By Jonathan S. Steinberg MD, Suneet Mittal MD
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Additional info for Electrophysiology: The Basics: A Companion Guide for the Cardiology Fellow during the EP Rotation
The strongest association is found with mitral stenosis, and a less potent association is seen with mitral regurgitation. Although the risk of developing AF long-term is relatively small with FIGURE 3-1. The age-related prevalence of AF relative to the US population. (Reprinted from Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med. indd 37 8/1/2009 6:43:26 PM 38 SECTION I TABLE 3-1 | Evaluation and Management Conditions Associated with AF Cardiovascular Hypertension Valvular heart disease Coronary heart disease and MI Pericardial disease Congenital heart disease Cardiomyopathy and heart failure Electrical conditions (sick sinus syndrome, WPW, familial) Postcardiac surgery Noncardiovascular Pulmonary Sepsis Central nervous system Autonomic (vagal, adrenergic) Hyperthyroidism Post-noncardiac surgery Toxin exposure (alcohol) Idiopathic MI, myocardial infarction.
Electrogram criteria have also been used to identify appropriate target sites for ablation of concealed pathway and include (i) retrograde AP potential, (ii) retrograde continuous electrical activity with ventricular pacing or during tachycardia, and (iii) electrogram stability. Left free wall pathways constitute the majority of APs and successful ablation requires detailed mapping of the lateral mitral annulus. Ablation can be guided by the CS catheter that is used to bracket the pathway’s location.
In patients without structural heart disease, susceptibility to subsequent atrial fibrillation is low (6% to 10%) after successful AP ablation. However, despite successful pathway ablation, some patients still have recurrence of their atrial fibrillation. The characteristics of these patients include (i) older age (>50 years old), (ii) a history of paroxysmal atrial fibrillation and presence of structural heart disease, (iii) no antegrade conduction in the AP, (iv) slow ventricular response during atrial fibrillation, and (v) inducible atrial fibrillation after AP ablation.
Electrophysiology: The Basics: A Companion Guide for the Cardiology Fellow during the EP Rotation by Jonathan S. Steinberg MD, Suneet Mittal MD