Long-Term Evolution of Patients Treated for Paroxysmal Atrial Fibrillation with First and Second Generation Cryoballoon Catheter Ablation with a Prospective Protocol Guided by Complete Bidirectional Left Atrium-Pulmonary Veins Disconnection after Adenosine as Main Target end Point to achieved. Seven Yearrs Follow-up of Patients with a rough estimation profile of Low ALARMEc Score. A Single Center Report

Jesus M. Paylos, Aracelis Morales, Luis Azcona, Marisol Paradela, Raquel Yagüe,Fernando Gómez-Guijarro, Lourdes Lacal, Clara Ferrero, Octavio Rodríguez

 

JAFIB is PUBMED indexed now!

Dhanunjaya (DJ) Lakkireddy, Andrea Natale

EHRA(European Heart Rhythm Association) EP-Wires Surveys: What Is Common Practice In Device Management?

Citation: Carina Blomström-Lundqvist, Maria G Bongiorni

Guidelines and recommendations within the field of electrophysiological (EP) practice are usually drawn from the results of multicentre trials, often conducted in selected centers and under special circumstances. In contrast, daily practice is generally influenced by many factors, which may be different from those that are considered in strictly controlled scientific conditions. Even though patient registries may mirror daily practice, the enrollment of consecutive patients for longer periods of time for such purpose within the health care community is costly and time consuming. A short form of survey directed to physicians, could within a reasonable time frame highlight areas where the evidence base for clinical practice and implementation of guidelines needs to be augmented. Such short form of surveys, called EP Wires, are on-line surveys carefully constructed to give a picture of daily cardiac EP practice in Europe without burdening the responders with extensive data collection. The network of centers formed, are contacted on a regular basis every month. It is the purpose of this summary to present the result of four such EP wires, all of which concern devices, with special emphasis on centre differences and adherence to guidelines.

How To Better Identify Patients That Do Not Benefit From Prophylactic ICD Therapy?

Citation: Ian Mann MBBS MRCP, Amit Kaura MBChB, Paul A Scott DM MRCP

The implantable cardioverter defibrillator (ICD) has been demonstrated to improve survival by reducing sudden cardiac death (SCD) in patients with a low left ventricular ejection fraction (LVEF). Randomised trial data suggest that this mortality reduction is not constant among those implanted with a device, and has raised the significance of non-sudden cardiac death (non-SCD) as an important mode of death predicting limited benefit from ICD therapy. In this review article we explore the role of non-SCD and the risk prediction models that may aid identification of low LVEF patients unlikely to gain significant benefit from ICD therapy.

Non-Inducibility Or Termination As Endpoints Of Atrial Fibrillation Ablation: What Is Their Role?

Citation: Matthew Baker, MD, Prabhat Kumar, MBBS, James P. Hummel, MD, Anil K. Gehi, MD, FHRS

Catheter ablation is widely used to treat drug-refractory, symptomatic atrial fibrillation (AF). However, beyond pulmonary vein isolation, there remains little consensus on the recommended approach to ablation both in paroxysmal or persistent AF patients. Although ancillary ablation strategies are often used, the lack of a clear endpoint for AF ablation makes it challenging to evaluate their importance. Non-inducibility and termination of AF during AF ablation have been advocated as potential endpoints. Several studies have attempted to assess their role in an AF ablation protocol. However, the data for non-inducibility and termination as endpoints are mixed. Moreover, there are a number of limitations in the studies reported and limitations of the endpoints themselves. It is likely that non-inducibility or termination of AF during AF ablation may be markers of less structural remodeling rather than true endpoints for ablation. Herein, we review the relevant literature on the topic of inducibility and termination with respect to AF ablation and attempt to draw conclusions with guidance to further investigation.

Experimental Evidence Of The Role Of Renal Sympathetic Denervation For Treating Atrial Fibrillation

Citation: Dominik Linz, Christian Ukena, Milan Wolf, Benedikt Linz, Felix Mahfoud, Michael Böhm

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, also the activity of the autonomic nervous system has been suggested to contribute to the progression from paroxysmal to persistent AF. Catheter-based renal denervation (RDN) was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation which may result in atrial antiarrhythmic effects under some pathophysiological conditions. This review focuses on the potential effects of RDN on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in hypertension, heart failure, and sleep apnea.

Indications For AF Ablation: Before Or After The Failure Of Antiarrhythmic Drug Therapy?

Citation: Akira Kimata, MD, Yoko Ito, MD, Kentaro Yoshida, MD

Catheter ablation of atrial fibrillation (AF) is considered to be better than anti-arrhythmic drug therapy in terms of maintaining sinus rhythm, and therefore, it has rapidly evolved to become a commonly performed procedure in major hospitals throughout the world. However, on the basis of the evidence currently available, we support the current guidelines recommending antiarrhythmic drugs as a first-line treatment in most patients with AF except younger patients with symptomatic paroxysmal AF with no evidence of structural heart disease, given the risk of fatal complications associated with the ablation procedure. We would like to emphasize that center volume and individual procedure experience are significant determinants of procedure-related complications. As another effect of AF ablation, preventing atrial remodeling and progression to persistent AF is also noteworthy. Further long-term data is needed to answer the question of whether ablation can prevent or delay the advance of structural remodeling and improve life prognosis, particularly in younger patients.