Left atrial catheter ablation (LACA) is an established therapeutic approach to abolish symptomatic atrial fibrillation (AF).
Based on the prospective MACPAF study (clinicaltrials.gov NCT01061931) we report the rate of ischemic brain lesions postablation and their impact on cognitive function.
Patients with symptomatic paroxysmal AF were randomized to LACA using the Arctic Front® or the HD Mesh Ablator® catheter. All patients underwent brain MRI at 3 Tesla, neurological, and neuropsychological examinations within 48 hours prior and after the ablation procedure.
There was no clinically evident stroke in 37 patients (mean age 62.4 ± 8.4 years; 41% female; median CHADS2 score 1 [IQR 0-2]) after LACA but high-resolution diffusion-weighted imaging (DWI) detected new ischemic lesions in 15 (41%) patients after LACA. Four (27%) of the HD Mesh Ablator® patients and 11 (50%) of the Arctic Front® patients suffered a silent ischemic lesion (P = 0.19). In these 15 patients, there was a nonsignificant trend toward lower cardiac ejection fraction (P = 0.07) and AF episodes during LACA (P = 0.09), while activated clotting time levels, number of energy applications, periprocedural electrocardioversion or CHADS(2) score had no impact. Lesion volumes varied from 5 to 150 mm(3) and 1 to 5 lesions were detected per patient. However, acute brain lesions had no effect on cognitive performance immediately after LACA. Of the DWI lesions postablation 82% were not detectable on FLAIR images 6-9 months postablation.
According to 3 Tesla high-resolution DWI, ischemic brain lesions after LACA were common but not associated with impaired cognitive function after the ablation procedure.
Continuous monitoring of cardiac rhythm may play an important role in measuring the true symptomatic/asymptomatic atrial fibrillation (AF) burden and improve the management of anti-arrhythmic and anti-thrombotic therapies. Forty-seven patients with mitral valve disease and longstanding persistent AF (LSPAF) underwent a left atrial maze procedure with bipolar radiofrequency and valve surgery. The follow-up data recorded by an implanted loop recorder were analysed after 3, 6 and 12 months. On discharge, 40 (85.1%) patients were in stable sinus rhythm, as documented by in-office electrocardiography (ECG), 4 (8.5%) were in pacemaker rhythm and 3 (6.4%) were in AF. One (2.1%) patient died after 7 months. On 12-month follow-up examination, 30 (65.2%) patients had an AF burden 0.5%. Two (4.3%) patients with AF recurrences were completely asymptomatic. Among the symptomatic events stored by the patients, only 27.6% was confirmed as genuine AF recurrences according to the concomitant ECG recorded by the implanted loop recorder. A concomitant bipolar maze procedure during mitral valve surgery is effective in treating AF, as proved by detailed 1-year continuous monitoring.
Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study.
The urge to facilitate the atrial fibrillation (AF) ablation procedure has led to the development of new ablation catheters specifically designed as 'one-shot tools' for pulmonary vein isolation (PVI). The purpose of this study was to compare the efficacy, safety, and procedure times for two such catheters using different energy sources.
One hundred and ten patients, referred for ablation of paroxysmal or persistent AF, were randomized to treatment with either the cryoballoon or the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation catheter (PVAC). Complete PVI was achieved in 98 vs. 93% patients in the cryoballoon and PVAC group, respectively, with complication rates of 8 vs. 2% (P = 0.2). Complete freedom from AF, without antiarrhythmic drugs, after one single ablation procedure was seen in 46% in the cryoballoon vs. 34% after 12 months (P = 0.2). Procedure times were comparable, but fluoroscopy time was shorter for the cryoballoon (32 ± 16 min) than for the PVAC procedures (47 ± 17 min) (P
AIMS: Catheter ablation research is reported extensively. Much less is known about the clinical practice in the field. Study databases and surveys target selected populations. A general registry is needed to evaluate the actual results of routine catheter ablation. We present statistics from the Swedish Catheter Ablation Registry. METHODS AND RESULTS: The registry is a nation-wide database collecting data from all the eight centres serving the country's population of 9.18 million inhabitants. During each ablation procedure, the data are entered into a local database. On demand, the data are transferred to the central data management facility. The central SQL-database presently covers 7018 ablations performed in 5885 patients during 2004-07. In 2007, 2314 ablation procedures [521 for atrial fibrillation (AF)] were performed (252 ablations per million inhabitants and 57 AF procedures per million inhabitants). Mean procedure and fluoroscopy times ranked from 75 and 12 min, respectively, for atrioventricular junction ablation to 224 and 43 min, respectively, for AF ablation. The incidence of complications during 2007 was 1.8%. One death after a procedure for AF was reported, due to a cerebrovascular embolus. CONCLUSION: The report presents prospective-gathered annual data from a nation-wide ablation register with voluntary participation. Several major complications have been reported, but the overall complication rate was low.
OBJECTIVE: We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography. METHODS: We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography. RESULTS: Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality. CONCLUSIONS: Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.
Ablation trumps meds for atrial fibrillation treatment. Catheter ablation provides better long-term relief from atrial fibrillation than medication, but surgical ablation is best, a second study concludes.
Pulmonary vein isolation (PVI) is an established method for treatment of drug refractory atrial fibrillation. The aim of this study was to evaluate whether a more active regular supply of analgesic and sedative drugs reduces pain and discomfort. We also wanted to evaluate gender differences in pain perception and to compare standard radiofrequency (RF) with cryo balloon ablation (Cryo) from this perspective.
A total of 80 patients, 40 men, median age 58 (range 23-76) years, who underwent PVI under conscious sedation were studied. They were randomized to either standard treatment with morphine and diazepam (control group, C) or to a more active analgesic strategy (A) with pre-medication with oral midazolam mixture and intravenous alfentanil and midazolam regularly administrated during the procedure. Forty patients were treated with RF and 40 with Cryo.
The majority of the patients experienced pain during the procedure. The maximal pain assessed with numerical rating scale (NRS), was lower in the active group compared with that in controls (p = 0.02). Women experienced more pain than men (p = 0.01). RF was more painful than Cryo (p
Hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in North America. Because the vast majority of HCCs occur in the setting of a cirrhotic liver, management of this malignancy is best performed in a multidisciplinary group that recognizes the importance of liver function, as well as patient and tumour characteristics. The Barcelona Clinic Liver Cancer (BCLC) staging system is preferred for HCC because it incorporates the tumour characteristics (ie, tumour-node-metastasis stage), the patient's performance status and liver function according to the Child-Turcotte-Pugh classification, and then links the BCLC stage to recommended therapeutic interventions. However, the BCLC algorithm does not recognize the potential role of radiofrequency ablation for very early stage HCC, the expanding role of liver transplantation in the management of HCC, the role of transarterial chemoembolization in single large tumours, the potential role of transarterial radioembolization with 90Yttrium and the limited evidence for using sorafenib in Child- Turcotte-Pugh class B cirrhotic patients. The current review article presents an evidence-based approach to the multidisciplinary management of HCC along with a new algorithm for the management of HCC that incorporates the BCLC staging system and the authors' local selection criteria for resection, ablative techniques, liver transplantation, transarterial chemoembolization, transarterial radioembolization and sorafenib in Alberta.
Cites: Hepatology. 2008 Jan;47(1):97-10418069697
Cites: Ann Surg Oncol. 2008 May;15(5):1375-8218324443