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Hugh Calkins - One of the best experts on this subject based on the ideXlab platform.

  • Catheter Ablation in patients with persistent atrial fibrillation
    European heart journal, 2016
    Co-Authors: Paulus Kirchhof, Hugh Calkins
    Abstract:

    Catheter Ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF Ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide Catheter Ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for Catheter Ablation of persistent AF. Other Ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to Catheter Ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to Ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials.

  • Catheter Ablation of atrial fibrillation: an update
    European heart journal, 2014
    Co-Authors: Laurent M. Haegeli, Hugh Calkins
    Abstract:

    Catheter Ablation of atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. There is considerable evidence available from several prospective randomized trials demonstrating that Catheter Ablation of AF is superior to antiarrhythmic drug therapy in controlling AF and that AF Ablation improves quality of life substantially. This is especially true for patients with paroxysmal AF without other severe comorbidities. Catheter Ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed. Although current guidelines state that is appropriate to perform Catheter Ablation as a first-line therapy in selected patients, in our clinical practice this is rare. This reflects a number of important realities concerning the field of AF Ablation. Catheter Ablation of AF is a challenging and complex procedure, which is not free of the risk of potentially life-threatening complications, such as an atrio-oesophageal fistula, stroke, and cardiac tamponade. Although these major complications are rare and their rate is falling, they must be considered by both patients and physicians. The progress made and the new developments on the horizon in the field of AF Catheter Ablation are remarkable. When radiofrequency Catheter Ablation was first introduced in the late 1980s, few would have predicted that Catheter Ablation of AF would emerge as the most commonly performed Ablation procedure in most major hospitals.

  • Catheter Ablation of Atrial Fibrillation - Techniques and Technology.
    Arrhythmia & electrophysiology review, 2012
    Co-Authors: George D. Katritsis, Hugh Calkins
    Abstract:

    For certain patients with atrial fibrillation (AF) Catheter Ablation is now an important, therapeutic, intervention. It is established that Catheter Ablation is more effective than antiarrhythmic drug therapy at maintaining middle-aged patients with paroxysmal AF in sinus rhythm. However, the role of Catheter Ablation in other patient groups is not yet well defined. Particularly in patients with long-standing persistent AF, heart failure and the elderly, the efficacy of Catheter Ablation remains uncertain. At experienced centers Catheter Ablation for AF can be performed with reasonable safety and efficacy. However, major complications can occasionally occur. Late recurrence of AF is not uncommon and many patients will require a further procedure to maintain sinus rhythm. Fortunately, there are promising developments in the techniques and technology used for AF Ablation that are likely to improve the outcomes of the procedure.

  • An Approach to Catheter Ablation of Atrial Fibrillation in the Elderly.
    Cardiac electrophysiology clinics, 2012
    Co-Authors: John N. Catanzaro, Hugh Calkins
    Abstract:

    Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice with a prevalence that is increasing with age. During the past decade, Catheter Ablation of AF has rapidly evolved from a highly experimental unproved procedure, to its current status as a commonly performed procedure in many major hospitals throughout the world for symptomatic, drug refractory, paroxysmal, and persistent AF. With improved safety and advances in technique, Catheter Ablation has also been offered to the elderly. This article reviews the most current literature with respect to long-term clinical efficacy, risks, and benefits of Catheter Ablation of AF in the elderly.

  • Catheter Ablation of Atrial Flutter and Atrial Fibrillation
    Management of Cardiac Arrhythmias, 2010
    Co-Authors: Joseph E. Marine, Hugh Calkins
    Abstract:

    Atrial flutter and atrial fibrillation are two of the most common arrhythmias seen in clinical practice and the most common indications for referral for Catheter Ablation. While they are historically grouped together, research over the past 20 years has shown that atrial flutter and atrial fibrillation are distinct arrhythmias with different electrophysiological mechanisms. This review will consider the development of and current approach to Catheter Ablation of atrial flutter and atrial fibrillation.

Masood Akhtar - One of the best experts on this subject based on the ideXlab platform.

  • Catheter Ablation IN SUPRAVENTRICULAR TACHYCARDIA
    Annual review of medicine, 1995
    Co-Authors: Sanjay Deshpande, Mohammad Jazayeri, Anwer Dhala, Zalmen Blanck, Jasbir Sra, Siobhan Bremner, Masood Akhtar
    Abstract:

    The evolution of Catheter Ablation for the treatment of supraventricular tachycardias represents a major advance in the management of cardiac arrhythmias. Excellent results in the majority of patients undergoing the procedure, together with a low rate of early complications and a brief hospitalization, make Catheter Ablation a highly cost-effective permanent cure. At present, however, its place in relation to alternate therapies in the management of supraventricular tachycardias has not been clearly established owing to unresolved risk-benefit issues. Continuing technical advances will likely enable Catheter Ablation to be successfully applied to a broader range of cardiac arrhythmias.

  • Catheter Ablation of ventricular tachycardia
    American Heart Journal, 1994
    Co-Authors: Zalmen Blanck, Sanjay Deshpande, Anwer Dhala, Jasbir Sra, Mohammad R. Jazayeri, Masood Akhtar
    Abstract:

    Abstract The role and success rate of Catheter Ablation for monomorphic ventricular tachycardia (VT) depend on the mechanism and origin of the tachycardia (i.e., myocardial versus His-Purkinje system) and whether it occurs in the presence or absence of structural heart disease. For sustained bundle-branch reentry, a form of VT associated with structural heart disease, radiofrequency Catheter Ablation of the right bundle-branch can be performed readily and is highly successful in eliminating this arrhythmia. Because of modest success rates of Catheter Ablation of VT associated with a prior infarction (between 17% and 75%), this treatment modality is usually considered for cases refractory to drug therapy and should be viewed as adjunctive therapy. The target for Ablation is a critical area of slow conduction, which is selected based on earliest endocardial activation, mid-diastolic potentials, concealed entrainment, or pace mapping. Radiofrequency Catheter Ablation may be the treatment of choice in patients with VT and no apparent structural heart disease; this is especially true for young patients who would otherwise require long-life antiarrhythmic therapy. Success rates between 75% and 100% have been reported, especially when the origin is in the right ventricular outflow tract.

Fred Morady - One of the best experts on this subject based on the ideXlab platform.

  • Atrial fibrillation: Catheter Ablation.
    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2006
    Co-Authors: Aman Chugh, Fred Morady
    Abstract:

    Catheter Ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the Catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach in which the PVs and other foci were targeted for Ablation. The pendulum then appeared to swing back toward the substrate approach after it was shown that left atrial circumferential Ablation afforded improved outcomes in patients with paroxysmal and persistent AF. It has become clear that there are several possible approaches in the Catheter Ablation of AF, each with its strengths and limitations. It is also becoming evident that not all patients will respond to a single Ablation technique and that the Ablation protocol is best tailored to suit the individual patient. This article strives to present an evidence-based review of the many techniques, and then offer a practical guide to the Catheter Ablation of AF.

  • Catheter Ablation of supraventricular arrhythmias: State of the art
    Pacing and clinical electrophysiology : PACE, 2004
    Co-Authors: Fred Morady
    Abstract:

    The era of Catheter Ablation for the treatment of arrhythmias began in 1981, when Dr. Melvin Scheinman performed the first atrioventricular junction Ablation using direct-current shocks in a patient with drug-refractory atrial fibrillation and an uncontrolled ventricular rate.1 Because of the barotrauma associated with intracardiac high-energy shocks, direct-current Catheter Ablation played only a limited role in the treatment of arrhythmias. With the advent of radiofrequency Catheter Ablation in the late 1980s, the range of arrhythmias amenable to Catheter Ablation and the number of patients who could be treated safely by Catheter Ablation vastly expanded. In the past decade, radiofrequency Catheter Ablation has become firmly established as first-line therapy for paroxysmal supraventricular tachycardia and typical atrial flutter. Furthermore, although still in an evolutionary phase, Catheter Ablation to eliminate atrial fibrillation has been demonstrated in the past 5 years to be feasible and clinically useful. The intent of this article is to review the current status of Catheter Ablation for the treatment of paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation.

  • Catheter Ablation of ventricular tachycardia.
    Current opinion in cardiology, 1995
    Co-Authors: Emile G. Daoud, Fred Morady
    Abstract:

    Endocardial lesions created by radiofrequency Catheter Ablation are relatively small and focal. The application of radiofrequency Ablation to patients with structural heart disease and ventricular tachycardia is quite limited because the substrate for these tachycardias is often diffuse or difficult

Calum J. Redpath - One of the best experts on this subject based on the ideXlab platform.

Girish M. Nair - One of the best experts on this subject based on the ideXlab platform.