Background—Atrial fibrillation ablation is an established therapy; however, limited data are available on associated complications. This systematic review determines the incidence and potential predictors of acute complications. Methods and Results—Electronic searches were conducted in MEDLINE and EMBASE for English scientific literature up to the 18th June 2012. A total of 2065 references were retrieved and evaluated for relevance. Reference lists of retrieved studies and review articles were examined to ensure all relevant studies were included. Data were extracted from 192 studies, total of 83 236 patients. The incidence of periprocedural complications for catheter ablation of atrial fibrillation was 2.9% (95% confidence interval, 2.6–3.2). There was a significant decrease in the acute complication rate in 2007 to 2012 compared with 2000 to 2006 (2.6% versus 4.0%; P=0.003). The complication rates reported were higher in prospective studies compared with those that retrospectively described complication...

Complications of catheter ablation of atrial fibrillation: a systematic review.

Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients.

Aims To assess the 1 year efficacy of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) comparing conventional radiofrequency irrigated-tip catheter ablation (RFCA) using contact-force technology and ablation using the second-generation cryoballoon (CB-AdvA).

Methods and results One hundred consecutive patients (74 male, 74%; mean age 62.4 ± 9.6 years) with drug-refractory PersAF undergoing PVI using RFCA and CB-AdvA were enrolled. Follow-up was based on outpatient clinic visits including Holter-electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. Among 100 patients, 50 underwent RFCA whereas 50 CB-AdvA. Mean procedure and fluoroscopy times were 90.5 ± 41.7 vs. 140.2 ± 46.9 min and 14.5 ± 6.6 vs. 19.8 ± 6.8 min in the CB-Adv and in the RFCA group, respectively ( P < 0.01). At 1 year follow-up, after a 3 months blanking period (BP), freedom from ATas off-drugs after a single procedure was 60% (28/50 patients) in the CB-Adv and 56% (27/50 patients) in the RFCA group ( P = 0.71). Multivariate analysis demonstrated that PersAF duration ( P = 0.01) and relapses during BP ( P = 0.02) were independent predictors of ATa recurrences following the index procedure.

Conclusion Freedom from ATas following PersAF ablation with RFCA and CB-Adv is comparable at 1 year follow-up after a single procedure. Ablation with the CB-Adv is associated with shorter procedure time and radiation exposure as compared with RFCA. Atrial tachyarrhythmias occurrence during BP and longer time of PersAF seem to be significant predictors of arrhythmia recurrences after the index procedure.

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Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation

Atrial fibrillation (AF) is a complex disease with multiple inter-relating causes culminating in rapid, seemingly disorganized atrial activation. Therapy targeting AF is rapidly changing and improving. The purpose of this review is to summarize current state-of-the-art diagnostic and therapeutic modalities for treatment of AF. The review focuses on reviewing treatment as it relates to the pathophysiological basis of disease and reviews preclinical and clinical evidence for potential new diagnostic and therapeutic modalities, including imaging, biomarkers, pharmacological therapy, and ablative strategies for AF. Current ablation and drug therapy approaches to treating AF are largely based on treating the arrhythmia once the substrate occurs and is more effective in paroxysmal AF rather than persistent or permanent AF. However, there is much research aimed at prevention strategies, targeting AF substrate, so-called upstream therapy. Improved diagnostics, using imaging, genetics, and biomarkers, are needed to better identify subtypes of AF based on underlying substrate/mechanism to allow more directed therapeutic approaches. In addition, novel antiarrhythmics with more atrial specific effects may reduce limiting proarrhythmic side effects. Advances in ablation therapy are aimed at improving technology to reduce procedure time and in mechanism-targeted approaches.

Atrial fibrillation therapy now and in the future: drugs, biologicals, and ablation.

https://www.heartrhythmjournal.com/article/S1547-5271(13)01319-2/pdf

Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury

Aims We examined the efficacy and safety of pulmonary vein (PV) isolation, using a cryoballoon catheter.

Methods and results We studied 117 consecutive patients presenting with paroxysmal ( n = 92) or persistent ( n = 25) atrial fibrillation (AF), who underwent attempts at isolation of 442 PV with a cryoballoon catheter. They were followed in our ambulatory department for every 3 months, or earlier if they reported symptoms. A 48 h ambulatory electrocardiogram  was recorded at the 3-month visit. We analysed the immediate and long-term procedural and clinical outcomes. We isolated 385 of 442 PV (87%) with a single cryoballoon application. In 19 patients (16%), an irrigated-tip radiofrequency (RF) catheter was used to create a supplemental focal lesion. A median of nine applications per procedure (range 6–12) was delivered. The mean, overall procedural duration was 155 ± 43 min (range 75–275), and mean duration of fluoroscopic exposure was 35 ± 15 min (range 12–73). At the end of the procedure, 103 patients (88%) were in sinus rhythm. Over a median period of 9.6 months (range 3–12), 11 patients were lost to follow-up. At 3, 6, 9, and 12 months of follow-up, respectively, 79, 79, 79, and 69% of patients presenting with paroxysmal AF had remained recurrence free, vs. 83, 73, 59, and 45% of patients, respectively, with persistent AF. Phrenic nerve palsy was the most frequent, although reversible complication.

Conclusions Pulmonary vein isolation, using a cryoballoon catheter, was completed with a high rate of procedural and long-term success and low rate of minor complications. Supplemented, when needed, by focal RF, cryoballoon ablation was a safe and an effective alternative to a circumferential RF procedure.

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Efficacy and safety of pulmonary veins isolation by cryoablation for the treatment of paroxysmal and persistent atrial fibrillation

Aortic dissection is an absolute cardiovascular emergency, its diagnosis has benefited from the development of modern imaging techniques including transoesophageal echocardiography, CT scan and Magnetic resonance angiography, its management can be medical, surgical or interventional depending on the type of the dissection and the potential associated complications. Thanks to its recent development, aortic stent-grafting technique is now extending its indication to high-risk patients even before clinical complications in order to prevent their occurrence. We present the clinical case of a patient admitted for uncomplicated type B aortic dissection with a contraindication to beta-blockers who successfully underwent a stent-graft implantation with positive outcome.

Endovascular Stent Grafting for Type B Acute Dissection: A Case Report and Literature Review

Wolff-Parkinson-White (WPW) syndrome is a relatively rare cardiac rhythm disorder entity encountered during pregnancy. However, its exacerbation under this physiological condition could be responsible, in certain cases, for life-threatening arrhythmias compromising both maternal and foetal prognosis. We report the observations of 03 pregnant women, without past medical history, presenting to the emergency room for palpitations related to a Wolff-Parkinson-White syndrome, complicated in one case with foetal death. The substantial severity of the WPW syndrome during pregnancy requires a prompt and adequate management strategy, based on a multidisciplinary cooperation between obstetricians, cardiologists and neonatologists.

/pdf/wolff-parkinson-white-syndrome-during-pregnancy-what-risk-lawn6gs1.pdf

Wolff-Parkinson-White Syndrome during Pregnancy, What Risk and What Management: About 03 Cases with Literature Review

Infective endocarditis in cardiac implantable electronic devices (pacemakers): Experience of the rhythmology department in Mohammed V military instruction hospital

The heart patients represent an unfavorable field for coronavirus disease 19 (COVID-19), and therefore, any regular follow-up consultation, not urgent, represents a great danger to catch up with this fatal disease. According to this study, we propose telemedicine as a comfortable, safe and efficient way to follow up our cardiac patients remotely.

/pdf/telecardiology-in-the-time-of-corona-study-about-112-252951mz.pdf

Ali Chaib

Papers

Efficacy and safety of pulmonary veins isolation by cryoablation for the treatment of paroxysmal and persistent atrial fibrillation

Endovascular Stent Grafting for Type B Acute Dissection: A Case Report and Literature Review

Wolff-Parkinson-White Syndrome during Pregnancy, What Risk and What Management: About 03 Cases with Literature Review

Infective endocarditis in cardiac implantable electronic devices (pacemakers): Experience of the rhythmology department in Mohammed V military instruction hospital

Telecardiology in the Time of Corona: Study About 112 Patients