Cryoballoon ablation of peri-mitral atrial flutter refractory to radiofrequency ablation: a case report
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PROVIDER: S-EPMC10794817 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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Project description:BackgroundTreatment of recurring atrial flutter can be challenging due to anatomical obstacles preventing complete conduction block of linear ablation lesions. Epicardial or bipolar ablation can be used as an alternative to create deeper ablation lesions but is still limitedly used in patients with atrial flutter.Case summaryWe describe a case of a 54-year-old patient with recurring peri-mitral flutter treated with ablation of an anteroseptal line using bipolar ablation to achieve a complete conduction block.DiscussionAs conventional ablation cannot always achieve, complete conduction block in linear ablation lesions alternatives may be used to create deeper lesions. In this, case bipolar ablation was used successfully for an anteroseptal line in a patient with recurring peri-mitral flutter.
| S-EPMC11404515 | biostudies-literature
Project description:Atrial flutter (AFL) is the second most common atrial tachyarrhythmia after atrial fibrillation. Catheter ablation (CA) for typical AFL is well-established and has a high success rate and adequate safety. However, sick sinus syndrome (SSS) occasionally occurs when long-term, persistent AFL is terminated by ablation. Sinus node function cannot be assessed during AFL, and the preoperative prediction of underlying SSS has not yet been investigated. When this situation occurs, pacemaker implantation is often necessary. Here, we report a case of SSS after persistent AFL CA.
| S-EPMC10023878 | biostudies-literature
Project description:BackgroundAtrial flutter (AFL) is a common arrhythmia following radiofrequency ablation (RFA) for atrial fibrillation (AF), with varying incidence depending on the ablation strategy. Patients with prior atrial septal defect (ASD) occlusion pose challenges for ablation, particularly when the lesions are located near the occluder. Pulsed field ablation (PFA) has emerged as a promising alternative to RFA for the treatment of AF or AFL; however, its use in patients with ASD occlusion remains unexplored.Case summaryWe present the case of a 46-year-old female with a history of ASD occlusion and subsequent RFA for AF. Despite the initial success, she developed symptomatic AFL 3 months post-procedure. Intracardiac echocardiography (ICE)-guided transseptal puncture guided by ICE revealed an AFL originating from the slow conduction area around the ASD occluder. Pulsed field ablation was successfully performed, and AFL was terminated without complications. Post-procedural follow-up demonstrated maintenance of sinus rhythm.DiscussionPatients with ASD occlusion present unique challenges for ablation, including difficulties in transseptal puncture and risk of injury to the occluder. Pulsed field ablation offers a potential solution, with studies showing fewer reconnected pulmonary veins and larger lesion creation compared with traditional methods. In our case, PFA effectively terminated the refractory AFL, highlighting its utility in this patient population. Moreover, the use of the Jinjiang PFA catheter with pulse circuit self-checking technology ensured procedural safety, particularly near the occluder.
| S-EPMC11558455 | biostudies-literature
Project description:Pulsed field ablation (PFA), a nonthermal ablative mechanism, has been proven to be effective and safe in clinical application. To date, PFA has been used for only atrial fibrillation (AF) ablation in limited clinical trials. The present study describes a case of paroxysmal AF in which mitral and cavotricuspid isthmus (CTI)-dependent atrial flutter was discovered incidentally during PFA operation and successfully ablated with PFA. This is the first medical record of PFA for AF combined with mitral and CTI atrial flutter. The present case report revealed that PFA can be independently used to treat complex arrhythmias, similar to radiofrequency (RF) ablation, without the need for assistance from other ablation methods. Concurrently, the present study, to the best of the authors' knowledge is the first to report a case using a point-to-point PFA ablation strategy for isthmus ablation. This highlights the potential of PFA in treating diverse arrhythmias across different regions, such as the mitral isthmus and other intricate areas, utilizing a point-to-point PFA ablation strategy.
| S-EPMC11462395 | biostudies-literature
Project description: Not available
| S-EPMC5419411 | biostudies-literature
Project description: Not available
| S-EPMC5419764 | biostudies-literature
Project description:Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF (n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis (n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p < 0.001). In patients with atrial flutter, the recurrence rate of atrial tachycardia or atrial flutter was more frequent (7.3% vs. 4.7%, p = 0.028), but the recurrence rate of AF was significantly lower (17.0% vs. 29.4%, p < 0.001). Atrial flutter has been identified as an independent predictor of the primary endpoint (adjusted hazard ratio, 0.704; 95% confidence interval, 0.548-0.906; p = 0.006). Typical atrial flutter in patients with AF may serve as a positive marker of the recurrence of atrial arrhythmia, and performing CTI ablation in this population is associated with a reduced likelihood of AF recurrence. Performing routine screening and ablation procedures for coexisting atrial flutter may improve the clinical outcomes of AF.
| S-EPMC10755020 | biostudies-literature
Project description: Not available
| S-EPMC5420036 | biostudies-literature
Project description:AbstractAtrial fibrillation is considered to be the most common arrhythmia in the clinic, and it gradually increases with age. In recent years, there has been increasing evidence that atrial fibrillation may exacerbate the progression of cognitive dysfunction. The current guidelines recommend ablation for drug-refractory atrial fibrillation.We aimed to prospectively analyze changes in cognitive function in patients with atrial fibrillation following treatment using different ablation methods.A total of 139 patients, with non-valvular atrial fibrillation, were included in the study. The patients were divided into the drug therapy (n = 41) and catheter ablation (n = 98) groups, with the catheter ablation group further subdivided into radiofrequency ablation (n = 68) and cryoballoon (CY) ablation (n = 30). We evaluated cognitive function at baseline, 3- and 12-months follow-up using the Telephone Interview for Cognitive Status-modified (TICS-m) test, then analyzed differences in cognitive function between the drug therapy and catheter ablation groups, to reveal the effect of the different ablation methods.We observed a significantly higher TICS-m score (39.56 ± 3.198) in the catheter ablation group at 12-month follow-up (P < .001), than the drug treatment group was. Additionally, we found no statistically significant differences in TICS-m scores between the radiofrequency ablation and CY groups at 3- and 12-month postoperatively (P > .05), although the two subgroups showed statistically significant cognitive function (P < .001).Overall, these findings indicated that radiofrequency and CY ablation improve cognitive function in patients with atrial fibrillation.
| S-EPMC8360464 | biostudies-literature
Project description:BackgroundLeft atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favorable effects on cardiac function. Atrial volume-pressure loops can optimally assess the LA function.ObjectiveTo investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between the radiofrequency and cryoballoon ablation.MethodsWe analyzed 44 patients undergoing paroxysmal AF ablation from 2 centers, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent a real-time three-dimensional transthoracic ECG to evaluate LA volume, while simultaneously recording LA pressure following transseptal puncture. Volume-pressure loops pre- and post-procedure were created by paired data. Areas of A-loop (LA booster pump function) and V-loop (LA reservoir function), and the stiffness constant determining the slope of the exponential curve during LA filling were calculated.ResultsAverage LA pressure, A-wave amplitude, and V-wave amplitude were increased post-procedurally (p < 0.001). Overall, A-loop area decreased (p = 0.001) and V-loop area tended to increase (p = 0.07). The change in both A-loop and V-loop areas was similar between radiofrequency- and cryoballoon-treated patients (p = 0.18 and p = 0.52, respectively). However, compared with cryoballoon-treated patients, radiofrequency-treated patients had higher increase in the stiffness constant (b = 0.059; 95% CI: 0.022-0.096; p = 0.006).ConclusionAF catheter ablation by the radiofrequency or cryoballoon is associated with the decrease of the booster pump function and increase of the reservoir function. Moreover, there is a post-procedural increase of LA pressure which is associated with an acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation.
| S-EPMC8959489 | biostudies-literature