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Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Speziale et al. described the use of an alternative surgical technique for pulmonary vein isolation through only a right minithoracotomy. A linear vacuum-assisted unipolar RF ablation catheter was looped around the pulmonary veins by way of the transverse and oblique pericardial sinuses using a magnet-tipped introducer [15]. While there is an advantage of using only a right thoracic incision for Speziale’s approach, the left atrial appendage is not addressed (Figure 13.9 and Figure 13.10).
Atrial Flutter
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Ayman A. Hussein, Oussama M. Wazni
This circuit rotates around one or more of the pulmonary veins or scar in the posterior wall.5,30,31 Re-entry may also involve both entrance and exit into a pulmonary vein in patients with prior pulmonary vein isolation who had pulmonary venous conduction recovery. Generally speaking, once the flutter circuit and critical isthmus are identified, successful ablation requires either isolation of the veins or linear ablation to connect non-conducting structures and therefore creating a structural barrier to re-entry.
Catheter ablation therapy
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
As with any invasive procedure, there is an inherent risk of complications, ranging from minor bruising or bleeding at the access site to major complications resulting in emergency rescue surgery, permanent disability, or death. As one would expect, major complication is more likely in high-risk complex cases, such as ablation of ventricular tachycardia, where patients are often frail with poor cardiac function and multiple comorbidities, and the ablation targets are difficult to reach or locate. Often, but not without exception, certain complications are more common depending on the specific area of the heart being ablated, due to ablation damage to nearby heart structures. For example, heart block is more common when ablating near the AV node (e.g. for AVNRT or for septal accessory pathways), and pulmonary vein stenosis is more likely to result from ablation within the pulmonary venous ostium during pulmonary vein isolation as treatment for atrial fibrillation. Transient ischaemic attack (TIA) or stroke is more likely to occur when operating in the left-sided chambers of the heart.
Slow pathway elimination using antegrade conduction improvement with fast atrial pacing during AVNRT radiofrequency ablation: a proof-of-concept study
Published in Acta Cardiologica, 2022
Sok-Sithikun Bun, Ahmed Mostfa Wedn, Ahmed Taher, Philippe Taghji, Fabien Squara, Karim Hasni, Claudio De Zuloaga, Emile Ferrari
Three catheters were inserted using ultrasound-guided right femoral venous puncture [7]: a decapolar catheter (IBI, Abbott Medical, St Paul, Minnesota, USA) was inserted in the coronary sinus (CS), a His bundle quadripolar catheter (Biosense Webster Inc, Diamond Bar, CA, USA), and a 4.0 mm closed-tip manual or remote magnetic ablation catheter (Celsius™ or Celsius RMT™, Biosense Webster Inc, Diamond Bar, CA, USA). In case of concomitant atrial fibrillation (AF) ablation associated procedure, an irrigated contact-force sensing catheter (Smart Touch ST™, Biosense Webster Inc, Diamond Bar, CA, USA) was chosen. Procedures were performed under local anaesthesia with or without conscious sedation, except for patients referred for concomitant pulmonary vein isolation (PVI) procedure in whom general anaesthesia was used.
A novel noncontact high-resolution charge density mapping system to guide ablation of complex atrial arrhythmias: overview of device technology and application
Published in Expert Review of Medical Devices, 2021
Gezim Bala, Carlo De Asmundis, Gian-Battista Chierchia
Visualization of more complex electrical propagation patterns may reveal new regional and temporal targets of clinical interest and has received significant attention in the past decade [8,9]. Pulmonary vein isolation has been established as the cornerstone of catheter-based therapies for AF [10]. While PVI may be effective in paroxysmal AF, the results of catheter ablation to treat PsAF continue to be suboptimal even when linear lesions or extensive ablations are added to PVI [11,12]. Identification of patient-specific mechanisms in PsAF remains essential to improve ablation outcomes. The historical mechanistic concept of AF as a self‐sustaining disorganized process has been challenged by the concept of localized sources [13,14]. This debate is intensified by the paradox that limited ablation can stop PsAF in some patients [15,16], while extensive ablation may not eliminate AF in others [11,12].
Left Atrial Appendage Closure Review: Addressing Unmet Needs of AF Mediated Stroke Prevention with Evolving Science
Published in Structural Heart, 2021
Anwar Tandar, Jack Nielsen, Brian K. Whisenant
Retrospective reports of patients undergoing pulmonary vein isolation (PVI) suggest a diminished risk of stroke.51 Patients undergoing pulmonary vein isolation anticipate a “cure” from both the symptoms of AF as well as the risk of AF-mediated stroke. However, the risk of AF recurrence following PVI is high, and current guidelines indicate ongoing OAC after PVI as directed by the patient’s CHADS-VASC score.52 The ongoing OPTION Trial will randomize 1,600 patients between PVI & Watchman FLX vs. PVI & usual OAC. The primary endpoints at 36 months are 1) noninferiority efficacy for all stroke, all-cause death, and systemic embolism; and 2) superior safety of major nonprocedural bleeding. OPTION is designed to evaluate the potential of combined PVI and LAAC to meet patient expectations of device-based management of both symptoms and stroke risk, and will further allow for a comparison of LAAC with contemporary OAC, including DOACs.