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Atrial fibrillation is an epidemic and the patient population with an estimated 33 million people suffering from the anomaly globally and that number is predicted to double in the next 15 years. Moreover, 30% of those patients could benefit from interventional therapy, but only 9% are treated with catheter ablation or surgery annually.
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Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including cathet...
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Impaired renal function and atrial fibrillation (AF) can form a vicious cycle. Although there have been reports on improved renal function in patients who undergo successful AF ablation, renal function in patients with recurrence of AF has not been studied separately. We explored the changes in renal function in recurrent AF patients a...
Introduction: Incidence rate with associated mortality of valvular atrial fibrillation (AF) continues to be significantly high. Drug therapy for such a malignant AF type offers minimal relief due to limited success rate and significant side effects. Catheter ablation for such variants is emerging as a reliable and successful treatment strategy.
Met...
Background: The ZFHX3 gene (16q22) is the second most highly associated gene with atrial fibrillation (AF) and is related to inflammation and fibrosis. We hypothesized that ZFHX3 is associated with extra-pulmonary vein (PV) triggers, left atrial (LA) structural remodeling, and poor rhythm outcomes of AF catheter ablation (AFCA).
Methods: We include...
Background: Catheter ablation is recommended in patients with frequent and symptomatic ventricular arrhythmias (VAs) in an otherwise normal heart. Right or left outflow tract (OT) are the most common origins, and catheter ablation is highly effective with low complication rates. However, outcome of catheter ablation of VAs other than the OT (non-OT...
Citations
... In the absence of data confirming causality, the presence of AF may be an early warning sign of worse outcomes. Regardless, data show that concomitant AF is undertreated (15). McCarthy (16) reported that only onethird of the patients undergoing mitral valve surgery (MVS) and only 16% of patients undergoing non-MVS had concomitant surgical ablation of their AF. ...
... Robotic-assisted atrial fibrillation ablation offers precise lesion creation and mapping, reducing the risk of complications and the need for repeat procedures. Patients experience shorter recovery times and a lower risk of postoperative complications [29]. ...
Robotic surgery, a groundbreaking advancement in medical technology, has redefined the landscape of surgical procedures. This comprehensive overview explores the multifaceted world of robotic surgery, encompassing its definition, historical development, current applications, clinical outcomes, benefits, emerging frontiers, challenges, and future implications. We delve into the fundamentals of robotic surgical systems, examining their components and advantages. From general and gynecological surgery to urology, cardiac surgery, orthopedics, and beyond, we highlight the diverse specialties where robotic surgery is making a significant impact. The many benefits discussed include improved patient outcomes, reduced complications, faster recovery times, cost-effectiveness, and enhanced surgeon experiences. The outlook reveals a healthcare landscape where robotic surgery is increasingly vital, enabling personalized medicine, bridging healthcare disparities, and advancing surgical precision. However, challenges such as cost, surgeon training, technical issues, ethical considerations, and patient acceptance remain relevant. In conclusion, robotic surgery is poised to continue shaping the future of health care, offering transformative possibilities while emphasizing the importance of collaboration, innovation, and ethical governance.
... Its incidence has risen by 33% over the past two decades, with projections indicating a potential doubling in the next few decades [1]. Despite often being perceived as less harmful due to its primary impact being on the elderly, AF has a five-fold stroke risk and impairs the function of the cardiac system, leading to substantial morbidity, mortality, hospitalization, and a diminished quality of life [1,2]. In fact, AF's five-year survival rate ranks 11th among the 25 most lethal malignancies in the United 2 of 14 States [3]. ...
... The included studies underwent a thorough screening process based on specific eligibility criteria. The eligibility criteria encompassed: (1) observational studies or RCTs, (2) studies that compared the surgical ablation outcomes between PVI, LAA, BAA, or compared two out of these three techniques, (3) studies that involved patients diagnosed with atrial fibrillation, and (4) studies that reported both qualitative and quantitative outcomes. Conversely, we excluded (1) studies with unsuitable designs-such as letters to the editor, reviews, commentaries, and preclinical studies-and (2) studies that solely provided qualitative outcome data ( Figure 1). ...
Atrial fibrillation (AF) ablation is a frequent procedure used in concomitant cardiac surgery. However, uncertainty still exists concerning the optimal extent of lesion sets. Hence, the objective of this study was to assess the results of various ablation techniques, aiming to offer a reference for clinical decision making. This review is listed in the prospective register of systematic reviews (PROSPERO) under ID CRD42023412785. A comprehensive search was conducted across eight databases (Scopus, Google Scholar, EBSCOHost, PubMed, Medline, Wiley, ProQuest, and Embase) up to 18 April 2023. Studies were critically appraised using the Cochrane Risk of Bias 2.0 for randomized control trials (RCTs) and the Newcastle Ottawa Scale adapted by the Agency for Healthcare Research and Quality (AHRQ) for cohort studies. Forest plots of pooled effect estimates and surface under the cumulative ranking (SUCRA) were used for the analysis. Our analysis included 39 studies and a total of 7207 patients. Both bi-atrial ablation (BAA) and left atrial ablation (LAA) showed similar efficacy in restoring sinus rhythm (SR; BAA (77.9%) > LAA (76.2%) > pulmonary vein isolation (PVI; 66.5%); LAA: OR = 1.08 (CI 0.94–1.23); PVI: OR = 1.36 (CI 1.08–1.70)). However, BAA had higher pacemaker implantation (LAA: OR = 0.51 (CI 0.37–0.71); PVI: OR = 0.52 (CI 0.31–0.86)) and reoperation rates (LAA: OR = 0.71 (CI 0.28–1.45); PVI: OR = 0.31 (CI 0.1–0.64)). PVI had the lowest efficacy in restoring SR and a similar complication rate to LAA, but had the shortest procedure time (Cross-clamp (Xc): PVI (93.38) > LAA (37.36) > BAA (13.89)); Cardiopulmonary bypass (CPB): PVI (93.93) > LAA (56.04) > BAA (0.03)). We suggest that LAA is the best surgical technique for AF ablation due to its comparable effectiveness in restoring SR, its lower rate of pacemaker requirement, and its lower reoperation rate compared to BAA. Furthermore, LAA ranks as the second-fastest procedure after PVI, with a similar CPB time.
... AF also confers a 3-fold enhanced risk for congestive cardiac failure as well as a 2-fold enhanced risk for dementia or demise [1]. Over the last decades, tremendous advancement has been achieved in the radical treatment of AF, especially in percutaneous catheter ablation procedures and cardiac Cox maze surgeries, which successfully restore the sinus rhythm in most AF patients [40][41][42][43][44]. However, the recurrence events of AF subsequent to catheter-based ablation or cardiac surgical therapy remain a major clinical challenge [45][46][47][48][49], irrespective of the decreasing but formidable periprocedural complications, encompassing pulmonary vein stenosis, systemic thromboembolism, esophageal injury, atrial-esophageal fistula, and cardiac perforation/tamponade [50]. ...
Simple Summary
Atrial fibrillation (AF), the most prevalent sustained dysrhythmia, is accountable for substantial mortality and morbidity. Accumulating convincing evidence highlights the predominant roles of heritable components in the initiation and maintenance of AF. Here, through pan-genomic genotyping with genetic markers followed by a genetic linkage study in an AF family, a novel AF-causing locus was located at human chromosome 7p14.2–p14.3. An exome-wide sequence assay unveiled that, at the defined locus, the mutation in TBX20, NM_001077653.2: c.695A>G; p.(His232Arg), was solely co-segregated with AF in the family. Additionally, a Sanger sequencing assay of TBX20 in another AF family uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations were found in 600 control persons. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 and the ability to bind the promoter of KCNH2, while they had no effect on the nuclear distribution of TBX20. These findings strongly indicate that TBX20 is a new AF-predisposing gene, shedding light on the mechanism underlying AF and suggesting clinical significance for the individually tailored treatment of AF.
Abstract
Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via whole-genome genotyping with genetic markers and a linkage assay in a family suffering from AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89 cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. An exome-wide sequencing assay unveiled that, at the defined locus, the mutation in the TBX20 gene, NM_001077653.2: c.695A>G; p.(His232Arg), was solely co-segregated with AF in the family. Additionally, a Sanger sequencing assay of TBX20 in another family suffering from AF uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations were observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while they had no effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-predisposing gene, shedding light on the mechanism underlying AF and suggesting clinical significance for the allele-specific treatment of AF patients.
... AF also confers a 3-fold enhanced risk for congestive cardiac failure as well as a 2-fold enhanced risk for dementia or demise [1]. Over the last decades, tremendous advancement has been achieved in the radical treatment of AF, especially in percutaneous catheter ablation procedures and cardiac Cox maze surgeries, which successfully restore the sinus rhythm in most AF patients [40][41][42][43][44]. However, the recurrence events of AF subsequent to catheter-based ablation or cardiac surgical therapy remain a major clinical challenge [45][46][47][48][49], irrespective of the decreasing but formidable periprocedural complications, encompassing pulmonary vein stenosis, systemic thromboembolism, esophageal injury, atrial-esophageal fistula, and cardiac perforation/tamponade [50]. ...
Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via the whole-genome genotyping with genetic markers and linkage assay in a family suffering AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89-cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. Exome-wide sequencing assay unveiled that at the defined locus, solely the mutation in the TBX20 gene, NM_001077653.2: c.695A>G; p.(His232Arg), co-segregated with AF in the family. Additionally, Sanger sequencing assay of TBX20 in another family suffering AF uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations was observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while without effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-causative gene, shedding light on the mechanism underlying AF and suggesting clinical significance for allele-specific treatment of AF patients.
... The incidence of atrial fibrillation (AF) is increasing worldwide, largely because AF occurs more frequently with advancing age, and a growing population of patients in high-income countries are aged >65 years [1,2]. As a method of treatment, catheter ablation is increasingly being used to restore patients to sinus rhythm [3]. One major risk from this procedure is thermal injury to the esophagus, which is a consequence of the proximity of the posterior wall of the left atrium to the anterior wall of the esophagus [4][5][6][7][8]. ...
Introduction
Radiofrequency (RF) ablation of the left atrium of the heart is increasingly used to treat atrial fibrillation (AF). Unfortunately, inadvertent thermal injury to the esophagus can occur during this procedure, potentially creating an atrioesophageal fistula (AEF) which is 80% fatal. The ensoETM (Attune Medical, Chicago, IL), is an esophageal cooling device that has been shown to reduce thermal injury to the esophagus during RF ablation.
Areas covered
This review summarizes growing evidence related to active esophageal cooling during RF ablation for the treatment of AF. The review presents data demonstrating improved outcomes related to patient safety and procedural efficiency and suggests directions for future research.
Expert opinion
The use of active esophageal cooling during RF ablation reduces esophageal injury, reduces or eliminates fluoroscopy requirements, reduces procedure duration and post-operative pain, and increases long-term freedom from arrhythmia. These effects in turn increase patient same-day discharge rates, decrease operator cognitive load, and reduce cost. These findings are likely to further accelerate adoption of active esophageal cooling.
... Contiguous, uniformly transmural atrial lesions are difficult to create with the tip of a long catheter in a beating, working heart (20). Another potential source of failure for LSpAF treatment with catheter ablation is that following initial pulmonary vein isolation, the localization and ablation of alleged focal AF drivers (21) outside the pulmonary veins are based solely on intraprocedural mappings. ...
Background
Improved understanding of the mechanisms that sustain persistent and long-standing persistent atrial fibrillation (LSpAF) is essential for providing better ablation solutions. The findings of traditional catheter-based electrophysiological studies can be impacted by the sedation required for these procedures. This is not required in non-invasive body-surface mapping (ECGI). ECGI allows for multiple mappings in the same patient at different times. This would expose potential electrophysiological changes over time, such as the location and stability of extra-pulmonary vein drivers and activation patterns in sustained AF.
Materials and methods
In this electrophysiological study, 10 open-heart surgery candidates with LSpAF, without previous ablation procedures (6 male, median age 73 years), were mapped on two occasions with a median interval of 11 days (IQR: 8–19) between mappings. Bi-atrial epicardial activation sequences were acquired using ECGI (CardioInsight™, Minneapolis, MN, United States).
Results
Bi-atrial electrophysiological abnormalities were documented in all 20 mappings. Interestingly, the anatomic location of focal and rotor activities changed between the mappings in all patients [100% showed changes, 95%CI (69.2–100%), p < 0.001]. Neither AF driver type nor their number varied significantly between the mappings in any patient (median total number of focal activities 8 (IQR: 1–16) versus 6 (IQR: 2–12), p = 0.68; median total number of rotor activities 48 (IQR: 44–67) versus 55 (IQR: 44–61), p = 0.30). However, individual zones showed a high number of quantitative changes (increase/decrease) of driver activity. Most changes of focal activity were found in the left atrial appendage, the region of the left lower pulmonary vein and the right atrial appendage. Most changes in rotor activity were found also at the left lower pulmonary vein region, the upper half of the right atrium and the right atrial appendage.
Conclusion
This clinical study documented that driver location and activation patterns in patients with LSpAF changes constantly. Furthermore, bi-atrial pathophysiology was demonstrated, which underscores the importance of treating both atria in LSpAF and the significant role that arrhythmogenic drivers outside the pulmonary veins seem to have in maintaining this complex arrhythmia.
... User workflow analysis1. During the user workflow analysis, use contextual inquiry to identify the key procedural steps and identify the personnel responsible for documenting these steps.Identify the EHR data structures that represent them, and map these data structures to tables in the EHR', and device representatives to develop a process map of the key procedural events required for tracking performance.2. ...
... Atrial fibrillation (AF) is the most common cardiac arrythmia, affecting approximately 33 million people worldwide [1]. Only 3% of all AF is associated with concomitant cardiac disease [2]. Endocardial catheter ablation (ECA) remains the mainstay of intervention in AF, however, its success may be limited by its inability to create transmural endocardial ablation lines [3][4][5]. ...
Introduction
Atrial fibrillation (AF) is the most common arrhythmia. Hybrid convergent ablation (HCA) is an emerging procedure for treating longstanding AF with promising results. HCA consists of a subxiphoid, surgical ablation followed by completion endocardial ablation. This meta-analysis of randomized control trials (RCT’s) and propensity score-matched studies aims to examine the efficacy and safety of HCA compared to endocardial catheter ablation (ECA) alone on patients with AF.
Methods
This review was written in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations and guidance. The primary outcome for the analysis was freedom from AF (FFAF) at final follow up. Secondary outcomes were mortality and significant complications such as tamponade, sternotomy, esophageal injury, atrio-esophageal fistulae post procedurally.
Results
Four studies where included, with a total of 233 patients undergoing HCA and 189 patients undergoing ECA only. Pooled analysis demonstrated that HCA cohorts had significantly higher rates of FFAF than ECA cohorts, with an OR of 2.78 (95% CI 1.82–4.24, P < 0.01, I ² = 0). Major post-operative complications were observed in significantly more patients in the HCA group, with an OR of 5.14 (95% CI 1.70–15.54, P < 0.01). There was only one death reported in the HCA cohorts, with no deaths in the ECA cohort.
Conclusion
HCA is associated with a significantly higher FFAF than ECA, however, it is associated with increased post-procedural complications. There was only one death in the HCA cohort. Large RCT’s comparing the HCA and ECA techniques may further validate these results.
... The mechanisms of TBS include alterations in myocardial architecture, ion channel metabolism, and gene expression [5][6][7]. Over the past decade, catheter ablation has advanced significantly, enabling a high proportion of AF and AFL to be completely eliminated [8][9][10]. Typically, SND will become apparent after atrial arrhythmias have been eliminated. ...
Identification of sinus node dysfunction (SND) before termination of persistent AFL by catheter ablation (CA) is challenging. This study aimed to investigate the characteristics and predictors of acute and delayed SND after AFL ablation. We retrospectively enrolled 221 patients undergoing CA of persistent AFL in a tertiary referral center. Patients with SND who required a temporary pacemaker (TPM) after termination of AFL or a permanent pacemaker (PPM) during follow-up were identified. Acute SND requiring a TPM was found in 14 of 221 (6.3%) patients following successful termination of AFL. A total of 10 of the 14 patients (71.4%) recovered from acute SND. An additional 11 (5%) patients presenting with delayed SND required a PPM during follow-up, including 4 patients recovering from acute SND. Of these, 9 of these 11 patients (81.8%) underwent PPM implantation within 1 year after the ablation. In multivariable analysis, female gender and a history of hypothyroidism were associated with the requirement for a TPM following termination of persistent AFL, while older age and a history of hypothyroidism predicted PPM implantation. This study concluded that the majority of patients with acute SND still require a PPM implantation despite the initial improvement. Therefore, it is reasonable to monitor the patients closely for at least one year after AFL ablation.
