Richard Hongo

• MD
• Managing Director at Sutter Health

Background Treatment of PAF with PVI is the gold standard approach. Recently, esophageal cooling has been shown to significantly reduce the risk of esophageal injury during thermal ablation. This study investigated outcomes of HPSD before and after instituting esophageal cooling. Methods In this natural experiment, we enrolled 346 consecutive pati...

Background: High grade atrioventricular (AV) block (HGAVB) after transcatheter aortic valve replacement (TAVR) requiring permanent pacemaker implantation (PPM) is a well-established complication, but recovery of intrinsic AV conduction is not well studied. We assessed the incidence and electrocardiography (ECG) predictors of AV conduction recovery...

Scar-mediated ventricular tachycardia (VT) is a recognized cause of morbidity and mortality in patients with ischemic cardiomyopathy and other cardiomyopathies such as nonischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and cardiac sarcoidosis. Implantable cardioverter-defibrillator (ICD) therapy improves survival but does...

A man in his 70s with a history of orthotopic heart transplant presented with dizziness. The heart transplantation had been performed using the biatrial surgical technique to treat advanced dilated cardiomyopathy. His posttransplant course was notable for grade 1 cardiac allograft vasculopathy, toxic multinodular goiter status postthyroidectomy, an...

Aims: This study investigated the impact of weight loss in longstanding persistent (LSPAF) patients undergoing catheter ablation (CA). Methods: Ninety consecutive obese LSPAF patients were approached; 58 volunteered to try weight loss interventions for up to 1 year (Group 1), while 32 patients declined weight loss interventions and were included...

Aims: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI...

Background: Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. Objectives: The aim of this study was to...

Background— We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results— A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation...

Background: -Whether catheter ablation (CA) is superior to Amiodarone (AMIO) for the treatment of persistent AF in patients with HF is unknown. Methods and results: -This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual chamber ICD or CRTD, NYHA II-III and LV EF <40% within the last 6 months wer...

Background: Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. Objective: To evaluate whether TEE is necessary before AF ablation in patients treated with novel oral anticoagulants (NOACs). Method: We performed a prospective multicenter registry...

Background: Catheter ablation reduces ventricular tachycardia (VT) recurrence and implantable cardioverter defibrillator shocks in patients with VT and ischemic cardiomyopathy. The most effective catheter ablation technique is unknown. Objectives: This study determined rates of VT recurrence in patients undergoing ablation limited to clinical VT...

Introduction: Post-operative atrial fibrillation (AF) is reported in up to 5-40% of patients following coronary artery bypass graft (CABG) surgery. Age-related atrial dilatation and fibrosis, electrical remodeling, autonomic imbalance and post-operative inflammation are few of the many pathophysiological factors that play an important role in the g...

Introduction: The best treatment option for the management of patients (pts) with heart failure (HF) and persistent AF is unknown. The AATAC trial showed that catheter ablation (CA) is superior to Amiodarone in achieving freedom from AF at follow up. In this analysis we present the outcome sorted by type of AF procedure. Methods: AATAC was a random...

Background: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF and severe LA scarring/fibrosis identified by 3D mapping undergoing ablation of the pulmona...

Background: Atrial fibrosis or scar is considered a substrate change related to atrial fibrillation (AF); by slowing conduction and increasing heterogeneity it could provide a substrate for AF. However, it is still not known whether AF causes the profibrotic changes in the left atrial wall or simply facilitates the manifestation of an existing agin...

Introduction: Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). LAA occlusion is recommended in patients that are not amenable to anticoagulation therapy because of elevated CHADS 2 or CHA 2 DS 2 -VASC score. We assessed the risk of stroke off anticoagulants in AF patients fol...

Background: Aggressive life-style changes by reversing obesity reportedly cause significant decrease in arrhythmia burden and symptom severity, thereby reducing or eliminating the need for arrhythmia medications in AF patients. However, these observations were documented in populations comprised primarily of paroxysmal and persistent AF patients. T...

Introduction: The Belief Randomized trial sought to assess whether the empirical isolation of the left atrial appendage (LAA) in addition to an extensive ablation could improve success at follow up in patients with long standing persistent (LSP) atrial fibrillation (AF). The aim of this sub-analysis of the trial aimed to evaluate the LAA contractio...

Introduction: Remote magnetic navigation (RMN) and ablation with the magnetic irrigated tip catheter has been reported as a feasible and safe technique for the treatment of ventricular arrhythmias (VA). We compared the procedural benefit and the outcomes of patients with ischemic cardiomyopathy (IC) undergoing VAs ablation with the RMN versus the m...

Whether in patients with paroxysmal atrial fibrillation (PAF) ablation of non-pulmonary vein triggers after antral pulmonary vein isolation (PVAI) improves the long-term outcome in patients with LV systolic dysfunction (LVSD) is unknown. We sought to evaluate whether a more extensive ablation improve outcomes at follow up. Consecutive patients with...

Objectives: The goal of this study was to evaluate the impact of hypertension on the outcome of atrial fibrillation (AF) ablation. Background: Hypertension is a well-known independent risk factor for incident AF. Methods: A total of 531 consecutive patients undergoing AF ablation were enrolled in this study and divided into 3 groups: patients...

This study examined incidence of AF following cavotricuspid isthmus (CTI) ablation alone or CTI plus prophylactic pulmonary vein isolation (PVI) in patients presenting with isolated atrial flutter (AFL) with no history of AF. We enrolled 216 patients with isolated typical atrial flutter and randomized them to CTI alone (group 1, n = 108, 61.2±9.7 y...

Periprocedural anticoagulation management with uninterrupted warfarin with a "therapeutic INR" represents the best approach reducing both thromboembolic and bleeding complications in the setting of catheter ablation for atrial fibrillation (AF). The purpose of this study was to evaluate the safety and feasibility of uninterrupted apixaban in this s...

Introduction: Catheter ablation of persistent atrial fibrillation (AF) has a lower success rate when compared to paroxysmal AF patients. Whether in persistent AF patients ablation of the pulmonary vein antrum and posterior wall is sufficient to achieve long term freedom from AF is debated in the literature. We investigated if the ablation on non pv...

Introduction: Periprocedural anticoagulation management is key to minimize bleeding and thromboembolic complications during and after radiofrequency catheter ablation. Uninterrupted strategies with warfarin in high risk patients have shown superiority over interrupted strategies. We sought to assess the safety and feasibility uninterrupted rivaroxa...

Introduction: Catheter ablation of cavo-tricuspid isthmus (CTI) is considered to be the most effective therapy for eliminating target arrhythmia in lone atrial flutter (AFL). However, many patients subsequently develop AF after CTI ablation. Therefore, prophylactic pulmonary vein antrum isolation (PVAI) along with CTI ablation could be considered a...

The impact of amiodarone on ablation outcome in long standing persistent atrial fibrillation (LSPAF) patients is not known yet. To assess the effect of amiodarone on procedural-outcomes in LSPAF patients undergoing catheter ablation. We enrolled 112 LSPAF patients on amiodarone and scheduled to undergo AF ablation. Patients were randomized to amiod...

Introduction: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. Methods and results: We included 1,257 AF...

Background Impact of catheter ablation on exercise performance, quality of life (QoL) and symptom-perception in asymptomatic longstanding persistent AF (LSP-AF) patients has not been reported yet.Methods and resultsSixty-one consecutive patients (mean age 62±13 years, 71% males) with asymptomatic LSP-AF undergoing first catheter ablation were enrol...

Introduction: Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods: Nine patients with AEF post-RFCA for AF were includ...

Periprocedural thromboembolic (TE) and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although, ablation procedures performed without warfarin discontinuation seem to be associated with lower TE...

IntroductionIt is unclear whether extended pulmonary vein antrum isolation (PVAI) plus non-pulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of two ablation strategies-PVAI alone...

Impact of catheter ablation on exercise performance, quality of life (QoL) and symptom-perception in asymptomatic longstanding persistent AF (LSP-AF) patients has not been reported yet.

Introduction: Inflammation and atrial fibrillation (AF) are often associated. Whether Neutrophil Lymphocyte Ratio (NLR) affects the radiofrequency catheter ablation outcome is unknown. The aim of this study is to evaluate baseline NLR as the inflammatory predictor of ablation outcome in Paroxysmal AF (PAF) patients. Method: One hundred seventy five...

-Pulmonary vein antrum isolation (PVAI) in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has been reported to have satisfactory results at the mid and short-term follow-up. We determined the outcomes at the long-term follow-up of PVAI in these patients. -We enrolled 43 patients with HCM and AF (28% paroxysmal AF). PVA...

Remote wireless follow-up of implanted pacemakers (PM) has become an attractive method of follow-up. Although wireless PM follow-up has several advantages compared with transtelephonic and office-based follow-up, its utility depends on successful transmission. Initial in-office setup of wireless PM will improve transmission rate as compared with ho...

Pulmonary vein antrum isolation (PVAI) remains associated with atrial fibrillation (AF) recurrence. We administered adenosine and isoproterenol (ISP) after PVAI to uncover non-PV atrial triggers and PV reconnection, potentially increasing ablation success rate. One hundred and ninety-two consecutive patients with symptomatic AF presenting for PVAI...

Background: Catheter ablation of inappropriate sinus tachycardia (IST) is a challenging procedure due to the proximity of the sinus node to the phrenic nerve, and the predominant epicardial location of the sinus node structure. We report a consecutive series of patients undergoing ablation of IST and characterized the site of earliest activation an...

This study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias. Catheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy. Ninety-two consecutive patients (81% male, age 62 ± 13 years) with...

Radiofrequency catheter ablation (RFCA) is an effective treatment for atrial fibrillation (AF), although studies evaluating the role of RFCA have largely excluded elderly patients. We report the safety and outcomes of RFCA of AF in octogenarians. From 2008 to 2011, out of 2,754 consecutive patients undergoing RFCA of AF, 103 (3.7%) had ≥80 years (a...

Islets of myocytes within fibrofatty scars represent the substrate for reentrant ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). Electroanatomic mapping can reliably identify such areas. To prospectively test the association between late and fragmented electrograms within scar and arrhythmic events in patients wit...

Background: Percutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASD). Atrial ibrillation (AF) is highly prevalent in these pts, and it is unclear whether ASD closure might affect the progression of AF in pts presenting with concomitant ASD and AF. We report the long-term effect of transcatheter clos...

Observational data suggest that performing radiofrequency catheter ablation of atrial fibrillation (AF) under therapeutic warfarin (continuous warfarin [CW]) may reduce the periprocedural risk of complications, such as thromboembolic events, compared to warfarin discontinuation (DW) with periprocedural bridging with heparin. We systematically revie...

The patient is a 57-year-old woman with newly diagnosed nonischemic dilated cardiomyopathy (LVEF 25–30%) and >11,000 uniform VPCs during a 24-h Holter monitor. She presented for electrophysiology study for ablation of the VPC focus (Fig. 62.1) and to assess for inducible sustained ventricular tachycardia. 3-D electroanatomic activation mapping was...

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five...

Relationship Between the Non-PV Triggers and the Critical CFAE Sites. Background: Complex fractionated atrial electrograms (CFAE) ablation has been performed in addition to pulmonary veins (PV) isolation to increase the success rate of atrial fibrillation (AF) ablation in patients with longstanding (LS) persistent AF. The mechanism underlying the c...

Percutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASDs). However, patients who have undergone the procedure are at increased risk for developing atrial fibrillation (AF), and treatment by catheter ablation is underutilized due to the perceived difficulty of obtaining transseptal access in the pres...

In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Forty-nine patients with arrhythmogenic right ventricu...

Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation. Nine hundred eigh...

Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in...

To assess whether treatment with statins or renin-angiotensin-aldosterone system (RAAS) inhibitors as potential procedural 'augmenting agents' improved atrial fibrillation (AF) catheter ablation recurrence rates in post-menopausal females (PMFS). Five hundred and eighteen consecutive female patients had undergone AF catheter ablation from January 2...

Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR). The purpose of this study was to determine whet...

Introduction Remote magnetic navigation (RMN) has been reported as an effective and safe tool to overcome the need for advanced operator skill in the treatment of complex arrhythmias. We report a series of patients undergoing radiofrequency catheter ablation of ventricular arrhythmias (VAs) using RMN with either a 4-mm catheter tip or an 8-mm cathe...

Most atrial fibrillation (AF) ablation studies have consisted predominantly of males; accordingly, there is a paucity of information on the safety and efficacy of catheter ablation in a large cohort of female AF patients. The purpose of this study was to evaluate catheter ablation for AF in female patients. From January 2005 to May 2008, 3265 femal...

Uncommon sites of ablation for arrhythmias can be the cause of failed ablations. This series includes 4 cases requiring ablation at the tip of the left atrial appendage after both endocardial and epicardial mapping and ablation failed.

The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence. One thousand four hundred four patients underwent...