Catheter ablation of atrial fibrillation: an update

Catheter ablation of atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. There is considerable evidence available from several prospective randomized trials demonstrating that catheter ablation of AF is superior to antiarrhythmic drug therapy in controlling AF and that AF ablation improves quality of life substantially. This is especially true for patients with paroxysmal AF without other severe comorbidities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed. Although current guidelines state that is appropriate to perform catheter ablation as a first-line therapy in selected patients, in our clinical practice this is rare. This reflects a number of important realities concerning the field of AF ablation. Catheter ablation of AF is a challenging and complex procedure, which is not free of the risk of potentially life-threatening complications, such as an atrio-oesophageal fistula, stroke, and cardiac tamponade. Although these major complications are rare and their rate is falling, they must be considered by both patients and physicians. The progress made and the new developments on the horizon in the field of AF catheter ablation are remarkable. When radiofrequency catheter ablation was first introduced in the late 1980s, few would have predicted that catheter ablation of AF would emerge as the most commonly performed ablation procedure in most major hospital

A Report on Snowflake

Excerpts: The Snowflake area, as here defined, lies within the drainage basin of Silver Creek which rises in the Sitgreaves National Forest and flows roughly northward, joining the Little Colorado River fifteen miles above Holbrook. The principal concentration of agricultural land with in the area extends for about nine miles along Silver Creek just north of the forest boundary, and includes 2000 acres of irrigated land. The population of this irrigated strip is concentrated for the most part in the three settlements of Snowflake, Taylor and Shumway. Together, these include about 1000 people or 225 families (Within this paper the name Snowflake will be used to designate these three settlements.

Tenant Herding in the Cuba Valley (New Mexico)

Excerpts: As it is generally understood, tenancy relates primarily to the use, under varying contractual arrangements of non-ownership, of agricultural land. In urban areas it refers principally to the renting of homes. In a range area it is concerned with the leasing of land and the renting of livestock. It is this last form of tenancy that is here called tenant herding. Tenant herding in the Cuba Valley is a contractual agreement between a large sheep owner (Bond, in this case) and about twenty-five tenants whereby these tenants agree to run sheep on a rental basis. Bond supplies breeding herds varying from a few hundred to 2,100 sheep

Notes on Community-Owned Land Grants in New Mexico

Excerpt from the Introduction: The land grants of New Mexico have long been the subject of considerable interest on the part of lawyers, livestock and lumber companies, governmental agencies, and the native resident owners and users. These grants, ranging in size from a few thousand to ever a million acres were originally made by the Spanish Crown and the Government of Mexico. By the treaty of Guadalupe Hidalgo in 1848 the United States agreed to recognize and protect the titles to these grants. The inadequacies of the supporting documents and the absence of careful surveys resulted in long drawn-out litigation before titles to most of the grants were confirmed. The following pages contain the information gathered on four land grants: The Canyon de San Diego Grant which was lost to its original community owners through litigation and sale marked by certain peculiarities; the Jacona Grant which was lost and repurchased and is now commonly owned and used; the Cundiyo Grant which is community owned and used; and the La Joya Grant which was lost by its community owners in a tax sale to Thomas D. Campbell early in 1937

The 2020 ESC Guidelines on the Diagnosis and Management of Atrial Fibrillation

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Radiofrequency Catheter Ablation of Supraventricular Tachycardia

Supraventricular tachycardias are quite common in clinical practice. Medical treatment of supraventricular tachycardia often involves regular intake of drugs for several years. Problems of drug therapy include poor efficacy and bothersome side effects including proarrhythmia. This has lead to the development of non-pharmacological therapies. Arrhythmia surgery initially demonstrated that many types of supraventricular arrhythmias could be cured. However during the past decade arrhythmia surgery has been largely replaced by catheter ablation. Catheter ablation can be defined as the use of an electrode catheter to destroy small areas of myocardial tissue or conduction system, or both, that are critical to the initiation or maintenance of cardiac arrhythmias. Arrhythmias most likely to be amenable to cure with catheter ablation are those which have a focal origin or involve a narrow, anatomically defined isthmus.1 This review aims to provide an update on the technique and results associated that can be achieved with catheter ablation of supraventricular tachycardias

Catheter ablation in patients with persistent atrial fibrillation

Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials