Publications
165 results found
Khan H, Haldar S, Boyalla V, et al., 2019, Left atrial reverse remodelling is not associated with improved success in treatment of long standing persistent atrial fibrillation, Publisher: OXFORD UNIV PRESS, Pages: 250-250, ISSN: 2047-2404
Shi R, Parikh P, Chen Z, et al., 2019, DIPOLE DENSITY MAPPING OF ATRIAL FIBRILLATION AND SINUS RHYTHM IN THE HUMAN LEFT ATRIUM: A CLINICAL VALIDATION STUDY, 68th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 326-326, ISSN: 0735-1097
Shi R, Chen Z, Kontogeorgis A, et al., 2019, EPICARDIAL VENTRICULAR TACHYCARDIA ABLATION GUIDED BY A NOVEL HIGH-RESOLUTION CONTACT MAPPING SYSTEM: A MULTICENTRE STUDY, 68th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 325-325, ISSN: 0735-1097
Mantziari L, Butcher C, Shi R, et al., 2019, Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: Impact on clinical outcomes, Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, Vol: 8, ISSN: 2047-9980
BackgroundAtrial tachycardia (AT) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra‐high‐density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes.Methods and ResultsA total of 50 ATs were mapped with ultra‐high‐density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 ATs induced (n=11 procedures). AT mechanism per procedure was macro re‐entry (n=10) and localized re‐entry (n=2) in group A and multiple focal (n=6) or multiple macro re‐entry (n=5) in group B. Procedure duration, low voltage area (0.05–0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147–180] versus 412 [352–420] minutes, P<0.001, 22.6 [12.2–29.8] versus 54.2 [51.1–61.6] cm2, P=0.014 and 0.17 [0.12–0.21] versus 0.26 [0.23–0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8–12.7 versus 4.9, CI 2.2–7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007).ConclusionsLarger low voltage area but not dense scar is associated with the induction of multiple focal or re‐entry ATs, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
Jarman JWE, Hussain W, Wong T, et al., 2018, Resource use and clinical outcomes in patients with atrial fibrillation with ablation versus antiarrhythmic drug treatment, BMC Cardiovascular Disorders, Vol: 18, ISSN: 1471-2261
BackgroundThe objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment.MethodsA retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England (2008–2013) was used. Patients undergoing catheter ablation treatment for AF were indexed to the date of first procedure. AAD patients with at least two different AAD drugs were indexed to the first fill of the second AAD. Patients were matched using 1:1 propensity matching. Primary endpoints including inpatient and outpatient visits were compared between ablation and AAD cohorts in the 4 months-1 year period after index. Secondary endpoints including heart failure, stroke, cardioversion, mortality, and a composite outcome were compared for the 4 months-3 years post-index period in the two groups. Cox-proportional hazards models were estimated for clinical outcomes comparison.ResultsA total of 558 patients were matched in the two groups for resource utilization comparison. The average number of cardiovascular (CV)-related outpatient visits in the 4–12 months post-index period were significantly lower in the ablation group versus the AAD group (1.76 vs 3.57, p < .0001). There was no significant difference in all-cause and CV-related inpatient visits and all-cause outpatient visits among the two groups. For secondary endpoints comparison, 615 matched patients in each group emerged. Ablation patients had 38% lower risk of heart failure (hazard ratio [HR] 0.62, p = 0.0318), 50% lower risk of mortality (HR 0.50, p = 0.0082), and 43% lower risk of experiencing a composite outcome (HR 0.57, p = 0.0009) as compared to AAD treatment cohort.ConclusionAF ablation was associated with significantly lower CV-related outpatient visits, and lower risk of heart failure and mortality v
Shi R, Chen Z, Kontogeorgis A, et al., 2018, Epicardial ventricular tachycardia ablation guided by a novel high-resolution contact mapping system: a multicenter study, Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, Vol: 7, ISSN: 2047-9980
Background Mapping using a multipolar catheter with small and closely spaced electrodes has been shown to improve the validity of electrograms to identify endocardial critical sites of reentry isthmus and foci of earliest activation. However, the feasibility, safety, and clinical outcome of using such technology to guide epicardial ventricular tachycardia (VT) ablation has not been reported. Methods and Results Thirty-three consecutive patients from 5 high-volume centers were studied. These patients had 43 epicardial maps using a novel 64-pole mini-basket catheter to guide VT ablation. Activation maps with 17 832 points per map (interquartile range: 7621-32 497 points per map) were acquired in 11 patients with tolerated VT (7 focal, 4 reentry). Substrate maps with 40149 points per map (interquartile range: 20926-49391 points per map) were acquired in 30 patients. Local abnormal ventricular activities were consistently demonstrated at the substrate regions of interest. Epicardial ablation was performed in 31 of 33 patients, with acute VT termination in 10 of 11 patients (91%). Complete elimination of local abnormal ventricular activities was achieved in 25 of 31 patients. At a median follow-up of 10 months (interquartile range: 4-14 months), 64% (7/11) of patients who had acute termination of VT and 55% (11/20) of those who had substrate modification alone were free of VT. There was no immediate complication following epicardial procedure. Conclusions Epicardial VT ablation guided by a mini-basket catheter is feasible and safe. Complete reentry VT circuits and foci of earliest activation were identified in all inducible stable VT. The longer term clinical outcome of ablation guided by this novel mapping technology utilizing small and closely spaced electrodes will have to be determined with a larger study.
Wong C, Zakeri R, Khan H, et al., 2018, Long-Term Outcomes Following Catheter Ablation in Patients With Atrial Fibrillation and Heart Failure: 7-Year Follow-Up of the ARC-HF Trial, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
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Ibrahim M, Panikker S, Lim E, et al., 2018, Relevance of electrical connectivity between the coronary sinus and the left atrial appendage for the intentional electrical isolation of the left atrial appendage in treating persistent atrial fibrillation: insights from the LEIO-AF study, HeartRhythm Case Reports, Vol: 4, Pages: 420-424, ISSN: 2214-0271
Catheter ablation is an accepted therapeutic option for paroxysmal atrial fibrillation (AF), but its role is less certain in patients with persistent AF.1 The difference in response to pulmonary vein (PV) isolation (PVI) between paroxysmal and persistent forms of AF may arise because of triggers from non-PV sites or alterations in atrial substrate favoring maintenance of AF that are unaffected by PVI alone.2 In support of this statement, adjunctive ablation of certain sites (including the superior vena cava, ligament of Marshall [LOM], crista terminalis, coronary sinus [CS], posterior wall of the left atrium [LA], and left atrial appendage [LAA]) as well as more widespread ablation aimed at modifying substrate has been shown to improve the success of catheter ablation of persistent AF.In the case of the LAA, the BELIEF study (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Long-standing Persistent Atrial Fibrillation Undergoing Catheter Ablation)3 recently showed that in patients with long-standing persistent AF, empirical electrical isolation of the LAA together with extensive atrial ablation markedly improved freedom from AF at 1 year compared to an extensive atrial ablation strategy alone. However, electrical isolation of the LAA can be challenging and is sometimes impossible to achieve. This may be partly because the electrical connections of the LAA are not completely understood.Here we report 2 patients showing that the CS can be an important electrical conduit to the LAA.
Markides V, 2018, CABANA - the (not so) neutral study, EUROPEAN HEART JOURNAL, Vol: 39, Pages: 2769-2769, ISSN: 0195-668X
Haldar SK, Jones DG, Khan H, et al., 2018, Characterising the difference in electrophysiological substrate and outcomes between heart failure and non-heart failure patients with persistent atrial fibrillation, EUROPACE, Vol: 20, Pages: 451-458, ISSN: 1099-5129
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Khan HR, Kralj-Hans I, Haldar S, et al., 2018, Catheter ablation versus thoracoscopic surgical ablation in long standing persistent atrial fibrillation (CASA-AF): study protocol for a randomised controlled trial, Trials, Vol: 19, ISSN: 1745-6215
BACKGROUND: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation. The main purpose of this trial is to compare the effectiveness and safety of these two interventions. METHODS/DESIGN: Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF) is a prospective, multi-centre, randomised controlled trial within three NHS tertiary cardiovascular centres specialising in treatment of atrial fibrillation. Eligible adults (n = 120) with symptomatic, long-standing, persistent atrial fibrillation will be randomly allocated to either catheter ablation or thoracoscopic ablation in a 1:1 ratio. Pre-determined lesion sets will be delivered in each treatment arm with confirmation of appropriate conduction block. All patients will have an implantable loop recorder (ILR) inserted subcutaneously immediately following ablation to enable continuous heart rhythm monitoring for at least 12 months. The devices will be programmed to detect episodes of atrial fibrillation and atrial tachycardia ≥ 30 s in duration. The patients will be followed for 12 months, completing appropriate clinical assessments and questionnaires every 3 months. The ILR data will be wirelessly transmitted daily and evaluated every month for the duration of the follow-up. The primary endpoint in the study is freedom from atrial fibrillation and atrial tachycardia at the end of the follow-up period. DISCUSSION: The CASA-AF Trial is a National Institute for Health
Corden B, Jarman J, Whiffin N, et al., 2017, Titin Truncating Variants Predict Life-threatening Arrhythmias in Patients With Dilated Cardiomyopathy, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Khan HR, Hnatkova K, Kralj-Hans I, et al., 2017, Heart rate variability evaluation in patients with long standing persistent atrial fibrillation treated with thoracoscopic surgical ablation with ganglionic plexi ablation or catheter ablation - recordings from implantable loop recorder, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: American Heart Association, ISSN: 0009-7322
Corden B, Jarman J, Whiffin N, et al., 2017, Titin Truncating Variants Predict Life-threatening Arrhythmias in Patients With Dilated Cardiomyopathy, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: American Heart Association, Pages: E96-E96, ISSN: 0009-7322
Introduction: There is an urgent need for better arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy (DCM), where the benefit of ICD implantation is unclear. Titin truncating variants (TTNtv) are the commonest genetic cause of DCM and are associated with early onset non-sustained ventricular tachycardia (NSVT) and atrial fibrillation (AF) in these patients.Hypothesis: We hypothesize that TTNtv status can predict potentially life threatening ventricular tachycardia (VT) or fibrillation (VF) and development of new persistent AF in DCM patients with CRT-D or ICD devices.Methods: We studied 117 DCM patients with an ICD or CRT-D and documented device-recorded arrhythmia over a median period of 4.2 years. Patients were stratified by TTN genotype (28 positive for a TTNtv, 89 negative). The primary outcome was time to first device-treated VT >200bpm or VF. Secondary outcome measures included time to first development of persistent AF.Results: TTNtv predicted the risk of receiving an appropriate ICD therapy for VT/VF (hazard ratio [HR] = 4.9, 95% confidence interval [CI]=2.3-10.7, P<0.0001). This association was independent of all covariates, including replacement fibrosis measured by late-gadolinium enhancement (LGE), (adjusted HR = 8.2, 95% CI 1.9-36.5, P=0.005). Individuals with both a TTNtv and fibrosis had a markedly greater risk for appropriate device therapy than those with neither (HR = 16.6, CI 3.5-79.3, P<0.0001). TTNtv were also a risk factor for developing new persistent AF (HR = 4.4, 95% CI = 1.45-13.1, P=0.006).Conclusion: TTNtv status is an important risk factor for clinically significant arrhythmia in patients with DCM and CRT-D or ICD devices. TTNtv status alone, or more powerfully in combination with fibrosis imaging by MRI, may provide an effective approach for risk stratifying the need for ICD therapy in DCM patients.
Niespialowska-Steuden M, Markides V, Farag M, et al., 2017, Catheter ablation for AF improves global thrombotic profile and enhances fibrinolysis, Journal of Thrombosis and Thrombolysis, Vol: 44, Pages: 413-426, ISSN: 0929-5305
Patients with atrial fibrillation (AF) are atincreased risk of thrombotic events despite oral anticoagulation(OAC). Radiofrequency catheter ablation (RFCA) canrestore and maintain sinus rhythm (SR) in patients with AF.To assess whether RFCA improves thrombotic status. 80patients (71% male, 64±12y) with recently diagnosed AF,on OAC and scheduled to undergo RFCA or DC cardioversion(DCCV) were recruited. Thrombotic status was assessedusing the point-of-care global thrombosis test (GTT), before,and 4–6 weeks after DCCV and 3 months after RFCA. TheGTT first measures the time taken for occlusive thrombusformation (occlusion time, OT), while the second phase ofthe test measures the time taken to spontaneously dissolvethis clot through endogenous thrombolysis (lysis time, LT).3 months after RFCA, there was a significant reduction inLT (1994s [1560; 2475] vs. 1477s [1015; 1878]) in thosewho maintained SR, but not in those who reverted to AF. Atfollow-up, LT was longer in those in AF compared to thosein SR (AF 2966s [2038; 3879] vs. SR 1477s [1015; 1878]).RFCA resulted in no change in OT value, irrespective of hythm outcome. Similarly, there was no change in OT orLT in response to DCCV, irrespective of whether SR wasrestored. Successful restoration and maintenance of SR followingRFCA of AF is associated with improved globalthrombotic status with enhanced fibrinolysis. Larger studiesare required to confirm these early results and investigatewhether improved thrombotic status translates into fewerthromboembolic events.
Haldar SK, Jones DG, Bahrami T, et al., 2017, Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study, Heart Rhythm, Vol: 14, Pages: 1596-1603, ISSN: 1547-5271
BackgroundCatheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort.ObjectiveTo compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF.MethodsFifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months.ResultsSingle- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group: 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P = .003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P = .19), respectively. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07).ConclusionIn LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications.
Khan H, Di Salvo G, Kralj-Hans I, et al., 2017, Left atrial appendage exclusion as treatment strategy of ablation in longstanding persistent atrial fibrillation does not adversely affect the left atrial function in human, Publisher: OXFORD UNIV PRESS, Pages: 1095-1096, ISSN: 0195-668X
Jarman JW, Hunter TD, Hussain W, et al., 2017, Stroke rates before and after ablation of atrial fibrillation and in propensity-matched controls in the UK, Pragmatic and Observational Research, Vol: 8, Pages: 107-118, ISSN: 1179-7266
Background: We sought to determine whether catheter ablation of atrial fibrillation (AF) is associated with reduced occurrence of ischemic cerebrovascular events.Methods and results: Using routinely collected hospital data, ablation patients were matched to two control cohorts via direct and propensity score matching. A total of 4,991 ablation patients were matched 1:1 to general AF controls with no ablation, and 5,407 ablation patients were similarly matched to controls who underwent cardioversion. Yearly rates of ischemic stroke or transient ischemic attack (stroke/TIA) before and after an index date were compared between cohorts. Index date was defined as the first ablation, the first cardioversion, or the second AF event in the general AF cohort. Matched populations had very similar demographic and comorbidity profiles, including nearly identical CHA2DS2-VASc risk distribution (p-values 0.6948 and 0.8152 vs general AF and cardioversion cohorts). Statistical models of stroke/TIA risk in the preindex period showed no difference in annual event rates between cohorts (mean±standard error 0.30% ± 0.08% ablation vs 0.28% ± 0.07% general AF, p=0.8292; 0.37% ± 0.09% ablation vs 0.42% ± 0.08% cardioversion, p=0.5198). Postindex models showed significantly lower annual rates of stroke/TIA in ablation patients compared with each control group over 5 years (0.64% ± 0.11% ablation vs 1.84% ± 0.23% general AF, p<0.0001; 0.82% ± 0.15% ablation vs 1.37% ± 0.18% cardioversion, p=0.0222).Conclusion: Matching resulted in cohorts having the same baseline risks and rates of ischemic cerebrovascular events. After the index date, there were significantly lower yearly event rates in the ablation cohort. These results suggest the divergence in outcome rates stems from variance in the treatment pathways beginning at the index date.
Jarman JW, Hunter TD, Hussain W, et al., 2017, Mortality, stroke, and heart failure in atrial fibrillation cohorts after ablation versus propensity-matched cohorts, Pragmatic and Observational Research, Vol: 8, Pages: 99-106, ISSN: 1179-7266
Background: We sought to determine from key clinical outcomes whether catheter ablation of atrial fibrillation (AF) is associated with increased survival.Methods and results: Using routinely collected hospital data, ablation patients were matched to two control cohorts using direct and propensity score methodology. Four thousand nine hundred ninety-one ablation patients were matched 1:1 with general AF controls without ablation. Five thousand four hundred seven ablation patients were similarly matched to controls who underwent cardioversion. We examined the rates of ischemic stroke or transient ischemic attack (stroke/TIA), heart failure hospitalization, and death. Matched populations had very similar comorbidity profiles, including nearly identical CHA2DS2-VASc risk distribution (p=0.6948 and p=0.8152 vs general AF and cardioversion cohorts). Kaplan–Meier models showed increased survival after ablation for all outcomes compared with both control cohorts (p<0.0001 for all outcomes vs general AF, p=0.0087 for stroke/TIA, p<0.0001 for heart failure, and p<0.0001 for death vs cardioversion). Cox regression models also showed improved survival after ablation for all outcomes compared with the general AF cohort (hazard ratio [HR]=0.4, 95% confidence interval [95% CI]: 0.3–0.6, p<0.0001 for stroke/TIA; HR=0.4, 95% CI: 0.2–0.6, p<0.0001 for heart failure; HR=0.1, 95% CI: 0.1–0.1, p<0.0001 for death) and the cardioversion cohort (HR=0.6 , 95% CI: 0.4–0.9, p=0.0111 for stroke/TIA; HR=0.4, 95% CI: 0.3–0.6, p<0.0001 for heart failure; HR=0.3, 95% CI:0.2–0.5, p<0.0001 for death).Conclusions: Catheter ablation of AF was associated with very significant reductions in mortality, stroke/TIA, and heart failure compared with a matched general AF population and a matched population who underwent cardioversion. Potential confounding of outcomes was minimized by very tight cohort matching.
Midha D, Chen Z, Jones DG, et al., 2017, Pacing in congenital heart disease - A four-decade experience in a single tertiary centre, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 241, Pages: 177-181, ISSN: 0167-5273
Jones DG, Markides V, Chow AW, et al., 2017, Characterization and consistency of interactions of triggers and substrate at the onset of paroxysmal atrial fibrillation., Europace, Vol: 19, Pages: 1454-1462, ISSN: 1099-5129
Aims: Initiating mechanisms of atrial fibrillation (AF) remain poorly understood, involving complex interaction between triggers and the atrial substrate. This study sought to classify the transitional phenomena, hypothesizing that there is consistency within and between patients in trigger-substrate interaction during transition to AF. Methods and results: Non-contact left atrial (LA) mapping was performed in 17 patients undergoing ablation for paroxysmal AF. All had spontaneous ectopy. Left atrial activation from the first ectopic to established AF was examined offline to characterize the initiating and transitional sequence of activation. In 57 fully mapped spontaneous AF initiations in 8 patients, all involved interaction of pulmonary venous/LA triggers with a septopulmonary line of block (SP-LOB) also evident in sinus rhythm, by 4 different transitional mechanisms characterized by (i) continuous focal firing: AF resulted from fragmentation of each ectopic wavefront through gaps in the SP-LOB and persisted only while focal firing continued (n = 18/32%) (ii) transient focal firing, wavefront fragmentation at the SP-LOB produced wavelet re-entry that persisted after cessation of an initiating ectopic source (n = 12/21%), (iii) of two separate interacting ectopic foci (n = 15/26%), or from (iv) transiently stable macroreentry (n = 12/21%), around the SP-LOB extending to the LA roof, resulting in progressive wavefront fragmentation. It was found that 79 ± 22% of each of the initiations in individual patients showed the same triggering mechanism. Conclusion: Onset of paroxysmal AF can be described by discrete mechanistic categories, all involving interaction of ectopic activity with a common SP-LOB. Within/between-patient consistency of initiations suggests constancy of the interacting triggers and substrate, and supports the concept of mechanistically tailored treatment.
Panikker S, Lord J, Jarman JWE, et al., 2016, Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation, EUROPEAN HEART JOURNAL, Vol: 37, Pages: 3470-3482A, ISSN: 0195-668X
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Viswanathan K, Mantziari L, Butcher C, et al., 2016, Evaluation of a novel high-resolution mapping system for catheter ablation of ventricular arrhythmias., Heart Rhythm, Vol: 14, Pages: 176-183, ISSN: 1547-5271
BACKGROUND: The mapping of ventricular arrhythmias in humans using a minibasket 64-electrode catheter paired with a novel automatic mapping system (Rhythmia) has not been evaluated. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of mapping ventricular arrhythmias and clinical outcomes after ablation using this system. METHODS: Electroanatomic maps for ventricular arrhythmias were obtained during 20 consecutive procedures in 19 patients (12 with ventricular tachycardia [VT] and 2 with ventricular ectopy [VE]). High-density maps were acquired using automatic beat acceptance and automatic system annotation of electrograms. RESULTS: Forty-seven electroanatomic maps (including 3 right ventricular and 9 epicardial maps) were obtained. Left ventricular endocardial mapping by transseptal (n = 13) and/or transaortic (n = 11) access was safe with no complications related to the minibasket catheter. VT substrate maps (n = 14; median 10,184 points) consistently demonstrated late potentials with high resolution. VT activation maps (n = 25; median 6401 points) obtained by automatic annotation included 7 complete maps (covering ≥90% of the tachycardia cycle length) in 5 patients in whom the entire VT circuit was accurately visualized. VE timing maps (n = 8) successfully localized the origin of VEs in all, with all accepted beats consistent with clinical VEs. Over a median follow-up of 10 months, no arrhythmia recurrence was noted in 75% after VT ablation and 86% after VE ablation. CONCLUSION: In this first human experience for ventricular arrhythmias using this system, ultra-high-density maps were created rapidly and safely, with a reliable automatic annotation of VT and consistent recording of abnormal electrograms. Medium-term outcomes after ablation were encouraging. Further larger studies are needed to validate these findings.
Panikker S, Jarman JWE, Virmani R, et al., 2016, Response by Panikker et al to letter regarding article, "Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation: a first-in-human safety, feasibility, and efficacy study", Circulation-Arrhythmia and Electrophysiology, Vol: 9, ISSN: 1941-3149
Jones DG, Haldar SK, Donovan J, et al., 2016, Biomarkers in persistent AF and heart failure: impact of catheter ablation compared with rate control, PACE-Pacing and Clinical Electrophysiology, Vol: 39, Pages: 926-934, ISSN: 0147-8389
BackgroundTo investigate the effects of catheter ablation and rate control strategies on cardiac and inflammatory biomarkers in patients with heart failure and persistent atrial fibrillation (AF).MethodsPatients were recruited from the ARC-HF trial (catheter Ablation vs Rate Control for management of persistent AF in Heart Failure, NCT00878384), which compared ablation with rate control for persistent AF in heart failure. B-type natriuretic peptide (BNP), midregional proatrial natriuretic peptide (MR-proANP), apelin, and interleukin-6 (IL-6) were assayed at baseline, 3 months, 6 months, and 12 months. The primary end point, analyzed per-protocol, was changed from baseline at 12 months.ResultsOf 52 recruited patients, 24 ablation and 25 rate control subjects were followed to 12 months. After 1.2 ± 0.5 procedures, sinus rhythm was present in 22 (92%) ablation patients; under rate control, rate criteria were achieved in 23 (96%) of 24 patients remaining in AF. At 12 months, MR-proANP fell significantly in the ablation arm (–106.0 pmol/L, interquartile range [IQR] –228.2 to –60.6) compared with rate control (–28.7 pmol/L, IQR –69 to +9.5, P = 0.028). BNP showed a similar trend toward reduction (P = 0.051), with no significant difference in apelin (P = 0.13) or IL-6 (P = 0.68). Changes in MR-proANP and BNP correlated with peak VO2 and ejection fraction, and MR-proANP additionally with quality-of-life score.ConclusionsCatheter ablation, compared with rate control, in patients with heart failure and persistent AF was associated with significant reduction in MR-proANP, which correlated with physiological and symptomatic improvement. Ablation-based rhythm control may induce beneficial cardiac remodeling, unrelated to changes in inflammatory state. This may have prognostic implications, which require confirmation by event end point studies.
Panikker S, Jarman JWE, Virmani R, et al., 2016, Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation A First-in-Human Safety, Feasibility, and Efficacy Study, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 9, ISSN: 1941-3149
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Wynn GJ, Panikker S, Morgan M, et al., 2016, Biatrial linear ablation in sustained nonpermanent AF: Results of the substrate modification with ablation and antiarrhythmic drugs in nonpermanent atrial fibrillation (SMAN-PAF) trial, HEART RHYTHM, Vol: 13, Pages: 399-406, ISSN: 1547-5271
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Butcher C, Mareev Y, Markides V, et al., 2015, Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?, CURRENT CARDIOLOGY REPORTS, Vol: 17, ISSN: 1523-3782
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Mantziari L, Butcher C, Kontogeorgis A, et al., 2015, Utility of a novel rapid high-resolution mapping system in the catheter ablation of arrhythmias: an initial human experience of mapping the atria and the left ventricle., JACC: Clinical Electrophysiology, Vol: 1, Pages: 411-420, ISSN: 2405-5018
OBJECTIVES: This study sought to assess the clinical efficacy, safety, and clinical utility of a novel electroanatomical mapping system. BACKGROUND: A new mapping system capable of rapidly acquiring detailed maps based on automatic annotation of thousands of points was recently released for clinical use. This is the first description of its utility in humans. METHODS: The first consecutive 20 cases (7 atrial tachycardia, 8 atrial fibrillation, 3 ventricular tachycardia, and 2 ventricular ectopic beat ablations) were analyzed. The system uses a bidirectional deflectable basket catheter with 64 closely spaced mini-electrodes. It automatically accepts and annotates electrograms when a number of predefined criteria are met. RESULTS: Thirty right atrial maps were acquired in 11 (4 to 15) min, consisting of 7,220 (3,467 to 10,947) points, 22 left atrial maps in 11 (6 to 19) min, consisting of 7,818 (4,379 to 12,262) points and 10 left ventricular maps in 37 (14 to 43) min, consisting of 8,709 (2,605 to 15,514) points. The mini-basket catheter could reach all areas of interest without deflectable sheaths. No embolic events, bleeding complications, or endocardial structure damage were observed. Correction of the automatic annotation was performed in 0.02% of points in 4 of 62 maps. The system revealed re-entry circuits of atrial tachyarrhythmias, identified gaps on linear lesions, and identified and correctly annotated the clinical ventricular ectopic beats and channels of slow conduction within ventricular scar. CONCLUSIONS: The novel automatic mapping system was rapid, safe, and efficacious in mapping a variety of cardiac arrhythmias in humans. Further clinical research is needed to optimize its use in the ablation of complex arrhythmias.
Haldar SK, Jones DG, Bahrami T, et al., 2015, Optimal ablation strategies in long standing persistent atrial fibrillation, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 741-742, ISSN: 0195-668X
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