Review
Medicine, General & Internal
Shaojie Chen, Yuehui Yin, Zhiyu Ling, Christian Meyer, Helmut Puererfellner, Martin Martinek, Marcio Galindo Kiuchi, Piotr Futyma, Lin Zhu, Alexandra Schratter, Jiazhi Wang, Willem-Jan Acou, Philipp Sommer, Feifan Ouyang, Shaowen Liu, Julian K. R. Chun, Boris Schmidt
Summary: Catheter ablation is an effective therapeutic option for atrial fibrillation, reducing AF burden and improving clinical outcomes. Early rhythm control is associated with lower risk of adverse cardiovascular outcomes. CA as an initial first line strategy significantly reduces arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA lowers the risk of progression from paroxysmal AF to persistent AF. In persistent AF, overall clinical success after ablation is unsatisfactory, but better outcomes are observed in patients with early persistent AF. Adjunctive ablations on top of PVI can further reduce arrhythmia recurrence.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Lucas Boersma
Summary: Ablation has become a cornerstone for the management of symptomatic atrial fibrillation (AF), but the durability of isolation is still a challenge. Novel therapies and tools, such as high power short duration radiofrequency ablation and cryoenergy, are being developed to enhance the effectiveness of ablation. Further research is needed in identifying ablation targets and developing patient-specific ablation strategies.
Review
Medicine, General & Internal
Patrick M. McCarthy, James L. Cox, Olga N. Kislitsina, Jane Kruse, Andrei Churyla, S. Chris Malaisrie, Christopher K. Mehta
Summary: Atrial fibrillation is the most common cardiac arrhythmia, and its incidence is expected to increase in the future. Most patients are treated with oral medications, while only a small percentage undergo interventional techniques. With the increasing prevalence, a more aggressive approach to the treatment of atrial fibrillation is needed.
JOURNAL OF CLINICAL MEDICINE
(2022)
Review
Health Care Sciences & Services
Sho Suzuki, Takeshi Kitai, John Skoularigis, Kyriakos Spiliopoulos, Andrew Xanthopoulos
Summary: Atrial fibrillation (AF) and heart failure (HF) are common cardiac disorders that often coexist and may have a causal relationship. AF is a significant risk factor for adverse outcomes in HF patients. Catheter ablation (CA) has emerged as a promising treatment option, but there are still some unknowns.
JOURNAL OF PERSONALIZED MEDICINE
(2023)
Review
Cardiac & Cardiovascular Systems
Teiichi Yamane
Summary: Catheter ablation has become a common treatment for atrial fibrillation, aiming to eliminate symptoms and improve quality of life. Recent studies have sought to determine its impact on patient prognosis, but clear evidence of long-term improvement has not been found. However, catheter ablation is widely performed for asymptomatic atrial fibrillation with similar effectiveness to symptomatic cases.
JOURNAL OF CARDIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Karim Benali, Paul Khairy, Nefissa Hammache, Adrian Petzl, Antoine Da Costa, Atul Verma, Jason G. Andrade, Laurent Macle
Summary: A systematic review and pooled analysis of randomized control trials showed that catheter ablation of atrial fibrillation is associated with low rates of procedure-related complications and mortality, which have declined over the past decade.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Elena Arbelo, Nikolaos Dagres
Summary: This article critically reviews the recommendations of the 2020 ESC guidelines for the management of AF in light of two landmark trials, emphasizing the safety of contemporary rhythm control treatment and the importance of personalized treatment strategies.
Article
Cardiac & Cardiovascular Systems
Jonathan M. Kalman, Ahmed M. Al-Kaisey, Ramanathan Parameswaran, Joshua Hawson, Robert D. Anderson, Michael Lim, David Chieng, Stephen A. Joseph, Alex McLellan, Joseph B. Morton, Paul B. Sparks, Geoffrey Lee, Prashanthan Sanders, Peter M. Kistler
Summary: This study aimed to determine if the timing of catheter ablation for atrial fibrillation (AF) affects arrhythmia outcomes. The results showed that there was no significant difference in the atrial arrhythmia free survival at 12 months post-ablation between patients who underwent early ablation and those who underwent delayed ablation. Other secondary outcomes also showed no significant difference. Therefore, delaying AF ablation by 12 months for antiarrhythmic drug management does not reduce the efficacy of ablation.
EUROPEAN HEART JOURNAL
(2023)
Review
Cardiac & Cardiovascular Systems
Gianluigi Bisleri, Arjun K. Pandey, Subodh Verma, Syed M. Ali Hassan, Bobby Yanagawa, Masud Khandaker, Mario Gaudino, Andrea M. Russo, Atul Verma, Deepak L. Bhatt, Andrew C. T. Ha
Summary: Hybrid ablation is a novel therapy that combines minimally invasive surgical and percutaneous catheter-based techniques for the management of atrial fibrillation (AF). Observational studies have shown approximately 70% success rates but higher risks compared to catheter-based ablation. Hybrid ablation is typically offered to patients with persistent or longstanding persistent AF, requiring two procedures. While a randomized trial demonstrated its superiority over catheter-based ablation, it also showed higher complication rates. Contemporary studies have shown a decrease in the incidence of serious complications. Additional randomized trials are needed to determine the risks, benefits, and cost effectiveness of hybrid ablation in clinical practice.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Thomas J. Buist, Douglas P. Zipes, Arif Elvan
Summary: Catheter ablation is an established treatment for atrial fibrillation, with pulmonary vein isolation as the gold standard. AF recurrence is often due to recovery of conduction from the pulmonary veins. Various technologies are being developed to improve lesion quality and safety in AF ablation procedures.
CLINICAL RESEARCH IN CARDIOLOGY
(2021)
Article
Physiology
Jae-Hyuk Lee, Oh-Seok Kwon, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak
Summary: Catheter ablation is an effective method for treating atrial fibrillation, but it may lead to atrial tissue damage and increase the risk of stiff LA physiology. Factors such as diabetes, E/Em ratio, LA pulse pressure, low LA voltage, empirical extra-PV ablation, and radiofrequency ablation duration are associated with stiff LA physiology after AFCA.
FRONTIERS IN PHYSIOLOGY
(2021)
Review
Medicine, General & Internal
Francesco Maria Angelo Brasca, Roberto Mene, Giovanni Battista Perego
Summary: Atrial fibrillation (AF) is a common arrhythmia, especially in patients with structural heart disease (SHD). Catheter ablation (CA) has emerged as an effective strategy for rhythm control in AF patients and has potential benefits beyond symptom relief. This review summarizes the current knowledge of CA in SHD patients.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Geoffroy Ditac, Pierre Jean Cottinet, Minh Quyen Le, Daniel Grinberg, Josselin Duchateau, Kevin Gardey, Arnaud Dulac, Antoine Deliniere, Christelle Haddad, Julie Boussuge-Roze, Frederic Sacher, Pierre Jais, Philippe Chevalier, Francis Bessiere
Summary: Atrial fibrillation (AF) catheter ablation procedure contributes significantly to GHG emissions, with a carbon footprint of 76.9 kg CO2-e. With approximately 600,000 annual procedures worldwide, AF catheter ablation leads to 125 tons of CO2 emissions every day, equivalent to a daily car ride of 700,000 km. Electrophysiology catheters and patches are identified as the main contributors to the carbon footprint, highlighting the importance of reducing, reusing, and recycling these items.
Review
Medicine, General & Internal
Ursula Rohrer, Martin Manninger, Andreas Zirlik, Daniel Scherr
Summary: Atrial fibrillation is a common cardiac arrhythmia that requires thorough assessment and classification. Catheter ablation is an effective treatment option with positive impact on quality of life.
JOURNAL OF CLINICAL MEDICINE
(2022)
Review
Cardiac & Cardiovascular Systems
Derek Chew, Jonathan P. Piccini
Summary: Catheter ablation is more effective than antiarrhythmic therapy in reducing symptomatic AF, recurrence, and burden. The debate on rate vs. rhythm control has been reopened, potentially impacting stroke risk. Discontinuation of oral anticoagulation post-ablation may increase stroke risk, highlighting the need for further randomized controlled trials to determine the appropriate management.
Article
Cardiac & Cardiovascular Systems
Chrishan Joseph Nalliah, Geoffrey R. Wong, Geoffrey Lee, Aleksandr Voskoboinik, Kirk Kee, Jeremy Goldin, Troy Watts, Dominik Linz, Daniel Wirth, Ramanathan Parameswaran, Hariharan Sugumar, Sandeep Prabhu, Alex McLellan, Han Ling, Stephen Joseph, Joseph B. Morton, Peter Kistler, Prashanthan Sanders, Jonathan M. Kalman
Summary: The study found a significant association between obstructive sleep apnoea and the atrial fibrillation substrate, particularly among patients with paroxysmal atrial fibrillation and severe OSA. This suggests that identifying and managing OSA in AF patients may lead to better outcomes, especially for those with severe OSA.
Article
Cardiac & Cardiovascular Systems
Hariharan Sugumar, David Chieng, Sandeep Prabhu, Aleksandr Voskoboinik, Robert D. Anderson, Ahmed Al-Kaisey, Geoffrey Lee, Alex J. McLellan, Joseph B. Morton, Andrew J. Taylor, Liang-Han Ling, Jonathan M. Kalman, Peter M. Kistler
Summary: In this study, it was found that junctional rhythm (JR) is necessary for successful catheter ablation of AVNRT. The cycle length of JR during radiofrequency (RF) was not predictive of success. Unintended junctional beat-atrial block during faster JR was associated with slow pathway block, but it should not be intentionally targeted as it is a precursor to fast pathway block.
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
David Chieng, Hariharan Sugumar, Liang-Han Ling, Louise Segan, Sonia Azzopardi, Sandeep Prabhu, Ahmed Al-Kaisey, Aleksandr Voskoboinik, Ramanathan Parameswaran, Joseph B. Morton, Bhupesh Pathik, Alex J. McLellan, Geoffrey Lee, Michael Wong, Sue Finch, Rajeev K. Pathak, Deep Chandh Raja, Prashanthan Sanders, Laurence Sterns, Matthew Ginks, Christopher M. Reid, Jonathan M. Kalman, Peter M. Kistler
Summary: This multi-center, prospective, international randomized clinical trial aims to determine whether adding posterior wall isolation (PWI) to pulmonary vein isolation (PVI) significantly improves freedom from atrial fibrillation (AF) recurrence in patients with persistent AF.
AMERICAN HEART JOURNAL
(2022)
Article
Cardiac & Cardiovascular Systems
Geoffrey R. Wong, Chrishan J. Nalliah, Geoffrey Lee, Aleksandr Voskoboinik, David Chieng, Sandeep Prabhu, Ramanathan Parameswaran, Hariharan Sugumar, Ahmed Al-Kaisey, Alex McLellan, Liang-Han Ling, Prashanthan Sanders, Peter M. Kistler, Jonathan M. Kalman
Summary: This study found that women with AF have higher risks of recurrence, which may be attributed to differences in atrial electrophysiological substrate. The findings provide a better understanding of the underlying mechanisms behind poor treatment outcomes in female AF patients.
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Richard G. Bennett, Kartheek Garikapati, Robert D. Anderson, Kasun De Silva, Timothy Campbell, Yasuhito Kotake, Samual Turnbull, Ivaylo Tonchev, Geoffrey Lee, Jonathan Kalman, Saurabh Kumar
Summary: This study described the clinical characteristics and catheter ablation outcomes of patients with ventricular tachycardia (VT) following aortic and/or mitral valve intervention. The results showed that most VT circuits involved perivalvular regions or unrelated regions, and catheter ablation was found to be safe and efficacious in treating these patients. New strategies may be needed for VT circuits not involving the valve regions themselves.
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Joshua Hawson, Jonathan Kalman, John Goldblatt, Robert D. Anderson, Troy Watts, Nick Hardcastle, Shankar Siva, Saurabh Kumar, Geoffrey Lee
Summary: This case report highlights the need for careful consideration when planning treatment for patients with double mechanical valves.
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
(2022)
Article
Medicine, General & Internal
Peter M. Kistler, David Chieng, Hariharan Sugumar, Liang-Han Ling, Louise Segan, Sonia Azzopardi, Ahmed Al-Kaisey, Ramanathan Parameswaran, Robert D. Anderson, Joshua Hawson, Sandeep Prabhu, Aleksandr Voskoboinik, Geoffrey Wong, Joseph B. Morton, Bhupesh Pathik, Alex J. McLellan, Geoffrey Lee, Michael Wong, Sue Finch, Rajeev K. Pathak, Deep Chandh Raja, Laurence Sterns, Matthew Ginks, Christopher M. Reid, Prashanthan Sanders, Jonathan M. Kalman
Summary: This randomized clinical trial compares pulmonary vein isolation (PVI) vs PVI with posterior wall isolation for achieving freedom from atrial arrhythmia in adult patients with persistent atrial fibrillation undergoing first-time catheter ablation in Australia, the UK, and Canada. The study findings suggest that adding posterior wall isolation to PVI does not significantly improve freedom from atrial arrhythmias in patients with persistent AF. Therefore, the empirical inclusion of posterior wall isolation for ablation of persistent AF may not be supported.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2023)
Article
Cardiac & Cardiovascular Systems
Jonathan M. Kalman, Ahmed M. Al-Kaisey, Ramanathan Parameswaran, Joshua Hawson, Robert D. Anderson, Michael Lim, David Chieng, Stephen A. Joseph, Alex McLellan, Joseph B. Morton, Paul B. Sparks, Geoffrey Lee, Prashanthan Sanders, Peter M. Kistler
Summary: This study aimed to determine if the timing of catheter ablation for atrial fibrillation (AF) affects arrhythmia outcomes. The results showed that there was no significant difference in the atrial arrhythmia free survival at 12 months post-ablation between patients who underwent early ablation and those who underwent delayed ablation. Other secondary outcomes also showed no significant difference. Therefore, delaying AF ablation by 12 months for antiarrhythmic drug management does not reduce the efficacy of ablation.
EUROPEAN HEART JOURNAL
(2023)
Article
Cardiac & Cardiovascular Systems
Jeremy William, Jack Shembrey, Edward Quine, Mark Perrin, Daryl Ridley, Ramanathan Parameswaran, Peter M. Kistler, Aleksandr Voskoboinik
Summary: This study presents a case series of three patients who developed polymorphic ventricular tachycardia storm after coronary artery bypass graft surgery. The recurrent episodes of ventricular tachycardia in these cases were initiated by short-coupled ventricular ectopy, with no evidence of acute coronary ischemia. Two out of three patients achieved rapid suppression of the arrhythmia with oral quinidine sulfate.
HEART LUNG AND CIRCULATION
(2023)
Article
Cardiac & Cardiovascular Systems
Ahmed M. Al-Kaisey, Ramanathan Parameswaran, Christina Bryant, Robert D. Anderson, Joshua Hawson, David Chieng, Aleksandr Voskoboinik, Hariharan Sugumar, Danielle West, Sonia Azzopardi, Sue Finch, Geoffrey Wong, Stephen A. Joseph, Alex Mclellan, Liang-Han Ling, Prashanthan Sanders, Geoffrey Lee, Peter M. Kistler, Jonathan M. Kalman
Summary: This study aimed to determine if AF catheter ablation is associated with persistent cognitive dysfunction at 12-month follow-up. The study found that the prevalence of cognitive dysfunction was significantly higher in the ablation group compared to the medical group at 3 months, but recovered to similar levels as the medical group at 12 months. Ablation time was identified as an independent predictor of POCD.
JACC-CLINICAL ELECTROPHYSIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Ahmed M. Al-Kaisey, Ramanathan Parameswaran, Robert Anderson, Joshua Hawson, Michael Nam, Hariharan Sugumar, David Chieng, Troy Watts, Alex McLellan, Peter M. Kistler, Geoffrey Lee, Jonathan M. Kalman
Summary: This study demonstrated complete wave front dissociation between the left and right interatrial septum in patients with persistent atrial fibrillation. The findings suggest that the two sides of the septum function as electrically discrete structures and may have implications for mapping and ablation of persistent atrial fibrillation.
JACC-CLINICAL ELECTROPHYSIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Chrishan J. Nalliah, Geoffrey R. Wong, Geoffrey Lee, Aleksandr Voskoboinik, Kirk Kee, Jeremy Goldin, Troy Watts, Dominik Linz, Ramanathan Parameswaran, Hariharan Sugumar, Sandeep Prabhu, Alex McLellan, Liang-Han Ling, Stephen A. Joseph, Joseph B. Morton, Peter Kistler, Prashanthan Sanders, Jonathan M. Kalman
Summary: This study aimed to determine the impact of OSA management on the atrial substrate in AF. The results showed that CPAP therapy can reverse atrial remodeling in AF.
JACC-CLINICAL ELECTROPHYSIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Peter M. Kistler, David Chieng, Ivaylo R. Tonchev, Hariharan Sugumar, Aleksandr Voskoboinik, Lorin A. Schwartz, Alex J. McLellan, Sandeep Prabhu, Liang-Han Ling, Ahmed Al-Kaisey, Ramanathan Parameswaran, Robert D. Anderson, Geoffrey Lee, Jonathan M. Kalman
Summary: This study aimed to report P-wave morphology from a series of paraseptal atrial tachycardia and prospectively evaluate a simplified PWM algorithm. The updated algorithm offers a simplified and accurate method of localizing the responsible site for focal AT. The P-wave remains an important first step in mapping atrial arrhythmias.
JACC-CLINICAL ELECTROPHYSIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Ahmed M. Al-Kaisey, Ramanathan Parameswaran, Stephen A. Joseph, Peter M. Kistler, Joseph B. Morton, Jonathan M. Kalman
Summary: The extensive low-voltage zone in the trabeculated right atrial wall can serve as a substrate for atrial fibrillation, with unstable atrial tachycardias also originating from the same zone. Radiofrequency ablation aimed at rendering the low-voltage zone electrically inert is an effective strategy for managing atrial fibrillation and atrial tachycardia.
