During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major hospitals throughout the world. Surgical ablation of AF, using either standard or minimally invasive techniques, is also performed in many major hospitals throughout the world.

In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society.1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons and the American College of Cardiology. Since the publication of the 2007 document, there has been much learned about AF ablation, and the indications for these procedures have changed. Therefore the purpose of this 2012 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a Task Force, convened by the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society and charged with defining the indications, techniques, and outcomes of this procedure. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation, including definitions relevant to this topic.

This statement summarizes the opinion of the Task Force members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF. This statement is not intended to recommend or promote catheter ablation of AF. Rather the ultimate judgment regarding care of a particular patient …

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

https://repub.eur.nl/pub/104203/REPUB_104203-OA.pdf

2017 HRS / EHRA / ECAS / APHRS / SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial.

Since publication of the last American Heart Association (AHA) scientific statement on this topic in 1998,1 device technology, advances in interventional techniques, and an innovative spirit have opened the field of congenital heart therapeutic catheterization. Unfortunately, studies testing the safety and efficacy of catheterization and transcatheter therapy are rare in the field because of the difficulty in identifying a control population, the relatively small number of pediatric patients with congenital heart disease (CHD), and the broad spectrum of clinical expression. This has resulted in the almost exclusive “off-label” use of transcatheter devices, initially developed for management of adult diseases, for the treatment of CHD.

The objective of the present writing group, which included representatives of the AHA and endorsements from the Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics, was not only to provide the reader with an inventory of diagnostic catheterization and interventional treatment options but also to critically review the literature and formulate relative recommendations that are based on key opinion leader expertise and level of evidence. The writing group was charged with the task of performing an assessment of the evidence and giving a classification of recommendations and a level of evidence to each recommendation. The American College of Cardiology/AHA classification system was used, as follows:

### Classification of Recommendations

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease A Scientific Statement From the American Heart Association

Aim The effect of applied therapy on quality of life (QoL) in patients with atrial fibrillation (AF) was investigated in recent studies. However, no information on clinical relevance of QoL assessing instruments in relation to post-ablation recurrence of AF is currently available. The aim of this study was to evaluate the clinical relevance of SF-36 and Arrhythmia Related Symptom Severity Check List (SSCL) to post-procedure AF recurrences in patients with paroxysmal AF undergoing pulmonary vein isolation (PVI).

Methods and results Sixty consecutive patients with AF were enroled in the study. The QoL was measured using SF-36 scale and SSCL. The questionnaires were administered at baseline then 3, 6, 9 and 12 months after the procedure. In order to define statistical power in relation to AF recurrence the scores were dichotomized. Positive and negative predictive accuracy (PPA, NPA) and test efficiency (sum of PPA and NPA) were calculated. Twenty-one out of 60 patients experienced a total of 66 recurrences of AF during follow-up. The parameters of SF-36 provided maximum test efficiency of 1.36, whereas the test efficiency of SSCL was 1.79.

Conclusion We conclude that SSCL is more specific instrument for a measurement of PVI success or failure.

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Comparison of generic health survey SF-36 and arrhythmia related symptom severity check list in relation to post-therapy AF recurrence

Background: The definition of symptomatic improvement after pulmonary vein isolation (PVI) is controversial. We assessed primarily the usefulness and predictive accuracy (PA) of AF (atrial fibrillation) burden (AFB) within the first 3 months after the procedure as an early predictor for curative success as well as reduction of symptoms.



Methods: We studied 100 pts (62 men, mean age: 54 ± 9 years, LVEF: 57 ± 9%, paroxysmal AF, 85, persistent AF, 15) who underwent PVI. RF ablation was used in 63 patients. The combination of cryoablation and RF (Hybrid therapy) was used in the remaining 37 patients, in 19 patients of whom additionally linear lesions were performed. All patients were followed up 3 months after PVI (the blanking period) and every 3 months thereafter. The significance of early recurrence of AF (ERAF) was separately analyzed for RF and for hybrid therapy arm. Quality of life (QoL) was assessed using the physical composite summary score (PCS) and mental composite summary score (MCS). AFB was dichotomized at: 0, 0.5, 1, 6, 12, and 24 hours.



Results: ANOVA revealed significant differences between PCS at baseline and after PVI in patients without recurrence and with those with postablation AFB <12 hours. There was no difference between PCS in patients with AFB ≥12 hours within a 3 months interval and PCS at baseline. ERAF occurred in 35% of patients (16 patients, AFB ≥12 hours). Symptomatic ERAF occurred in 29 patients (17 patients AFB ≥12 hours). After the blanking period, documented AF recurrence was found in 50 patients (17 patients, AFB ≥12 hour). Symptomatic late recurrence was found in 47 patients (31 patients with AFB ≥12 hours). Absence of ERAF was revealed to be predictive for long-term success and symptomatic ERAF was found to be predictive for symptomatic AF recurrence (P <0.0001).



Conclusion: AF recurrence with AFB ≥12 hours within 3 months is associated with a missed improvement of QoL. Symptomatic ERAF predicts recurrence independently of therapy.

Usefulness of Atrial Fibrillation Burden as a Predictor for Success of Pulmonary Vein Isolation

Cryocatheter Ablation of Ventricular Tachycardia. Introduction: Cryocatheter techniques have been successfully applied to treat supraventricular tachycardia but there are no reports on their value in treating ventricular tachycardia (VT). We present our initial experience with cryocatheter ablation of right ventricular outflow tract (RVOT) tachycardia. Methods and Results: Cryocatheter ablation was attempted in 14 patients (13 females, age 45.9 ′ 12.7 years) who were highly symptomatic due to frequent monomorphic ventricular extrasystole (VES) or nonsustained VT originating within the RVOT. A 9-Fr, 8-mm-tip cryocatheter was used for both mapping and ablation. Cryoablation was started after localizing the arrhythmic focus by pace and activation mapping. Ablation success, defined by complete disappearance of target VES/VT acutely and during a follow-up of 9.3 ′ 1.4 weeks, was achieved in 13 of 14 patients. Ablation was successful with local activation times of 35 ′ 4 ms, 5.8 ′ 3.3 applications, 18.8 ′ 7.5 minutes total cryo time, 9.4 ′ 4.2 minutes fluoroscopy time, and 66.9 ′ 26.1 minutes total procedure time, the latter two measures showing a reduction with number of patients treated. Three patients reported slight pain related to local pressure of the catheter on the RVOT wall. No pain was described related to delivery of cryothermal energy. Conclusions: Initial experience shows that focal VES/VT originating in the RVOT can be successfully treated using cryocatheter ablation. Acute and short term success rates, fluoroscopy times, and duration of procedure are comparable to conventional ablation techniques. A major advantage seems to be the virtual absence of ablation related pain.

Cryocatheter Ablation of Right Ventricular Outflow Tract Tachycardia

We propose novel methods for (a) detection of a catheter in fluoroscopic images and (b) reconstruction of this catheter from two views The novelty of (a) is a reduced user interaction and a higher accuracy It requires only a single seed point on the catheter in the fluoroscopic image Using this starting point, possible parts of the catheter are detected using a graph search An evaluation of the detection using 66 clinical fluoroscopic images yielded an average error of 07 mm ± 20 mm The novelty of (b) is a better ability to deal with highly curved objects as it selects an optimal set of point correspondences from two point sequences describing the catheters in two fluoroscopic images The selected correspondences are then used for computation of the 3-D reconstruction The evaluation on 33 clinical biplane images yielded an average backprojection error of 04 mm ± 06 mm

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Semi-automatic catheter reconstruction from two views

Electrophysiology (EP) studies and catheter ablation have become important treatment options for several types of cardiac arrhythmias. We present a novel image-based approach for automatic detection and 3-D reconstruction of EP catheters where the physician marks the catheter to be reconstructed by a single click in each image. The result can be used to provide 3-D information for enhanced navigation throughout EP procedures. Our approach involves two X-ray projections acquired from different angles, and it is based on two steps: First, we detect the catheter in each view after manual initialization using a graph-search method. Then, the detection results are used to reconstruct a full 3-D model of the catheter based on automatically determined point pairs for triangulation. An evaluation on 176 different clinical fluoroscopic images yielded a detection rate of 83.4%. For measuring the error, we used the coupling distance which is a more accurate quality measure than the average point-wise distance to a reference. For successful outcomes, the 2-D detection error was $1.7\ {\rm mm} \pm 1.2$ mm. Using successfully detected catheters for reconstruction, we obtained a reconstruction error of $1.8\ {\rm mm} \pm 1.1$ mm on phantom data. On clinical data, our method yielded a reconstruction error of $2.2\ {\rm mm} \pm 2.2$ mm.

Klaus Kurzidim

Papers

Comparison of generic health survey SF-36 and arrhythmia related symptom severity check list in relation to post-therapy AF recurrence

Usefulness of Atrial Fibrillation Burden as a Predictor for Success of Pulmonary Vein Isolation

Cryocatheter Ablation of Right Ventricular Outflow Tract Tachycardia

Semi-automatic catheter reconstruction from two views

Electrophysiology Catheter Detection and Reconstruction From Two Views in Fluoroscopic Images