560 results match your criteria Cardiac electrophysiology clinics[Journal]


Advances in Atrial Fibrillation Ablation.

Card Electrophysiol Clin 2020 Jun 13;12(2):xv. Epub 2020 Apr 13.

Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2020.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152907PMC

Advances in Atrial Fibrillation Ablation.

Authors:
Ranjan K Thakur

Card Electrophysiol Clin 2020 Jun;12(2):xiii

Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2020.04.001DOI Listing

Discontinuing Anticoagulation After Catheter Ablation of Atrial Fibrillation.

Card Electrophysiol Clin 2020 Jun;12(2):259-264

Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA. Electronic address:

Atrial fibrillation is a leading cause of ischemic stroke. Stroke risk can be reduced with oral anticoagulation. Current guidelines recommend that decisions regarding anticoagulation after ablation be based solely on preprocedural risk. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.007DOI Listing

Current Status of Esophageal Protection.

Card Electrophysiol Clin 2020 Jun;12(2):247-257

Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Suite 1030, New York, NY 10029, USA. Electronic address:

Catheter ablation of atrial fibrillation necessitates ablation on the posterior left atrium. The anterior esophagus touches the posterior left atrium, although its course is highly variable. The proximity of the left atrium to the esophagus confers risk of injury with radiofrequency and cryoablation owing to the heat transfer that occurs with thermal ablation. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.03.001DOI Listing

Fluoroless Atrial Fibrillation Catheter Ablation: Technique and Clinical Outcomes.

Card Electrophysiol Clin 2020 Jun;12(2):233-245

Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA. Electronic address:

Fluoroscopy continues to be considered an indispensable part of atrial fibrillation (AF) ablation worldwide. Deleterious effects of radiation exposure to patients, physicians, and catheter laboratory personnel are gaining increased consideration. Safety and efficacy of a fluoroless approach for AF ablation is comparable with outcomes achieved with fluoroscopy use. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.01.001DOI Listing

Beyond Pulmonary Vein Isolation in Nonparoxysmal Atrial Fibrillation: Posterior Wall, Vein of Marshall, Coronary Sinus, Superior Vena Cava, and Left Atrial Appendage.

Card Electrophysiol Clin 2020 Jun;12(2):219-231

Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA. Electronic address:

The optimal ablation strategy for non-paroxysmal atrial fibrillation remains controversial. Non-PV triggers have been shown to have a major arrhythmogenic role in these patients. Common sources of non-PV triggers are: posterior wall, left atrial appendage, superior vena cava, coronary sinus, vein of Marshall, interatrial septum, crista terminalis/Eustachian ridge, and mitral and tricuspid valve annuli. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.01.002DOI Listing

Recurrent Atrial Fibrillation with Isolated Pulmonary Veins: What to Do.

Card Electrophysiol Clin 2020 Jun;12(2):209-217

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; HCA National Medical Director of Cardiac Electrophysiology, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.001DOI Listing

Recurrent Atrial Fibrillation After Cryoballoon Ablation: What to Expect!

Card Electrophysiol Clin 2020 Jun;12(2):199-208

Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.

Atrial fibrillation (AF) recurrence following cryoballoon ablation may occur as a consequence of pulmonary vein (PV) reconnection, which can be treated effectively by performing repeat PV isolation. Alternatively, AF recurrence can manifest in presence of bilateral antral PV isolation. In such circumstances, one may pursue catheter ablation of AF triggers, if present, or proceed with empiric posterior left atrial wall ablation. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.002DOI Listing

Recurrent Atrial Fibrillation After Radiofrequency Ablation: What to Expect.

Card Electrophysiol Clin 2020 Jun;12(2):187-197

Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9.129 Founders Pavilion, 3400 Spruce Street, Philadelphia PA 19104, USA. Electronic address:

Recurrent atrial fibrillation after radiofrequency ablation is observed in up to 50% of patients within 3 months. Early and multiple recurrences predict late recurrences within 1 year, which occurs in 20% to 50% of patients. Although no consensus exists regarding patient selection and timing of redo ablation, we refer symptomatic patients with multiple recurrences and persistent atrial fibrillation for ablation. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.003DOI Listing

Balloon-Based Ablation Technologies.

Card Electrophysiol Clin 2020 Jun;12(2):175-185

Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029, USA. Electronic address:

Pulmonary vein isolation (PVI) is widely accepted as the mainstay of interventional treatment of atrial fibrillation. Ablation with radiofrequency (RF) point-by-point catheters is highly operator dependent and may fail because of ineffective lesions or gaps. Several balloon-based catheter ablation technologies have emerged as an alternative to effect PVI. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.008DOI Listing

Advances in Atrial Fibrillation Ablation: Energy Sources Here to Stay.

Card Electrophysiol Clin 2020 Jun;12(2):167-174

Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:

Energy sources used for catheter ablation of atrial fibrillation (AF) ablation have undergone an exceptional journey over the past 50 years. Traditional energy sources, such as radiofrequency and cryoablation, have been the mainstay of AF ablation. Novel investigations have led to inclusion of other techniques, such as laser, high-frequency ultrasound, and microwave energy, in the armamentarium of electrophysiologists. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.005DOI Listing

How, When, and Why: High-Density Mapping of Atrial Fibrillation.

Card Electrophysiol Clin 2020 Jun;12(2):155-165

Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA. Electronic address:

High-density (HD) mapping presents opportunities to enhance delineation of atrial fibrillation (AF) substrate, improve efficiency of the mapping procedure without sacrificing safety, and afford new mechanistic insights regarding AF. Innovations in hardware, software algorithms, and development of novel multielectrode catheters have allowed HD mapping to be feasible and reliable. Patients to particularly benefit from this technology are those with paroxysmal AF in setting of preexisting atrial scar, persistent AF, and AF in the setting of complex congenital heart disease. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.004DOI Listing

Risk Factor Management Before and After Atrial Fibrillation Ablation.

Card Electrophysiol Clin 2020 Jun;12(2):141-154

Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia. Electronic address:

Atrial fibrillation (AF) is increasingly recognized as the cardiac electrophysiologic manifestation of a multifactorial systemic disease. Several risk factors for development of AF have been identified; many are modifiable. There is evidence to suggest that aggressive management of modifiable risk factors has potential to significantly reduce the burden of AF, before and after AF ablation. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.009DOI Listing

Utility of Cardiac MRI in Atrial Fibrillation Management.

Card Electrophysiol Clin 2020 Jun;12(2):131-139

Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA. Electronic address:

Advances in cardiac magnetic resonance (CMR) techniques and image acquisition have made it an excellent tool in the assessment of atrial myopathy. Remolding of the left atrium is the mainstay of atrial fibrillation (AF) development and its progression. CMR can detect phasic atrial volumes, atrial function, and atrial fibrosis using cine, and contrast-enhanced or non-contrast-enhanced images. Read More

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http://dx.doi.org/10.1016/j.ccep.2020.02.006DOI Listing

Left Atrial Appendage: What Do We Know? What Do We Need? Where Are We Going?

Card Electrophysiol Clin 2020 Mar;12(1):xv

David Geffen School of Medicine at UCLA, Structural Heart Disease Interventions & Research, Los Robles Regional Medical Center, 227 W Janss Road, Suite 360 Thousand Oaks, CA 91360, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.12.001DOI Listing

Left Atrial Appendage Occlusion.

Card Electrophysiol Clin 2020 Mar;12(1):xiii

Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.12.002DOI Listing

Epicardial versus Endocardial Closure: Is One Better than the Other?

Card Electrophysiol Clin 2020 Mar;12(1):97-108

The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA. Electronic address:

Left atrial appendage occlusion is an evolving technology with demonstrable benefits of stroke prophylaxis in patients with atrial fibrillation unsuitable for anticoagulation. This has resulted in the development of a plethora of transcatheter devices to achieve epicardial exclusion and endocardial occlusion. In this review, the authors summarize the differences in technique, target patient population, outcomes, and complication profiles of endocardial and epicardial techniques. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.011DOI Listing

Clinical Implications and Management Strategies for Left Atrial Appendage Leaks.

Card Electrophysiol Clin 2020 Mar;12(1):89-96

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA.

Left atrial appendage (LAA) is the dominant source of systemic thromboembolic (TE) events in patients with nonvalvular atrial fibrillation (AF). In patients with significant bleeding risk, various LAA exclusion strategies have been developed as an alternative to pharmacologic TE prophylaxis. Nevertheless, in a relatively small percentage of patients, incomplete LAA closure can be documented, either at the time of procedure or during follow-up. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.010DOI Listing

Postprocedural Management: Anticoagulation and Beyond.

Card Electrophysiol Clin 2020 Mar 25;12(1):77-88. Epub 2019 Dec 25.

Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands; Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

Excluding the left atrial appendage in patients with nonvalvular atrial fibrillation is a mechanical way to decrease stroke risk. During endothelialization, the closure device is exposed to circulating blood, which might activate the coagulation cascade. In excessive proportions, possibly resulting in the development of device-related thrombus, requiring a bridging period with optimal antithrombotic treatment. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.10.002DOI Listing

Left Atrial Appendage Closure: Prevention and Management of Periprocedural and Postprocedural Complications.

Card Electrophysiol Clin 2020 Mar 25;12(1):67-75. Epub 2019 Dec 25.

Department of Cardiology, Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark. Electronic address:

Left atrial appendage closure (LAAC) is noninferior to oral vitamin K antagonist therapy for the reduction of nonvalvular atrial fibrillation-related stroke risk. Currently, the procedure is most widely accepted in patients who cannot tolerate oral anticoagulants. This patient population is generally comorbid, making any reduction in procedural complications paramount. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.10.003DOI Listing

Periprocedural Imaging for Left Atrial Appendage Closure: Computed Tomography, Transesophageal Echocardiography, and Intracardiac Echocardiography.

Card Electrophysiol Clin 2020 Mar;12(1):55-65

Interventional Cardiology, Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, British Columbia V5Z1M9, Canada. Electronic address:

Percutaneous left atrial appendage closure is increasingly performed for stroke prevention for patients with nonvalvular atrial fibrillation with contraindications to oral anticoagulation. The success and complication rates with left atrial appendage closure have dramatically improved with maturing experience, growing procedural familiarity, and preprocedural planning. Multimodality imaging involving cardiac computer tomography angiography, transesophageal echocardiography, or intracardiac echocardiography in conjunction with fluoroscopy has improved the efficacy, procedural success, and safety of left atrial appendage closure in recent years. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.007DOI Listing

Left Atrial Appendage Closure: Technical Considerations of Endocardial Closure.

Card Electrophysiol Clin 2020 Mar;12(1):47-54

OhioHealth Riverside Methodist Hospital, 3705 Olentangy River Road Suite 100, Columbus, OH 43214, USA.

Left atrial appendage closure (LAAC) is a safe and effective therapy for the prevention of stroke in patients with nonvalvular atrial fibrillation and high bleeding risk with oral anticoagulants. Multimodality imaging with transesophageal echocardiography and computed tomography angiography to define the anatomy and its implications on endocardial exclusion is becoming increasingly important. The only LAAC device currently approved for clinical use in the United States is the WATCHMAN device. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.002DOI Listing

Anatomic Considerations for Epicardial and Endocardial Left Atrial Appendage Closure.

Card Electrophysiol Clin 2020 Mar 25;12(1):39-45. Epub 2019 Dec 25.

Department of Electrophysiology, University of California San Francisco, 500 Parnassus Ave., MU-East Fourth Floor, San Francisco, CA 94143, USA. Electronic address:

Left atrial appendage closure is an increasingly used means of achieving thromboprophylaxis in atrial fibrillation, particularly in patients with contraindications to anticoagulation. Left atrial appendage anatomy is highly variable, and preprocedural imaging is critical to choosing the correct device and approach for left atrial appendage closure. This article reviews the common endocardial and epicardial closure systems, including anatomic considerations, advantages and disadvantages, as well as complications to be avoided. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.001DOI Listing

When to Refer Patients for Left Atrial Appendage Closure.

Card Electrophysiol Clin 2020 Mar 25;12(1):29-37. Epub 2019 Dec 25.

Internal Medicine Residency Program, Vanderbilt University Medical Center, 1211 21st Avenue South, Nashville, TN 37232-8802, USA.

Referring patients with nonvalvular atrial fibrillation (NVAF) for left atrial appendage closure (LAAC) device should be based on bleeding risks, poor anticoagulation compliance, and patient goals. Patient selection should consider overall prognosis and risk of implant procedure. We detail specific clinical scenarios where LAAC could be considered, based on FDA-approved indications. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.005DOI Listing

Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond.

Card Electrophysiol Clin 2020 Mar;12(1):21-28

The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA. Electronic address:

The left atrial appendage (LAA) affects body homeostasis via atrial natriuretic peptide and the renin-angiotensin-aldosterone system and plays an important role in atrial compliance. Approximately 90% of clots in nonvalvular atrial fibrillation (AF) are formed in the LAA. AF is the most common sustained cardiac arrhythmia and is frequently associated with stroke. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.004DOI Listing

Thromboembolism in Atrial Fibrillation: Role of the Left Atrial Appendage.

Card Electrophysiol Clin 2020 Mar 25;12(1):13-20. Epub 2019 Dec 25.

Cardiology, Baylor College of Medicine, 6624 Fannin Street Suite 2480, Houston, TX 77030, USA; Cardiology, Texas Heart Institute, Houston, TX, USA. Electronic address:

Atrial fibrillation (AF) is the most common arrhythmia. Patients with AF have a higher risk for thromboembolism than individuals without AF. The left atrial appendage (LAA) is the main source of thromboembolism because of its anatomic, mechanical, and electrophysiologic properties, and accounts for more than 90% of thrombus formation in patients with AF. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.003DOI Listing

What Does the Future Hold?: Ideal Device, Newer Devices, and More.

Card Electrophysiol Clin 2020 Mar;12(1):125-130

Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Strasse 4, Frankfurt/Main 60431, Germany.

Please verify if "pigtail guided" should be "pigtail catheter-guided": Recent design changes for left atrial appendage (LAA) closure devices have led to significant improvement by facilitating the procedural workflow (no need for pigtail guided LAA intubation), moving the workspace from distal LAA to the landing zone (closed distal end design), and improving device stability (different anchor design). The availability of different device types (plug vs disc-lobe design) offers an option to tailor a device type to a patient's anatomy; thereby, sealing results have improved substantially. The issue of device-related thrombus has not been resolved and deserves future research, with the goal of eliminating postprocedural antithrombotic medication without increasing risk for stroke. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.008DOI Listing

Left Atrial Appendage Occlusion for Patients with Transcatheter Aortic Valve Replacement, MitraClip, Percutaneous Coronary Intervention, and Ablation for Atrial Fibrillation: Optimizing Long-Term Patient Outcomes.

Card Electrophysiol Clin 2020 Mar;12(1):117-124

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.

Interventional cardiologists and electrophysiologists perform various procedures to improve the quality and longevity of life. The mitigation of stroke risk in patients with atrial fibrillation may be ignored when considering other more acute or urgent situations, such as severe coronary or valvular heart disease requiring treatment or symptomatic atrial fibrillation necessitating ablation. However, we must keep this long-term stroke risk in mind to optimize patients' overall outcomes. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.006DOI Listing

Current State of Surgical Left Atrial Appendage Exclusion: How and When.

Authors:
James R Edgerton

Card Electrophysiol Clin 2020 Mar 25;12(1):109-115. Epub 2019 Dec 25.

Department of Epidemiology, Baylor Scott and White Health, PO Box 190667, Dallas, TX 75219, USA. Electronic address:

Left atrial appendage exclusion is efficacious for stroke prophylaxis in patients with atrial fibrillation. Surgical excision provides reliable left atrial appendage exclusion, whereas surgical occlusion does not. Specifically, 2-layer internal suture ligation has a high failure rate. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.10.001DOI Listing

The History of the Left Atrial Appendage Occlusion.

Card Electrophysiol Clin 2020 Mar;12(1):1-11

Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.

Atrial fibrillation (AF) has been a source of fascination for more than 100 years. Most early investigations centered on the mechanisms of the arrhythmia (reentry versus automaticity; site of origin; approaches to treatment or prevention; and the clinical consequences), specifically tachycardia-induced cardiomyopathy and the potential for lethal events in special circumstances (eg, preexcitation syndromes). The current increased interest in AF has been heightened by increasing information on the clinical volume and number of patients affected. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.11.009DOI Listing

Advances in Cardiac Mapping Part 2.

Card Electrophysiol Clin 2019 12 4;11(4):xv. Epub 2019 Oct 4.

Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.09.001DOI Listing
December 2019

Mapping the Heart.

Card Electrophysiol Clin 2019 12 3;11(4):xiii. Epub 2019 Oct 3.

Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.09.002DOI Listing
December 2019

The Ideal Cardiac Mapping System.

Card Electrophysiol Clin 2019 12;11(4):739-748

Texas Cardiac Arrhythmia Institute, 3000 North IH35, Suite 700, Austin, TX 78705, USA.

Cardiac mapping has witnessed significant and unprecedented progress over more than a century. At present, several mapping/imaging technologies are commercially available, alone or in combination. This article briefly discusses the advantages and limitations (disadvantages) of each technique. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.015DOI Listing
December 2019

Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation.

Card Electrophysiol Clin 2019 12;11(4):731-738

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA; Interventional Electrophysiology, Scripps Clinic, 9898 Genesee Avenue, La Jolla, CA 92037, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Division of Cardiology, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA.

Atrial fibrillation catheter ablation has emerged as the most effective strategy to restore and maintain sinus rhythm. The cornerstone of atrial fibrillation ablation is elimination of triggers from the pulmonary veins by pulmonary vein isolation. Nevertheless, some patients may experience atrial tachyarrhythmia recurrences even with permanent pulmonary vein antral isolation. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.014DOI Listing
December 2019

Fluoroless Catheter Ablation of Cardiac Arrhythmias.

Card Electrophysiol Clin 2019 12;11(4):719-729

Amita Health-Elign Campus, 1975 Lin Lor Lane, Suite 155, Elgin, IL 60123, USA. Electronic address:

Fluoroless catheter ablation of all endocardial cardiac arrhythmias is feasible using current, and often standard, electrophysiology laboratory equipment. This article lays out a road map for performing fluoroless ablations, safely and efficaciously. We outline optimizing intracardiac echocardiography, performing complex ablations with radiofrequency and cryoballoon technology. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.013DOI Listing
December 2019

Challenges in Ablation of Complex Congenital Heart Disease.

Card Electrophysiol Clin 2019 12;11(4):711-718

Washington University School of Medicine, One Children's Place, Campus Box 8116, Saint Louis, MO 63110, USA. Electronic address:

The field of congenital cardiac electrophysiology is growing rapidly due to the rapid growth in the population of survivors of childhood critical congenital heart disease surgery. Chronic arrhythmias pose one of the biggest challenges in this patient population, and catheter ablation, despite its challenges, is still the most desirable and acceptable approach when successful. Clinicians who propose catheter ablation in such patients need to understand the congenital anatomy, should carefully review the details of all prior cardiac surgery, and should be prepared to deal with the various challenges posed by lack of normal cardiac access and the possibility of poor hemodynamics. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.002DOI Listing
December 2019

The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights.

Card Electrophysiol Clin 2019 12;11(4):699-709

IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France.

Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.011DOI Listing
December 2019

Mapping and Ablation of Ventricle Arrhythmia in Patients with Left Ventricular Assist Devices.

Card Electrophysiol Clin 2019 12 3;11(4):689-697. Epub 2019 Oct 3.

Indiana University, Indianapolis, IN, USA. Electronic address:

Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients to transplantation or as destination therapy. In this article, we focus on etiology, mechanisms, periprocedural management, and mapping and ablation techniques in patients with LVADs and VA. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.07.001DOI Listing
December 2019

Mapping and Ablation of Unmappable Ventricular Tachycardia, Ventricular Tachycardia Storm, and Those in Acute Myocardial Infarction.

Card Electrophysiol Clin 2019 12;11(4):675-688

Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague 14021, Czech Republic.

In stable ventricular tachycardia (VT), activation mapping and entrainment mapping are the most important strategies to describe the reentrant circuit and its critical components. In many patients, however, VT is noninducible or hemodynamically unstable and unmappable. Several technological advances have broadened ablation options in unmappable VTs. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.006DOI Listing
December 2019

Mapping and Ablation of Arrhythmias from Uncommon Sites (Aortic Cusp, Pulmonary Artery, and Left Ventricular Summit).

Card Electrophysiol Clin 2019 12;11(4):665-674

Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA. Electronic address:

Despite advances in our understanding of the relevant anatomy and mapping and catheter ablation techniques of idiopathic outflow tract ventricular arrhythmias, challenging sites for catheter ablation remain the aortic cusps, pulmonary artery, and notably the left ventricular summit. A systematic approach should be used to direct mapping efforts efficiently between endocardial, coronary venous, and epicardial sites. Foci at the left ventricular summit, particularly intraseptal and at the inaccessible epicardial region, remain difficult to reach and when percutaneous techniques fail, surgical ablation remains an option but with risk of late coronary artery stenosis. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.012DOI Listing
December 2019
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Substrate Mapping in Ventricular Arrhythmias.

Authors:
Roderick Tung

Card Electrophysiol Clin 2019 12;11(4):657-663

Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 6080, Chicago, IL 60637, USA. Electronic address:

Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic ablation. Electroanatomic mapping is the cornerstone of substrate-based strategies; ablation can be directed within a delineated scar region defined by low voltage. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.009DOI Listing
December 2019

Mapping and Ablation of Ventricular Arrhythmias in Cardiomyopathies.

Card Electrophysiol Clin 2019 12;11(4):635-655

Department of Cardiology, Huashan Hospital Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China.

Mapping and ablation of ventricular arrhythmias in patients with nonischemic cardiomyopathies remain a major challenge. The electroanatomic abnormalities are frequently inaccessible to conventional endocardial ablations. Diagnostic diligence with a thorough understanding of the potential mechanisms/substrate, coupled with detailed electroanatomic mapping, is essential. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.005DOI Listing
December 2019

Ablation of Neuroaxial in Patients with Ventricular Tachycardia.

Card Electrophysiol Clin 2019 12;11(4):625-634

Department of Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address:

Ventricular tachycardia (VT) remains a common cause of sudden cardiac death. It is widely accepted that VTs are strongly associated with autonomic imbalance with reduced vagal and increased sympathetic activities. Pharmacologic therapy remains the first-line therapy, but antiarrhythmic agents may not be effective or carry significant side effects. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.001DOI Listing
December 2019

Mapping and Ablation of Fascicular Tachycardias (Reentrant and Nonreentrant).

Card Electrophysiol Clin 2019 12;11(4):609-623

Heart and Rhythm Medical Group, 105 North Bascom Avenue, Suite 204, San Jose, CA 95128, USA.

Fascicular ventricular tachycardia (FVT) usually involves the left fascicular system; namely the left posterior fascicle, anterior fascicle, and rarely the upper septal fascicle. It may also involve the right Purkinje arborization. This tachycardia can be seen in normal heart or in the setting of structural heart diseases. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.004DOI Listing
December 2019

Mapping and Ablation of Ventricular Outflow Tract Arrhythmias.

Card Electrophysiol Clin 2019 12;11(4):597-607

Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK.

Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.003DOI Listing
December 2019

Mapping and Ablation of Rotational and Focal Drivers in Atrial Fibrillation.

Card Electrophysiol Clin 2019 12;11(4):583-595

Department of Medicine/Cardiovascular Medicine and Cardiovascular Institute, Stanford University, 780 Welch Road, Suite CJ250F, MC 5773, Stanford, CA 94305, USA. Electronic address:

Drivers are increasingly studied ablation targets for atrial fibrillation (AF). However, results from ablation remain controversial. First, outcomes vary between centers and patients. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954051PMC
December 2019

Postablation Atrial Arrhythmias.

Authors:
Suraj Kapa

Card Electrophysiol Clin 2019 12;11(4):573-582

Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:

Atrial arrhythmias, including atrial tachycardia and atrial flutter, are not uncommon after prior ablation. Mechanisms for arrhythmogenesis may vary and include recurrent conduction through sites of ablation, leading to recurrence of prior ablated arrhythmias and creation of new substrate. Incidence of postablation atrial arrhythmias varies across studies and may relate to the approach to ablation, including extent of ablation performed, or to extent of substrate identified at the time of prior ablation and how that relates to the lesion set. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.008DOI Listing
December 2019

New Findings in Atrial Fibrillation Mechanisms.

Card Electrophysiol Clin 2019 12;11(4):563-571

Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia 5000, Australia. Electronic address:

This review focusses on novel findings in atrial fibrillation mechanisms derived from mapping studies. Recent panoramic mapping techniques have identified 2 arrhythmic mechanisms of interest, namely, rotational (rotors) and ectopic focal activations as drivers of atrial fibrillation. Epicardial adipose tissue and fatty infiltration into the myocardium have been described as novel substrates for atrial fibrillation. Read More

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http://dx.doi.org/10.1016/j.ccep.2019.08.007DOI Listing
December 2019

Advances in Cardiac Mapping: Part 1.

Card Electrophysiol Clin 2019 09 9;11(3):xvii. Epub 2019 Jul 9.

Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.06.003DOI Listing
September 2019
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Mapping the Heart.

Card Electrophysiol Clin 2019 09 9;11(3):xv. Epub 2019 Jul 9.

Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccep.2019.06.004DOI Listing
September 2019
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