Treatment Of Chronic Atrial Fibrillation Research Articles

Correlation between Electrocardiogram Changes and Right Ventricular Systolic Function in Patients with Chronic Atrial Fibrillation

Background: Chronic atrial fibrillation (CAF) induces various electric disturbances, and a single mutation can cause multifarious phenotypes or combinations. Identifying the correlation of electrocardiogram changes corresponding to the disorders of electrical activity with right ventricular systolic function (RVSF) is important for the treatment and prognosis of CAF. Therefore, this study explored the correlation of electrocardiogram changes and RVSF in patients with CAF. Methods: From March 2022, to March 2023, 97 patients with CAF admitted to the Department of Cardiology of our hospital (study group) and 100 normal people who received health examination (control group) were subjected to echocardiogram and electrocardiogram to record relevant parameters for correlation analysis. Results: Significant differences were found in the electrocardiogram indices and right heart function parameters between the two groups. The study group had significantly higher heart rate, QTc interval, QT interval and T wave time than the control group (p < 0.05). The study group showed significantly higher right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV), and lower right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) than the control group (p < 0.05). Pearson correlation analysis showed that QTc interval, QT interval, and T wave time were positively correlated with RVESV (p < 0.05); QTc interval, QT interval, and T wave time were negatively correlated with RVSV (p < 0.05); and QTc interval was negatively correlated with RVEF (p < 0.05). Conclusion: A correlation exists between electrocardiogram changes and RVSF in patients with CAF.

Surgical Radiofrequency Ablation Using the Left Modified Maze Procedure in the Treatment of Chronic Atrial Fibrillation during Mitral Valve Surgery – Early Results

Surgical Radiofrequency Ablation Using the Left Modified Maze Procedure in the Treatment of Chronic Atrial Fibrillation during Mitral Valve Surgery – Early Results

Sudden onset of vomiting and intestinal ischemia during the treatment of chronic atrial fibrillation

Sudden onset of vomiting and intestinal ischemia during the treatment of chronic atrial fibrillation

A predictive model for the left atrial diameter in estimating success rates of radio-frequency ablation treating atrial fibrillation

Abstract Background Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan-Meier method. Results Pre-operatively left atrial diameter of > 59 mm was significantly associated with decrease in the possibility of reverting to sinus rhythm after surgery (OR 0.292, p-value = 0.001). The cut-off value for left atrial diameter was 59mm (sensitivity = 93.3%, specificity = 96.1%). Kaplan-Meier survival estimates were 175.07 days (156.3 - 193.9) for patients with left atrial diameter < 59mm and 62.64 days (26.6-98.7) for patients with left atrial diameter > 59mm. Conclusion In patients undergoing mitral valve surgery, higher degrees of ablation success are associated with smaller left atrial diameter in terms of conservation of the sinus rhythm post operatively.

Left atrial diameter in estimating success rates of radio-frequency ablation treating atrial fibrillation.

Background: Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods: A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan‐Meier method. Results: Pre-operatively left atrial diameter of 59 mm was significantly associated with decrease in the possibility of reverting to sinus rhythm after surgery (OR 0.292, p-value = 0.001). The cut-off value for left atrial diameter was 59mm (sensitivity = 93.3%, specificity = 96.1%). Kaplan-Meier survival estimates were 175.07 days (156.3 - 193.9) for patients with left atrial diameter < 59mm and 62.64 days (26.6-98.7) for patients with left atrial diameter > 59mm. Conclusion: In patients undergoing mitral valve, higher degrees of success are associated with smaller left atrial diameter in terms of conservation of the sinus rhythm post operatively.

Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery.

ObjectiveTo evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge.MethodsWe studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier) was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months.Results86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%), congestive heart failure (70%), and previous episodes of acute pulmonary edema (27%). Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm.ConclusionSurgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8%) after 60 months of follow-up.

Treatment of Chronic Atrial Fibrillation During Surgery for Rheumatic Mitral Valve Disease.

IntroductionThe result of surgical ablation of atrial fibrillation remains controversial, although prospective and randomized studies have shown significant differences in the return to sinus rhythm in patients treated with ablation versus control group. Surgery of the Labyrinth, proposed by Cox and colleagues, is complex and increases the morbidity rate. Therefore, studies are needed to confirm the impact on clinical outcomes and quality of life of these patients.ObjectiveTo analyze the results obtained in the treatment of atrial fibrillation by surgical approach, by Gomes procedure, for mitral valve surgery in patients with rheumatic heart disease associated with chronic atrial fibrillation.MethodsWe studied 20 patients with mitral valve dysfunction of rheumatic etiology, evolving with chronic atrial fibrillation, submitted to surgical treatment of valvular dysfunction and atrial fibrillation by Gomes procedure.ResultsThe mean duration of infusion ranged from 65.8±11.22 and aortic clamping of 40.8±7.87 minutes. Of 20 patients operated, 19 (95%) patients were discharged with normal atrial heart rhythm. One (5%) patient required permanent endocardial pacing. In the postoperative follow-up of six months, 18 (90%) patients continued with regular atrial rhythm, one (5%) patient returned to atrial fibrillation and one (5%) patient continued to require endocardial pacemaker to maintain regular rhythm.ConclusionGomes procedure associated with surgical correction of mitral dysfunction simplified the surgical ablation of atrial fibrillation in patients with rheumatic mitral valve disease and persistent atrial fibrillation. The results showed that it is a safe and effective procedure.

The effect of diterpene alkaloids on the GIRK channels

The GIRK (G protein-activated inwardly rectifying potassium channel) channel is a potential target in the treatment of atrial fibrillation. These channels are selectively expressed in the atrium and they are not present in the ventricle thus the electrical remodelling of atrial heart muscle might be achieved by their inhibition. Diterpene alkaloids isolated from Aconitum and Consolida species exert activity on Na+ and K+ channels and most of them are highly toxic. Depending on skeletal type and substitution pattern the binding affinity thereby the physiological activity may be diverse. Compounds with selective inhibitory activity on GIRK channels might be useful in the treatment of chronic atrial fibrillation. The aim of this work was the investigation of diterpene alkaloids on the GIRK channel.

Clinical Treatment of Elderly Patients with Chronic Atrial Fibrillation and Heart Failure

<strong>Objective: </strong>To study the clinical treatment of chronic atrial fibrillation and heart failure in elderly patients. <strong>Method: </strong>In our hospital, 120 patients with chronic atrial fibrillation complicated with heart failure were selected from March 2011 to March 2014 as the study subject. The clinical treatment of chronic atrial fibrillation with heart failure was discussed by comparing with the control group and the treatment group. <strong>Results: </strong>After 1 months of treatment, the total effective rate was 90% in the treatment group and 70% in the control group, the average recovery time of the treatment group was (4.45 + 0.88) day, and the average recovery time of the control group was (7.76 + 1.34) day. <strong>Conclusion: </strong>To improve cardiac function and ventricular remodeling, heart rate control, blocking neurosecretory system in the treatment for elderly patients with chronic atrial fibrillation and heart failure patients affect significantly, has very important clinical value.

Efficiency of radiofrequency ablation for surgical treatment of chronic atrial fibrillation in rheumatic valvular disease

BackgroundIt remains unclear whether concomitant radiofrequency ablation procedure in valvular surgery could offer additional benefits to patients with rheumatic valvular disease. We designed a prospective and randomized control study to evaluate the efficacy of surgical radiofrequency ablation in patients with rheumatic heart disease. MethodsFrom June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic heart disease were randomized: (1) control group, patients underwent only valve replacement followed by amiodarone for rhythm control, (2) left atrial group (LA group), patients underwent valve replacement and left atrial mono-polar radiofrequency ablation, (3) bi-atrial group (BA group), patients underwent valve replacement and bi-atrial mono-polar radiofrequency ablation. The primary endpoints included: cardiac death, stroke, and recurrent AF after discharge. ResultsThere was no perioperative death. One patient died 4months after MVR in BA group. In univariate Cox analysis, the two ablation groups were associated with less AF (BA group vs control group: P<0.001; LA group vs control group: P<0.001) as well as atrial tachycardia arrhythmia (AF/AT/AFL) recurrent (BA group vs control group: P<0.001; LA group vs control group: P=0.02). The comparison between BA and LA groups revealed no differences in terms of AF (P=0.06) or AF/AT/AFL (P=0.09). Atrial transport function restoration rate 12months after operation was 31.4% in LA group, 32.9% in BA group, and 8.6% in control group respectively (P<0.01). ConclusionsRadiofrequency ablation concurring with valvular surgery can bring a higher sinus rhythm restoration rate when compared with medical anti-arrhythmic drug therapy in low-medium risk rheumatic heart disease.The trial was registered on Clinicaltrials.gov (registry number NCT01013688).

Meta-analysis of the therapeutic effects of various methods for the treatment of chronic atrial fibrillation

The aim of this study was to analyze the therapeutic effects of various methods for the treatment of chronic atrial fibrillation (AF). Randomized controlled trials (RCT) concerning drug therapy and catheter ablation for the treatment of chronic AF were retrieved. The RevMan 5.1 software package was used for the meta-analysis. A total of 20 papers were assessed in this study. The results of the analysis indicated that the success rate was lower [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.70–17.02; P<0.0001] and the relapse rate was higher (OR, 0.07, 95% CI, 0.05–0.10; P<0.0001) for drug therapy compared with that for catheter ablation. With regard to different catheter ablation procedures, the success rate for pulmonary vein antrum isolation (PVAI) was lower compared with that for PVAI plus complex fractionated atrial electrogram (CFAE; OR, 0.53; 95% CI, 0.37–0.78; P=0.0001). Pulmonary vein isolation (PVI) plus left atrial ablation (LAA) had a higher success rate compared with PVI alone (OR, 2.79; 95% CI, 1.59–4.88, P=0.0003). There was not identified to be a significant difference in the success rates between PVAI and CFAE (OR, 2.05; 95% CI, 0.06–205.74; P=0.76) or between PVI and circumferential pulmonary vein isolation (CPVI; OR, 0.94; 95% CI, 0.29–3.00; P=0.91). All the funnel plots of publication bias were essentially symmetrical. In conclusion, the success rate was higher and the relapse rate was lower for catheter ablation compared with drug therapy. Among the different procedures of catheter ablation, there were no significant differences in success rate between two single procedures; however, the success rates were higher for the combined methods compared with those for the single methods.

Comparison of Uniatrial and Biatrial Radiofrequency Ablation Procedures in Atrial Fibrillation: Initial Results

Atrial fibrillation (AF) is the most commonly sustained cardiac rhythm disturbance. Surgical ablation techniques were developed involving the left atrium only and modifications of the maze procedure in ablating both atria. The aim of this study was to compare, in patients with permanent AF, the efficacy of uniatrial versus biatrial radiofrequency ablation procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. Between September 2003 and May 2009, 30 patients were submitted to the radiofrequency ablation procedure for AF associated with concomitant cardiac surgery; 15 patients underwent a uniatrial procedure, and 15 patients underwent biatrial ablation. The mean age was 47.73 ± 9.85 years, and 53.4% were men. The average followup time was 12.16 ± 10.89 months for the uniatrial group and 7.0 ± 4.0 months for the biatrial group. Neither hospital mortality nor complications related to radiofrequency ablation were was registered. At the time of hospital discharge, 9 patients (60%) were in a state of sinus rhythm in both groups. However, patients undergoing biatrial ablation (range 73.3% versus 46.7%) demonstrated complete freedom from atrial fibrillation at all times. Biatrial ablation surgical procedures were more effective in controlling atrial fibrillation than procedures limited to the left atrium.

New Insight of Chronic Atrial Fibrillation: Lessons from CHADS2 and CHADS-Vas Score and Long-Term Catheter Ablation Outcome

The optimal treatment of chronic atrial fibrillation includes the effort to restore sinus rhythm and maintenance of sinus rhythm. Catheter ablation has been considered as one of the choice for treatment of chronic atrial fibrillation. The short and intermediate-term (one year) outcome after one single ablation procedure is not as good as the ablation of paroxysmal atrial fibrillation. This presentation will show the long-term outcome of catheter ablation for chronic atrial fibrillation, also present the new insight of chronic atrial fibrillation based on the analysis of stroke risk score, including the CHADS2 and CHADS2-Vas score, and the correlation with the atrial substrate properties. Based on this investigation, the optimal patient population selected for the catheter ablation of chronic atrial fibrillation will be more acceptable.

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

To evaluate the results of intraoperative radiofrequency ablation with biatrial procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. Between February 2008 and May 2009, 15 consecutive patients were underwent mitral valve procedure plus modified radiofrequency biatrial ablation of chronic atrial fibrillation. The mean age was 47.73 +/- 9.85 years and 60% were male. The mean left atrial diameter was 55.06 +/- 7.56 mm. There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 7 +/- 4 months. At the time of hospital discharge nine (60%) patients were in sinus rhythm. After a mean follow-up period 11 (73.3%) were in sinus rhythm. Intraoperative biatrial radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterms outcomes in terms of conversion to sinus rhythm.

Update on cardiac arrhythmias in the ICU

To explore recent findings on the treatment and outcome of cardiac arrhythmias and how they affect ICU activities. The rate vs. rhythm control debate for the treatment of chronic atrial fibrillation continues. It is still unclear whether the postcardiac surgery inflammatory response contributes to the development of atrial fibrillation. In noncardiothoracic surgery/trauma patients hospitalized in an ICU, new-onset supraventricular arrhythmias are associated with markedly elevated mortality when compared with patients with a prior history of such arrhythmias and patients who do not develop arrhythmias. The onset of new supraventricular arrhythmias in such patients appears to be a manifestation of multiple system organ failure as it is closely associated with sepsis. Cardioversion of supraventricular arrhythmias with biphasic waveforms is being studied to determine whether it is more effective than cardioversion with monophasic waveforms. Supraventricular arrhythmias, especially atrial fibrillation, occur frequently in ICU patients. Intensivists not only treat atrial fibrillation itself but also its complications and the complications of the therapies used to prevent these complications. In ICU patients, ventricular arrhythmias have ominous implications because they usually portend either a major cardiac or a systemic dysfunction or both.

Rhythm-'a-line-ment' during catheter ablation of chronic atrial fibrillation: the role of left atrial linear lesions

Although recommended by the current guidelines for the treatment of atrial fibrillation (AF),1,2 catheter ablation of long-standing persistent AF (herein referred to as chronic AF) still remains a challenge for the interventional electrophysiologist. Initial attempts at a successful treatment of chronic AF have concentrated on different lesion sets. In the past, we have learned that pulmonary vein (PV) isolation alone, irrespective of its extension in terms of isolated atrial tissue around the PVs, is not sufficient to achieve a considerable success rate and, therefore, is restricted to a very selected cohort of chronic AF patients.3,4 Thus, additional arrhythmogenic processes beyond the PVs have become evident in the pathophysiology of chronic AF. Based on the concept of the ‘multiple wavelet’ hypothesis and in an effort to replicate the results of the surgical treatment of AF, linear lesions were applied to the left atrium, alone or in addition to PV isolation. However, with bidirectionally blocked lines at the left atrial roof and the mitral isthmus,4 or even with complete electrical isolation of the posterior left atrium including the PVs,5 the success rates range between 60 and 70%. Since a significant number of patients did not benefit from a standardized lesion set, the new concept rather to tailor the ablation approach to the patients' individual chronic AF processes has been implemented by Haissaguerre and co-workers.6 This concept was based on the observation that chronic AF could occasionally be terminated by ablation. Thus, using the combination of different strategies, … *Corresponding author. Tel: +49 40 428034120, Fax: +49 40 428034125, Email: willems{at}uke.uni-hamburg.de

Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation

Although the classical Cox-Maze III is the gold standard surgical therapy with a proven efficacy in the treatment of atrial fibrillation (AF), complexity of this procedure has resulted in a search for a simpler, less invasive and more cost-effective method. In this study we evaluated the results of cryosurgical ablation in the treatment of chronic AF in patients undergoing concomitant mitral valve surgery. Ninety patients (mean age: 50.9+/-12 years) with chronic AF who were having mitral valve surgery as the main procedure underwent cryoablation with a newly designed N(2)O-based cryotherapy device. Pulmonary vein isolation with or without left atrial appendage closure (group A) was carried out in 65 cases and cryoablative bi-atrial Cox-Maze III (group B) in 25 patients. This additional procedure took only an extra 10 min for group A and about 20 min for group B. Half of the patients received a beta-blocker following the procedure. The overall success rate of cryoablation was 65.5%. Normal sinus rhythm was achieved in 26.7% in the operating room, 10% in ICU and the remaining cases reverted to sinus rhythm during the follow-up period. There were no major ablation-related complications such as bleeding, thromboembolic events or A-V block. The only predictor for failure of ablative procedure was left atrial size of greater than 6 cm. Although in this study the efficacy rate of cryoablative surgery was not the same as classical Cox-Maze III, it seems that this procedure is safe, simple, cost-effective and at the same time does not increase the operative time significantly. Using cryoablation may enhance the cure rate of chronic AF during mitral valve surgery.

Transvenous, intracardial cardioversion for the treatment of postoperative atrial fibrillation

Atrial fibrillation (AF) following cardiac surgery is an important factor contributing to postoperative morbidity. Transvenous, intracardial cardioversion (TIC) has been shown to be effective in the treatment of chronic AF, but is an invasive and cost-intensive procedure. However, TIC would definitely be a beneficial approach if recurrence of AF following TIC is low and pharmacological treatment could be avoided. Thus, we hypothesised that TIC would be superior to conventional treatment with amiodarone with respect to the conversion rate and recurrence of AF. We compared TIC and conventional amiodarone therapy in a prospective, randomised and controlled trial in patients who developed AF following cardiac surgery. Twenty-three patients developed AF out of a total of 76 patients who gave written informed consent. Eighteen of these AF patients could be randomised into two equally sized groups to receive either an ALERT pulmonary artery catheter and TIC, or a standard pulmonary artery catheter and treatment with amiodarone. Haemodynamic parameters were registered before intervention to exclude pulmonary hypertension or fluid overload. Rates of cardioversion were compared by a Likelyhood ratio test. Out of the nine ALERT patients, AF in five cases converted to sinus rhythm (SR) with a median of two shocks (6 J). After 24 hours however, only two patients remained in sinus rhythm. On the other hand, six of the nine patients treated with amiodarone were still in SR after 24 hours. Whereas no difference was detectable in the conversion rate, persistence of SR following TIC was low. Thus, TIC without antiarrhythmic treatment is not recommendable for the treatment of postoperative AF.

Reduction plastic of the posterior left atrial wall and endocardial radiofrequency ablation in patients with giant left atrium, mitral valve disease and chronic atrial fibrillation (AF). Long term results of a single center

Aims: The aim of the study was to evaluate the efficacy of left atrial (LA) size reduction plastic combined with radiofrequency ablation (RFA) for the treatment of chronic atrial fibrillation (AF) by patients operated on mitral valve disease (MVD) who have a giant LA (>5cm), regarding restoration of sinus rhythm (SR).

Treatment of Chronic Atrial Fibrillation in the Horse with Flecainide: Personal Observation

Birettoni, F., Porciello, F., Rishniw, M., della Rocca, G., Di Salvo, A. and Sgorbini, M., 2007. Treatment of chronic atrial fibrillation in the horse with flecainide: Personal observation. Veterinary Research Communications, 31(Suppl. 1), 273–275