Atrial Fibrillation
Pulsed‑field ablation—are we ready for fast and furious atrial tachycardia ablation?
Guidelines/Clinical Documents: Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices. (J Am Coll Cardiol Intv 2023;16:1384–1400) © 2023 Society for Cardiovascular Angiography and Interventions Foundation, Heart Rhythm Society and American College of Cardiology, published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Care Pathways/CDS: Care pathway for patient visit related to AFib. Includes an overall AF management pathway, outpatient medication recommendations, and a CHA2DS2-VASc and a HAS-BLED decision support tool.
Guidelines/Clinical Documents: Clinical research article from the European Society of Cardiology outlining the INDI-FREEZE trial, a prospective randomized trial aiming at assessing the acute efficacy and clinical outcome of an individualized vs. a fixed ablation protocol using the fourth-generation CB guided by PV potential recordings and CB temperature.
Education – Patient/Caregiver: One-page patient education resource explaining Pulmonary Vein Isolation. Includes procedure, post-procedure, procedural risk, and office follow up.
Education – Patient/Caregiver: Two-page patient education resources about LAAC. Includes information about the procedure, risk factors, and post-procedure instructions.
Education – Patient/Caregiver: Extensive collection of patient education sheets for 17 different medications used for anticoagulation, rate control, and rhythm control. Each sheet includes how to take the medication, potential interactions, side effects, and warnings.
Education – Patient/Caregiver: CHA2DS2-VASc and Your Risk of Stroke
Education – Patient/Caregiver: Two-page patient education resource explaining AFib, its causes, management and treatment. Includes a description of medications, procedures, and implantable devices, as well ask suggested lifestyle changes.
Journal Articles: Background—The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results—A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St. George’s hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful second generation 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131–357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002). Conclusions—The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.