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1.
Alexander Wutzler Thomas Wolber Abdul Shokor Parwani Martin Huemer Philipp Attanasio Florian Blaschke Laurent Haegeli Wilhelm Haverkamp Firat Duru Leif-Hendrik Boldt 《Journal of interventional cardiac electrophysiology》2014,40(3):215-219
Purpose
Pulmonary vein isolation (PVI) is widely established as a curative treatment option for atrial fibrillation (AF). A wide range of techniques to improve catheter manipulation and steerability has been developed over the past years. A new remote catheter system (RCS) has recently become available (Amigo Remote Catheter System, Catheter Robotics, Budd Lake, NJ, USA). Here, we present a dual-center study on the RCS for left atrial mapping and PVI in patients with paroxysmal AF compared to a control group undergoing conventional PVI.Methods
One hundred nineteen patients who underwent PVI for paroxysmal AF were studied. Forty patients underwent PVI with the use of the RCS. Seventy-nine patients, who underwent conventional PVI, served as control group. Procedural data were compared between the two groups.Results
PVI was achieved in all patients. In the RCS group compared to standard ablation group, there were no significant differences in procedure duration (159.1?±?45.4 vs. 146?±?30.1 min, p?=?0.19), total energy delivery (78,146.3?±?26,992.4 vs. 87,963.9?±?79,202.1 Ws, p?=?0.57), and total fluoroscopy time (21.2?±?8.6 vs. 23.9?±?5.4 min, p?=?0.15). Operator fluoroscopy exposure was significantly reduced in the RCS group (13.4?±?6.1 vs. 23.9?±?5.4 min, p?0.001).Conclusions
These initial results suggest that left atrial mapping and PVI are feasible with the use of the Amigo RCS. Acute procedural efficacy is comparable to the standard approach. The use of the Amigo RCS leads to a significant reduction of operator fluoroscopy exposure. 相似文献2.
von Bary C Dornia C Eissnert C Nedios S Roser M Hamer OW Gerds-Li JH Paetsch I Jahnke C Gebker R Weber S Fleck E Kriatselis C 《Journal of interventional cardiac electrophysiology》2012,34(2):181-188
Purpose
We investigate the role of left atrial volume (LAV) as a predictor of outcome following pulmonary vein isolation (PVI) in patients with exclusive paroxysmal atrial fibrillation (AF).Methods
PVI was performed in 213 patients (80 females, aged 60?±?10?years) with paroxysmal AF using either the pulmonary vein ablation catheter (PVAC, n?=?78) or conventional single-tip ablation (n?=?135). LAV was assessed by multi-detector computed tomography (n?=?39) or cardiac magnetic resonance imaging (n?=?174) prior to ablation. LA diameter (LAD) and LA area were determined by echocardiography. Patients were followed up for 12?months clinically and with 72-h Holter ECG.Results
The mean LAV was 85?±?28?ml (range, 22?C189?ml). Mean LAD and mean LA area were 43?±?6?mm and 23?±?6?cm2. After a follow-up period of 18?±?5?months, 202 patients were analyzed. AF recurrence was documented in 50 (23%) patients. Univariate analysis showed age (59?±?11 vs. 65?±?6?years, p?=?0.049), LA area (23?±?5 vs. 27?±?6?cm2, p?=?0.03), and LAV (80?±?27 vs. 96?±?28?ml, p?=?0.04) to be significantly associated with the outcome. Multivariate analysis revealed that none of these parameters were statistically significant (hazards ratio LAV, 0.52?C1.12, p?=?0.058; LA area, 0.63?C1.14, p?=?0.069; and age, 0.90?C1.09, p?=?0.41). In the case of AF recurrence, patients with LAV >95?ml showed a significantly higher probability for the occurrence of persistent AF (24% vs. 8%, p?=?0.02).Conclusions
The assessment of LA size should not be incorporated as a main factor with regard to predicted ablation success in patients with paroxysmal AF being considered for PVI, as PVI may be successful even with considerable LA enlargement. Ablation should be performed promptly in patients with LAV ??95?ml to prevent further LA dilatation, as patients with LAV >95?ml have an increased probability to develop persistent AF in the case of ablation failure. 相似文献3.
Martina Nassif Sébastien P. J. Krul Antoine H. G. Driessen Thomas Deneke Arthur A. M. Wilde Jacques M. T. de Bakker Joris R. de Groot 《Journal of interventional cardiac electrophysiology》2013,37(3):275-282
Background
Changes in P wave duration (PWD) and P wave area (PWA) have been described following catheter ablation for atrial fibrillation (AF). We hypothesize that video-assisted thoracoscopic pulmonary vein isolation (VATS-PVI) for AF results in decrease of PWD, PWA and P wave dispersion, which may resemble reverse electrical remodeling of the atrium after restoration of sinus rhythm.Methods
VATS-PVI consisted of PVI and ganglionic plexus ablation in 29 patients (mean age, 59?±?7 years; 23 males; 17 paroxysmal AF) and additional left atrial lesions in patients with persistent AF. PWD and PWA were measured in ECG lead II, aVF and V2 of ECGs during sinus rhythm before, directly after, and 6 months postprocedure. P wave dispersion was derived from the 12 lead ECG.Results
Prior to VATS-PVI, PWD did not correlate with left atrial size and no difference in left atrial size was found between patients with paroxysmal or persistent AF (p?=?0.27). Following VATS-PVI, PWD initially prolonged in all patients from 115?±?4.6 ms to 131?±?3.6 ms (p?<?0.01) but shortened to 99?±?3.2 ms after 6 months (p?<?0.01). PWA was 5.60?±?0.32 mV*ms at baseline, 6.44?±?0.32 mV*ms post-VATS-PVI (P?=?NS), and 5.40?±?0.28 mV*ms after 6 months (p?=?NS vs. baseline, p?<?0.05 vs. post-VATS-PVI). P wave dispersion decreased in the persistent AF group from baseline 67?±?3.3 to 64?±?2.5 ms post-VATS-PVI (p?=?0.30) and to 61?±?3.4 ms after 6 months (p?<?0.05).Conclusions
PWD increases significantly directly after successful VATS-PVI in both groups. There was significant decrease in PWD after 6 months. Similarly, P wave dispersion decreased in the persistent group. These changes suggest an immediate procedure related effect, but the later changes may represent reverse electrical atrial remodeling following cessation of AF. 相似文献4.
Markus Linhart Thorsten Lewalter Erica L. Mittmann-Braun Nicole C. Karbach René P. Andrié Christoph Hammerstingl Rolf Fimmers Jens Kreuz Georg Nickenig Jan W. Schrickel Lars M. Lickfett 《Journal of interventional cardiac electrophysiology》2013,38(2):107-114
Purpose
Identification of reliable risk factors for recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) has important implications. Left atrial (LA) pressure is a largely observator-independent parameter that can easily be determined after transseptal puncture. The purpose of this study was to investigate the predictive value of LA pressure for AF recurrence after PVI.Methods
Two hundred five consecutive patients with paroxysmal or persistent AF scheduled for first PVI were included. Baseline clinical data were collected. During PVI, LA pressure was determined invasively after transseptal puncture. PVI was performed with radiofrequency or cryoenergy, and patients were followed for 25?±?7 months.Results
One hundred five (51 %) patients had AF recurrence. Patients with persistent AF prior to ablation had significantly more recurrences than patients with paroxysmal AF (70.1 vs. 42.0 %, p?<?0.001). Mean LA pressure was significantly higher in patients with recurrence of AF (13.4?±?7.1 vs. 11.0?±?5.2 mmHg, p?=?0.007), as was mean LA volume index (40.1?±?18.5 vs. 33.0?±?11.2 mL/m2, p?<?0.001). In the multivariate analysis, mean LA pressure was predictive in patients with normal or mildly enlarged LA, while AF type was not predictive. For each 1-mmHg increase in LA pressure, the risk of AF recurrence increased by 11 % in this subgroup. In patients with moderately or severely enlarged LA, AF type was predictive whereas LA pressure was not.Conclusion
LA pressure, AF type, and LA volume index are independent predictors for recurrence of AF after PVI. LA pressure may be helpful especially in patients with small atria, where AF type is not predictive. 相似文献5.
Rangadham Nagarakanti April Slee Sanjeev Saksena 《Journal of interventional cardiac electrophysiology》2014,40(3):245-254
Introduction
Dual-site right atrial pacing (DAP) produces electrical atrial resynchronization but its long-term effect on the atrial mechanical function in patients with refractory atrial fibrillation (AF) has not been studied.Methods
Drug-refractory paroxysmal (PAF) and persistent AF (PRAF) patients previously implanted with a dual-site right atrial pacemaker (DAP) with minimal ventricular pacing modes (AAIR or DDDR mode with long AV delay) were studied. Echocardiographic structural (left atrial diameter [LAD] and left ventricular [LV] end diastolic diameter [EDD], end systolic diameter [ESD]) and functional (ejection fraction [EF]) parameters were serially assessed prior to, after medium-term (n?=?39) and long-term (n?=?34) exposure to DAP.Results
During medium-term follow-up (n?=?4.5 months), there was improvement in left atrial function. Mean peak A wave flow velocity increased with DAP as compared to baseline (75?±?19 vs. 63?±?23 cm/s, p?=?0.003). The long-term impact of DAP was studied with baseline findings being compared with last follow-up data with a mean interval of 37?±?25 (range 7–145) months. Mean LAD declined from 45?±?5 mm at baseline to 42?±?7 mm (p?=?0.003). Mean LVEF was unchanged from 52?±?9 % at baseline and 54?±?6 % at last follow-up (p?=?0.3). There was no significant change in LV dimensions with mean LVEDD being 51?±?6 mm at baseline and 53?±?5 mm at last follow-up (p?=?0.3). Mean LVESD also remained unchanged from 35?±?6 mm at baseline to 33?±?6 mm at last follow-up (p?=?0.47). During long-term follow-up, 30 patients (89 %) remained in sinus or atrial paced rhythm as assessed by device diagnostics at 3 years.Conclusions
DAP can achieve long-term atrial reverse remodeling and preserve LV systolic function. DAP when added to antiarrhythmic drug (AAD) and/or catheter ablation (ABL) maintains long-term rhythm control and prevents AF progression in elderly refractory AF patients. Reverse remodeling with DAP may contribute to long-term rhythm control. 相似文献6.
Ngai-Yin Chan Ho-Chuen Yuen Pui-Shan Chu Chi-Chung Choy Hoi-Fan Chow Ho-Fai Fong Chun-Leung Lau Ying-Keung Lo Ping-Tim Tsui Suet-Ting Lau Ngai-Shing Mok 《Journal of interventional cardiac electrophysiology》2013,37(2):169-177
Purpose
This study aims to investigate whether the use of a novel inner lumen circular mapping catheter (IMC) can shorten the procedural duration and fluoroscopic exposure of the single transseptal big cryoballoon (CB) pulmonary vein isolation (PVI) procedures in patients with atrial fibrillation (AF).Methods
This is a prospective non-randomized case–control study. Forty-two patients (28 men, mean age 55.7?±?12.1) with drug-refractory paroxysmal or persistent AF and underwent CB PVI procedures were divided into Group A (conventional single transseptal big CB approach, n?=?21) and Group B (IMC-facilitated approach, n?=?21). They were compared in the co-primary endpoints: (1) procedural duration and (2) fluoroscopic exposure and secondary endpoints: (1) 6-month AF-free survival and (2) number of cryo-applications.Results
Both the procedural duration (162?±?26 vs. 215?±?25 min; p?<?0.001) and fluoroscopic exposure (44.1?±?10.4 vs. 56.8?±?11.7 min; p?=?0.001) were significantly shorter in Group B than Group A patients. With multivariate stepwise regression, only the use of IMC was an independent predictor for procedural duration (β?=??59; 95 % CI, ?84.1 to ?33.8; p?<?0.001) and fluoroscopic exposure (β?=??16.9; 95 % CI, ?28.4 to ?5.4; p?=?0.006). The number of cryo-applications was significantly fewer in Group B than Group A patients (median 8 vs. 11; p?=?0.001). There was no significant difference in the 6-month AF-free survival between the two approaches (57 % vs. 71 %; p?=?0.351).Conclusions
Compared to conventional single transseptal big CB PVI procedures, the use of IMC may reduce procedural duration, fluoroscopic exposure and the number of cryo-applications with comparable mid-term efficacy. 相似文献7.
Catalin Loghin Kaveh Karimzadehnajar Ijeoma Ananaba Ekeruo Siddharth S. Mukerji Nada B. Memon Bharat K. Kantharia 《Journal of interventional cardiac electrophysiology》2014,39(1):7-15
Introduction
Although few clinical variables have been associated with recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) the role of left atrial (LA) mechanical function in the outcome of catheter ablation of AF is not adequately defined. The aim of our study was to determine whether LA mechanical dyssynchrony as evaluated by speckle tracking echocardiography can predict outcome of PVI ablation procedure in patients with paroxysmal AF.Methods
Twenty-five patients (age 58?±?11 years, [mean ± standard deviation], 17 males) with paroxysmal AF who met specific enrollment criteria pertaining to clinical presentation and follow-up, assessment of LA mechanical dyssynchrony, and strategy of catheter ablation procedure were enrolled. For LA mechanical dyssynchrony assessment, the time to peak longitudinal strain (TPk) in opposing walls in the midportion of the LA walls at peak atrial contraction in standard two- and four-chamber echocardiographic views by vector velocity imaging (VVI) was measured. Outcome of PVI procedure, whether no recurrence (NR) or AF recurrence (AFR) after 3 months of post-procedural blanking period, was evaluated based on AF-related symptoms and documentation of AF by electrocardiogram, continuous 24-h Holter, and intermittent event monitor recordings.Results
During a follow-up period of 20.3?±?8.6 months, 18 out of 25 (72 %) patients had no recurrence (NR group), and 7 out of 25 (28 %) patients had recurrence of AF (AFR group). Significant gender difference was observed in terms of outcome such that all AFR patients were men and no woman had recurrence of AF. Between the NR and AFR groups, neither the left atrial diameter, 4.0?±?0.3 and 4.2?±?0.2 cm, respectively (p?=?0.2), nor the left atrial volume indexes, 45?±?15 and 48?±?20 ml/m2, respectively (p?=?0.56), were statistically significantly different. For LA mechanical function, compared to the patients in NR group who had maximum opposing wall TPk delay of 39.9?±?12.0 ms, those in the AFR group demonstrated significantly more LA mechanical dyssynchrony with maximum opposing wall TPk delay of 64.4?±?17.0 ms prior to ablation (p?=?0.007). Using receiver operative characteristic analyses of the data that had an area under the curve of 0.865, we identified a maximum opposing wall delay cutoff value of 51 ms which predicted AF recurrence with sensitivity and specificity values of 89 and 72 %, respectively (p?=?0.005).Conclusions
Speckle tracking strain analysis echocardiography can evaluate the LA mechanical dyssynchrony quantitatively. The severity of LA mechanical dyssynchrony by VVI can predict the outcome of PVI catheter ablation for paroxysmal AF. 相似文献8.
Mehmet Akkaya Henri Roukoz Selcuk Adabag David G. Benditt Inder Anand Jian Ming Li Marina Zakharova Venkat Tholakanahalli 《Journal of interventional cardiac electrophysiology》2013,38(3):179-185
Aims
Catheter ablation of premature ventricular complexes (PVC) improves left ventricular (LV) systolic performance in certain patients; however, the effect on diastolic function and left atrial (LA) remodeling is unclear. We assessed the effects of catheter ablation of PVCs on parameters of LV diastolic function and LA remodeling.Methods
Forty-seven patients (age 65?±?10 years, 46 men) who underwent catheter ablation for symptomatic PVCs were evaluated using two-dimensional echocardiography before and 6?±?2 months after ablation. The measured diastolic indices included mitral inflow parameters (E wave, A wave, E/A ratio, and deceleration time (DT)), mitral lateral annulus early diastolic velocity (Ea), and E/Ea ratio. The LA volume was measured using modified biplane Simpson's method. We also compared the changes in the left atrial volumes and left atrial volume index (LAVI) after PVC ablation.Results
After catheter ablation of PVCs, the mean LV ejection fraction (EF) increased significantly (49.9?±?10.3 vs. 42.8?±?11.8, p?<?0.01). Significant improvement was also seen in A wave velocity (71.3?±?17.1 vs. 59.5?±?15.1 cm/s, p?=?0.039), E/A ratio (1.42?±?0.6 vs. 1.07?±?0.5 ml, p?=?0.034), Ea (8.9?±?3.9 vs. 6.8?±?2.9 cm/s, p?=?0.04), and E/Ea ratio (15.4?±?5.8 vs. 10.6?±?3.4, p?=?0.027), whereas mitral E and DT did not show significant change. LAVI decreased significantly after ablation (44.4?±?14.8 vs. 36.7?±?12.5, p?<?0.001). Significant improvement in LAVI was also seen in patients with normal baseline LVEF (p?=?0.04).Conclusion
Catheter ablation of PVCs improved LV diastolic function and resulted in left atrial reverse remodeling. 相似文献9.
Mehmet Fatih Özlü Kemalettin Erdem Gülhanım Kırış Ali İhsan Parlar Abdullah Demirhan Selim Suzi Ayhan Alim Erdem Serkan Öztürk Ümit Yaşar Tekelioğlu Mehmet Yazıcı 《Journal of interventional cardiac electrophysiology》2013,37(1):27-33
Objective
Postoperative atrial fibrillation (POAF) complicating coronary artery bypass grafting surgery (CABG) increases morbidity and stroke risk. Total atrial conduction time (PA-TDI duration) has been identified as an independent predictor of new-onset atrial fibrillation (AF). We aimed to assess whether PA-TDI duration is a predictor of AF after CABG.Methods
In 128 patients who had undergone CABG, preoperative clinical and echocardiographic data were compared between patients with and without POAF. The PA-TDI duration was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from left atrium (LA) lateral wall just over the mitral annulus.Results
Patients with POAF (38/128, 29.6 %) were older (68.1?±?11.1 vs. 59.3?±?10.2 years; p?<?0.001), had higher LA maximum volume, had prolonged PA-TDI duration, and had lower ejection fraction compared with patients without POAF. PA-TDI duration was found to be significantly increased in POAF group (134.3?±?19.7 vs. 112.5?±?17.7 ms; p?=?0.01). On multivariate analysis, age (95 % CI?=?1.03–1.09; p?=?0.003), LA maximum volume (95 % CI?=?1.01–1.06; p?=?0.03), and prolonged PA-TDI duration (95 % CI, 1.02–1.05; p?=?0.001) were found to be the independent risk factors of POAF.Conclusions
In this study, LA maximum volume and PA-TDI duration were found to be the independent predictors of the development of POAF after CABG. Echocardiographic predictors of left atrial electromechanical dysfunction may be useful in risk stratifying of patients in terms of POAF development after CABG. 相似文献10.
Thomas J. van Brakel Thomas van der Krieken Sjoerd W. Westra Jeroen A. van der Laak Joep L. Smeets Henry A. van Swieten 《Journal of interventional cardiac electrophysiology》2013,38(2):85-93
Purpose
This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for potential ablation therapy.Methods
Interstitial fibrosis from right (RAA) and/or left atrial appendages (LAA) was studied in patients with sinus rhythm (SR, n?=?8), paroxysmal (n?=?21), and persistent AF (n?=?20) undergoing coronary artery bypass and/or aortic or mitral valve surgery. Atrial fibrosis quantification was performed with Masson trichrome staining. Intraoperative bipolar epicardial electrophysiological measurements were performed to correlate fibrosis to electrogram fractionation, voltage, and AF cycle length.Results
The average degree of fibrosis was 11.2?±?7.2 % in the LAA and 22.8?±?7.6 % in the RAA (p?<?0.001). Fibrosis was not significantly higher in paroxysmal AF patients compared to SR subjects (18.2?±?8.7 versus 20.7?±?5.3 %). Persistent AF patients had a higher degree of LAA and RAA fibrosis compared to paroxysmal AF patients (LAA 14.6?±?8.7 versus 8.6?±?4.7 %, p?=?0.02, and RAA 28.2?±?7.9 versus 18.2?±?8.7 %, respectively, p?=?0.04). The left atrial end diastolic volume index was higher in persistent AF patients compared to SR controls (38.3?±?16.4 and 28?±?11 ml/m2, respectively, p?=?0.04). No correlation between atrial fibrosis and electrogram fractionation or voltage was found.Conclusion
Patients with structural heart disease undergoing cardiac surgery have more fibrosis in the RAA than in the LAA. Furthermore, RAA fibrosis is increased in persistent AF but not paroxysmal AF patients compared to control subjects. Electrogram fractionation and low voltage did not provide accurate identification of the fibrotic substrate. 相似文献11.
Lluis Asmarats Mathieu Bernier Gilles O’Hara Jean-Michel Paradis Kim O’Connor Jonathan Beaudoin Sylvie Bilodeau Rafael Cavalcanti Jean Champagne Josep Rodés-Cabau 《Journal of interventional cardiac electrophysiology》2018,53(2):151-157
Purpose
Percutaneous left atrial appendage (LAA) closure has become a valid alternative to anticoagulation therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). However, scarce data exist on the impact of LAA closure on left atrial and ventricular function. We sought to assess the acute hemodynamic changes associated with percutaneous LAA closure in patients with paroxysmal AF.Methods
The study population consisted of 31 patients (mean age 73?±?10 years; 49% women) with paroxysmal AF who underwent successful percutaneous LAA closure. All patients were in sinus rhythm and underwent 2D transthoracic echocardiography at baseline and the day after the procedure. A subset of 14 patients underwent preprocedural cardiac computed tomography (CT) with 3D LA and LAA reconstruction.Results
Left ventricular systolic function parameters and LA volumetric indexes remained unchanged after the procedure. No significant changes in left ventricular stroke volume (72.4?±?16.0 vs. 73.3?±?15.7 mL, p?=?0.55) or LA stroke volume (total 15.6?±?4.2 vs. 14.6?±?4.2 mL, p?=?0.21; passive 9.0?±?2.8 vs. 8.3?±?2.6 mL, p?=?0.31; active 10.3?±?5.6 vs. 10.0?±?6.4 mL, p?=?0.72) occurred following LAA closure. Mean ratio of LAA to LA volume by 3D CT was 10.2?±?2.3%. No correlation was found between LAA/LA ratio and changes in LA stroke volume (r?=?0.35, p?=?0.22) or left ventricular stroke volume (r?=?0.28, p?=?0.33).Conclusions
The LAA accounts for about 10% of the total LA volume, but percutaneous LAA closure did not translate into any significant changes in LA and left ventricular function.12.
Hiroshi Hayashi Meiso Hayashi Yasushi Miyauchi Kenta Takahashi Shunsuke Uetake Ippei Tsuboi Kenji Yodogawa Yu-Ki Iwasaki Wataru Shimizu 《Journal of interventional cardiac electrophysiology》2014,40(2):153-160
Purpose
Catheter ablation of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is still challenging, and it is unclear whether the difficulty is caused by the hypertrophy of left atrial (LA) myocardial wall thickness. The objective of the study was to compare the LA wall thickness and AF ablation outcomes between patients with HCM and those without structural heart disease.Methods
The present study enrolled 17 consecutive HCM patients (63?±?12 years) with drug-refractory AF and 34 control patients without any detectable heart disease, whose age, gender, type of AF, and LA dimension were matched to the HCM patients. The myocardial wall thickness of 11 distinct LA locations, measured using 64-slice computed tomography images, and AF ablation outcomes were compared between the two groups.Results
The LA wall thickness did not differ at 9 of the 11 locations and was significantly thinner in the HCM patients than in the control patients at the mid-posterior wall (1.44?±?0.17 vs. 1.58?±?0.22, p?=?0.04) and infero-posterior wall (1.62?±?0.16 vs. 1.74?±?0.18, p?=?0.03). Although antiarrhythmic drugs were used more frequently in the HCM patients (p?=?0.008), the rate of maintaining sinus rhythm during the follow-up did not differ between the HCM and control patients (53 vs. 56 % after the initial ablation [log-rank p?=?0.78] and 82 and 88 % after the repeat procedure [log-rank p?=?0.35]).Conclusions
The LA wall in the HCM patients with AF was not thicker than that of the matched patients without structural heart disease. Catheter ablation of AF showed favorable outcomes in both patient groups. 相似文献13.
Sebastian Spethmann Katharina Stüer Ivan Diaz Till Althoff Bernd Hewing Gert Baumann Henryk Dreger Fabian Knebel 《Journal of interventional cardiac electrophysiology》2014,40(1):53-62
Background
Atrial fibrillation (AF) is a common arrhythmia with relevant impact on mortality and morbidity. Pulmonary vein isolation (PVI) is an established therapy in patients who remain symptomatic under optimal medical therapy. However, up to 70 % of patients present with recurrence of AF after PVI. Therefore, identifying ideal candidates is an unmet clinical need. Left atrial (LA) fibrosis is associated with reduced LA function. Analysis of LA mechanics using 2D speckle tracking echocardiography (STE) might give more insight into LA substrates and be therefore of predictive value.Methods
This prospective single-center pilot study included 31 patients (mean age, 62.3?±?9.1 years; 19 males) with AF who underwent PVI and 20 matched healthy controls (mean age, 60.6?±?6.6 years; 10 males). 2D STE strain indices of LA reservoir (RLA), conduit, and, if feasible, contractile function, were analyzed before and 6 months after PVI. Assessment of the LV diastolic function was based on standard indices. Responders to PVI were defined as being asymptomatic and free of AF in a 7-day Holter-ECG after 6 months.Results
At baseline, all patients with AF had significantly lower reservoir and contractile function compared with controls. After 6 months, 17 patients (54.8 %) were identified as responders. At baseline, the reservoir function was significantly higher in responders compared with nonresponders (32.7?±?11.1 vs. 22.9?±?10.9 %; P?=?0.019). Only in responders, RLA and contractile LA function improved and reached normal values whereas LA function remained unchanged in nonresponders. In a ROC analysis, a RLA value of ≥19.5 % discriminated responders and nonresponders in patients with persistent AF with a sensitivity of 86 % and a specificity of 100 % (P?=?0.012; area under the curve 0.943; CI, 0.81–1.0).Conclusions
LA reservoir function helps to predict efficacy of PVI after 6 months. Only in responders, reservoir, and contractile function normalized within 6 months after PVI indicating a lower level of atrial remodeling at baseline. No deleterious effects of ablation were detected in nonresponders. 相似文献14.
B. Demirkan M.D. Y. Guray U. Guray M.R. Ege H.L. Kisacik H. Sasmaz S. Korkmaz 《Herz》2013,38(2):210-215
Background and aim of the study
The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters.Materials and methods
This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5?±?8.5 years, with a mean MVA of 1.1?±?0.2 cm2) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4?±?6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values.Results
The maximum P-wave duration (138?±?15 vs. 101?±?6 ms, p?<?0.01), PWD (58?±?18 vs 23?±?4, p?<?0.01), the interatrial (55?±?16 vs 36?±?11 ms, p?<?0.01) and left-sided intra-atrial EMD (40?±?11 vs 24?±?12 ms, p?<?0.01) were higher in patients with MS than in healthy subjects. The left atrial (LA) diameter, LA volume and LA volume index had positive association with the interatrial (r?=?0.5, p?<?0.01; r?=?0.5, p?<?0.01 and r?=?0.5, p?<?0.01, respectively) and left-sided intra-atrial EMD (r?=?0.5, p?<?0.01; r?=?0.4, p?<?0.01; r?=?0.4, p?<?0.01 respectively). After PMBV, the interatrial (55?±?16 vs. 40?±?11 ms, p?<?0.01) and left-sided intra-atrial EMD (40?±?11 vs 31?±?10, p?<?0.01) showed significant improvement compared to previous values. There was also a statistically significant difference in maximum P-wave duration and PWD between pre-and post-PMBV (138?±?15 vs 130?±?14, p?<?0.01, and 58?±?18 vs 49?±?16, p?<?0.01, respectively).Conclusions
Our study shows that PMBV has a favorable effect on the electrocardiographic and echocardiographic parameters related with AF risk in patients with MS. 相似文献15.
Zhen-xing Xu Jing-quan Zhong Bing Rong Xin Yue Zhao-tong Zheng Qing Zhu Shao-lei Yi Jun-tao Wang Man Li Yun Zhang 《Journal of interventional cardiac electrophysiology》2014,41(2):169-175
Purpose
This study aimed to assess pulmonary vein isolation (PVI) efficacy on atrial fibrillation (AF) recurrence and to determine a predictive dispersion of atrial refractoriness (dERP) value for performing PVI in paroxysmal supraventricular tachycardia (PSVT) patients.Methods
Of 67 PSVT patients with past AF episodes who underwent accessory pathway (AP) or slow pathway of atrioventricular node ablation, 63 (4 lost to follow-up or death) were assigned into two groups (A and B; 29 and 34 patients, respectively) based on whether they underwent or not subsequent PVI, and all were followed-up up to 3 years. Atrial effective refractory period (AERP) and dERP were measured during the ablation procedure.Results
In receiver operating characteristic (ROC) curve analysis, dERP?=?74.5 ms effectively predicted AF recurrence in PSVT patients (p?=?0.003). Difference in AF recurrence rate between groups did not reach statistical significance (17.2 %, 5/29 vs. 29.4 %, 10/34, p?=?0.203). AF recurrence rate was lower in patients with dERP >74.5 ms who underwent AP or slow-pathway ablation with vs. without PVI (18.2 %, 2/11 vs. 77.8 %, 7/9, p?=?0.012).Conclusions
PVI addition after successful AP or slow pathway of atrioventricular node ablation significantly reduced AF recurrence in PSVT patients with high atrial vulnerability (dERP >74.5 ms). 相似文献16.
Friedrich Felix Hoyer Lars Martin Lickfett Erica Mittmann-Braun Charlotte Ruland Jens Kreuz Stefan Pabst Jan Schrickel Uwe Juergens Selcuk Tasci Georg Nickenig Dirk Skowasch 《Journal of interventional cardiac electrophysiology》2010,29(1):37-41
Objectives
To address the question whether obstructive sleep apnea (OSA) is associated with the recurrence of paroxysmal atrial fibrillation (AF) in patients treated with ≥2 pulmonary vein isolation procedures.Patients and Methods
In this study, we included adults with therapy-resistant symptomatic paroxysmal AF, defined as AF recurring after ≥2 PV-isolation procedures (n?=?23). For comparison, we selected another cohort of patients being successfully treated by one PV isolation without AF recurrence within 6 months (n?=?23). PV isolation was performed by radiofrequency with an open irrigated tip catheter. Each of the 46 participants completed an overnight polygraphic study. The two groups were matched for age, gender, and ejection fraction. Patients were late middle-aged (65?±?7 vs 63?±?10 years, P?=?0.23), white (100%), and overweight (BMI 27.3?±?3.6 vs. 27.2?±?4.6 kg/m2, P?=?0.97).Results
The prevalence of sleep apnea, defined as an apnea–hypopnea index (AHI) of >5 per hour of sleep, was 87% in patients with therapy-resistant AF compared to 48% in the control cohort (P?=?0.005). In addition, OSA was more severe in the resistant AF group indicated by a significantly higher AHI (27?±?22 vs 12?±?16, P?=?0.01).Conclusion
The extraordinarily high prevalence of sleep apnea in patients with recurrent paroxysmal AF supports its presumable role in the pathogenesis of AF and demands further controlled prospective trials. Moreover, OSA should inherently be considered in patients with therapy-resistant AF. 相似文献17.
Guangwei Pan Zhiqiang Liu Pengyi He Yuchun Yang Yuming Mu Wei Han Muhuyati Wulasihan 《Journal of interventional cardiac electrophysiology》2014,39(1):87-93
Purpose
Few data exist about the effect of cardiac resynchronization therapy (CRT) on left atrial (LA) reverse remodeling and function, and whether echocardiographic (echo)-guide pacemaker optimization of atrioventricular and interventricular delays could beneficially affect LA reverse remodeling in long-term CRT therapy.Methods
Effect of periodic pacemaker optimization on LA reverse remodeling induced by CRT was analyzed in 113 consecutive patients (mean age, 60?±?11 years) and stratified according to periodic pacemaker optimization (group 1) and nonperiodic pacemaker optimization (group 2). Left atrial volumes index percent changes were assessed at every continuing 6-month follow-up visit. The primary endpoint was LA reverse remodeling. The secondary endpoint included left ventricular reverse remodeling and left ventricular ejection fraction.Results
There is no significant difference of follow-up duration in subgroups (42.43?±?18.94 months in group 1 vs 37.76?±?20.24 months in group 2, p?=?0.228). The responder’s rate of subgroups showed similar after follow-up of 12 months (60.0 vs 53.2 %, p?=?0.483). After 24-month follow-up, the mean reduction of LAV index was similar in two groups (10.34 vs 7.53 %, p?=?0.257). The improvement effect of LA reverse remodeling induced by CRT was sustained during 24-month follow-up to the end of current study in periodic pacemaker optimization group. The degree of LAV index percent reduction was directly correlated to periodic pacemaker optimization at end of current analysis (17.13 vs 10.35 %, p?=?0.047).Conclusions
Periodic echo-guide pacemaker optimization of atrioventricular and interventricular delays plays a positive role on LA reverse remodeling in long-term CRT therapy. 相似文献18.
Alessandro De Bortoli Ole-Jørgen Ohm Per Ivar Hoff Li-Zhi Sun Peter Schuster Eivind Solheim Jian Chen 《Journal of interventional cardiac electrophysiology》2013,38(1):19-26
Purpose
The adjunctive ablation of areas of complex fractionated electrogram (CFE) to pulmonary vein isolation (PVI) is an emerging strategy for patients with non-paroxysmal atrial fibrillation (AF). We studied the long-term outcomes of this approach.Methods
Sixty-six patients (mean age 58?±?9, 86.4 % male) with non-paroxysmal AF underwent ablation procedures consisting of PVI plus extensive CFE ablation. Post-ablation atrial tachycardia (AT) was also targeted if presented. All patients were followed up regularly on an ambulatory basis by means of ECG and Holter recordings.Results
After a mean follow-up period of 40?±?14 months and 1.7?±?0.7 procedures, 38 patients (57.6 %) were free of arrhythmias, 15 (22.7 %) displayed clinical improvement and 13 (19.7 %) suffered recurrences of persistent AF/AT. Females displayed poorer long-term outcomes than males (arrhythmia-free 22.2 vs. 63.2 %, p?<?0.05). Multivariate analysis demonstrated that long duration of uninterrupted AF prior to the procedure was an additional predictor of long-term failure (odds ratio 1.49, p?<?0.01). ROC analysis (area under curve 0.80; p?<?0.001) estimated 3.5 years as the optimal cut-off point for predicting long-term failure (sensitivity 85 %, specificity 74 %). The cumulative data showed a significantly higher percentage of arrhythmia-free patients when the duration of AF had been ≤2 years (69.7 %) and ≤4 years (68.9 %) than when it was >4 years (33.3 %; p?<?0.01).Conclusions
PVI?+?CFE ablation in non-paroxysmal AF appears to provide a reasonable proportion of arrhythmia-free patients during long-term follow-up. Poorer long-term results can be expected among female patients and those with an uninterrupted AF duration of >4 years. 相似文献19.
Yasushi Akutsu Kyouichi Kaneko Yusuke Kodama Fumito Miyoshi Hui-Ling Li Norikazu Watanabe Taku Asano Kaoru Tanno Jumpei Suyama Atsuo Namiki Takehiko Gokan Youichi Kobayashi 《Journal of interventional cardiac electrophysiology》2013,38(2):79-84
Purpose
Development of atrial fibrillation (AF) is complexly associated with electrical and structural remodeling and other factors every stage of AF development. We hypothesized that P wave electrocardiography with an elevated brain natriuretic peptide (BNP) level would be associated with the progression to persistence from paroxysmal AF.Methods
P wave electrocardiography such as a maximum P wave duration (MPWD) and dispersion by 12-leads ECG, heart/mediastinum (H/M) ratio by delayed iodine-123 metaiodobenzylguanidine scintigraphic imaging, left ventricular ejection fraction (LVEF), and left atrial dimension (LAD) by echocardiography, and plasma BNP level were measured to evaluate the electrical and structural properties and sympathetic activity in 71 patients (mean ± standard deviation, age: 67?±?13 years, 63.4 % males) with idiopathic paroxysmal AF.Results
Over a 12.9-year follow-up period, AF developed into persistent AF in 30 patients. A wider MPWD (>129 ms) (p?=?0.001), wider P wave dispersion (>60 ms) (p?=?0.001), LAD enlargement (>40 mm) (p?=?0.001), higher BNP level (>72 pg/mL) (p?=?0.002), lower H/M ratio (≤2.7) (p?=?0.025), and lower LVEF (≤60 %) (p?=?0.035) were associated with the progression to persistent AF, and the wide MPWD was an independently powerful predictor of the progression to persistent AF with a hazard ratio (HR) of 5.49 [95 % confidence interval (CI) 2.38–12.7, p?<?0.0001] after adjusting for potential confounding variables, such as age and sex. The combination of wide MPWD and elevated BNP level was additive and incremental prognostic power with 13.3 [2.16–13, p?<?0.0001].Conclusion
The wide MPWD with elevated BNP level was associated with the progression to persistent AF. 相似文献20.
J. C. Balt S. Karadavut A. A. W. Mulder J. G. L. M. Luermans M. C. E. F. Wijffels L. V. A. Boersma 《Journal of interventional cardiac electrophysiology》2013,37(2):197-204