The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)  

Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC  

Endorsed by the European Stroke Organisation (ESO)

/pdf/2016-esc-guidelines-for-the-management-of-atrial-ba0601yb9m.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

/pdf/2016-esc-guidelines-for-the-management-of-atrial-36b2cidm1x.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)

ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Authors/Task Force Members: Paulus Kirchhof* (Chairperson) (UK/Germany) Stefano Benussi* (Co-Chairperson) (Switzerland), Dipak Kotecha (UK), Anders Ahlsson (Sweden), Dan Atar (Norway), Barbara Casadei (UK), Manuel Castella (Spain), Hans-Christoph Diener (Germany), Hein Heidbuchel (Belgium), Jeroen Hendriks (The Netherlands), Gerhard Hindricks (Germany), Antonis S. Manolis (Greece), Jonas Oldgren (Sweden), Bogdan Alexandru Popescu (Romania), Ulrich Schotten (The Netherlands), Bart Van Putte (The Netherlands), and Panagiotis Vardas (Greece)

/pdf/2016-esc-guidelines-for-the-management-of-atrial-e0lfp612oq.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO)

Background— Recent studies have demonstrated that a positive response to cardiac resynchronization therapy (CRT) is related to the presence of preimplantation left ventricular (LV) dyssynchrony. The time course and the extent of LV resynchronization after CRT implantation and their relationship to response are currently unknown. Methods and Results— One hundred consecutive patients scheduled for implantation of a CRT device were prospectively included if they met the following criteria: New York Heart Association class III to IV, LV ejection fraction ≤35%, QRS duration >120 ms, and LV dyssynchrony (≥65 ms) on color-coded tissue Doppler imaging. Immediately after CRT implantation, LV dyssynchrony was reduced from 114±36 to 40±33 ms (P 10% reduction in LV end-systolic volume). Immediatel...

http://lib.ajaums.ac.ir/booklist/354423.pdf

Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy Analysis in Patients With Echocardiographic Evidence of Left Ventricular Dyssynchrony at Baseline

Mapping of Atrial Fibrillation. Introduction: While atrial fibrillation (AF) initiation in the pulmonary veins has been well-studied, simultaneous biatrial and three-dimensional noncontact mapping (NCM) has not been performed. We hypothesized that these two techniques would provide novel information on triggers, initiation, and evolution of spontaneous AF and permit study of different AF populations. Methods and Results: The origin of atrial premature beats (APBs), onset of spontaneous AF and its evolution were analyzed in 50 patients with AF in the presence or absence of structural heart disease (SHD) and in different AF presentations (group A: Persistent, group B: Paroxysmal). In 45 patients, spontaneous APBs in the right atrium (RA; n = 60) and left atrium (LA; n = 25) with similar regional distributions regardless of heart disease status were demonstrated. In total, 22 patients (44%) had >2 disparate regional origins. Biatrial regional foci were seen with equal frequency in patients with SHD (31%), without SHD (40%), in group A (32%), and in group B (36%). Biatrial mapping and NCM showed organized monomorphic atrial tachyarrhythmias arising in the RA (17), septum (17), or LA (21) and were classified as atrial flutter (RA = 34, LA = 8), macro-reentrant atrial tachycardia (RA = 1, LA = 3) or focal atrial tachycardia (RA = 2, LA = 7). Their regional distribution was more extensive in patients with SHD and persistent AF compared with patients without SHD or paroxysmal AF. Simultaneous biatrial tachycardias were observed only in group A patients and those with SHD. Conclusions: Simultaneous biatrial and NCM permits successful AF mapping in different AF populations and demonstrates a biatrial spectrum of spontaneous triggers and tachycardias. Organized monomorphic tachycardias with multiple unilateral or biatrial locations are commonly observed in human AF. Patients with heart disease or persistent AF have a more extensive distribution as well as simultaneous coexistence of multiple tachycardias during AF.

Biatrial and three-dimensional mapping of spontaneous atrial arrhythmias in patients with refractory atrial fibrillation.

Atrial flutter or tachycardia may coexist with atrial fibrillation [AF] and can be treated with ablation techniques in attempt to reduce the total AF burden. The role of ablation of latent atrial tachyarrhythmias elicited at electrophysiologic study in conjunction with atrial pacing and antiarrhythmic drugs in patients with refractory AF has not been evaluated. We evaluated the efficacy of catheter ablation of electrically induced atrial flutter or atrial tachycardia in improving rhythm control in patients with refractory AF. Methods: Consecutive patients with refractory AF, and spontaneous atrial flutter (Group 1) or without spontaneous atrial flutter (Group 2) underwent programmed stimulation in a baseline drug-free state. All patients had electrically induced atrial flutter or tachycardia. Radiofrequency ablation of the arrhythmia substrate was performed in all patients. Primary endpoints evaluated for patient outcome in both groups included maintenance of rhythm control and freedom from recurrent atrial tachyarrhythmias. Results: Forty-three patients, with a mean age of 66±13 years were studied. Group 1 consisted of 22 patients while Group 2 had 21 patients. Ablation of the tricuspid valve-inferior venacaval isthmus was performed in 41 patients who had common atrial flutter induced at electrophysiologic study. Ablation of other atrial sites was performed in 8 patients with induced atypical flutter and 4 patients with induced atrial tachycardia. Ten of these patients had ablation of more than one arrhythmia. 17 patients (40%) had atrial pacing instituted and 28 patients remained on a class 1/3 antiarrhythmic drug. During a mean follow-up of 26±14 months, 33 patients (82.5%) remained in rhythm control. Actuarial analysis showed 96% of patients in rhythm control at 6 months, 94% at 12 months, and 90% at 24 months. Freedom from symptomatic AF recurrence was 64% at 6 months, 58% at 12 months, and 42% at 24 months. The outcome for both of these endpoints was similar for Group 1 and Group 2 (p = NS). The AF free interval increased significantly from 7±9 days to 172±121 days (p < 0.01) after ablation. This increase was again similar in both the groups. In the 14 patients were who did not receive atrial pacing and who remained on the same class 1/3 antiarrhythmic drug, the AF free interval increased from 18±17 days to 212±102 days (p < 0.01).

Catheter ablation of inducible atrial flutter, in combination with atrial pacing and antiarrhythmic drugs ("hybrid therapy") improves rhythm control in patients with refractory atrial fibrillation.

Right atrial (RA) maze procedures using linear catheter ablation have had limited efficacy in paroxysmal atrial fibrillation (AF). We hypothesized that “hybrid” therapy using overdrive atrial pacing and antiarrhythmic drugs can improve efficacy of catheter RA maze and expand its role to persistent or permanent AF. Catheter RA maze procedures were performed in 26 patients with persistent or permanent AF refractory to 4.5 ± 2.1 antiarrhythmic drugs. Overdrive dual-site RA pacing (21 patients) or high RA pacing (5 patients) was continued (n = 11) or instituted periablation (n = 15). All patients continued receiving previously ineffective antiarrhythmic drugs. Freedom from permanent AF (rhythm control), symptomatic and/or asymptomatic AF recurrences, the safety of hybrid therapy, and overall survival were assessed. There was no procedure-related mortality or stroke. Rhythm control was achieved in 24 patients (92%) within 3 months. During long-term follow-up (6 to 49 months, mean 17 ± 10), rhythm control was maintained in 20 patients (77%). Nine patients (35%) had no AF recurrences, whereas 11 patients maintained rhythm control with infrequent AF recurrences. Device datalogs at the study cut-off point demonstrated no AF events in 6 patients, nonsustained atrial tachycardia in 2 patients, and brief asymptomatic paroxysmal AF in 12 patients. Actuarial patient survival was 95% at 1 year and 74% at 2 years of follow-up. Thus, hybrid therapy utilizing catheter RA maze procedures with overdrive atrial pacing and antiarrhythmic drugs can be performed safely and can reestablish rhythm control in selected patients with refractory persistent or permanent AF.

Effectiveness of Rhythm Control in Persistent or Permanent Atrial Fibrillation With Overdrive Atrial Pacing and Antiarrhythmic Drugs After Linear Right Atrial Catheter Ablation

Since the follow-up report of the Danish Trial of Physiologic Pacing in sick sinus syndrome reported reduction in chronic atrial  brillation (AF) with atrial-based pacing, this apparently simple subject has become a complex investigative issue.1 Clinical investigation of atrial pacing techniques for management of AF in symptomatic or high-risk populations is now being examined by a series of clinical trials.2 -5 One such trial is reported by Bailin et al.6 in this issue of the Journal. Another measure of the serious interest has been the formal investigation of the electrophysiologic effects of different atrial pacing methods in experimental and clinical laboratory AF models.7 -9 Students of this subject are now confronted by a variety of relatively simple interventions in a heterogeneous AF population that has been defying efforts at classi cation.10 ,1 1 Furthermore, our limited knowledge of the natural history of the arrhythmia in its different substrates, as well as the appropriate endpoints for demonstration of device clinical ef cacy and safety, has become increasingly apparent.1 2 ,13 In trying to appropriately evaluate the scienti c contribution of each of these trials, it now is necessary to reassess our understanding in each of these areas.

Alternate‐Site Pacing as Monotherapy for Prevention of Atrial Fibrillation: Is It Here to Stay?

Three-dimensional noncontact mapping demonstrates synergistic electrophysiologic effects of multisite atrial pacing and linear atrial ablation in patients with refractory atrial fibrillation

Artur Filipecki

Papers

Biatrial and three-dimensional mapping of spontaneous atrial arrhythmias in patients with refractory atrial fibrillation.

Catheter ablation of inducible atrial flutter, in combination with atrial pacing and antiarrhythmic drugs ("hybrid therapy") improves rhythm control in patients with refractory atrial fibrillation.

Effectiveness of Rhythm Control in Persistent or Permanent Atrial Fibrillation With Overdrive Atrial Pacing and Antiarrhythmic Drugs After Linear Right Atrial Catheter Ablation

Alternate‐Site Pacing as Monotherapy for Prevention of Atrial Fibrillation: Is It Here to Stay?

Three-dimensional noncontact mapping demonstrates synergistic electrophysiologic effects of multisite atrial pacing and linear atrial ablation in patients with refractory atrial fibrillation