Atrial Flutter Ablation Using MediGuideTM Non-fluoroscopic Catheter Tracking System: A Novel Technology to Reduce Radiation Exposure

Citation : Anand Pillai, Madhu Reddy, Michael Heard BS, Ajay Vallakati, Loren Berenbom, DhanunjayaLakkireddy

We describe the first case of cardiac arrhythmia ablation with the novel MediGuideTM non-fluoroscopic catheter tracking system in North America. This new technology uses electromagnetic field to track sensor integrated intracardiac electrophysiology catheters which are projected on pre-recorded fluoroscopy cine loops. This new technology permits catheter tracking in virtual biplane fluoroscopy and enhances spatial resolution of conventional 3D mapping systems while drastically reducing radiation exposure.

Differences of BiAtrial Substrate Properties in Patients with Different Types of AF

Citation : Kazuyoshi Suenari, Hidekazu Hirao, Mitsunori Okamoto, Yasuki Kihara, Shih-Ann Chen

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and induces cardiac dysfunction and strokes. The development of AF requires a “trigger” and also an electroanatomic “substrate” capable of both initiating and perpetuating AF. Over the past decade, the understanding of the AF substrate properties in both atria has increased with fractionation and frequency analyses of the local atrial electrograms using three-dimensional electroanatomic mapping systems. The purpose of this review was to discuss the differences in the atrial substrate properties in patients with different types of AF.

Body Mass Index, Quality of Life, and Catheter Ablation in Patients with Atrial Fibrillation

Citation : Ethan R. Ellis, Matthew R. Reynolds

Atrial fibrillation and obesity are interlinked epidemics and both impair quality of life. As the prevalence of both conditions in the US continues to rise, so will the number of obese patients with atrial fibrillation referred for catheter ablation. Catheter ablation has already been shown to significantly improve quality of life in patients with atrial fibrillation. Until recently, there has been little attention to the effects of catheter ablation on quality of life specifically in obese patients with atrial fibrillation. This paper will review what is known about the effects of atrial fibrillation and obesity on quality of life and how quality of life is affected by catheter ablation for atrial fibrillation in obese patients.

How Does Alcohol Intake Relate to the Risk of Atrial Fibrillation?

Citation : Andreas J. Zimmermann and David Conen

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. The close relationship between acute excesses of alcohol and the occurrence of AF even in healthy individuals has been known for several decades. More recently, a significant relationship has been consistently observed between elevated consumption of alcoholic beverages on a regular basis and an increased risk of developing AF. However, the amount of alcohol needed to confer an increased risk of AF is rather elevated, approximately two alcoholic beverages per day in women and four to five alcoholic beverages per day in men, suggesting that on a population level, alcohol is not a major contributor to the global AF epidemic.

Respiratory Cycle-Dependent Atrial Trachycardia; its Unique Characteristics and Relation with Autonomic Nerve System

Citation : Teppei Yamamoto, Hiroshige Murata

Respiration influences the sinus heart rate, however, little is still known about the tachyarrhythmias related to respiration. Atrial tachycardia (AT) rarely emerges during inspiration and it also ceases during expiration. This type of AT is thus called respiratory cycle-dependent atrial tachycardia (RCAT), and it demonstrates a centrifugal activation pattern. Based on these peculiar P wave morphologies, the foci converged either around the right superior pulmonary vein (RSPV) or inside the superior vena cava where the anterior right ganglionated plexi (ARGP) is considered to be located. The mechanism of such AT is therefore thought to be related to the activity of the autonomic system.

Rate Control in Atrial Fibrillation: Avoiding Morbidity

Citation : Thomas D. Callahan

Despite great strides in our understanding and treatment of atrial fibrillation over the past decade or so, much remains to be learned. Debate continues over the relative merits of rate versus rhythm control strategies. More recently, even the optimal targets for rate control have come into question. Specifically, the results of the RACE II trial support a more lenient rate control target compared to more traditional targets. This paper will review the role elevated heart rates play in the morbidity associated with atrial fibrillation, tools available for rate control and their relative merits as well as the targets for rate control.

Interdependent Relationship Between Atrial Fibrillation and Sinus Rhythm at the Hypothetical Interface of Atrial Fibrillation, Autonomic Tone, Sinoatrial Node and Inflammation : Analytical Review, Reconsiderations, Speculations and New Insights

Citation : Petras Stirbys

Underlying mechanisms of atrial fibrillation occurrence and its self-extinguishing remain not completely investigated yet. The role of autonomic tone and sinoatrial node in the interplay between atrial fibrillation and sinus rhythm is also not fully understood. The influence of inflammation as a possible source of arrhythmia and likelihood of its pharmacologic treatment deserves special attention. These complex issues are important for better understanding of arrhythmogenesis and rhythm control. Conceptual reconsiderations through the new insights primarily on the hypothetic basis may delineate new therapeutic and preventive strategies. The aim of this analytical review was to reinforce the clinical and laboratory studies regarding the role of: 

1) autonomic tone and sinoatrial node in restitution of sinus rhythm, 

2) new concept of “vibrantly quiescent stroboscopic tuning” as a matured status of atrial fibrillation being prepared for its abruption by slight impulse, 

3) inflammation in the interplay between atrial fibrillation and sinus rhythm, 

4) anti-inflammation and anti-allergic therapy to prevent and to treat the arrhythmia.