Latest Research on Atrial Fibrillation: Jan – 2020

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Latest Research on Atrial Fibrillation: Jan – 2020

January 9, 2020 Cardiology 0

The surgical treatment of atrial fibrillation: II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation

Computerized mapping of fibrillation was performed in animals and man. to review fibrillation during a systematic manner, we developed a clinically relevant experimental model of fibrillation . Chronic mitral regurgitation was created surgically in 25 dogs without opening the pericardium. After several months of chronic mitral regurgitation, the atria became enlarged and sustained fibrillation might be induced by standard programmed electrical stimulation techniques. Computerized isochronous activation maps of the atria were recorded during fibrillation from 208 bipolar electrodes simultaneously. during a parallel study, human fibrillation was mapped with a separate 160-channel intraoperative mapping system in patients with paroxysmal fibrillation who were undergoing surgical correction of the Wolff-Parkinson-White syndrome. [1]

Canadian atrial fibrillation anticoaguiation (CAFA) study

The Canadian fibrillation Anticoagulation Study was a randomized double-blind placebo-controlled trial to assess the potential of warfarin to scale back systemic thromboembolism and its inherent risk of hemorrhage. As a results of the publication of two other “positive” studies of comparable design and objective, this study was stopped early before completion of its planned recruitment of 630 patients. there have been 187 patients randomized to warfarin and 191 to placebo. Permanent discontinuation of study medication occurred in 26% of warfarin-treated and 23% of placebo-treated patients. The firing range of the international normalized ratio was 2 to three . For the warfarin-treated patients, the international normalized ratio was within the firing range 43.7% of the study days, above it 16.6% of the study days and below it 39.6% of the study days. Fatal or major bleeding occurred at annual rates of two .5% in warfarin-treated and 0.5% in placebo-treated patients. Minor bleeding occurred in 16% of patiente receiving warfarin and 9% receiving placebo. [2]

The surgical treatment of atrial fibrillation: III. Development of a definitive surgical procedure

On the idea of the known electrophysiologic mechanisms of fibrillation , multiple surgical procedures were designed and tested in dogs to work out the feasibility of developing a surgical cure for human fibrillation . These experimental studies culminated during a surgical approach that effectively creates an electrical maze within the atrium. The atrial incisions prevent atrial reentry and permit sinus impulses to activate the whole atrial myocardium, thereby preserving atrial transport function postoperatively. Since September 1987, this surgery has been applied in seven patients, five with paroxysmal fibrillation of two to 9 years’ duration and two with chronic fibrillation of three and 10 years’ duration. [3]

Biobank-driven genomic discovery yields new insight into atrial fibrillation biology

To identify genetic variation underlying fibrillation , the foremost common arrhythmia , we performed a genome-wide association study of >1,000,000 people, including 60,620 fibrillation cases and 970,216 controls. We identified 142 independent risk variants at 111 loci and prioritized 151 functional candidate genes likely to be involved in fibrillation . Many of the identified risk variants fall near genes where more deleterious mutations are reported to cause serious heart defects in humans (GATA4, MYH6, NKX2-5, PITX2, TBX5)1, or near genes important for skeletal muscle function and integrity (for example, CFL2, MYH7, PKP2, RBM20, SGCG, SSPN). [4]

Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures

Background: Catheter of fibrillation remains challenging due to the high degree of variability of the vena pulmonalis anatomy. Therefore, 3D imaging systems are frequently used before an ablation procedure. Three-dimensional transesophageal echocardiography provides a superb overview over the individual left atrial morphology without a number of the restrictions related to other imaging techniques. [5]

Reference

[1] Cox, J.L., Canavan, T.E., Schuessler, R.B., Cain, M.E., Lindsay, B.D., Stone, C., Smith, P.K., Corr, P.B. and Boineau, J.P., 1991. The surgical treatment of atrial fibrillation: II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. The Journal of thoracic and cardiovascular surgery, 101(3), (Web Link)

[2] Connolly, S.J., Laupacis, A., Gent, M., Roberts, R.S., Cairns, J.A. and Joyner, C., 1991. Canadian atrial fibrillation anticoaguiation (CAFA) study. Journal of the American College of Cardiology, 18(2), (Web Link)

[3] Cox, J.L., Schuessler, R.B., D’Agostino Jr, H.J., Stone, C.M., Chang, B.C., Cain, M.E., Corr, P.B. and Boineau, J.P., 1991. The surgical treatment of atrial fibrillation: III. Development of a definitive surgical procedure. The Journal of thoracic and cardiovascular surgery, 101(4), (Web Link)

[4] Biobank-driven genomic discovery yields new insight into atrial fibrillation biology
Jonas B. Nielsen, Rosa B. Thorolfsdottir, […]Cristen J. Willer
Nature Genetics volume 50, (Web Link)

[5] Kettering, K., Gramley, F. and von Bardeleben, S. (2017) “Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures”, Cardiology and Angiology: An International Journal, 6(2), (Web Link)

 

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