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Article ; Online: Relationship between sodium channel function and clinical phenotype in SCN5A variants associated with Brugada syndrome.

Pearman, Charles M / Denham, Nathan C / Mills, Robert W / Ding, Wern Y / Modi, Simon S / Hall, Mark C S / Todd, Derick M / Mahida, Saagar

Human mutation

2020 Volume 41, Issue 12, Page(s) 2195–2204

Abstract: The identification of a pathogenic SCN5A variant confers an increased risk of conduction defects and ventricular arrhythmias (VA) in Brugada syndrome (BrS). However, specific aspects of sodium channel function that influence clinical phenotype have not ... ...

Abstract	The identification of a pathogenic SCN5A variant confers an increased risk of conduction defects and ventricular arrhythmias (VA) in Brugada syndrome (BrS). However, specific aspects of sodium channel function that influence clinical phenotype have not been defined. A systematic literature search identified SCN5A variants associated with BrS. Sodium current (I
MeSH term(s)	Arrhythmias, Cardiac/genetics ; Brugada Syndrome/diagnostic imaging ; Brugada Syndrome/genetics ; Brugada Syndrome/pathology ; Electrocardiography ; Heart Conduction System/pathology ; Humans ; Mutation/genetics ; NAV1.5 Voltage-Gated Sodium Channel/genetics ; Phenotype
Chemical Substances	NAV1.5 Voltage-Gated Sodium Channel ; SCN5A protein, human
Language	English
Publishing date	2020-11-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1126646-6
ISSN	1098-1004 ; 1059-7794
ISSN (online)	1098-1004
ISSN	1059-7794
DOI	10.1002/humu.24128
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Zs.A 3586: Show issues

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Article ; Online: Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review.

Ding, Wern Yew / Pearman, Charles M / Bonnett, Laura / Adlan, Ahmed / Chin, Shui Hao / Denham, Nathan / Modi, Simon / Todd, Derick / Hall, Mark C S / Mahida, Saagar

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

2021 Volume 63, Issue 1, Page(s) 59–67

Abstract: Background: Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) ... ...

Abstract	Background: Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods: PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results: A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1-10.7) and NICM cohorts was 7.1% (95% CI, 6.0-8.3). Reported complication rates were highly variable between studies (ICM I Conclusion: Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy.
MeSH term(s)	Cardiomyopathies/surgery ; Catheter Ablation ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/surgery ; Tachycardia, Ventricular/surgery
Language	English
Publishing date	2021-01-29
Publishing country	Netherlands
Document type	Journal Article ; Systematic Review
ZDB-ID	1329179-8
ISSN	1572-8595 ; 1383-875X
ISSN (online)	1572-8595
ISSN	1383-875X
DOI	10.1007/s10840-021-00948-6
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Zs.A 5214: Show issues

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Article ; Online: Novel Extravascular Defibrillation Configuration With a Coil in the Substernal Space: The ASD Clinical Study.

Chan, Joseph Y S / Lelakowski, Jacek / Murgatroyd, Francis D / Boersma, Lucas V / Cao, Jian / Nikolski, Vladimir / Wouters, Griet / Hall, Mark C S

JACC. Clinical electrophysiology

2017 Volume 3, Issue 8, Page(s) 905–910

Abstract: Objectives: This study assessed the defibrillation efficacy of the substernal-lateral electrode configuration.: Background: Subcutaneous implantable cardioverter-defibrillators (ICDs) are regarded as alternatives to transvenous ICDs in certain ... ...

Abstract	Objectives: This study assessed the defibrillation efficacy of the substernal-lateral electrode configuration. Background: Subcutaneous implantable cardioverter-defibrillators (ICDs) are regarded as alternatives to transvenous ICDs in certain subjects. However, substantially higher shock energy of up to 80 J may be required. Proposed is a new defibrillation method of placing the shock coil into the substernal space. Methods: This prospective, nonrandomized, feasibility study was conducted in subjects scheduled for midline sternotomy or implant of ICD. A blunted end tunneling tool was used to insert a defibrillation lead behind the sternum using a percutaneous subxiphoid approach. A skin patch electrode was placed on the left mid-axillary line at the fourth to fifth intercostal space. After ventricular fibrillation induction, a single 35-J shock was delivered between the lead and skin patch. Results: Sixteen subjects (12 males, 4 females; mean age: 61.6 ± 11.8 years) were enrolled. The mean lead placement time was 11.1 ± 6.6 min. Of the 14 subjects with successfully induced ventricular fibrillation episodes, 13 subjects (92.9%) had successful defibrillation. The 1 failure was associated with high and lateral shock coil placement. Mean ventricular fibrillation duration was 18.4 ± 5.6 s with a shock impedance of 98.1 ± 19.3 ohms. Of the 11 subjects with coil-patch electrograms, the average R-wave amplitude during sinus rhythm was 3.0 ± 1.4 mV. Conclusions: These preliminary data demonstrate that substernal defibrillation is feasible and successful defibrillation can be achieved with the shock energy available in current transvenous ICDs. This may open new alternatives to extravascular ICD therapy.
MeSH term(s)	Defibrillators, Implantable ; Electrocardiography ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prosthesis Implantation ; Sternum ; Ventricular Fibrillation/therapy
Language	English
Publishing date	2017-03-29
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2016.12.026
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Article ; Online: Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation.

Pearman, Charles M / Redfern, James / Williams, Emmanuel A / Snowdon, Richard L / Modi, Paul / Hall, Mark C S / Modi, Simon / Waktare, Johan E P / Mahida, Saagar / Todd, Derick M / Mediratta, Neeraj / Gupta, Dhiraj

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2019 Volume 21, Issue 5, Page(s) 738–745

Abstract: Aims: Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre's early experience are sparse. ...

Abstract	Aims: Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre's early experience are sparse. Methods and results: Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion: During a centre's early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/surgery ; Cardiac Tamponade/epidemiology ; Cardiac Tamponade/etiology ; Cardiac Tamponade/surgery ; Catheter Ablation/adverse effects ; Catheter Ablation/methods ; Cohort Studies ; Comparative Effectiveness Research ; Conversion to Open Surgery/statistics & numerical data ; Female ; Humans ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Phrenic Nerve/injuries ; Thoracic Surgery, Video-Assisted/adverse effects ; Thoracic Surgery, Video-Assisted/methods ; United Kingdom
Keywords	covid19
Language	English
Publishing date	2019-02-12
Publishing country	England
Document type	Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euy303
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Zs.A 5434: Show issues

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Article ; Online: Fractionation of electrograms is caused by colocalized conduction block and connexin disorganization in the absence of fibrosis as AF becomes persistent in the goat model.

Kirubakaran, Senthil / Chowdhury, Rasheda A / Hall, Mark C S / Patel, Pravina M / Garratt, Clifford J / Peters, Nicholas S

Heart rhythm

2014 Volume 12, Issue 2, Page(s) 397–408

Abstract: Background: Electrogram fractionation and atrial fibrosis are both thought to be pathophysiological hallmarks of evolving persistence of atrial fibrillation (AF), but recent studies in humans have shown that they do not colocalize. The interrelationship ...

Abstract	Background: Electrogram fractionation and atrial fibrosis are both thought to be pathophysiological hallmarks of evolving persistence of atrial fibrillation (AF), but recent studies in humans have shown that they do not colocalize. The interrelationship and relative roles of fractionation and fibrotic change in AF persistence therefore remain unclear. Objective: The aim of the study was to examine the hypothesis that electrogram fractionation with increasing persistence of AF results from localized conduction slowing or block due to changes in atrial connexin distribution in the absence of fibrotic change. Methods: Of 12 goats, atrial burst pacemakers maintained AF in 9 goats for up to 3 consecutive 4-week periods. After each 4-week period, 3 goats underwent epicardial mapping studies of the right atrium and examination of the atrial myocardium for immunodetection of connexins 43 and 40 (Cx43 and Cx40) and quantification of connective tissue. Results: Despite refractoriness returning to normal in between each 4-week period of AF, there was a cumulative increase in the prevalence of fractionated atrial electrograms during both atrial pacing (control and 1, 2, and 3 months period of AF 0.3%, 1.3% ± 1.5%, 10.6% ± 2%, and 17% ± 5%, respectively; analysis of variance, P < .05) and AF (0.3% ± 0.1%, 2.3% ± 1.2%, 14% ± 2%, and 23% ± 3%; P < .05) caused by colocalized areas of conduction block during both pacing (local conduction velocity <10 cm/s: 0.1% ± 0.1%, 0.3% ± 0.6%, 6.5% ± 3%, and 6.9% ± 4%; P < .05) and AF (1.5% ± 0.5%, 2.7% ± 1.1%, 10.1% ± 1.2%, and 13.6% ± 0.4%; P < .05), associated with an increase in the heterogeneity of Cx40 and lateralization of Cx43 (lateralization scores: 1.75 ± 0.89, 1.44 ± 0.31, 2.85 ± 0.96, and 2.94 ± 0.31; P < .02), but not associated with change in connective tissue content or net conduction velocity. Conclusion: Electrogram fractionation with increasing persistence of AF results from slow localized conduction or block associated with changes in atrial connexin distribution in the absence of fibrotic change.
MeSH term(s)	Animals ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/metabolism ; Atrial Fibrillation/physiopathology ; Connexins/metabolism ; Disease Models, Animal ; Electrophysiologic Techniques, Cardiac ; Female ; Fibrosis ; Goats ; Heart Atria/metabolism ; Heart Atria/physiopathology ; Heart Block/diagnosis ; Heart Block/metabolism ; Heart Block/physiopathology ; Heart Conduction System/metabolism ; Heart Conduction System/physiopathology ; Magnetic Resonance Imaging, Cine ; Prognosis
Chemical Substances	Connexins
Language	English
Publishing date	2014-10-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Video-Audio Media
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2014.10.027
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Zs.A 6278: Show issues

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Article ; Online: Pulmonary Vein Re-Isolation as a Routine Strategy Regardless of Symptoms: The PRESSURE Randomized Controlled Trial.

Das, Moloy / Wynn, Gareth J / Saeed, Yawer / Gomes, Sean / Morgan, Maureen / Ronayne, Christina / Bonnett, Laura J / Waktare, Johan E P / Todd, Derick M / Hall, Mark C S / Snowdon, Richard L / Modi, Simon / Gupta, Dhiraj

JACC. Clinical electrophysiology

2017 Volume 3, Issue 6, Page(s) 602–611

Abstract: Objectives: The goal of this study was to determine whether a strategy of early re-isolation of pulmonary vein (PV) reconnection in all patients, regardless of symptoms, would reduce the recurrence of atrial fibrillation (AF) and improve quality of life. ...

Abstract	Objectives: The goal of this study was to determine whether a strategy of early re-isolation of pulmonary vein (PV) reconnection in all patients, regardless of symptoms, would reduce the recurrence of atrial fibrillation (AF) and improve quality of life. Background: Lasting pulmonary vein isolation (PVI) remains elusive. PV reconnection is strongly linked to the recurrence of arrhythmia. Methods: A total of 80 patients with paroxysmal AF were randomized 1:1 after contact force-guided PVI to receive either standard care or undergo a repeat electrophysiology study after 2 months regardless of symptoms (repeat study). At the initial procedure, PVI was demonstrated by entrance/exit block and adenosine administration after a minimum 20-min wait. At the repeat study, all sites of PV reconnection were re-ablated. Patients recorded electrocardiograms daily and whenever symptomatic for 12 months using a handheld monitor. Recurrence was defined as ≥30 s of atrial tachyarrhythmia (AT) after a 3-month blanking period. The Atrial Fibrillation Effect on Quality-of-Life Questionnaire was completed at baseline and at 6 and 12 months. Results: All 40 patients randomized to repeat study attended for this after 62 ± 6 days, of whom 25 (62.5%) had reconnection of 41 (26%) PVs. There were no complications related to these procedures. Subjects recorded a total of 32,203 electrocardiograms (380 [335 to 447] per patient) during 12.6 (12.2 to 13.2) months of follow-up. AT recurrence was significantly lower for the repeat study group (17.5% vs. 42.5%; p = 0.03), as was AT burden (p = 0.03). Scores on the Atrial Fibrillation Effect on Quality-of-Life Questionnaire were higher in the repeat study group at 6 months (p < 0.001) and 12 months (p = 0.02). Conclusions: A strategy of routine repeat assessment with re-isolation of PV reconnection improved freedom from AT recurrence, AT burden, and quality of life compared with current standard care. (The Effect of Early Repeat Atrial Fibrillation [AF] on AF Recurrence [PRESSURE]; NCT01942408).
MeSH term(s)	Aged ; Atrial Fibrillation/surgery ; Catheter Ablation/methods ; Electrocardiography, Ambulatory ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Veins/surgery ; Quality of Life ; Recurrence ; Reoperation ; Treatment Outcome
Language	English
Publishing date	2017-03-29
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2017.01.016
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Article ; Online: Effects of angiotensin receptor blockade on atrial electrical remodelling and the 'second factor' in a goat burst-paced model of atrial fibrillation.

Hall, Mark C S / Kirubakaran, Senthil / Choudhury, Rasheda / Abidin, Nik / Peters, Nicholas S / Garratt, Clifford J

Journal of the renin-angiotensin-aldosterone system : JRAAS

2010 Volume 11, Issue 4, Page(s) 222–233

Abstract: Atrial fibrillation (AF) is self-perpetuating, via mechanisms of acute electrical remodelling and 'second factors' acting over a longer time course. Renin-angiotensin system (RAS) blockade may inhibit AF self-perpetuation. We evaluated the effects of RAS ...

Abstract	Atrial fibrillation (AF) is self-perpetuating, via mechanisms of acute electrical remodelling and 'second factors' acting over a longer time course. Renin-angiotensin system (RAS) blockade may inhibit AF self-perpetuation. We evaluated the effects of RAS blockade with candesartan in a burst-paced goat model of lone AF in which both mechanisms are known to operate. Bioactivity of oral candesartan was demonstrated in 10 goats by inhibition of the pressor effect of angiotensin II. The effects of candesartan on electrical remodelling were assessed in 12 placebo and 12 candesartan-treated goats in a 28-day burst pacing protocol. To assess the effects of candesartan on second factors (structural remodelling), 16 goats underwent further 28-day periods of burst pacing (two periods in 16 goats, three periods in eight goats) each separated by periods of sinus rhythm sufficient for electrical remodelling to reverse. There was a progressive rise in angiotensin levels in both groups. Candesartan (0.5 mg/kg/day) achieved a 76% blunting of the pressor effect of angiotensin II and had no effect on electrical remodelling; the half time for fall of atrial effective refractory period (AERP) was 22.3 ± 4.9 h (placebo) and 22.0 ± 3.2 h (candesartan) (p = ns). Candesartan had no effect on AF stability, which progressively increased over successive 28-day periods (ANOVA p < 0.05). Candesartan had no effect on atrial electrical remodelling or the operation of 'second factors' in a goat model of lone AF. These findings suggest that any benefits of RAS blockade in patients with AF are unlikely to be due to direct effects on atrial remodelling.
MeSH term(s)	Angiotensin II/administration & dosage ; Angiotensin II/blood ; Angiotensin II/pharmacology ; Angiotensin Receptor Antagonists/pharmacology ; Animals ; Atrial Fibrillation/physiopathology ; Benzimidazoles/pharmacology ; Disease Models, Animal ; Electrophysiological Phenomena/drug effects ; Female ; Goats ; Heart Atria/drug effects ; Heart Atria/physiopathology ; Receptors, Angiotensin/metabolism ; Tetrazoles/pharmacology ; Time Factors ; Ventricular Function/drug effects
Chemical Substances	Angiotensin Receptor Antagonists ; Benzimidazoles ; Receptors, Angiotensin ; Tetrazoles ; Angiotensin II (11128-99-7) ; candesartan (S8Q36MD2XX)
Language	English
Publishing date	2010-05-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2086948-4
ISSN	1752-8976 ; 1470-3203
ISSN (online)	1752-8976
ISSN	1470-3203
DOI	10.1177/1470320310369604
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Zs.A 5668: Show issues

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Article ; Online: Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study.

DAS, Moloy / Wynn, Gareth J / Morgan, Maureen / Ronayne, Christina / Waktare, Johan E P / Todd, Derick M / Hall, Mark C S / Snowdon, Richard L / Modi, Simon / Gupta, Dhiraj

Journal of cardiovascular electrophysiology

2016 Volume 27, Issue 4, Page(s) 381–389

Abstract: Introduction: Acute reconnection of pulmonary veins (PVs) is frequently seen in the waiting period following pulmonary vein isolation (PVI). There are concerns that reablation at these sites may not be durably effective due to tissue edema caused by the ...

Abstract	Introduction: Acute reconnection of pulmonary veins (PVs) is frequently seen in the waiting period following pulmonary vein isolation (PVI). There are concerns that reablation at these sites may not be durably effective due to tissue edema caused by the initial ablation. We aimed to prospectively study the relationship between acute and late reconnection. Methods and results: Wide-area circumferential PVI was performed in 40 paroxysmal AF patients. Spontaneous reconnection was assessed after a minimum 20-minute waiting period, with adenosine administered to unmask dormant reconnection. All sites of acute reconnection were ablated to reisolate the PV. All 40 patients then underwent repeat electrophysiology study after 2 months, regardless of symptoms, to identify late reconnection. Sites of acute and late reconnection were compared according to a 12-segment PVI model. Acute reconnection was seen in 28 (6%) PVI segments in 20 (50%) patients, affecting 24/160 (15%) PVs. All were successfully reisolated. At repeat electrophysiology study, 51 (11%) PVI segments were reconnected in 25 (62%) patients, affecting 41 (25%) PVs. The proportion of PVI segments with and without acute reconnection exhibiting late reconnection at repeat study was no different (14% vs. 10%, P = 0.524). There was also no difference in late reconnection between PVI circles or patients with and without acute reconnection. Conclusion: Most PVI segments that undergo further ablation for acute reconnection show persistent isolation at repeat electrophysiology study, and the rate of late reconnection for these segments is no different to that for segments that did not acutely reconnect. This implies that effective reablation is delivered at these sites.
MeSH term(s)	Acute Disease ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/prevention & control ; Atrial Fibrillation/surgery ; Body Surface Potential Mapping/methods ; Catheter Ablation/methods ; Electrophysiologic Techniques, Cardiac/methods ; Female ; Heart Conduction System/physiopathology ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Veins/surgery ; Recurrence ; Reoperation/methods ; Treatment Outcome
Language	English
Publishing date	2016-04
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.12933
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Zs.A 2863: Show issues

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Article ; Online: Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values.

Das, Moloy / Loveday, Jonathan J / Wynn, Gareth J / Gomes, Sean / Saeed, Yawer / Bonnett, Laura J / Waktare, Johan E P / Todd, Derick M / Hall, Mark C S / Snowdon, Richard L / Modi, Simon / Gupta, Dhiraj

2016 Volume 19, Issue 5, Page(s) 775–783

Abstract: Aims: Force-Time Integral (FTI) is commonly used as a marker of ablation lesion quality during pulmonary vein isolation (PVI), but does not incorporate power. Ablation Index (AI) is a novel lesion quality marker that utilizes contact force, time, and ... ...

Abstract	Aims: Force-Time Integral (FTI) is commonly used as a marker of ablation lesion quality during pulmonary vein isolation (PVI), but does not incorporate power. Ablation Index (AI) is a novel lesion quality marker that utilizes contact force, time, and power in a weighted formula. Furthermore, only a single FTI target value has been suggested despite regional variation in left atrial wall thickness. We aimed to study AI's and FTI's relationships with PV reconnection at repeat electrophysiology study, and regional threshold values that predicted no reconnection. Methods and results: Forty paroxysmal atrial fibrillation patients underwent contact force-guided PVI, and the minimum and mean AI and FTI values for each segment were identified according to a 12-segment model. All patients underwent repeat electrophysiology study at 2 months, regardless of symptoms, to identify sites of PV reconnection. Late PV reconnection was seen in 53 (11%) segments in 25 (62%) patients. Reconnected segments had significantly lower minimum AI [308 (252-336) vs. 373 (323-423), P < 0.0001] and FTI [137 (92-182) vs. 228 (157-334), P < 0.0001] compared with non-reconnected segments. Minimum AI and FTI were both independently predictive, but AI had a smaller P value. Higher minimum AI and FTI values were required to avoid reconnection in anterior/roof segments than for posterior/inferior segments (P < 0.0001). No reconnection was seen where the minimum AI value was ≥370 for posterior/inferior segments and ≥480 for anterior/roof segments. Conclusion: The minimum AI value in a PVI segment is independently predictive of reconnection of that segment at repeat electrophysiology study. Higher AI and FTI values are required for anterior/roof segments than for posterior/inferior segments to prevent reconnection.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Body Surface Potential Mapping/methods ; Diagnosis, Computer-Assisted/methods ; Female ; Heart Conduction System/surgery ; Humans ; Male ; Middle Aged ; Outcome Assessment, Health Care/methods ; Pulmonary Veins/surgery ; Reproducibility of Results ; Sensitivity and Specificity ; Treatment Outcome
Language	English
Publishing date	2016-05-30
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euw105
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Zs.A 5434: Show issues

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Article ; Online: Recurrence of atrial tachyarrhythmia during the second month of the blanking period is associated with more extensive pulmonary vein reconnection at repeat electrophysiology study.

Das, Moloy / Wynn, Gareth J / Morgan, Maureen / Lodge, Ben / Waktare, Johan E P / Todd, Derick M / Hall, Mark C S / Snowdon, Richard L / Modi, Simon / Gupta, Dhiraj

Circulation. Arrhythmia and electrophysiology

2015 Volume 8, Issue 4, Page(s) 846–852

Abstract: Background: Current guidelines recommend a 3-month blanking period after pulmonary vein isolation (PVI) as early recurrence of atrial tachyarrhythmia (ERAT) may be due to transient proarrhythmic factors. However, studies have suggested that these ... ...

Abstract	Background: Current guidelines recommend a 3-month blanking period after pulmonary vein isolation (PVI) as early recurrence of atrial tachyarrhythmia (ERAT) may be due to transient proarrhythmic factors. However, studies have suggested that these factors resolve by 1 month. PV reconnection (PVrc) is strongly associated with postblanking AT recurrence in paroxysmal atrial fibrillation. We hypothesized that ERAT occurring beyond 4 weeks after PVI is associated with PVrc at repeat electrophysiology study. Methods and results: Forty patients with paroxysmal atrial fibrillation underwent mandatory repeat electrophysiology study 2 months after PVI, regardless of symptoms, to document the number of reconnected PVs. Antiarrhythmic drugs, including β-blockers, were discontinued 4 weeks after PVI. Patients were instructed to record a 30-second ECG everyday between the 2 procedures using a portable monitor, with additional recordings for symptoms. ERAT was defined as ≥30 seconds of AT. Patients recorded a total of 3293 ECGs. Four (10%) patients had ERAT in the first 4 weeks (M1) only, 2 (5%) in month 2 (M2) only, and 11 (28%) in both. PVrc of 1 PV was identified in 12 (30%) patients and of >1 PV in 13 (32%) patients. ERAT in M2 was associated with PVrc, whereas M1 was not (11/13 [85%] versus 0/4 [0%]; P=0.006). M2 ERAT was strongly associated with PVrc of >1 PV (10/13 [77%] versus 3/27 [11%] without M2 ERAT; P<0.0001). Conclusions: ERAT occurring beyond 4 weeks after PVI is associated with PVrc and particularly of PVrc of >1 PV. ERAT confined to M1 is unrelated to underlying PVrc. The relationship between ERAT beyond 4 weeks after PVI and postblanking AT recurrence merits further investigation.
MeSH term(s)	Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Catheter Ablation/methods ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pulmonary Veins/surgery ; Recurrence ; Tachycardia, Paroxysmal/drug therapy ; Tachycardia, Paroxysmal/physiopathology ; Tachycardia, Paroxysmal/surgery ; Time Factors ; Treatment Outcome
Chemical Substances	Anti-Arrhythmia Agents
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2426129-4
ISSN	1941-3084 ; 1941-3149
ISSN (online)	1941-3084
ISSN	1941-3149
DOI	10.1161/CIRCEP.115.003095
Database	MEDical Literature Analysis and Retrieval System OnLINE

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