Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk in Communities [ARIC] study). A randomized clinical trial of early invasive intervention for atrial fibrillation (EARLY-AF) - methods and rationale. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study. The effect of ranolazine on maintaining sinus rhythm in patients with resistant atrial fibrillation Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation. Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation. Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF) - study design. Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Efficacy, safety, and outcomes of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial. A randomized, controlled trial of RSD1235, a novel anti-arrhythmic agent, in the treatment of recent onset atrial fibrillation. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial† Noninducibility of Atrial Fibrillation as an End Point of Left Atrial Circumferential Ablation for Paroxysmal Atrial Fibrillation: A Randomized Study Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study. Safety and efficacy of catheter ablation of atrial fibrillation in patients with diabetes mellitus—single center experience Adjunctive renal sympathetic denervation to modify hypertension as upstream therapy in the treatment of atrial fibrillation (H-FIB) study: clinical background and study design. Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women.
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia in adults with congenital heart disease ( CHD ) .  Long-term antiarrhythmic therapy ( AAT ) in these patients has significant shortcomings . The safety and efficacy of pulmonary vein antrum isolation ( PVAI ) for the treatment of AF in CHD is presently unknown . HYPOTHESIS We hypothesized that PVAI for AF in patients with CHD is effective and safe . METHODS We review ed a prospect i ve cohort of 4315 patients ( age ≥ 18 ) undergoing PVAI for drug refractory AF at a single institution and identified 36 consecutive patients with CHD ( single ventricle physiology , tetralogy of Fallot , coa rct ation of the aorta , ventricular septal defects , atrial septal defects ( ASD ) and cardiomyopathy result ing from anomalous origin of the left main coronary from the pulmonary artery ) . A second cohort of 355 consecutive patients with noncongenital structural heart disease ( NSHD ) ( coronary artery disease , valvular heart disease , ejection fraction < 50 % , or prior noncongenital cardiac surgery ) undergoing PVAI during the same time period was used as a control . Success was defined as freedom from AF starting two months after PVAI in the absence AAT until the end of follow-up . Partial success was defined as freedom from AF in the presence of AAT until the end of follow-up . Combined success was defined as the sum of success and partial success . We compared the outcomes with the use of propensity-score matching in the overall cohort . RESULTS Patients with NSHD were older and had higher prevalence of hypertension ( P < .01 ) , diabetes ( P < .01 ) and hyperlipidemia ( P < .01 ) . The most common CHD lesion was ASD ( 61 % ) and the most common NSHD lesion was valvular heart disease ( 57 % ) . After one PVAI , success was achieved in 42 % and 53 % at 300 days in the CHD and NSHD groups respectively . Four-year success was achieved in 27 % and 36 % in the CHD and NSHD groups , respectively . There were no significant differences in the success rates between patients groups ( P= .46 ) , nor were there any differences in left atrial size or changes in ejection fraction after one or two PVAI in the respective groups . Complication rates between the CHD and NSHD groups were similar ( 15 % vs. 11 % , P= .42 ) except for a higher risk of vascular site complications in patients with CHD ( 8 % vs. 1 % , P < .05 ) . CONCLUSION PVAI is an attractive treatment modality in drug refractory AF in CHD , with combined success rates in excess of 60 % . The maintenance of sinus rhythm after PVAI in CHD appears similar to that of NSHD and warrants prospect i ve validation BACKGROUND Contact force ( CF ) sensing catheters provide advantages with regard to safety and efficacy . This study aim ed to evaluate if CF catheters reduce cardiac perforations and other major complications and offer equal safety compared to the magnetic navigation system ( MNS ) . METHODS Data from 1.517 ablation procedures from our prospect i ve registry was analyzed . Ablations were performed using either CF guided catheters ( CF group , n=248 ) , non-CF catheters ( NCF group , n=813 ) , or MNS ( n=456 ) . Four subgroups were analyzed : atrial fibrillation ( AF , n=557 ) , supraventricular tachycardia ( SVT , n=715 ) , ventricular tachycardia ( VT , n=190 ) and patients with congenital heart defects ( CHD , n=55 ) . The primary endpoint of this study was incidence of cardiac perforation . Secondary endpoints were major and minor complications within 30 days of the procedure . RESULTS Complications occurred in 11.3 % ( n=172 ) of the procedures . In 2.8 % ( n=43 ) a major complication occurred , 0.9 % ( n=13 ) had a perforation , 8.5 % ( n=129 ) had a minor complication and 2 patients died ( 0.1 % ) . No cardiac perforation occurred in the CF group , which was significantly different from NCF procedures ( 0.0 % vs. 1.6 % ; relative risk 0.76 , 95 % CI 0.74 - 0.79 , P=0.031 ) and equal to MNS ( 0.0 % ) . This was also observed in the AF subgroup ( 0.0 % vs. 3.3 % ; RR 0.67 , 95 % CI 0.63 - 0.72 , P=0.021 ) , and the occurrence of major complications was lower for CF versus NCF procedures ( 2.1 % vs. 7.8 % , P=0.010 ) . CONCLUSIONS CF-guided catheter ablation is superior to NCF with regard to procedural safety and avoidance of cardiac perforation . This difference is due to a reduction of cardiac perforation and major complications in the AF subgroup A risk score for atrial fibrillation ( AF ) has been developed by the Framingham Heart Study ; however , the applicability of this risk score , derived using data from white patients , to predict new-onset AF in nonwhites is uncertain . Therefore , we developed a 10-year risk score for new-onset AF  from risk factors commonly measured in clinical practice using 14,546 subjects from the Atherosclerosis Risk In Communities ( ARIC ) study , a prospect i ve community-based cohort of blacks and whites in the United States . During 10 years of follow-up , 515 incident AF events occurred . The following variables were included in the AF risk  score  : age , race , height , smoking status , systolic blood pressure , hypertension medication use , precordial murmur , left ventricular hypertrophy , left atrial enlargement , diabetes , coronary heart disease , and heart failure . The area under the receiver operating characteristics curve ( AUC ) of a Cox regression model that included the previous variables was 0.78 , suggesting moderately good discrimination . The point-based score developed from the coefficients in the Cox model had an AUC of 0.76 . This clinical risk score for AF in the Atherosclerosis Risk In Communities cohort compared favorably with the Framingham Heart Study 's AF ( AUC 0.68 ) , coronary heart disease ( CHD ) ( AUC 0.63 ) , and hard CHD ( AUC 0.59 ) risk scores and the Atherosclerosis Risk In Communities CHD risk score ( AUC 0.58 ) . In conclusion , we have developed a risk score for AF and have shown that the different pathophysiologies of AF and CHD limit the usefulness of a CHD risk score in identifying subjects at greater risk of AF BACKGROUND The ideal management of patients with newly diagnosed symptomatic atrial fibrillation ( AF ) remains unknown . Current practice guidelines recommend a trial of antiarrhythmic drugs ( AAD ) prior to considering an invasive ablation procedure . However , earlier ablation offers an opportunity to halt the progressive patho-anatomical changes associated with AF , as well as impart other important clinical benefits . OBJECTIVE The aim of this study is to determine the optimal initial management strategy for patients with newly diagnosed , symptomatic atrial fibrillation . METHODS / DESIGN The EARLY-AF study ( Clinical Trials.govNCT02825979 ) is a prospect i ve , open label , multicenter , r and omized trial with a blinded assessment of outcomes . A total of 298 patients will be r and omized in a 1:1 fashion to first-line AAD therapy , or first-line cryoballoon-based pulmonary vein isolation .  Patients with symptomatic treatment naïve AF will be included . Arrhythmia outcomes will be assessed by implantable cardiac monitor ( ICM ) . The primary outcome is time to first recurrence of AF , atrial flutter , or atrial tachycardia ( AF/AFL/AT ) between days 91 and 365 following AAD initiation or AF ablation . Secondary outcomes include arrhythmia burden , quality of life , and healthcare utilization . DISCUSSION The EARLY-AF study is a r and omized trial design ed to evaluate the optimal first management approach for patients with AF . We hypothesize that catheter ablation will be superior to drug therapy in prevention of AF recurrence OBJECTIVES The aim of this study was to compare -- in patients with persistent and permanent atrial fibrillation (AF)--the  efficacy and safety of left atrial ablation with that of a biatrial approach . BACKGROUND Left atrium-based catheter ablation of AF , although very effective in the paroxysmal form of the arrhythmia , has an insufficient efficacy in patients with persistent and permanent AF . METHODS Eighty highly symptomatic patients ( age , 58.6 + /- 8.9 years ) with persistent ( n = 43 ) and permanent AF ( n = 37 ) , refractory to antiarrhythmic drugs , were r and omized to two different ablation approaches guided by electroanatomical mapping . A procedure including circumferential pulmonary vein , mitral isthmus , and cavotricuspid isthmus ablation was performed in 41 cases ( left atrial ablation group ) . In the remaining 39 patients ( biatrial ablation group ) , the aforementioned approach was integrated by the following lesions in the right atrium : intercaval posterior line , intercaval septal line , and electrical disconnection of the superior vena cava . RESULTS During follow-up ( mean duration 14 + /- 5 months ) , AF recurred in 39 % of patients in the left atrial ablation group and in 15 % of patients in the biatrial ablation group ( p = 0.022 ) . Multivariable Cox regression analysis showed that ablation technique was an independent predictor of AF recurrence during follow-up . CONCLUSIONS In patients with persistent and permanent AF , circumferential pulmonary vein ablation , combined with linear lesions in the right atrium , is feasible , safe , and has a significantly higher success rate than left atrial and cavotricuspid ablation alone Background Atrial fibrillation ( AF ) may arise out of anomalous impulse activity at atrial venous junctions . Triggered activity may be a source of abnormal impulse activity . Ranolazine is an anti-anginal agent , which inhibits normal and abnormal late Na+ channel current in the ventricle and peak Na+ channel current in the atrium . This produces an energy sparing effect and stabilizes cardiac membranes . Ranolazine is a potent inhibitor of triggered activity . The purpose of this report is to describe our initial experience with ranolazine used in patients with resistant AF . Methods Seven patients ( 4 males , 3 females , 67 ± 9 years ) who developed recurrent AF within hours to a few days of restoring sinus rhythm despite AF ablation and /or failing one or more anti-arrhythmic agents  were started on ranolazine ( 500 - 1000 mg/twice/day ) after stopping all other anti-arrhythmic therapy .  All but one patient had some form of associated structural heart disease . Results Two patients received no apparent benefit from ranolazine  developing recurrent AF within 2 days . All other patients derived significant benefit . Four patients have experienced no recurrent AF . The other patient relapsed at 3 months and again at 6 months . The mean time in sinus rhythm to date , or to the first relapse , for the five responders was 27 ± 11 weeks . No clinical ly evident pro-arrhythmic episodes occurred . Conclusion Ranolazine was helpful in maintaining sinus rhythm in the majority of patients in which more established measures had failed . A controlled prospect i ve trial is warranted to further investigate the efficacy of ranolazine in AF AIM To investigate the impact of using computed tomography ( CT ) and contact force ( CF ) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation ( AF ) ablation . METHODS This non-r and omized study included 2 groups of patients . All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication . The first group included 33 patients who underwent circumferential pulmonary veins isolation ( PVI ) for AF during 2012 and 2013 guided by CT image integration ( Cartomerge , Biosense Webster , Diamond Bar , CA , United States ) of left atrium and pulmonary veins into an electroanatomic mapping ( EAM ) system ( CT group ) using st and ard irrigated radiofrequency catheter ( ThermoCool , Carto , Biosense Webster , Diamond Bar , CA , United States ) or irrigated catheter with integrated CF sensor ( Smart Touch , Carto , Biosense Webster , Diamond Bar , CA , United States ) . The second group included immediately preceding 32 patients who had  circumferential PVI by st and ard irrigated catheter ( ThermoCool ) using only EAM ( Carto ) system ( EAM group ) . Linear lesions were performed according to the discretion of operator . RESULTS Sex , age , and persistent AF were not different between groups . PVI was achieved in all patients in both groups . Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups . Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group ( 81 % vs 55 % ; respectively ; P = 0.027 ) . When 11 patients from CT group who had ablation using Smart Touch catheter were excluded , the difference between CT group and EAM became non significant ( 73 % vs 55 % ; respectively ; P = 0.16 ) . Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using st and ard irrigated catheter during follow-up ( 100 % vs 73 % ; respectively ; P = 0.07 ) . Major complications ( pericardial effusion , cerebrovascular accident/transient ischemic attack , vascular access injury requiring intervention ) did not occurred in both groups . CONCLUSION These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF OBJECTIVES We tested the hypothesis that the response to flecainide infusion can identify patients with atrial fibrillation ( AF ) in whom the hybrid pharmacologic and ablation therapy reduces the recurrences of AF . BACKGROUND Infusion of class IC anti-arrhythmic drugs may promote transformation of AF into atrial flutter . Catheter ablation of atrial flutter has been demonstrated to be highly effective in preventing recurrences of atrial flutter . METHODS Seventy-one consecutive patients with paroxysmal or chronic AF , in whom flecainide infusion ( 2 mg/kg body weight , intravenously ) determined the transformation of AF into common atrial flutter ( positive response ) , were r and omized to receive one of the following treatments : oral pharmacologic treatment with flecainide ( group A , n = 23 ) ; the hybrid treatment ( catheter ablation of the inferior vena cava-tricuspid annulus isthmus , plus oral flecainide ) ( group B , n = 24 ) ; or catheter ablation of the isthmus only ( group C , n = 24 ) . Thirty-seven patients with a negative response to flecainide , who chose to be su bmi tted to the hybrid treatment , were selected as the control group ( group D ) . RESULTS During a mean follow-up period of 24 + /- 7.2 months , the recurrences of AF and atrial flutter in group B ( 42 % ) were significantly lower than those in group A ( 78 % , p < 0.001 ) , group C ( 92 % , p < 0.001 ) and group D ( 92 % , p < 0.001 ) . CONCLUSIONS The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus , plus flecainide administration , reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter . Moreover , the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF BACKGROUND Electrical isolation of the pulmonary veins by catheter ablation is an emerging treatment modality for the treatment of atrial fibrillation ( AF ) and is increasingly used in patients with heart failure . METHODS The catheter ablation versus st and ard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation trial ( CASTLE-AF ) is a r and omized evaluation of ablative treatment of atrial fibrillation in patients with left ventricular dysfunction . The primary endpoint is the composite of all-cause mortality or worsening of heart failure requiring unplanned hospitalization using a time to first event analysis . Secondary endpoints are all-cause mortality , cardiovascular mortality , cerebrovascular accidents , worsening of heart failure requiring unplanned hospitalization , unplanned hospitalization due to cardiovascular reason , all-cause hospitalization , quality of life , number of therapies ( shock and antitachycardia pacing ) delivered by the implantable cardioverter-defibrillator ( ICD ) , time to first ICD therapy , number of device-detected ventricular tachycardia and ventricular fibrillation episodes , AF burden , AF free interval , left ventricular function , exercise tolerance , and percentage of right ventricular pacing . CASTLE-AF will r and omize 420 patients for a minimum of 3 years at 48 sites in the United States , Europe , Australia , and South America AIMS To investigate the effectiveness of additional substrate modification ( SM ) by left atrial ( LA ) linear lesions as compared with pulmonary vein isolation ( PVI ) alone in patients with persistent atrial fibrillation ( AF ) in a prospect i ve r and omized study . Percutaneous PVI has evolved as an accepted treatment for paroxysmal AF but seemed to be less effective in patients with persistent AF . The benefit of PVI alone and additional linear lesions has not been vali date d in a r and omized study so far . METHODS AND RESULTS Sixty-two patients with persistent AF ( median duration 7 , range 1 - 18 months ) were r and omly assigned to either PVI alone ( n = 30 ) or additional SM ( n = 32 ) consisting of a roof line connecting both left superior and right superior PV and LA isthmus ablation between left inferior PV and mitral annulus . Procedures including SM were performed using a three-dimensional mapping system ( EnSite NavX , St Jude Medical , St Paul , MN , USA ) . Anti-arrhythmic drugs were discontinued within 8 weeks after ablation in both groups . Follow-up included daily trans-telephonic ECG transmitted irrespective of the patient 's symptoms . PVI was successful in 98 % of all targeted veins in both groups . Additional SM did not increase fluoroscopy time ( 72.1+/-18.7 vs. 72.9+/-17.3 min , P=0.92 ) because of the use of three-dimensional navigation in the PVI+SM group . AF recurrences within the first 4 weeks following ablation were more common after PVI alone ( 77 % ) than additional SM ( 44 % , P=0.002 ) . After a follow-up time of 487 ( 429 - 570 ) days , only 20 % of patients undergoing st and alone PVI  remained in sinus rhythm when compared with 69 % following PVI combined with SM ( P=0.0001 ) . Two patients assigned to PVI+SM experienced procedure-related complications ( cardiac tamponade and minor stroke ) which resolved without sequelae . CONCLUSION PVI alone is insufficient in the treatment of persistent AF . However , additional left linear lesions increase the success rate significantly . Early AF-relapses are associated with a negative outcome after PVI alone but not following additional SM OBJECTIVES This study sought to investigate the efficacy and safety of catheter ablation for atrial fibrillation ( AF ) in patients with heart failure with preserved ejection fraction ( HFPEF ) . BACKGROUND AF is a precipitating factor for clinical deterioration of HFPEF . METHODS Catheter ablation for AF was performed in a consecutive 74 patients with compensated HFPEF ( left ventricular [ LV ] ejection fraction > 50 % ) . AF-free probability after catheter ablation and factors relating to maintenance of sinus rhythm were investigated . LV strain and strain rate were assessed by echocardiography at baseline and over 12 months after ablation . RESULTS During a 34 ± 16-month follow-up period , single- and multiple-procedure drug-free success rates were 27 % ( n = 20 ) and 45 % ( n = 33 ) , respectively . Multiple procedures and pharmaceutically assisted success rate was 73 % ( n = 54 ) . No major complications occurred during follow-up . Multivariate Cox regression analyses revealed that AF type ( other than long-st and ing persistent AF ) and lack of hypertension were independently associated with maintenance of sinus rhythm ( hazard ratio [ HR ] : 1.81 , 95 % confidence interval [ CI ] : 1.03 to 3.17 , p = 0.04 ; HR : 0.49 , 95 % CI : 0.24 to 0.96 , p = 0.04 , respectively ) . LV systolic indices ( LV ejection fraction , LV strain/strain rate at systole ) and diastolic indices ( E/E ' , ratio of LV strain rate at diastole with early transmitral flow ) were improved only in patients maintaining sinus rhythm at follow-up . CONCLUSIONS Our results suggest that AF can be effectively and safely treated with a composite of repeat procedures and pharmaceuticals in patients with HFPEF . However , the current study was a single-arm analysis ; therefore , larger r and omized control studies are needed to verify the benefit of AF ablation in this cohort Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients AIMS The Atrial Fibrillation Ablation Pilot Study is a prospect i ve registry design ed to describe the clinical epidemiology of patients undergoing an atrial fibrillation ( AFib ) ablation  , and the diagnostic/therapeutic processes applied across Europe . The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications . METHODS AND RESULTS Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure .  A web-based case report form captured information on pre-procedural , procedural , and 1-year follow-up data . Between October 2010 and May 2011 , 1410 patients were included and 1391 underwent an AFib ablation ( 98.7 % ) . A total of 1300 patients ( 93.5 % ) completed a follow-up control 367 ± 42 days after the procedure . Arrhythmia documentation was done by an  electrocardiogram  in 76 % ,  Holter-monitoring  in 52 % ,  transtelephonic monitoring in 8 % , and /or implanted systems in 4.5 % . Over 50 % became asymptomatic . Twenty-one per cent were re-admitted due to post-ablation arrhythmias . Success without antiarrhythmic drugs was achieved in 40.7 % of patients ( 43.7 % in paroxysmal AF ; 30.2 % in persistent AF ; 36.7 % in long-lasting persistent AF ) . A second ablation was required in 18 % of the cases and 43.4 % were under antiarrhythmic treatment . Thirty-three patients ( 2.5 % ) suffered an adverse event , 272 ( 21 % ) experienced a left atrial tachycardia , and 4 patients died ( 1 haemorrhagic stroke , 1 ventricular fibrillation in a patient with ischaemic heart disease , 1 cancer , and 1 of unknown cause ) . CONCLUSION The AFib Ablation Pilot Study provided crucial information on the epidemiology , management , and outcomes of catheter ablation of AFib in a real-world setting . The methods used to assess the success of the procedure appeared at least suboptimal . Even in this context , the 12-month success rate appears to be somewhat lower to the one reported clinical trials BACKGROUND The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation ( MANTRA-PAF ) is a r and omized trial comparing radiofrequency catheter ablation ( RFA ) to antiarrhythmic drugs ( AADs ) as first-line treatment of paroxysmal atrial fibrillation ( PAF ) . In order to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data . METHODS AND RESULTS Patients ( n=294 ) were divided into three groups : those receiving only the assigned therapy ( RFA and AAD groups ) and those receiving both therapies ( crossover group ) . The primary end points were AF burden in 7-day Holter recordings at 3 , 6 , 12 , 18 , and 24 months and cumulative AF burden in all recordings . At 24 months , AF burden was significantly lower in the RFA ( n=110 ) than in the AAD ( n=92 ) and the crossover ( n=84 ) groups ( 90th percentile 1 % vs. 10 % vs. 16 % , P=0.007 ) , and more patients were free from any AF ( 89 % vs. 73 % vs. 74 % , P=0.006 ) . In the RFA , AAD and the crossover groups 63 % , 59 % and 21 % ( P<0.001 ) of the patients had no AF episodes in any Holter recording , respectively . Quality of life improved significantly in all groups . There were no differences in serious adverse events between the RFA , AAD and crossover groups ( 19 % vs. 8 % vs. 23 % ) ( P=0.10 ) . CONCLUSIONS In the treatment of antiarrhythmic therapy naïve patients with PAF long-term efficacy of RFA was superior to AAD therapy . Thus , it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s ) OBJECTIVES The purpose of this study was to determine the efficacy and safety of intravenous RSD1235 in terminating  recent onset atrial fibrillation ( AF ) .  BACKGROUND Anti-arrhythmic drugs currently available to terminate AF have limited efficacy and safety . RSD1235 is a novel atrial selective anti-arrhythmic drug . METHODS This was a phase II , multi-centered , r and omized , double-blinded , step-dose , placebo-controlled , parallel group study . Fifty-six patients from 15 U.S. and Canadian sites with AF of 3 to 72 h duration were r and omized to one of two  RSD1235  dose groups or to placebo . The two RSD1235 groups were RSD-1 ( 0.5 mg/kg followed by 1 mg/kg ) or RSD-2 ( 2 mg/kg followed by 3 mg/kg ) , by intravenous infusion over 10 min ; a second dose was given only if AF was present . The primary end point was termination of AF during infusion or within 30-min after the last infusion . Secondary end points included the number of patients in sinus rhythm at 0.5 , 1 , and 24 h post-last infusion and time to conversion to sinus rhythm . RESULTS The RSD-2 dose showed significant differences over placebo in : 1 ) termination of AF ( 61 % vs. 5 % , p < 0.0005 ) ; 2 ) patients in sinus rhythm at 30 min ( 56 % vs. 5 % , p < 0.001 ) ; 3 ) sinus rhythm at 1 h ( 53 % vs. 5 % , p = 0.0014 ) ; and 4 ) median time to conversion to SR ( 14 vs. 162 min , p = 0.016 ) . There were no serious adverse events related to RSD1235 . CONCLUSIONS RSD1235 , a new atrial-selective anti-arrhythmic agent , appears to be efficacious and safe for converting recent onset AF to sinus rhythm Aims This multicentre , r and omized trial compared three strategies of AF ablation : ablation of complex fractionated electrograms ( CFE ) alone , pulmonary vein isolation ( PVI ) alone , and combined PVI + CFE ablation , using st and ardized automated mapping software . Methods and results Patients with drug-refractory , high-burden paroxysmal ( episodes > 6 h , > 4 in 6 months ) or persistent atrial fibrillation ( AF ) were enrolled at eight centres . Patients ( n = 100 ) were r and omized to one of three arms . For CFE alone ( n = 34 ) , spontaneous/induced AF was mapped using vali date d , automated CFE software and all sites < 120 ms were ablated until AF termination/non-inducibility . For PVI ( n = 32 ) , all four PV antra were isolated and confirmed using a circular catheter . For PVI + CFE ( n = 34 ) , all four PV antra were isolated , followed by AF induction and ablation of all CFE sites until AF termination/non-inducibility . Patients were followed at 3 , 6 , and 12 months with a visit , ECG , 48 h Holter . Atrial fibrillation symptoms were confirmed by loop recording . Repeat procedures were allowed within the first 6 months . The primary endpoint was freedom from AF > 30 s at 1 year . Patients ( age 57 ± 10 years , LA size 42 ± 6 mm ) were 35 % persistent AF . In CFE , ablation terminated AF in 68 % . Only 0.4 PVs per patient were isolated as a result of CFE . In PVI , 94 % had all four PVs successfully isolated . In PVI + CFE , 94 % had all four PVs isolated , 76 % had inducible AF with additional CFE ablation , with 73 % termination of AF . There were significantly more repeat procedures in the CFE arm ( 47 % ) vs. PVI ( 31 % ) or PVI + CFE ( 15 % ) ( P = 0.01 ) . After one procedure , PVI + CFE had a significantly higher freedom from AF ( 74 % ) compared with PVI ( 48 % ) and CFE ( 29 % ) ( P = 0.004 ) . After two procedures , PVI + CFE still had the highest success ( 88 % ) compared with PVI ( 68 % ) and CFE ( 38 % ) ( P = 0.001 ) . Ninety-six percent of these patients were off anti-arrhythmics . Complications were two tamponades , no PV stenosis , and no mortality . Conclusion In high-burden paroxysmal/persistent AF , PVI + CFE has the highest freedom from AF vs. PVI or CFE alone after one or two procedures . Complex fractionated electrogram alone has the lowest one and two procedure success rates with a higher incidence of repeat procedures . Clinical Trials.gov identifier number NCT00367757 Background —An anatomic approach of left atrial radiofrequency circumferential ablation ( LACA ) to encircle the pulmonary veins is often effective in eliminating  paroxysmal atrial fibrillation ( AF ) .  However , no electrophysiological end points other than voltage abatement and /or conduction slowing or block across ablation lines have been used . It has been unclear whether noninducibility of AF is a clinical ly useful end point . Methods and Results —In 100 patients with paroxysmal AF ( mean age , 55±10 years ) , LACA to encircle the left- and right-sided pulmonary veins was performed during AF , with additional ablation lines in the posterior left atrium and mitral isthmus , with an 8-mm-tip catheter . After completion of this lesion set , sinus rhythm was present , and AF lasting > 60 seconds was not inducible in 40 patients ( 40 % ; group 1 ) . The 60 patients in whom AF was still present or who still had inducible AF were r and omly assigned to no further ablation ( group 2 ; 30 patients ) or to additional ablation lines along the left atrial septum , roof , and /or anterior wall where there were fractionated electrograms ( group 3 ; 30 patients ) . In group 3 , AF was rendered noninducible in 27 of 30 patients ( 90 % ) . At a 6-month follow-up , 67 % of patients in group 2 were free of AF without drug therapy compared with 86 % of patients in group 3 . ( P=0.05 , log-rank test ) . Left atrial flutter occurred in 17 % and 27 % of patients in each group , respectively ( P=0.3 ) . Conclusions —After LACA in patients with paroxysmal AF , AF usually can be rendered noninducible by additional ablation at sites of fractionated electrograms . Noninducibility of AF attained by additional electrogram-guided left atrial ablation may be associated with a better midterm clinical outcome than when AF is still inducible after LACA alone AIMS The urge to facilitate the atrial fibrillation ( AF ) ablation procedure has led to the development of new ablation catheters specifically design ed as ' one-shot tools ' for pulmonary vein isolation ( PVI ) . The purpose of this study was to compare the efficacy , safety , and procedure times for two such catheters using different energy sources . METHODS AND RESULTS One hundred and ten patients , referred for ablation of paroxysmal or persistent AF , were r and omized to treatment with either the cryoballoon or the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation catheter ( PVAC ) .  Complete PVI was achieved in 98 vs. 93 % patients in the cryoballoon and PVAC group , respectively , with complication rates of 8 vs. 2 % ( P = 0.2 ) . Complete freedom from AF , without antiarrhythmic drugs , after one single ablation procedure was seen in 46 % in the cryoballoon vs. 34 % after 12 months ( P = 0.2 ) . Procedure times were comparable , but fluoroscopy time was shorter for the cryoballoon ( 32 ± 16 min ) than for the PVAC procedures ( 47 ± 17 min ) ( P < 0.001 ) . A significant improvement of quality of life ( QoL ) and arrhythmia-related symptoms was seen in both groups after ablation . CONCLUSION Both catheters proved comparably effective and safe in achieving acute PVI , apart from the shorter fluoroscopy times achieved with the cryoballoon . At follow-up , there was no statistically significant difference between the groups regarding freedom from AF and clinical success . The QoL increased to the same levels as for the general Swedish population in both groups Background and objective Little is known about the outcome of  catheter ablation of  atrial fibrillation ( AF )  in patients with diabetes mellitus ( DM ) . We investigated the safety and efficacy of catheter ablation of AF  in patients with DM . Material s and methods Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure  were enrolled in a prospect i ve study . The ablation protocol ( guided by CARTO system ) consisted in two continuous circular lesions around ipsilateral pulmonary veins . Results The following clinical characteristics differed between DM and no-DM patients : age ( 62.0 ± 10.8 vs. 56.1 ± 10.6 years , P = 0.004 ) , longer AF history ( 9.6 ± 9.3 vs. 6.7 ± 6.3 years , P = 0.024 ) , significantly larger left atrium size ( 41.1 ± 7.8 vs. 38.3 ± 5.8 mm , P = 0.021 ) , hypertension ( 58.1 vs. 35.8 % , P = 0.018 ) and structural heart disease ( 67.7 vs. 43.5 % , P = 0.011 ) . Despite a similar AF recurrence rate in DM and no-DM patients ( 32.3 vs. 22.4 % , P = 0.240 ) , the ablation procedure was complicated in 28 patients ( 11 hematomas , three cardiac tamponades and three strokes ) and the incidence of complications was significantly higher in DM than in no-DM patients ( 29.0 vs. 8.2 % , respectively , P = 0.002 ) . Multivariate analysis showed that DM was an independent risk factor for complications occurrence ( odd ratio 5.936 , 95 % confidence interval 2.059 to 17.112 , P = 0.001 ) . Conclusions First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients . However , DM patients had a higher incidence of complications , mostly thrombotic or hemorrhagic BACKGROUND Hypertension is the most important risk factor directly attributable to the high prevalence of atrial fibrillation ( AF ) , and is one of the few modifiable risk factors for AF . Activation and overactivity of the sympathetic nervous system ( SNS ) have been implicated in the pathogenesis of both essential hypertension and AF . Catheter-based renal sympathetic denervation ( RSDN ) appears to be an effective adjunctive treatment for refractory hypertension , and may be beneficial in other conditions characterized by SNS overactivity , such as left ventricular hypertrophy and atrial arrhythmias . OBJECTIVE The H-FIB study is a multicenter prospect i ve , double-blind , r and omized ( 1:1 ) controlled trial . The primary efficacy endpoint is antiarrhythmic drug-free freedom from AF recurrence through 12 months . METHODS Patients with a history of significant hypertension who are receiving treatment with at least one antihypertensive agent who are planned for a first time ablation for symptomatic paroxysmal or persistent AF will be r and omized to either AF ablation alone ( control group ) or AF ablation + RSDN ( study group ) . CONCLUSIONS H-FIB is a multicenter , r and omized trial that will test the hypothesis that adjunctive renal sympathetic denervation , at the time of AF ablation , will increase the freedom from recurrent AF Introduction Atrial fibrillation ( AF ) is commonly found in patients with structural heart disease ( SHD ) , including atrial septal defect ( ASD ) . The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported . Objectives This study aims to evaluate and compare the long-term efficacy of  AF ablation  in patients with and without ASD . Methods From January 2008 to December 2012 , 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation .  For each ASD patient , four control subjects were matched from our data base . Results There were no significant differences between groups in terms of age , sex , type of AF , LA diameter , LVIDD , and EF . The mean procedural and fluoroscopy times were not different between the groups ( p = NS ) . After a median follow-up of 20 months , the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group ( p = 0.11 ) . The mean LA diameter in non-recurrent patients was smaller than in recurrent patients ( p = 0.03 ) . In univariate Cox proportional hazards analyses , the factor found to have a significant association with arrhythmia recurrences was left atrial diameter ( hazard ratio 1.059 , 95 % confidence interval 1.002 to 1.120 , p = 0.03 ) . Conclusions These results indicate that in patients with AF and an ASD amenable to percutaneous closure , a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy OBJECTIVES It is uncertain whether gender affects the outcomes of catheter ablation ( CA ) for atrial fibrillation ( AF ) . The objective of the study is to evaluate the efficacy and safety of CA for long-st and ing persistent AF in women . METHODS Between January 2010 and May 2011 , 220 consecutive patients ( 73 females , 33.2 % ) , with long-st and ing persistent AF who underwent CA were prospect ively recruited . Gender-related differences in clinical presentation , periprocedural complications , and outcomes were compared . RESULTS Women were less likely to have lone AF than men ( 27.4 % vs 47.6 % ; P = 0.004 ) . The incidence of rheumatic heart disease was higher in women ( 19.2 % in women vs 1.4 % in men ; P < 0.001 ) . Women had a lower initial ablation success rate than men ( 35.6 % vs 57.1 % ; P = 0.003 ) . Hematomas occurred more often in women ( 6.8 % in women vs 0.7 % in men ; P = 0.027 ) . A Cox regression analysis demonstrated total duration of AF ( per month , hazard ratio [ HR ] 1.003 , confidence interval [ CI ] 1.001 - 1.006 ; P = 0.006 ) and gender ( HR 1.663 , CI 1.114 - 2.485 ; P = 0.013 ) as the independent predictors for recurrence after the first CA . CONCLUSIONS Women and long AF duration were closely related to the recurrence of AF after the first ablation in patients with long-st and ing persistent AF . Women also had a higher risk of vascular complications
The complexity of CHD appears to have a significant effect on a study but not in others .
Catheter ablation in ASD and persistent left superior vena cava had a high success rate .
Overall , catheter ablation is safe whichever the type of CHD is .
Conclusion Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile .
Abstract Background Prevalence of atrial fibrillation ( AF ) in patients with congenital heart disease ( CHD ) is on the rise .
Anti-arrhythmic drugs are usually the first line of treatment in CHD , however , it is often ineffective and poorly tolerated .
We aim ed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD .