[Show abstract][Hide abstract] ABSTRACT: To the Editor: Verma et al. (May 7 issue)(1) report that the performance of neither linear ablation nor ablation of complex fractionated electrograms provided an incremental benefit when added to pulmonary-vein isolation to decrease the rate of recurrent atrial fibrillation. Di Biase et al.(2) note that the left atrial appendage acts as a potential trigger for atrial fibrillation or atrial tachycardia in approximately 27% of patients with atrial fibrillation who require repeat catheter ablation. They found that recurrent atrial fibrillation was significantly reduced in patients undergoing isolation of the left atrial appendage (segmental or circumferential ablation), with a recurrence rate . . .
New England Journal of Medicine 08/2015; DOI:10.1056/NEJMc1508689 · 55.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Since its introduction in 1953, lone atrial fibrillation (LAF) has not been defined with any consistency, resulting in an enormous variation in the way the term is used. Inherent to this, results from studies vary considerably. Many predisposing factors and pathogenic influences have been discovered over the past years, which raise the question if the term LAF should still be used and if the treatment should be different from non-lone atrial fibrillation (non-LAF). Therefore this systematic review on LAF provides an overview of risk factors and triggers, the second part focuses on the application of catheter and surgical ablation techniques.
METHODS: A systematic literature search was performed in the PubMed database. All identified articles were screened and checked for eligibility by the two authors. Additional literature was sought by screening the references of eligible articles.
RESULTS: The term LAF is used very variably and inconsistently, and results concerning etiology in different studies are often contradictory. Overall finding is that LAF has many risk factors (e.g. subclinical atherosclerosis, enlarged left atrial volume, left ventricular dysfunction, occult hypertension, arterial stiffness, systemic inflammation and genetic factors) and can be induced by many different triggers (e.g. use of substances, endurance sports, mental stress and sleeping). However, compared to non-LAF there are no unique mechanisms related to LAF. Concerning the therapy, catheter ablation is first or second choice after antiarrhythmic drugs, however surgical and hybrid approaches may be indicated in complex cases.
CONCLUSIONS: Insufficient evidence exists to consider LAF as a real, isolated and useful entity. A re-definition or even avoiding the use of the term LAF might be appropriate.
Journal of Atrial Fibrillation 06/2015; 8(1):18-27.
[Show abstract][Hide abstract] ABSTRACT: Aim:
Hybrid procedure (HP) involves epicardial isolation of pulmonary vein and posterior wall of left atrium, and endocardial checking of lesions and touchups (if needed). We aimed at observing the effect of hybrid procedure on P wave duration (PWD), calculated automatically from surface ECG leads at start and end of HP, and also for relationship to atrial fibrillation (AF) recurrence at 9 months.
Forty-one patients (32 male; mean age, 58.4 ± 9.5 years) underwent HP, as first ever ablation. A new automated method was used for P wave segmentation and PWD estimation from recognizable P waves in ECG lead I or II before and after HP, based on fitting of each P wave by means of two Gaussian functions.
Overall, PWD was significantly decreased after procedure (104.4 ± 25.1 ms vs. 84.7 ± 23.8 ms, p = 0.0151), especially in persistent AF patients (122.4 ± 32.2 ms vs. 85.6 ± 24.5 ms, p = 0.02). PWD preprocedure was significantly higher in persistent than in paroxysmal patients (122.4 ± 32.2 ms vs. 92.5 ± 17.9 ms, p = 0.0383). PWD was significantly decreased after procedure in prior electrical cardioverted patients (106.7 ± 30.5 ms vs. 84.7 ± 23.1 ms, p = 0.0353). After 9-month follow-up of 40 patients, HP-induced PWD decrease was significant for the 12 persistent patients without recurrence (122.4.1 ± 35.3 ms vs. 85.6 ± 22.0 ms, p = 0.0210).
Preprocedure PWD was higher for persistent than paroxysmal patients. HP reduced PWD significantly. Nine-month follow-up suggests that HP is successful in restoring and maintaining sinus rhythm. To individualize AF therapy, AF type-based selection of patients may be possible before procedure. Automated analysis of PWD from surface ECG is possible.