scholarly journals Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation?

2018 ◽  
Vol 7 (4) ◽  
pp. 256 ◽  
Author(s):  
Domenico G Della Rocca ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
Luigi Di Biase ◽  
Andrea Natale ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Paradigm Shift ◽  
Structural Changes ◽  
Pulmonary Veins ◽  
Percutaneous Treatment ◽  
Rhythm Control ◽  
Current Evidence ◽  
Lower Success Rate ◽  
Pulmonary Vein Antrum Isolation

Pulmonary vein antrum isolation is the most effective rhythm control strategy in patients with paroxysmal AF. However, catheter ablation of non-paroxysmal AF has a lower success rate, even when persistent isolation of pulmonary veins (PVs) is achieved. As a result of arrhythmia-related electophysiological and structural changes in the atria, sites other than the PVs can harbour triggers. These non-PV triggers contribute to AF relapse. In this article, we summarise the rationale and current evidence supporting the arrhythmogenic role of non-PV triggers and our ablation approach to patients with non-paroxysmal AF.

scholarly journals IVUS guided drug-coated balloon venoplasty for in-stent restenosis in pulmonary veins stenosis: a case report

2021 ◽  
Author(s):  
Juan J Portero-Portaz ◽  
Juan G Córdoba-Soriano ◽  
Arsenio Gallardo-López ◽  
Jesús M Jiménez-Mazuecos
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Percutaneous Treatment ◽  
Pulmonary Vein Stenosis ◽  
Heart Team ◽  
Stent Restenosis ◽  
Specific Material ◽  
Vein Stenosis ◽  
Pulmonary Veins Stenosis

Abstract Background pulmonary veins stenosis after atrial fibrillation radiofrequency ablation is an uncommon complication. When it occurs, percutaneous treatment is the preferred approach. There is a lack of standardized procedures, and when stenting restenosis is relatively common. Case summary we present a young patient with recurrence of pulmonary vein stenosis after a first percutaneous treatment. The recurrence of haemoptysis and dyspnoea after treatment in pulmonary vein stenosis allowed the diagnosis of significant stenosis again in our patient. In the Heart Team we opted for new percutaneous treatment, using IVUS to optimize the final result. Discussion nowadays, percutaneous approach is preferred and among percutaneous treatments for pulmonary veins stenosis, and stenting has shown better results than ballon angioplasty. Despite this, experience in instent restenosis is limited, and there is a lack of adequate and specific material for its approach. In this case we present the possible role of the IVUS and the drug-coated ballon angioplasty in this entity.

Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment

2008 ◽  
Vol 9 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Antonio Rossillo ◽  
Aldo Bonso ◽  
Sakis Themistoclakis ◽  
Giuseppe Riccio ◽  
Michela Madalosso ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Anticoagulation Therapy ◽  
Pulmonary Vein Antrum Isolation

Role of connexin 43 in vascular hyperpermeability and relationship to Rock1-MLC20 pathway in septic rats

2015 ◽  
Vol 309 (11) ◽  
pp. L1323-L1332 ◽  
Author(s):  
Jie Zhang ◽  
Guang-ming Yang ◽  
Yu Zhu ◽  
Xiao-yong Peng ◽  
Tao Li ◽  
...  
Keyword(s):  
Vascular Permeability ◽  
Pulmonary Vein ◽  
Connexin 43 ◽  
Vascular Endothelial Cells ◽  
Pulmonary Veins ◽  
Cecal Ligation ◽  
Underlying Mechanism ◽  
Vascular Endothelial ◽  
Cx 43

Connexin (Cx)43 has been shown to participate in several cardiovascular diseases. Increased vascular permeability is a common and severe complication in sepsis or septic shock. Whether or not Cx43 takes part in the regulation of vascular permeability in severe sepsis is not known, and the underlying mechanism has not been described. With cecal ligation and puncture-induced sepsis in rats and lipopolysaccharide (LPS)-treated vascular endothelial cells (VECs) from pulmonary veins, the role of Cx43 in increased vascular permeability and its relationship to the RhoA/Rock1 pathway were studied. It was shown that vascular permeability in the lungs, kidneys, and mesentery in sepsis rats and LPS-stimulated monolayer pulmonary vein VECs was significantly increased and positively correlated with the increased expression of Cx43 and Rock1 in these organs and cultured pulmonary vein VECs. The connexin inhibitor carbenoxolone (10 mg/kg iv) and the Rock1 inhibitor Y-27632 (2 mg/kg iv) alleviated the vascular leakage of lung, mesentery, and kidney in sepsis rats. Overexpressed Cx43 increased the phosphorylation of 20-kDa myosin light chain (MLC20) and the expression of Rock1 and increased the vascular permeability and decreased the transendothelial electrical resistance of pulmonary vein VECs. Cx43 RNA interference decreased the phosphorylation of MLC20 and the expression of Rock1 and decreased LPS-stimulated hyperpermeability of cultured pulmonary vein VECs. The Rock1 inhibitor Y-27632 alleviated LPS- and overexpressed Cx43-induced hyperpermeability of monolayer pulmonary vein VECs. This report shows that Cx43 participates in the regulation of vascular permeability in sepsis and that the mechanism is related to the Rock1-MLC20 phosphorylation pathway.

scholarly journals Prospective Randomized Clinical Trial of Wide Area Circumferential Pulmonary Vein Ablation versus Segmental Pulmonary Vein Ablation for Pulmonary Vein Isolation as a Treatment for Short-Duration Paroxysmal Atrial Fibrillation

2021 ◽  
Author(s):  
Sapan Bhuta ◽  
Gustaf Sverin ◽  
Hiro Kawata ◽  
Malek Bashti ◽  
Jessica Hunter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Wide Area ◽  
Pulmonary Vein Ablation ◽  
Total Procedure Time

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

Ranolazine as you have never seen it before: an antiarrhythmic for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Sousa ◽  
L Puga ◽  
J Ribeiro ◽  
J Lopes ◽  
C Saleiro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Rhythm Control ◽  
Current Evidence ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Interval Prolongation ◽  
Secondary Endpoints

Abstract Background Currently available pharmacological options for rhythm control in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and both frequent and potentially severe adverse events. Recent studies have added evidence to the hypothesis that ranolazine might exert antiarrhythmic effects, particularly in atrial tachyarrhythmias. Purpose To perform a systematic review with meta-analysis in order to ascertain the potential role of ranolazine in the management of AF. Methods We systematically searched MEDLINE, Embase and Scopus for randomized controlled trials (RCTs) and cohort studies addressing the association between ranolazine and AF outcomes, published up until December 1, 2019. The primary endpoint was incidence of AF, which was evaluated under a ranolazine versus placebo design. In this regard, patients in the setting of postcardiac surgery were further investigated separately. Secondary endpoints included AF cardioversion outcomes, which were addressed through comparison between ranolazine plus amiodarone and amiodarone alone for proportional efficacy and temporal requirements (time-to-cardioversion). The latter analysis was also undertaken in a dose-sensitive fashion (≤1000mg vs. 1500mg of ranolazine). Tertiary endpoints covered AF burden and episodes, in paroxysmal AF patients, and safety outcomes, namely death, QTc interval prolongation and hypotension. Study-specific odds ratios (ORs) were pooled using meta-analytic techniques with a random-effects model. Results A total of 10 RCTs comprising 8.109 participants and 3 cohort studies encompassing 37.112 patients were regarded as eligible for evaluation. Ranolazine was found to attenuate patients' odds of developing AF (OR 0.53, 95% CI: 0.41–0.69, p&lt;0.001, i2=58%). This effect held true, with an even larger effect size, in the context of post-cardiac surgery (OR 0.34, 95% CI: 0.16–0.72, p=0.005, i2=64%). Ranolazine increased the chances of successful AF cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95% CI: 1.49–29.89, p=0.01, i2=76%), while significantly reducing time-to-cardioversion [SMD 9.54h, 95% CI: −13.3–5.75, p&lt;0.001, i2=99%]. Interestingly, cardioversion was faster with ≤1000mg of ranolazine (SMD −13.16h, 95% CI: −15.07–11.25, p&lt;0.001, i2=95%) than with 1500mg (SMD −3.57h, 95% CI: −5.06–2.08, p&lt;0.001, i2=23%). In paroxysmal AF, ranolazine was also proved to significantly reduce both AF burden and episodes. There were no safety signals regarding mortality odds, QTc interval prolongation (mostly clinically insignificant) and hypotension (mostly transitory). Conclusion Current evidence suggests that ranolazine provides an effective and safe option for a chemical rhythm control strategy in AF management, a field in which medical breakthroughs are desperately needed. Funding Acknowledgement Type of funding source: None

scholarly journals Coronary Sinus Ablation Is a Key Player Substrate in Recurrence of Persistent Atrial Fibrillation

Cardiology ◽  
2019 ◽  
Vol 143 (3-4) ◽  
pp. 107-113 ◽  
Author(s):  
Naseer Ahmed ◽  
Shahida Perveen ◽  
Adeela Mehmood ◽  
Gulab Fatima Rani ◽  
Giulio Molon
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Coronary Sinus ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Arrhythmogenic Substrate ◽  
Electrophysiological Procedures ◽  
Very High ◽  
Insight Into

Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.

scholarly journals Hybrid Convergent Procedure for the Treatment of Persistent and Long-standing Persistent Atrial Fibrillation

2021 ◽  
Vol 10 (3) ◽  
pp. 198-204
Author(s):  
David B DeLurgio ◽  
Jaswinder S Gill ◽  
Syed Ahsan ◽  
Riyaz A Kaba ◽  
Kristen M Plasseraud ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Rhythm Control ◽  
Published Data ◽  
Future Directions ◽  
Ablation Therapy ◽  
Treatment Gaps ◽  
Made In

Recent advances have been made in AF treatment, including the role of early rhythm control and landmark clinical trials using ablation therapy. However, some treatment gaps remain, including the creation of durable lesions outside the pulmonary veins and effective treatment of longstanding persistent AF. A novel epicardial-endocardial ablation approach – the hybrid convergent procedure – was developed to combine surgical and catheter ablation techniques into a collaborative, multidisciplinary approach to managing AF. In this review, the authors discuss recently published data on hybrid convergent ablation, including results of the CONVERGE clinical trial, in the context of current challenges to treatment of persistent and long-standing persistent AF. The review also aims to provide perspective on outstanding questions and future directions in this area.

Abstract 2544: Pulmonary Venous Anatomy Predicts Recurrent Arrhythmia after Pulmonary Vein Antrum Isolation for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ron Jacob ◽  
Dimpi Patel ◽  
Michael Lieber ◽  
Michelle Williams ◽  
Andrea Natale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Complex Anatomy ◽  
Recurrent Atrial Fibrillation ◽  
Increased Risk ◽  
Left Pulmonary Vein ◽  
Pulmonary Vein Anatomy ◽  
Pulmonary Vein Antrum Isolation

Background: Pulmonary Vein Antrum Isolation (PVAI) is being used with increasing frequency for the treatment of atrial fibrillation. Multi-detector computed tomography (MDCT) can be used to evaluate the complex anatomy of the left atrium and pulmonary veins to facilitate PVAI. We hypothesized that pulmonary vein anatomy, as determined by MDCT, would predict recurrent atrial fibrillation after PVAI. Methods: We evaluated consecutive patients scheduled for PVAI who underwent a CT examination of the pulmonary veins on a Philips Brilliance 64 or Siemens Sensation-64 slice MDCT scanner < 3 months prior to a PVAI procedure. The number and ostial area of all pulmonary veins, indexed to body surface area, were determined by 2 independent blinded observers. Transtelephonic monitoring was performed for the first 3– 6 months after the PVAI procedure. Patients were followed at 3, 6, and 12 months with a 12-lead EKG and 48-hour Holter monitor. Results: A total of 113 patients (mean age 58±10 years; 73% male) were enrolled and followed for 12 months. A total of 445 pulmonary vein ostia were analyzed; 26% of patients had left sided pulmonary veins with a shared common ostium. The remaining patients had 2 separate left sided pulmonary veins. At the end of the 12-month follow-up, patients with two left sided pulmonary veins had a significantly increased risk of recurrent arrhythmia (34.3%) after PVAI than patients with a common left pulmonary vein (7.7%; p=0.009; OR 4.45). There was no relationship between the number of right sided pulmonary veins or total pulmonary vein ostial size and recurrent arrhythmia (582 cm 2 /m 2 in patients with recurrence vs 505 cm 2 /m 2 without recurrence (P= 0.14). Conclusion: In patients undergoing PVAI for atrial fibrillation, the presence of two left sided pulmonary veins, as determined by MDCT, is associated with an increased risk of recurrent arrhythmia at 12 months compared with patients who have a single common left pulmonary vein.

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