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Articles by R. A Schweikert
Total Records ( 5 ) for R. A Schweikert
  L Di Biase , J. D Burkhardt , P Mohanty , J Sanchez , S Mohanty , R Horton , G. J Gallinghouse , S. M Bailey , J. D Zagrodzky , P Santangeli , S Hao , R Hongo , S Beheiry , S Themistoclakis , A Bonso , A Rossillo , A Corrado , A Raviele , A Al Ahmad , P Wang , J. E Cummings , R. A Schweikert , G Pelargonio , A Dello Russo , M Casella , P Santarelli , W. R Lewis and A. Natale

Background— Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation.

Methods and Results— Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71% nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation were enrolled. Two hundred sixty-six patients (27%) showed firing from the LAA and became the study population. In 86 of 987 patients (8.7%; 5 paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of arrhythmia with no pulmonary veins or other extrapulmonary vein site reconnection. Ablation was performed either with focal lesion (n=56; group 2) or to achieve LAA isolation by placement of the circular catheter at the ostium of the LAA guided by intracardiac echocardiography (167 patients; group 3). In the remaining patients, LAA firing was not ablated (n=43; group 1). At the 12±3-month follow-up, 32 patients (74%) in group 1 had recurrence compared with 38 (68%) in group 2 and 25 (15%) in group 3 (P<0.001).

Conclusions— The LAA appears to be responsible for arrhythmias in 27% of patients presenting for repeat procedures. Isolation of the LAA could achieve freedom from atrial fibrillation in patients presenting for a repeat procedure when arrhythmias initiating from this structure are demonstrated.

  L Di Biase , L. C Saenz , D. J Burkhardt , M Vacca , C. S Elayi , C. D Barrett , R Horton , R Bai , A Siu , T. S Fahmy , D Patel , L Armaganijan , C. T Wu , S Kai , C. K Ching , K Phillips , R. A Schweikert , J. E Cummings , M Arruda , W. I Saliba , M Dodig and A. Natale

Background— Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation.

Methods and Results— Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6±1°C versus 39.6±0.8°C; P< 0.003). The time to peak temperature was 9±7 seconds in group 1 and 21±9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination.

Conclusion— The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.

  L Di Biase , C. S Elayi , T. S Fahmy , D. O Martin , C. K Ching , C Barrett , R Bai , D Patel , Y Khaykin , R Hongo , S Hao , S Beheiry , G Pelargonio , A. D Russo , M Casella , P Santarelli , D Potenza , R Fanelli , R Massaro , P Wang , A Al Ahmad , M Arruda , S Themistoclakis , A Bonso , A Rossillo , A Raviele , R. A Schweikert , D. J Burkhardt and A. Natale

Background— Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF.

Methods and Results— One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs.

Conclusion— No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF.


More patients are asking their physicians about radiofrequency ablation. Although it has shown promising clinical results, some patients may have unrealistic expectations.

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