Catheter ablation for atrial tachyarrhythmias: which patients are indicated for the procedure and what is the follow-up care?

Česká verze

Authors: doc. MUDr. Mgr. Alan Bulava, Ph.D.
Authors place of work: Kardiocentrum Nemocnice České Budějovice, a. s. alanbulava@seznam. cz
Published in the journal: Kardiol Rev Int Med 2008, 10(Mimořádné): 10-16

Summary

Atrial fi brillation is undoubtedly the most frequent heart rate disorder. The prevalence of this type of arrhythmia in general population is estimated to exceed 1 % and its incidence increases with age. The vast medical and socioeconomic implications of this problem are also accentuated by the fact that arrhythmia is related to a number of clinical consequences, e. g. thromboembolic cerebrovascular accidents, congestive heart failure, cognitive dysfunction and, last but not least, increased mortality. The paper deals with the pathophysiology of atrial fibrillation and its primary focus is on the new options for its non-pharmacological treatment, especially radiofrequency catheter ablation which has become a widely used procedure in spite of having been introduced in clinical practice just a few years ago. The effect of this treatment of atrial fibrillation highly exceeds the efficiency of standard anti-arrhythmia drugs. The greatest limitation for radiofrequency ablation today is the variability of the results in the different centres performing the procedure, a relatively higher incidence of complications, and last but not least the time consuming nature of the procedure and the resulting restrictions on the number of patients getting the treatment.

Key words

atrial fibrillation – pathophysiology – radiofrequency catheter ablation

Zdroje

1. Chen LY, Shen WK. Epidemiology of atrial fibrillation: a current perspective. Heart Rhythm 2007; 4: S1-S6.

2. Lloyd-Jones DM, Wang TJ, Leip EP et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110: 1042-1046.

3. Miyasaka Y, Barnes ME, Gersh BJ et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119-125.

4. Fuster V, Ryden LE, Asinger RW et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 2001; 104: 2118-2150.

5. Calkins H, Brugada J, Packer DL et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4: 816-861.

6. Allessie MA, Boyden PA, Camm AJ et al. Pathophysiology and prevention of atrial fibrillation. Circulation 2001; 103: 769-777.

7. 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: 659-666.

8. Jais P, Weerasooriya R, Shah DC et al. Ablation therapy for atrial fibrillation (AF): past, present and future. Cardiovasc Res 2002; 54: 337-346.

9. de Bakker JM, Ho SY, Hocini M. Basic and clinical electrophysiology of pulmonary vein ectopy. Cardiovasc Res 2002; 54: 287-294.

10. Pappone C, Oreto G, Lamberti F et al. Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation 1999; 100: 1203-1208.

11. Oral H, Knight BP, Tada H et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105: 1077-1081.

12. Haissaguerre M, Marcus FI, Fischer B et al. Radiofrequency catheter ablation in unusual mechanisms of atrial fibrillation: report of three cases. J Cardiovasc Electrophysiol 1994; 5: 743-751.

13. Jais P, Haissaguerre M, Shah DC et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997; 95: 572-576.

14. Saad EB, Rossillo A, Saad CP et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003; 108: 3102-3107.

15. Nakashima H, Kumagai K, Noguchi H et al. Evaluation of the recurrence of atrial fibrillation after pulmonary venous ablation. J Cardiol 2002; 40: 87-94.

16. Haissaguerre M, Jais P, Shah DC et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000; 101: 1409-1417.

17. Pappone C, Oreto G, Rosanio S et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-2544.

18. Daoud EG, Weiss R, Augostini R et al. Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 157-165.

19. 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: 2044-2053.

20. Scherlag BJ, Yamanashi W, Patel U et al. Autonomically induced conversion of pulmonary vein focal firing into atrial fibrillation. J Am Coll Cardiol 2005; 45: 1878-1886.

21. Scherlag BJ, Patterson E, Po SS. The neural basis of atrial fibrillation. J Electrocardiol 2006; 39: S180-S183.

22. Pappone C, Santinelli V, Manguso F et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation 2004; 109: 327-334.

23. Schauerte P, Scherlag BJ, Pitha J et al. Catheter ablation of cardiac autonomic nerves for prevention of vagal atrial fibrillation. Circulation 2000; 102: 2774-2780.

24. Scherlag BJ, Nakagawa H, Jackman WM et al. Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation. J Interv Card Electrophysiol 2005; 13(suppl 1): 37-42.

25. Verma A, Saliba WI, Lakkireddy D et al. Vagal responses induced by endocardial left atrial autonomic ganglion stimulation before and after pulmonary vein antrum isolation for atrial fibrillation. Heart Rhythm 2007; 4: 1177-1182.

26. Scanavacca M, Pisani CF, Hachul D et al. Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation. Circulation 2006; 114: 876-885.

27. Haissaguerre M, Sanders P, Hocini M et al. Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination. J Cardiovasc Electrophysiol 2005; 16: 1125-1137.

28. O'Neill MD, Jais P, Takahashi Y et al. The stepwise ablation approach for chronic atrial fibrillation-evidence for a cumulative effect. J Interv Card Electrophysiol 2006; 16: 153-167.

29. Fuster V, Ryden LE, Cannom DS et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 2006; 8: 651-745.

30. Karch MR, Zrenner B, Deisenhofer I et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation 2005; 111: 2875-2880.

31. Pappone C, Manguso F, Vicedomini G et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation 2004; 110: 3036-3042.

32. Gerstenfeld EP, Callans DJ, Dixit S et al. Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation 2004; 110: 1351-1357.

33. Ouyang F, Antz M, Ernst S et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation 2005; 111: 127-135.

34. Chugh A, Oral H, Lemola K et al. Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm 2005; 2: 464-471.

35. Hindricks G, Piorkowski C, Tanner H et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation 2005; 112: 307-313.

36. Kottkamp H, Tanner H, Kobza R et al. Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions: trigger elimination or substrate modification: early or delayed cure? J Am Coll Cardiol 2004; 44: 869-877.

37. Kanagaratnam L, Tomassoni G, Schweikert R et al. Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a three-dimensional nonfluoroscopic mapping system: long-term follow-up. Pacing Clin Electrophysiol 2001; 24: 1774-1779.

38. Oral H, Scharf C, Chugh A et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108: 2355-2360.

39. Khaykin Y, Marrouche NF, Saliba W et al. Pulmonary vein antrum isolation for treatment of atrial fibrillation in patients with valvular heart disease or prior open heart surgery. Heart Rhythm 2004; 1: 33-39.

40. Vasamreddy CR, Dalal D, Eldadah Z et al. Safety and efficacy of circumferential pulmonary vein catheter ablation of atrial fibrillation. Heart Rhythm 2005; 2: 42-48.

41. Ouyang F, Ernst S, Chun J et al. Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation 2005; 112: 3038-3048.

42. Oral H, Pappone C, Chugh A et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934-941.

43. Pappone C, Augello G, Sala S et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 2006; 48: 2340-2347.

44. Nakagawa H, Antz M, Wong T et al. Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2007; 18: 136-144.

45. Kanj MH, Wazni O, Fahmy T et al. Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study. J Am Coll Cardiol 2007; 49: 1634-1641.