Practical Guide to Catheter Ablation of Atrial Fibrillation

Now in its second edition, this practical guide offers clear-headed guidance to the successful application of catheter ablation for atrial fibrillation. This book concentrates on clinically-relevant information that providers can put to immediate use caring for patients.

• Takes a clear-headed practical approach to ablation of atrial fibrillation – long on actionable, clinically-relevant guidance, succinct and to-the-point on the theory behind the procedure
• Edited by three leading, internationally-known electrophysiologists with extensive experience in ablation for atrial fibrillation
• Written by international team of experts reflecting global best practices from centers with considerable experience in the use of catheter ablation
• Format designed to serve the needs of electrophysiologists regardless of experience, electrophysiology fellows, electrophysiology nurses and lab technical staff
• Covers hot topics such as new noninvasive imaging techniques, the treatment of challenging left atrial flutters, options for persistent atrial fibrillation and when a redo ablation is needed; and novel application of ablation targeting the autonomic nervous system

Jonathan S. Steinberg, MD, Adjunct Professor of Medicine, University of Rochester School of Medicine and Dentistry; Director, The Arrhythmia Institute, The Valley Health System, New York, NY and Ridgewood, NJ, USA.
Professor Jonathan S. Steinberg has helped produce many of the seminal and innovative clinical trials in electrophysiology, with a recent specific focus on the technical and clinical aspects of catheter ablation of atrial fibrillation. He is the author of more than 180 peer-reviewed publications and 250 abstracts, an editorial board member or regular reviewer for numerous journals, and is part of the American Board of Internal Medicine Clinical Cardiac Electrophysiology Committee. He continues to have an active clinical practice, managing patients with complex arrhythmias who require catheter ablation.

Pierre Jais, M.D., Professor, Department of Cardiology, Universite Victor Segalen-Bordeaux 2 and Hopital Cardiologique du Haut-Leveque, Bordeaux, France.
Pierre Jais is Professor at the Cardiology Hospital, Pessac, France, working with Michel Haissaguerre in the Rhythmology and Cardiac Stimulation Department. With this group he has pioneered AF ablation. He is a regular contributor at national and international symposia (240 communications) and has written many journal articles, mainly on electrophysiology and RF catheter ablation, particularly focusing on atrial and ventricular arrhythmias (412 journal publications, 38 as first author).

Hugh Calkins, M.D., F.A.C.C., FHRS, FAHA.

Nicholas J. Fortuin, M.D., Professor of Cardiology; Professor of Medicine; Director, Cardiac Arrhythmia Services and Electrophysiology Laboratory; Director, Johns Hopkins ARVD/C Program, Baltimore, MD, USA.

Dr Hugh Calkins is the Nicholas J. Fortuin M.D. Professor of Cardiology and Professor of Medicine at the Johns Hopkins University School of Medicine. He also is the Director of the Clinical Electrophysiology Laboratory, the Atrial Fibrillation Center, and the Arrhythmia Service at the Johns Hopkins Hospital. Dr Calkins has published more 500 articles and book chapters. He has lectured extensively throughout the world. The focus of his research efforts have been on atrial fibrillation, and catheter ablation. Dr Calkins is on the editorial board of the Journal of the American College of Cardiology, Circulation, Heart Rhythm, the Journal of Interventional Electrophysiology, and Circulation Arrhythmia and Electrophysiology. He is a past President of the Heart Rhythm Society.

Contributors, vii

1 Indications for Catheter and Surgical Ablation of Atrial Fibrillation, 1
Hugh Calkins

2 Catheter Ablation for Atrial Fibrillation: Past, Present, and Future, 7
David Spragg & Hugh Calkins

3 Staffing, Training, and Ongoing Volume Requirements, 17
Mehdi Namdar & Dipen Shah

4 Equipment Options for the Ablation of Atrial Fibrillation, 23
German Kamalov & John D. Hummel

5 Preprocedure Preparation for Catheter-based Ablation of Atrial Fibrillation, 33
Jose F. Huizar & Kenneth A. Ellenbogen

6 Intracardiac Ultrasound, 49
Dan L. Musat, Jayanthi N. Koneru, Scott W. Burke, Farooq A. Chaudhry, & Jonathan S. Steinberg

7 Electroanatomic Mapping Systems, 65
Carlos Macias, Olujimi Ajijola, Kalyanam Shivkumar, & Eric Buch

8 Magnetic and Robotic Catheter Navigation, 75
John M. Miller, Mark A. Dixon, Deepak Bhakta, Rahul Jain, & Mithilesh K. Das

9 MRI-guided Procedures, 85
Henry Halperin & Aravindan Kolandaivelu

10 MRI Definition of Atrial Substrate, 101
Leenhapong Navaravong & Nassir F. Marrouche

11 The Utility of Noninvasive Mapping in Persistent Atrial Fibrillation Ablation, 109
Han S. Lim, Stephan Zellerhoff, Nicolas Derval, Seigo Yamashita, Darren Hooks, Benjamin Berte, Saagar Mahida, Arnaud Denis, Ashok. J. Shah, Frédéric Sacher, Mélèze Hocini, Pierre Jaïs, & Michel Haïssaguerre

12 Interpretation of Circular Mapping Catheter Recordings, 119
Laurent Macle & Jason G. Andrade

CONTROVERSY: Differing Energy Sources – the Use of Radiofrequency Energy, 131
Suneet Mittal

CONTROVERSY: Differing Energy Sources/Use of Cryo-energy, 137
Pipin Kojodjojo & D. Wyn Davies

13 Circumferential Ablation with Pulmonary Vein Isolation Guided by Lasso Catheter, 145
A. Metzner, K. Satomi, K.-H. Kuck, & F. Ouyang

CONTROVERSY: Circumferential versus Segmental Pulmonary Vein Isolation/Circumferential PVI, 176
R. Proietti, L. Di Biase, P. Santangeli, P. Mohanty, C. Barrett, S. Danik, S. Mohanty, R. Bai, C. Trivedi, J.D. Burkhardt, & A. Natale

CONTROVERSY: Circumferential versus Segmental Pulmonary Vein Isolation/Segmental PVI, 183
Gregory K. Feld

14 How to Select Target Sites in Electrogram-guided Ablation: Options, Techniques, and Results, 191
Anand N. Ganesan, Dennis H. Lau, & Prashanthan Sanders

CONTROVERSY: Electrogram-guided Ablation: Valuable Technique, 206
Naoya Oketani & Koonlawee Nademanee

CONTROVERSY: Electrogram-guided Ablation: Limited Contribution to Successful Outcome, 215
Hatice Duygu Bas, Kazim Baser, & Hakan Oral

15 Left Atrial Linear Lesions, 221
Stephan Zellerhoff, Han S. Lim, & Pierre Jaïs

16 Ablation of Autonomic Ganglia, 229
Evgeny Pokushalov & Jonathan S. Steinberg

17 Trigger Mapping, 245
Pasquale Santangeli & Francis E. Marchlinski

18 Mapping and Ablation of Electrical Rotor and Focal Sources for Atrial Fibrillation: A Patient-tailored Mechanistic
Approach, 271
Junaid A. B. Zaman, Siva K. Mulpuru, David E. Krummen, & Sanjiv M. Narayan

19 Renal Artery Denervation: Modulation of the Autonomic Nervous System to Treat Atrial Fibrillation, 283
Evgeny Pokushalov & Jonathan S. Steinberg

20 The Stepwise Ablation Approach for Persistent Atrial Fibrillation, 293
Han S. Lim, Stephan Zellerhoff, & Pierre Jaïs

21 Limited Ablation for Persistent Atrial Fibrillation Using Preprocedure Reverse Remodeling, 303
David J. Slotwiner & Jonathan S. Steinberg

22 Long-standing Persistent Atrial Fibrillation Ablation, 315
Luigi Di Biase, Pasquale Santangeli, Alessandro Paoletti Perini, Francesco Santoro, Rong Bai, Javier E. Sanchez, Rodney Horton, John David Burkhardt, & Andrea Natale

23 Mapping and Ablation of Left Atrial Flutter, 323
Matthew Daly, Yuki Komatsu, & Pierre Jaïs

24 Follow-up After Ablation: Assessing Success, Symptom Status, and Recurrent Arrhythmias, 333
Simon Kircher, Charlotte Eitel, & Gerhard Hindricks

25 How to Strategize the “Redo” Ablation Procedure, 343
Jeffrey S. Arkles & David J. Callans

26 Periprocedural Care for Catheter Ablation of Atrial Fibrillation, 351
Chirag Barbhaiya, Justin Ng, & Gregory F. Michaud

27 Complications: Early and Late After Ablation, 361
Antonio Sorgente & Riccardo Cappato

28 Charting Long-term Success and the Challenge of Monitoring Outcomes, 371
Isabel Deisenhofer

Index, 381

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