Monday, January 3, 2011

Anticoagulation after Atrial Fibrillation Ablation: Many Blanks to Fill


Citation : Martin Fiala.Anticoagulation after Atrial Fibrillation Ablation: Many Blanks to Fill .JAFIB.2010 December;Volume 2 Issue(3): 853-855.

Long-term maintenance of sinus rhythm (SR) after catheter ablation of atrial fibrillation (AF) has remained an open issue awaiting further relevant data. It is of paramount importance as our everyday decisions on discontinuing anticoagulation after ablation rest on the belief in the absence of clinically significant asymptomatic AF episodes and constant SR for the rest of the patient\'s life. Both aspects are difficult to ascertain, for the tools of truly continuous ECG monitoring are not comfortably applicable, and routine follow-up tends to thin out beyond 1 year in asymptomatic patients without apparent arrhythmia recurrences.

Atrial Tachycardia Successfully Ablated from the Left Coronary Sinus Cusp of the Aorta: An Unusual Site of Origin


Citation : Takumi Yamada.Atrial Tachycardia Successfully Ablated from the Left Coronary Sinus Cusp of the Aorta: An Unusual Site of Origin .JAFIB.2010 December;Volume 2 Issue(3): 851-852.

It has been recognized in the last decade that atrial and ventricular tachycardias may arise from the myocardium around the aorta. These tachycardias can be ablated from the coronary sinus cusps of the aorta (ASCs). In some of those tachycardias, the site of origin may be epicardial and thus can be ablated only through the thin structure of the ASCs. It is important to know how to make a diagnosis, map and ablate tachycardias arising from this region.

The Use of Cryoballoon Ablation in Atrial Fibrillation: Simplifying Pulmonary Vein Isolation?


Citation : Gian Battista Chierchia, Antonio Sorgente, Andrea Sarkozy, Carlo de Asmundis, Pedro Brugada.The Use of Cryoballoon Ablation in Atrial Fibrillation: Simplifying Pulmonary Vein Isolation? .JAFIB.2010 December;Volume 2 Issue(3): 839-850.

Atrial fibrillation (AF) is certainly the most common arrhythmia encountered in clinical practice, reaching epidemic proportions in occidental society. Nowadays, transcatheter ablation using radiofrequency (RF) has become a popular technique in the treatment of drug-resistant AF. Since ectopic beats originating from the pulmonary veins (PVs) have been shown to be the main trigger initiating AF, electrical isolation of these venous structures has become the goal when performing this procedure.

Atrial Fibrillation after Cardiac Surgery: Benign or Deserving of Prophylaxis


Citation : Stephen Westaby.Atrial Fibrillation after Cardiac Surgery: Benign or Deserving of Prophylaxis .JAFIB.2010 December;Volume 2 Issue(3): 835-838.

New onset atrial fibrillation (AF) is the commonest complication after cardiac surgery affecting around 30% of coronary artery bypass graft (CABG) patients, up to 50% of valve surgery patients and as many as 60% of those undergoing combined valve and CABG operations.

Gender and Racial Characteristics of Patients Referred to a Tertiary Atrial Fibrillation Center


Citation : Pamela K. Mason, Liza Moorman, Douglas E. Lake, J. Michael Mangrum, John P. DiMarco, John D. Ferguson, Srijoy Mahapatra, Kenneth C. Bilchick, David Wiggins, J. Paul Mounsey, J. Randall Moorman.Gender and Racial Characteristics of Patients Referred to a Tertiary Atrial Fibrillation Center .JAFIB.2010 December;Volume 2 Issue(3): 827-834.

Atrial Fibrillation Centers (AFCs) are becoming increasingly common and are often developed at institutions to provide comprehensive evaluation and management for patients with atrial fibrillation (AF) including catheter and surgical ablation. Studies have shown that women and racial minority patients are less likely to be offered aggressive or invasive therapies. The University of Virginia (UVA) AFC was opened in 2004. We analyzed data collected during initial visits to our AFC from 2004-2008 to determine the gender and racial characteristics of a tertiary AFC population. Multivariable regression analysis was used to compare clinical characteristics. There were a total of 1664 consecutive initial patient visits. Cardiologists referred 61% and primary care physicians referred 37% of patients. Twice as many men were referred as women (570 vs. 1094; P< 0.0001). Women were older (68.0+11.9 vs. 62.4+13.0 years; P< 0.0001) and more symptomatic with palpitations (80% vs. 73%; P=0.008), but otherwise were not substantially different from men. Both men and women were aggressively treated with anticoagulation and rate-controlling medications by our referring physicians. Minority patients were infrequently referred, with only 46 African American patients in the total population. In conclusion, the demographics of a tertiary FAC are different than those of the general population. Women and racial minority patients are underrepresented, and the women have few comorbidities and symptoms than the known epidemiology would lead us to expect.

Reducing Ionizing Radiation Associated with Atrial Fibrillation Ablation


Citation : Nisha L. Bhatia, Arshad Jahangir, William Pavlicek, Luis R.P. Scott, Gregory T. Altemose, Komandoor Srivathsan.Reducing Ionizing Radiation Associated with Atrial Fibrillation Ablation .JAFIB.2010 December;Volume 2 Issue(3): 822-826.

While radiation exposure with cardiac interventional procedures is an emerging concern, patients undergoing radiofrequency ablation (RFA) for atrial fibrillation (AF) still routinely undergo pre- and post-ablation computed tomography (CT) scans for 1) definition of left atrial and pulmonary vein anatomy, 2) creation of a surrogate geometry, and 3) assessment for complications such as pulmonary vein (PV) stenosis. In an effort to decrease ionizing radiation associated with atrial fibrillation ablation, an ultrasound-guided surrogate geometry approach is proposed as an alternative to routine CT imaging. Ten patients underwent AF ablation using intracardiac ultrasound for the creation of a surrogate left atrial geometry (CartoSound, Biosense Webster, CA); and ten control-cases who had conventional CT-guided imaging (CartoMerge, Biosense Webster, CA) were matched for age, gender, and type of catheter ablation. Sources of radiation included 1) intraprocedural fluoroscopy (CartoSound: 151 ± 43 mGray*cm^2, CartoMerge: 174 ± 130 mGray*cm^2; p=0.6) and 2) CT ionizing radiation (CartoSound: 0 mSv, CartoMerge 9.4 ± 2.3 mSv/CT scan.) When comparing clinical success rates after a trial of previously ineffective anti-arrhythmic drugs, ultrasound-guided AF ablation was non-inferior to a CT-guided approach, and obviated the need for CT imaging, therefore reducing doses of ionizing radiation by nearly 20 mSv per AF catheter ablation.

Left Atrial Volume and Post-Operative Atrial Fibrillation after Aortic Valve Replacement


Citation : Yeruva Madhu Reddy, Ruby Satpathy, Xuedong Shen, Mark Holmberg, Claire Hunter, Aryan Mooss, Dennis Esterbrooks.Left Atrial Volume and Post-Operative Atrial Fibrillation after Aortic Valve Replacement .JAFIB.2010 December;Volume 2 Issue(3): 814-821.

Post-operative atrial fibrillation (POAF) after valve surgery is associated with increased morbidity and mortality. Risk factors identified in the past to predict POAF are of moderate accuracy. We performed a retrospective analysis of 139 patients undergoing aortic valve replacement for aortic stenosis. Post-operative AF occurred in 44% of the patients. In multivariate analysis only left atrial volume (LAV) index was a predictor of POAF. A LAV index of >46 cc/m2 predicted POAF with a sensitivity and specificity of 92% and 77%. We propose that LAV index can be used preoperatively to identify patients at risk for POAF to target preventive interventions.