Natale / Jalife Atrial Fibrillation

From Bench to Bedside
1. Auflage 2008
ISBN: 978-1-59745-163-5
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 453 Seiten

Reihe: Contemporary Cardiology

This important new book presents advancements in the treatment and prevention of Atrial Fibrillation (AF). The reader is provided with the latest information that is critically important in the daily care and for the potential cure of patients with AF. Each chapter deals with a different aspect of AF and each chapter is authored by internationally recognized experts in the evolving field of cardiac electrophysiology. This book is a single source that provides a multi-perspective look at and approach to AF. Because AF is so prevalent and affects all areas of medicine, the information in this book will be useful to all those in the medical field.

Autoren/Hrsg.

Natale, Andrea

Jalife, José

Jalife, Jose

Inhaltsverzeichnis

1;Preface;7
2;Acknowledgment;9
3;Contents;11
4;Contributors;15
5;Introduction: Epidemiology of Atrial Fibrillation and Impact on Health System;23
5.1;Epidemiology of Atrial Fibrillation;24
5.1.1;Prevalence;25
5.1.2;Incidence;28
5.1.3;References;29
5.2;Economic Costs Associated with Atrial Fibrillation;34
5.2.1;Economic Considerations;35
5.2.2;Atrial Fibrillation Evaluation and Treatment;39
5.2.3;Future Directions;42
5.2.4;References;43
5.2.5;Introduction;48
5.3;Cost-Effectiveness of Catheter Ablation for Atrial Fibrillation;48
5.3.1;Cost-Effectiveness Analysis;49
5.3.2;Cost-Effectiveness of Pharmacological Rhythm vs Rate Control Strategies;49
5.3.3;Cost-Effectiveness of Radio-Frequency Ablation of Atrial Fibrillation;49
5.3.4;Conclusions;52
5.3.5;References;53
6;Pathophysiology, Molecular Mechanisms, and Genetics of Atrial Fibrillation;56
6.1;Cellular Electrophysiology and the Substrate for Atrial Fibrillation;58
6.1.1;Basics of Normal Atrial Cellular Electrophysiology;58
6.1.2;Acquired Substrates for Atrial Fibrillation;61
6.1.3;Genetic Substrates for Atrial Fibrillation;67
6.1.4;Conclusions;70
6.1.5;References;70
6.2;Electrical and Structural Remodeling in Atrial Fibrillation;78
6.2.1;Atrial Electrophysiological Remodeling;79
6.2.2;Summary and Future Directions;85
6.2.3;References;85
6.3;Genetics of Atrial Fibrillation: The Clinician’s Perspective;90
6.3.1;Introduction;90
6.3.2;Molecular Mechanisms in Atrial Fibrillation;91
6.3.3;Genetic Studies: Implications for the Future;94
6.3.4;References;95
6.4;Dominant Frequency Mapping to Assess the Consequences of Remodeling in the Mechanism of Atrial Fibrillation;98
6.4.1;Introduction;99
6.4.2;Mechanisms of Atrial Fibrillation;99
6.4.3;Paroxysmal and Persistent Atrial Fibrillation;100
6.4.4;Acute Atrial Fibrillation: The Sheep Heart Model;101
6.4.5;Role of Atrial Structure;104
6.4.6;Role of Dispersion of Action Potential Duration and Refractoriness;105
6.4.7;Atrial Fibrillation in Chronically Instrumented Animal Models;107
6.4.8;Activation Rate in Atrial Fibrillation;107
6.4.9;Radio-Frequency Ablation of Atrial Fibrillation;108
6.4.10;Cycle Length During Atrial Fibrillation in Humans;110
6.4.11;Mapping Dominant Frequencies in Patients with Atrial Fibrillation;111
6.4.12;How Stable Is Atrial Fibrillation and How Reliable Is Dominant Frequency Mapping?;114
6.4.13;References;115
6.5;Intracellular Calcium Dynamics and Atrial Fibrillation;122
6.5.1;Automaticity, Triggered Activity, and Reentry;123
6.5.2;Electrophysiological Remodeling and Atrial Dysfunction in Atrial Fibrillation;123
6.5.3;Intracellular Calcium Overload and Atrial Fibrillation;124
6.5.4;Spontaneous Electrical Activities of the Pulmonary Veins;125
6.5.5;Pacemaking Cells in the Pulmonary Veins;125
6.5.6;Cellular Electrophysiology of Pulmonary Vein Cardiomyocytes;126
6.5.7;Mechanisms of Focal Activities Underlying Pulmonary Vein Arrhythmogenesis of Atrial Fibrillation;127
6.5.8;Dual-Optical Mapping of Canine Pulmonary Veins;127
6.5.9;Late Phase 3 Early Afterdepolarization Contributing to Initiation of Atrial Fibrillation;129
6.5.10;Conclusion;130
6.5.11;References;131
6.5.12;Introduction;136
6.6;Role of the Vagus in AF;136
6.6.1;The Cardiac Autonomic Nervous System;137
6.6.2;Pathophysiology of Vagal Control in Atrial Fibrillation;138
6.6.3;Vagal Denervation and Inducibility of Atrial Fibrillation;140
6.6.4;Vagal Denervation and Postoperative Atrial Fibrillation;143
6.6.5;Vagal Nerve Stimulation: A Novel Strategy for Ventricular Rate Control During Atrial Fibrillation;144
6.6.6;Conclusion;146
6.6.7;References;147
6.7;Atrial Fibrillation Genetic Considerations: The Basic Scientist’s Perspective;154
6.7.1;Introduction;154
6.7.2;Genetic Component of Atrial Fibrillation;155
6.7.3;Classification of Atrial Fibrillation Genes: Disease-Causing Genes, Susceptibility Genes, and Disease- Linked Genes;156
6.7.4;Genomewide Single Nucleotide Polymorphism Association Studies;160
6.7.5;Future Perspectives;160
6.7.6;References;161
7;Medical Treatment in Atrial Fibrillation;166
7.1;Review of Recent Trials of Medical Therapy for Atrial Fibrillation;168
7.1.1;Introduction;168
7.1.2;Trials of Pharmacological Rate Control;169
7.1.3;Trials of Pharmacological Rhythm Control;172
7.1.4;Trials of Pharmacological Rate vs Rhythm Control;180
7.1.5;Summary and Conclusions;185
7.1.6;References;185
7.2;Antithrombotic Treatment and Cardioversion of Patients with Atrial Fibrillation;190
7.2.1;Stroke Risk in Atrial Fibrillation;190
7.2.2;Warfarin;193
7.2.3;Anticoagulation for Acute Stroke;197
7.2.4;Bridging Antithrombotic Therapy;197
7.2.5;Aspirin;198
7.2.6;Implementation of Trial Evidence to Clinical Practice;199
7.2.7;The Future;201
7.2.8;References;201
7.3;Current Role of Medical Therapy for Prevention or Termination of Atrial Fibrillation;206
7.3.1;Antiarrhythmic Drugs to Prevent Atrial Fibrillation;207
7.3.2;Currently Available Agents for Long-Term Use;207
7.3.3;Adverse Effects of Antiarrhythmic Drugs;208
7.3.4;Inhibition of the Renin–Angiotensin System for the Prevention of Atrial Fibrillation;209
7.3.5;Pharmacological Cardioversion;210
7.3.6;The Pill-in-the-Pocket Concept;211
7.3.7;Newer Agents;212
7.3.8;Conclusions;213
7.3.9;References;213
8;Atrial Fibrillation Ablation;218
8.1;Applied Cardiac Anatomy for Catheter Ablation of Atrial Fibrillation;220
8.1.1;Introduction;220
8.1.2;Anatomy of the Atrial Septum and Transseptal Catheterization;220
8.1.3;Anatomy of the Atria and the Pulmonary Veins;224
8.1.4;Anatomy of the Major Structures Surrounding the Heart;225
8.1.5;Conclusion;227
8.1.6;References;227
8.2;Selection of Ablation Catheters, Energy Sources, and Power Delivery;230
8.2.1;Introduction;230
8.2.2;Evolution of Technology;232
8.2.3;Radio-Frequency Ablation;232
8.2.4;Cryoablation;235
8.2.5;High-Intensity Focused Ultrasound;237
8.2.6;Other Energy Sources and Approaches for Lesion Formation;238
8.2.7;References;240
8.3;Anatomically Guided Catheter Ablation for Atrial Fibrillation;244
8.3.1;Mechanistic Background;244
8.3.2;Clinical Applications;246
8.3.3;Conclusions;252
8.3.4;References;252
8.4;Chronic Atrial Fibrillation and Catheter Ablation;258
8.4.1;Introduction;259
8.4.2;Techniques and Strategies for Chronic Atrial Fibrillation Ablation;259
8.4.3;Conclusion;264
8.4.4;References;264
8.5;Hybrid Strategies for Ablation of Permanent AF;266
8.5.1;Adjunctive Strategies to Improve Long-Term Outcome of Atrial Fibrillation Ablation;267
8.5.2;Clinical Implications;272
8.5.3;References;273
8.6;Isolation of Pulmonary Vein Antrum Triggers;276
8.6.1;Introduction;276
8.6.2;Pathophysiology of the Pulmonary Veins in the Triggering and Maintenance of Atrial Fibrillation;277
8.6.3;Anatomy of the Pulmonary Vein Antrum;278
8.6.4;Evolution in the Technique of Pulmonary Vein Isolation;280
8.6.5;Pulmonary Vein Antrum Isolation Technique;281
8.6.6;Efficacy of Pulmonary Vein Antrum Isolation;288
8.6.7;Relationship of Recurrence to Pulmonary Vein–Left Atrium Reconnection;290
8.6.8;Conclusions;290
8.6.9;References;291
8.7;Complications and Definition of Success;296
8.7.1;Complications;296
8.7.2;Definitions of Success for Atrial Fibrillation Ablation;302
8.7.3;References;304
8.8;Strategies on How to Diagnose, Prevent, and Treat Pulmonary Vein Stenosis;312
8.8.1;Introduction;313
8.8.2;Pulmonary Vein Injury;313
8.8.3;Diagnosis and Pulmonary Vein Stenosis;314
8.8.4;Interventional Approach to Pulmonary Vein Stenosis;318
8.8.5;Asymptomatic Stenosis;322
8.8.6;Risk of Intervention for Pulmonary Vein Stenosis;323
8.8.7;Conclusion;323
8.8.8;References;323
9;Surgery for Atrial Fibrillation;328
9.1;Ablation of Atrial Fibrillation with Cardiac Surgery;330
9.1.1;Introduction;330
9.1.2;Rationale for Surgical Ablation;331
9.1.3;The Maze Procedure;333
9.1.4;New Approaches to Surgical Ablation of Atrial Fibrillation;335
9.1.5;The Left Atrial Appendage;338
9.1.6;Challenges and Future Directions;339
9.1.7;Conclusions;340
9.1.8;References;340
9.2;Epicardial Atrial Fibrillation Ablation;344
9.2.1;Introduction;344
9.2.2;Concepts Behind Epicardial Approach to Atrial Fibrillation Ablation;345
9.2.3;Experimental Studies;347
9.2.4;Early Clinical Results;348
9.2.5;Limitations to Epicardial Approach;349
9.2.6;Future Directions;350
9.2.7;References;351
9.2.8;Introduction;354
9.3;Minimally Invasive Surgical Treatment of Atrial Fibrillation;354
9.3.1;Minimally Invasive Epicardial Ablation;354
9.3.2;References;359
10;Imaging, Technologies, and Associated Arrhythmias;360
10.1;CT and MR Images in Atrial Fibrillation;362
10.1.1;Introduction;362
10.1.2;Anatomic Characteristics of Pulmonary Veins;363
10.1.3;Anatomic Relationship Between the Left Atrium, Esophagus, and Adjacent Vascular Structures;364
10.1.4;Morphological Remodeling of Pulmonary Veins and Left Atrium in Patients with Atrial Fibrillation;365
10.1.5;Detection of Complications After Catheter Ablation;366
10.1.6;Conclusion;366
10.1.7;References;366
10.2;Integrative Approaches to Imaging;370
10.2.1;Fluoroscopy;371
10.2.2;Computed Tomography;372
10.2.3;Magnetic Resonance Imaging;376
10.2.4;Intracardiac Echocardiography;376
10.2.5;Nonfluoroscopic Three-Dimensional Catheter Navigation and Mapping;378
10.2.6;Image Integration;379
10.2.7;Conclusions;380
10.2.8;References;380
10.3;Novel Balloon Catheter Technologies for Pulmonary Vein/ Antrum Isolation;384
10.3.1;High-Intensity Focused Ultrasound Balloon Catheter;385
10.3.2;Endoscopic Laser Balloon Catheter;395
10.3.3;Cryothermal Balloon Catheter;400
10.3.4;Summary;402
10.3.5;References;402
10.4;Remote Catheter Navigation;406
10.4.1;Background;406
10.4.2;Remote Magnetic Navigation;407
10.4.3;Remote Robotic Navigation;412
10.4.4;Conclusion;416
10.4.5;References;416
10.5;Insight into the Pathophysiology of Atrial Flutter and Its Relationship to Atrial Fibrillation;418
10.5.1;Introduction;418
10.5.2;Spontaneous Conversion;419
10.5.3;As a Result of Medications;419
10.5.4;As a Result of Ablation or Surgery;419
10.5.5;Common Triggers;420
10.5.6;Conclusion;420
10.5.7;References;420
10.6;Ablation Strategies for Left Atrial Flutter;422
10.6.1;Introduction;422
10.6.2;Definition of Left Atrial Flutter;423
10.6.3;Incidence;423
10.6.4;Identification of Left Atrial Flutter;425
10.6.5;Mechanisms of Left Atrial Flutter Postprocedure;426
10.6.6;Management /Approach to the Patient with Suspected Left Atrial Flutter;428
10.6.7;Ablative Procedure for Post-Atrial Flutter Ablation Tachycardias;429
10.6.8;Prognosis;435
10.6.9;Complications;436
10.6.10;Conclusion;437
10.6.11;References;437
10.6.12;Ablation Strategies for Left Atrial Flutter ;440
10.6.13;Case 1;440
10.6.14;Case 2;444
11;Future Directions in Atrial Fibrillation;448
11.1;Atrial Fibrillation: Future Directions;450
11.1.1;Better Understanding the Mechanism of Atrial Fibrillation;451
11.1.2;Rhythm Control of Atrial Fibrillation;453
11.1.3;Rate Control of Atrial Fibrillation ( Drugs and Implantable Devices);459
11.1.4;Prevention of Thromboembolism;460
11.1.5;Conclusion;460
11.1.6;References;461
12;Index;466