF) can be cured by pulmonary vein antrum
isolation (PVAI) in a substantial proportion of
patients. The high efficacy of PVAI is partially
undermined by a small but concrete
periprocedural risk of complications, such as
thromboembolic events and bleeding. A correct
management of anticoagulation is essential to
prevent such complications. Performing PVAI
without interruption of oral anticoagulation has
been demonstrated feasible by our group in
previous studies. Recently, we reported that
continuation of therapeutic warfarin during
radiofrequency catheter ablation consistently
reduces the risk of periprocedural
stroke/transient ischemic attack without
increasing the risk of hemorrhagic events. Of
note, interrupting warfarin anticoagulation may
actually increase the risk of stroke even when
bridged with heparin. The latter strategy is
also associated with an increased risk of minor
bleeding. With regard to major bleeding, we
found no significant difference between patients
with a therapeutic INR and those who were
bridged with heparin. Therefore, continuation of
therapeutic warfarin during ablation of AF
appears to be the best anticoagulation strategy.
In this paper we summarize our experience with
AF ablation without interruption of
anticoagulation
Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia
Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of ‘substrate’-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms – sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability
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