Download kB Absztrakt kivonat idegen nyelven Catheter ablation using radiofrequency energy has gained acceptance as an effective treatment for atrial fibrillation AF. Several technical approaches have been developed that correspond to pathophysiological concepts of AF initiation and maintenance.
Isolation of pulmonary veins is identified as the cornerstone of any ablation approach. The additional ablation of fragmented or complex ostial or nonostial potentials or left atrial linear ablation has been recently introduced to modify the substrate besides isolating the triggerin order to improve the success rate of AF ablation, especially in patients with persistent AF. In our non-randomized, single-center, observational study we can you live with afib without treatment the acute effects of complex fractionated atrial electrogram CFAE ablation guided by automated detection on dominant frequency DF and regulatory index RI for the fibrillatory process.
The termination rate by CFAE ablation was low Based on our results CFAE ablation guided by a dedicated software algorithm and performed after standard pulmonary vein isolation PVI without CFAE remapping does not influence the fibrillatory process significantly. With introduction of additional extensive left atrial LA ablations the risk of complications have been increased.
Esophageal ulcerations EU have been proposed to be potential precursor lesions. In our large single-center study of more than patients, we consistently screened patients for evidence of esophageal injury after AF ablation.
In total, we found 2. Parameters exposing a specific patient to risk of developing EU were persistent AF 5 of 95additional lines performed roofline: 6 of ; LA isthmus: 4 of 49; coronary sinus: 5 of 66and LA enlargement leading to sandwiching of the esophagus between the LA and thoracic spine.
Multivariate analysis revealed LA-to-esophagus distance as the only significant risk factor. With the use of a reasonable energy maximum of 25 W at the posterior LA wall using open irrigation catheters, we showed a low percentage of EU creation compared with other studies published.
Identifying high-risk patients for esophageal injury 7 potentially has an impact on follow-up or treatment of these individuals by endoscopy or prophylactic treatment. In our substudy including 31 patients we assessed the acute effect of radiofrequency ablation RFA on distal esophageal acidity using leadless pH-metry capsules.
Living with Atrial Fibrillation (AFib)
We found that a significant number of patients In addition, a subgroup of patients This finding may explain a potential mechanism for progression of esophageal injury to atrio-esophageal fistulas.
We recommend a regular screening for EU in high-risk patients with an extensive lesion set and treatment with proton-pump inhibitor PPI medication if EU is discovered.