Abstract
Ablation for atrial fibrillation has now become the most common procedure performed in the electrophysiology laboratory. This chapter begins by exploring the clinical significance and pathogenesis of Atrial Fibrillation and reviews its ablative approaches and potential complications. One of the most common reasons for redo-ablation is for post AF Atrial Tachycardia, and this chapter will review their mechanisms, and some of the latest approaches to their 3D mapping.
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Abbreviations
- AF:
-
Atrial Fibrillation
- ANS:
-
Autonomic Nervous System
- AT:
-
Atrial Tachycardia
- CFAE:
-
Complex Fractionated Atrial Electrograms
- CT:
-
Computed Tomography
- ECG:
-
Electrocardiogram
- EF:
-
Ejection Fraction
- EGM:
-
Electrogram
- GP:
-
Ganglionated Plexi
- HFS:
-
High Frequency Stimulation
- HR:
-
Heart Rate
- LA:
-
Left Atrium
- LAA:
-
Left Atrial Appendage
- LAT:
-
Local Activation Time
- LV:
-
Left Ventricle
- MRI:
-
Magnetic Resonance Imaging
- PV:
-
Pulmonary Vein
- PVI:
-
Pulmonary Vein Isolation
- RA:
-
Right atrium
- RF:
-
Radiofrequency
- SVC:
-
Superior Vena Cava
- TOE:
-
Transoesophageal echocardiogram
- WACA:
-
Wide area circumferential ablation
- WOI:
-
Window of Interest
References
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the american college of cardiology/american heart association task force on clinical practice guidelines and the heart rhythm society. Heart Rhythm. 2019.
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.
Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129(8):837–47.
Andersson T, Magnuson A, Bryngelsson IL, et al. All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J. 2013;34(14):1061–7.
Wijesurendra RS, Liu A, Eichhorn C, et al. Lone atrial fibrillation is associated with impaired left ventricular energetics that persists despite successful catheter ablation. Circulation. 2016;134(15):1068–81.
Nerheim P, Birger-Botkin S, Piracha L, Olshansky B. Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia. Circulation. 2004;110(3):247–52.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22(8):983–8.
Aspberg S, Chang Y, Atterman A, Bottai M, Go AS, Singer DE. Comparison of the ATRIA, CHADS2, and CHA2DS2-VASc stroke risk scores in predicting ischaemic stroke in a large Swedish cohort of patients with atrial fibrillation. Eur Heart J. 2016;37(42):3203–10.
Corley SD, Epstein AE, DiMarco JP, et al. Relationships between sinus rhythm, treatment, and survival in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study. Circulation. 2004;109(12):1509–13.
Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33.
Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834–40.
Ogawa S, Yamashita T, Yamazaki T, et al. Optimal treatment strategy for patients with paroxysmal atrial fibrillation: J-RHYTHM study. Circ J. 2009;73(2):242–8.
Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation—pharmacological Intervention in atrial fibrillation (PIAF): a randomised trial. Lancet. 2000;356(9244):1789–94.
Siontis KC, Ioannidis JPA, Katritsis GD, et al. Radiofrequency ablation versus antiarrhythmic drug therapy for atrial fibrillation: meta-analysis of quality of life, morbidity, and mortality. JACC Clin Electrophysiol. 2016;2(2):170–80.
Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.
Pappone C, Rosanio S, Oreto G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation. 2000;102(21):2619–28.
Sundt TM 3rd, Camillo CJ, Cox JL. The maze procedure for cure of atrial fibrillation. Cardiol Clin. 1997;15(4):739–48.
Hamabe A, Okuyama Y, Miyauchi Y, et al. Correlation between anatomy and electrical activation in canine pulmonary veins. Circulation. 2003;107(11):1550–5.
Kumagai K, Ogawa M, Noguchi H, Yasuda T, Nakashima H, Saku K. Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter. J Am Coll Cardiol. 2004;43(12):2281–9.
Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954–68.
Moe GK, Abildskov JA. Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. Am Heart J. 1959;58(1):59–70.
Moe GK, Rheinboldt WC, Abildskov JA. A computer model of atrial fibrillation. Am Heart J. 1964;67:200–20.
Calkins H, Reynolds MR, Spector P, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009;2(4):349–61.
Nielsen JC, Johannessen A, Raatikainen P, et al. Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial. Heart. 2017;103(5):368–76.
Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311(7):692–700.
Mont L, Bisbal F, Hernandez-Madrid A, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501–7.
Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019.
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Arrhythm. 2017;33(5):369–409.
Jiang RH, Po SS, Tung R, et al. Incidence of pulmonary vein conduction recovery in patients without clinical recurrence after ablation of paroxysmal atrial fibrillation: mechanistic implications. Heart Rhythm. 2014;11(6):969–76.
Cappato R, Calkins H, Chen SA, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–8.
Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial. Circ Arrhythm Electrophysiol. 2014;7(1):69–75.
Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45.
Dallaglio PD, Betts TR, Ginks M, Bashir Y, Anguera I, Rajappan K. The role of adenosine in pulmonary vein isolation: a critical review. Cardiol Res Pract. 2016;2016:8632509.
Deneke T, Jais P, Scaglione M, et al. Silent cerebral events/lesions related to atrial fibrillation ablation: a clinical review. J Cardiovasc Electrophysiol. 2015;26(4):455–63.
Wazni OM, Beheiry S, Fahmy T, et al. Atrial fibrillation ablation in patients with therapeutic international normalized ratio: comparison of strategies of anticoagulation management in the periprocedural period. Circulation. 2007;116(22):2531–4.
Deshmukh A, Patel NJ, Pant S, et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128(19):2104–12.
Ghia KK, Chugh A, Good E, et al. A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol. 2009;24(1):33–6.
Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812–22.
Chen SA, Tai CT. Catheter ablation of atrial fibrillation originating from the non-pulmonary vein foci. J Cardiovasc Electrophysiol. 2005;16(2):229–32.
Fassini G, Riva S, Chiodelli R, et al. Left mitral isthmus ablation associated with PV Isolation: long-term results of a prospective randomized study. J Cardiovasc Electrophysiol. 2005;16(11):1150–6.
Kottkamp H, Berg J, Bender R, Rieger A, Schreiber D. Box isolation of fibrotic areas (BIFA): a patient-tailored substrate modification approach for ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2016;27(1):22–30.
Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43(11):2044–53.
Pokushalov E, Romanov A, Katritsis DG, et al. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm. 2013;10(9):1280–6.
Rappel WJ, Narayan SM. Theoretical considerations for mapping activation in human cardiac fibrillation. Chaos. 2013;23(2):023113.
Gianni C, Mohanty S, Di Biase L, et al. Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation. Heart Rhythm. 2016;13(4):830–5.
Jais P, Matsuo S, Knecht S, et al. A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry. J Cardiovasc Electrophysiol. 2009;20(5):480–91.
Zhang XD, Gu J, Jiang WF, et al. Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial. Eur Heart J. 2014;35(20):1327–34.
Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Three-dimensional mapping of cardiac arrhythmias: what do the colors really mean? Circ Arrhythm Electrophysiol. 2010;3(6):e6–11.
Liuba I, Walfridsson H. Activation mapping of focal atrial tachycardia: the impact of the method for estimating activation time. J Interv Card Electrophysiol. 2009;26(3):169–80.
De Ponti R, Verlato R, Bertaglia E, et al. Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus. Europace. 2007;9(7):449–57.
Jamil-Copley S, Linton N, Koa-Wing M, et al. Application of ripple mapping with an electroanatomic mapping system for diagnosis of atrial tachycardias. J Cardiovasc Electrophysiol. 2013;24(12):1361–9.
Linton NW, Koa-Wing M, Francis DP, et al. Cardiac ripple mapping: a novel three-dimensional visualization method for use with electroanatomic mapping of cardiac arrhythmias. Heart Rhythm. 2009;6(12):1754–62.
Luther V, Linton NW, Koa-Wing M, et al. A prospective study of ripple mapping in atrial tachycardias: a novel approach to interpreting activation in low-voltage areas. Circ Arrhythm Electrophysiol. 2016;9(1):e003582.
Luther V, Cortez-Dias N, Carpinteiro L, et al. Ripple mapping: initial multicenter experience of an intuitive approach to overcoming the limitations of 3D activation mapping. J Cardiovasc Electrophysiol. 2017;28(11):1285–94.
Luther V, Qureshi N, Lim PB, et al. Isthmus sites identified by ripple mapping are usually anatomically stable: a novel method to guide atrial substrate ablation? J Cardiovasc Electrophysiol. 2018;29(3):404–11.
Luther V, Agarwal S, Chow A et al. Ripple-AT study. Circ Arrhythm Electrophysiol. 2019;12(8):e007394.
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Luther, V., Katritsis, G. (2020). Ablation of Atrial Fibrillation and Atrial Tachycardia. In: Sohaib, A. (eds) Decoding Cardiac Electrophysiology. Springer, Cham. https://doi.org/10.1007/978-3-030-28672-9_6
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DOI: https://doi.org/10.1007/978-3-030-28672-9_6
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