{"title":"A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent.","authors":"Riyaz A Kaba, Omar Ahmed, Elijah Behr, Aziz Momin","doi":"10.15420/aer.2022.05","DOIUrl":"https://doi.org/10.15420/aer.2022.05","url":null,"abstract":"<p><p>The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e12"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/b0/aer-11-e12.PMC9277617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in <i>De Novo</i> Persistent AF.","authors":"Michael Tb Pope, Timothy R Betts","doi":"10.15420/aer.2021.64","DOIUrl":"https://doi.org/10.15420/aer.2021.64","url":null,"abstract":"<p><p>Results from catheter ablation for persistent AF are suboptimal, with no strategy other than pulmonary vein isolation showing clear benefit. Recently employed empirical strategies beyond pulmonary vein isolation involve widespread atrial ablation in all patients and do not take into account patient-specific differences in AF mechanisms or phenotype. Charge density mapping using the non-contact AcQMap system (Acutus Medical) allows visualisation of whole-chamber activation during AF and reveals localised patterns of complex activation thought to represent important mechanisms for AF maintenance that can be targeted with focal ablation. In this review, the authors outline the fundamentals of this technology, the initial data exploring the mechanistic role of activation patterns seen and the application to ablation of persistent AF.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e06"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/be/aer-11-e06.PMC9204651.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40400550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanjiv M Narayan, Hugh Calkins, Andrew Grace, Gregory Yh Lip, Ken Ellenbogen, Pier D Lambiase, Demosthenes G Katritsis
{"title":"What Cannot Be Missed: Important Publications on Electrophysiology in 2021.","authors":"Sanjiv M Narayan, Hugh Calkins, Andrew Grace, Gregory Yh Lip, Ken Ellenbogen, Pier D Lambiase, Demosthenes G Katritsis","doi":"10.15420/aer.2022.04","DOIUrl":"https://doi.org/10.15420/aer.2022.04","url":null,"abstract":"Clinical Arrhythmias Atrial Fibrillation Lurie A, Wang J, Hinnegan KJ, et al. Prevalence of left atrial thrombus in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 2021;77:2875–86. https://doi.org/10.1016/j.jacc.2021.04.036; PMID: 34112315. • Left atrial thrombus prevalence is high in subgroups of anticoagulated patients with AF/atrial flutter, who may benefit from routine pre-procedural transoesophageal echocardiography before cardioversion or catheter ablation.","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 ","pages":"e01"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/ef/aer-11-e01.PMC9014699.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Future Directions for Mapping Atrial Fibrillation.","authors":"Junaid Ab Zaman, Andrew A Grace, Sanjiv M Narayan","doi":"10.15420/aer.2021.52","DOIUrl":"https://doi.org/10.15420/aer.2021.52","url":null,"abstract":"Mapping for AF focuses on the identification of regions of interest that may guide management and – in particular – ablation therapy. Mapping may point to specific mechanisms associated with localised scar or fibrosis, or electrical features, such as localised repetitive, rotational or focal activation. In patients in whom AF is caused by disorganised waves with no spatial predilection, as proposed in the multiwavelet theory for AF, mapping would be of less benefit. The role of AF mapping is controversial at the current time in view of the debate over the underlying mechanisms. However, recent clinical expansions of mapping technologies confirm the importance of understanding the state of the art, including limitations of current approaches and potential areas of future development.","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 ","pages":"e08"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/ff/aer-11-e08.PMC9194915.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahul K Mukherjee, Manav Sohal, Nesan Shanmugam, Simon Pearse, Fadi Jouhra
{"title":"Successful Identification of and Discrimination Between Atrial and Ventricular Arrhythmia with the Aid of Pacing and Defibrillator Devices.","authors":"Rahul K Mukherjee, Manav Sohal, Nesan Shanmugam, Simon Pearse, Fadi Jouhra","doi":"10.15420/aer.2021.54","DOIUrl":"https://doi.org/10.15420/aer.2021.54","url":null,"abstract":"<p><p>The presence of supraventricular tachycardia is the leading cause of inappropriate shock in ICD recipients, and it can be a significant cause of morbidity, psychological distress and worsened clinical outcome. Modern pacing and ICD systems offer a number of discriminators that are integrated into algorithms to differentiate sustained ventricular tachycardia from supraventricular tachycardia. These algorithms can be adapted and optimised for each individual patient to ensure that only those arrhythmias that need treatment through the use of an ICD, are actually treated. This review summarises the single- and dual-chamber discriminators that can be used in the detection and classification of tachyarrhythmias.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"235-240"},"PeriodicalIF":3.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/fb/aer-10-235.PMC8785083.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of Catheter Ablation on Quality of Life and Healthcare Utilisation.","authors":"Sanghamitra Mohanty, Andrea Natale","doi":"10.15420/aer.2021.50","DOIUrl":"https://doi.org/10.15420/aer.2021.50","url":null,"abstract":"<p><p>Impairment of quality of life (QoL) is a well-known complication of AF. Because of the association of AF with older age and many other cardiovascular comorbidities, there are multiple factors that could influence QoL score even after successful AF intervention. However, substantial improvement in QoL has been reported following catheter ablation for AF regardless of ablation outcomes. In terms of healthcare resource utilisation, the expenses associated with AF are very high because of the hospitalisations for AF-related thromboembolic complications, aggravation of heart failure, AF interventions, and emergency room visits for incessant arrhythmia episodes, and they represent a large economic burden worldwide. Several trials have shown a drastic reduction in healthcare costs following successful AF ablation. In this review, the authors discuss this evidence systematically.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"258-261"},"PeriodicalIF":3.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/36/aer-10-258.PMC8785075.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frits W Prinzen, Joost Lumens, Jürgen Duchenn, Kevin Vernooy
{"title":"Electro-energetics of Biventricular, Septal and Conduction System Pacing.","authors":"Frits W Prinzen, Joost Lumens, Jürgen Duchenn, Kevin Vernooy","doi":"10.15420/aer.2021.30","DOIUrl":"https://doi.org/10.15420/aer.2021.30","url":null,"abstract":"<p><p>Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 4","pages":"250-257"},"PeriodicalIF":3.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/99/aer-10-250.PMC8785089.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atrial Fibrosis, Ischaemic Stroke and Atrial Fibrillation.","authors":"Christian Mahnkopf, Younghoon Kwon, Nazem Akoum","doi":"10.15420/aer.2021.51","DOIUrl":"https://doi.org/10.15420/aer.2021.51","url":null,"abstract":"<p><p>Atrial fibrosis is an important component of the arrhythmic substrate in AF. Evidence suggests that atrial fibrosis also plays a role in increasing the risk of stroke in patients with the arrhythmia. Patients with embolic stroke of undetermined source (ESUS), who are suspected to have AF but are rarely shown to have it, frequently demonstrate evidence of atrial fibrosis; measured using late-gadolinium enhancement MRI, this manifests as atrial remodelling encompassing structural, functional and electrical properties. In this review, the authors discuss the available evidence linking atrial disease, including fibrosis, with the risk of ischaemic stroke in AF, as well as in the ESUS population, in whom it has been linked to recurrent stroke and new-onset AF. They also discuss the implications of this association on future research that may elucidate the mechanism of stroke and stroke prevention strategies in the AF and ESUS populations.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"225-229"},"PeriodicalIF":3.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/30/aer-10-225.PMC8785072.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}