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102
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Knight BP, Lin AC. Ablation for Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:161-163. [DOI: 10.1016/j.jacep.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
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103
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Koutalas E, Rolf S, Dinov B, Richter S, Arya A, Bollmann A, Hindricks G, Sommer P. Contemporary Mapping Techniques of Complex Cardiac Arrhythmias - Identifying and Modifying the Arrhythmogenic Substrate. Arrhythm Electrophysiol Rev 2015; 4:19-27. [PMID: 26835095 PMCID: PMC4711490 DOI: 10.15420/aer.2015.4.1.19] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/12/2015] [Indexed: 12/16/2022] Open
Abstract
Cardiac electrophysiology has moved a long way forward during recent decades in the comprehension and treatment of complex cardiac arrhythmias. Contemporary electroanatomical mapping systems, along with state-of-the-art technology in the manufacture of electrophysiology catheters and cardiac imaging modalities, have significantly enriched our armamentarium, enabling the implementation of various mapping strategies and techniques in electrophysiology procedures. Beyond conventional mapping strategies, ablation of complex fractionated electrograms and rotor ablation in atrial fibrillation ablation procedures, the identification and modification of the underlying arrhythmogenic substrate has emerged as a strategy that leads to improved outcomes. Arrhythmogenic substrate modification also has a major role in ventricular tachycardia ablation procedures. Optimisation of contact between tissue and catheter and image integration are a further step forward to augment our precision and effectiveness. Hybridisation of existing technologies with a reasonable cost should be our goal over the next few years.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
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104
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Iravanian S, Langberg JJ. Spatiotemporal organization during ablation of persistent atrial fibrillation. Heart Rhythm 2015; 12:1937-44. [PMID: 25916566 DOI: 10.1016/j.hrthm.2015.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Targeting complex fractionated atrial electrograms improves the outcome of ablation of persistent atrial fibrillation (AF); however, the mechanism(s) responsible for the generation of complex fractionated atrial electrogram signals and efficacy of ablation is not clear. OBJECTIVE The aim of this study was to gain mechanistic insight into ablation of persistent AF by evaluating the spatiotemporal patterns of atrial organization during ablation. METHODS Intracardiac recordings from 18 ablation procedures were analyzed. Signals recorded by right atrial/coronary sinus catheters were processed. We quantified atrial organization using recurrence maps and recurrence percentage (Rec%) methodology and generated temporally dense time series of cycle lengths and Rec%. RESULTS A total of 162 intra-atrial recordings were categorized into type I (sudden jump in Rec%), type II (gradual increase), and type III (no increase). Type I was the most common form and was seen in 57% ± 4% of the recordings. A typical pattern was the initial appearance of local organization, which then expanded to adjacent channels in discrete jumps until eventually an organized atrial flutter emerged. This pattern is consistent with the atrial organization signature expected from ablation of a single spiral wave with fibrillatory conduction to the rest of atria. CONCLUSION Temporally dense spatiotemporal assessment of atrial organization during the ablation of persistent AF is feasible and provides complementary information to cycle length measurements. Atrial organization starts locally and expands spatially in discrete jumps. The regularization of AF to atrial flutter exhibits characteristics of phase transition in complex systems.
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Affiliation(s)
- Shahriar Iravanian
- Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan J Langberg
- Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
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105
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Affiliation(s)
- Sanjiv M Narayan
- Department of Medicine/Cardiology, University of California, San Diego, CA, USA Veterans Affairs Medical Center, San Diego, CA, USA
| | - José Jalife
- Center for Arrhythmia Research and Department of Medicine/Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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106
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Allessie M, de Groot N. CrossTalk opposing view: Rotors have not been demonstrated to be the drivers of atrial fibrillation. J Physiol 2015; 592:3167-70. [PMID: 25085969 DOI: 10.1113/jphysiol.2014.271809] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Maurits Allessie
- Department of Physiology, University of Maastricht, The Netherlands
| | - Natasja de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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107
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Schreiber D, Rostock T, Fröhlich M, Sultan A, Servatius H, Hoffmann BA, Lüker J, Berner I, Schäffer B, Wegscheider K, Lezius S, Willems S, Steven D. Five-Year Follow-Up After Catheter Ablation of Persistent Atrial Fibrillation Using the Stepwise Approach and Prognostic Factors for Success. Circ Arrhythm Electrophysiol 2015; 8:308-17. [DOI: 10.1161/circep.114.001672] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/16/2015] [Indexed: 11/16/2022]
Abstract
Background—
In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination.
Methods and Results—
A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007–2009). A total of 493 patients were included (Holter ECGs ≥every 6 months). Mean follow-up was 59±16 months with 2.1±1.1 procedures per patient. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off antiarrhythmic drug). Antiarrhythmic drug–free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 patients (28%) and persistent AF/atrial tachycardia in 123 patients (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (hazard ratio [HR], 1.279; 95% confidence interval [CI], 1.093–1.497;
P
=0.002), number of procedures (HR, 1.154; 95% CI, 1.051–1.267;
P
=0.003), female sex (HR, 1.263; 95% CI, 1.027–1.553;
P
=0.027), and the presence of structural heart disease (HR, 1.236; 95% CI, 1.003–1.524;
P
=0.047). AF termination was correlated with a higher rate of consecutive procedures because of atrial tachycardia recurrences (
P
=0.003; HR, 1.71; 95% CI, 1.20–2.43).
Conclusions—
Catheter ablation of persistent AF using the stepwise approach provides limited long-term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, sex, and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive atrial tachycardia procedures.
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Affiliation(s)
- Doreen Schreiber
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Thomas Rostock
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Max Fröhlich
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Arian Sultan
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Helge Servatius
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Boris A. Hoffmann
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Jakob Lüker
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Imke Berner
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Benjamin Schäffer
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Karl Wegscheider
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Susanne Lezius
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Stephan Willems
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
| | - Daniel Steven
- From the Department of Electrophysiology, University Heart Center (D.S., M.F., A.S., H.S., B.A.H., J.L., B.S., S.W., D.S.) and Department of Medical Biometry and Epidemiology (K.W., S.L.), University Hospital Eppendorf, Hamburg, Germany; II Medical Clinic, Department of Electrophysiology, Johannes-Gutenberg University, Mainz (T.R.); and Center for Electrophysiology at Klinikum Links der Weser, Bremen, Germany (I.B.)
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108
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Pashaei A, Bayer J, Meillet V, Dubois R, Vigmond E. Computation and projection of spiral wave trajectories during atrial fibrillation: a computational study. Card Electrophysiol Clin 2015; 7:37-47. [PMID: 25784021 DOI: 10.1016/j.ccep.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To show how atrial fibrillation rotor activity on the heart surface manifests as phase on the torso, fibrillation was induced on a geometrically accurate computer model of the human atria. The Hilbert transform, time embedding, and filament detection were compared. Electrical activity on the epicardium was used to compute potentials on different surfaces from the atria to the torso. The Hilbert transform produces erroneous phase when pacing for longer than the action potential duration. The number of phase singularities, frequency content, and the dominant frequency decreased with distance from the heart, except for the convex hull.
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Affiliation(s)
- Ali Pashaei
- LIRYC Electrophysiology and Heart Modelling Institute, University of Bordeaux, PTIB-Campus Xavier, Arnozan, Avenue du Haut Lévèque, Bordeaux 33600, France; Inserm U1045, Cardiothoracic Research Center, 146 rue Léo-Saignat, Bordeaux Cedex 33076, France.
| | - Jason Bayer
- LIRYC Electrophysiology and Heart Modelling Institute, University of Bordeaux, PTIB-Campus Xavier, Arnozan, Avenue du Haut Lévèque, Bordeaux 33600, France; Inserm U1045, Cardiothoracic Research Center, 146 rue Léo-Saignat, Bordeaux Cedex 33076, France
| | - Valentin Meillet
- LIRYC Electrophysiology and Heart Modelling Institute, University of Bordeaux, PTIB-Campus Xavier, Arnozan, Avenue du Haut Lévèque, Bordeaux 33600, France; Inserm U1045, Cardiothoracic Research Center, 146 rue Léo-Saignat, Bordeaux Cedex 33076, France
| | - Rémi Dubois
- LIRYC Electrophysiology and Heart Modelling Institute, University of Bordeaux, PTIB-Campus Xavier, Arnozan, Avenue du Haut Lévèque, Bordeaux 33600, France; Inserm U1045, Cardiothoracic Research Center, 146 rue Léo-Saignat, Bordeaux Cedex 33076, France
| | - Edward Vigmond
- LIRYC Electrophysiology and Heart Modelling Institute, University of Bordeaux, PTIB-Campus Xavier, Arnozan, Avenue du Haut Lévèque, Bordeaux 33600, France; Bordeaux Institute of Mathematics UMR 5251, University of Bordeaux, 351 cours de la Libération, Talence 33405, France
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109
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Krummen DE, Hebsur S, Salcedo J, Narayan SM, Lalani GG, Schricker AA. Mechanisms Underlying AF: Triggers, Rotors, Other? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:371. [PMID: 25778423 DOI: 10.1007/s11936-015-0371-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT There is ongoing debate regarding the precise mechanisms underlying atrial fibrillation (AF). An improved understanding of these mechanisms is urgently needed to improve interventional strategies to suppress and eliminate AF, since the success of current strategies is suboptimal. At present, guidelines for AF ablation focus on pulmonary vein (PV) isolation for the prevention of arrhythmia. Additional targets are presently unclear, and include additional linear ablation and electrogram-guided substrate modification, without clear mechanistic relevance. PV and non-PV triggers are likely central in the first few seconds of AF initiation. Rapid activation from such triggers interacts with transitional mechanisms including conduction velocity slowing, action potential duration (APD) alternans, and steep APD restitution to cause conduction block and initiate functional reentry. However, complete suppression of potential triggers has proven elusive, and the intra-procedural mapping and targeting of transitional mechanisms has not been reported. A growing body of research implicates electrical rotors and focal sources as central mechanisms for the maintenance of AF. In several recent series, they were observed in nearly all patients with sustained arrhythmia. Ablation of rotor and focal source sites, prior to pulmonary vein isolation, substantially modulated atrial fibrillation in a high proportion of patients, and improved ablation outcomes versus pulmonary vein isolation alone. These results have subsequently been confirmed in multicenter series, and the improved outcomes have been found to persist to a mean follow-up of 3 years. Recently, rotors have been observed by multiple groups using diverse technologies. These findings represent a paradigm shift in AF, focusing on sustaining mechanisms, as is currently done with other arrhythmias such as atrioventricular node reentrant tachycardia. Studies are currently underway to assess the optimal strategy for the application of rotor-based ablation in AF management, including clinical trials on the relative efficacy of rotor-only ablation versus PVI-only ablation, which will inform future practice guidelines.
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Affiliation(s)
- David E Krummen
- University of California San Diego and VA San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA, 92161, USA,
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110
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Abstract
The sequence of myocardial electrical activation during fibrillation is complex and changes with each cycle. Phase analysis represents the electrical activation-recovery process as an angle. Lines of equal phase converge at a phase singularity at the center of rotation of a reentrant wave, and the identification of reentry and tracking of reentrant wavefronts can be automated. We examine the basic ideas behind phase analysis. With the exciting prospect of using phase analysis of atrial electrograms to guide ablation in the human heart, we highlight several recent developments in preprocessing electrograms so that phase can be estimated reliably.
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Affiliation(s)
- Richard H Clayton
- Insigneo Institute for in-silico medicine and Department of Computer Science, University of Sheffield, Regent Court, 211 Portobello Street, Sheffield S1 4DP, UK.
| | - Martyn P Nash
- Auckland Bioengineering Institute and Engineering Science, University of Auckland, Uniservices House, Level 7, Room 439-715, 70 Symonds Street, Auckland 1010, New Zealand
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111
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Lim HS, Zellerhoff S, Derval N, Denis A, Yamashita S, Berte B, Mahida S, Hooks D, Aljefairi N, Shah AJ, Sacher F, Hocini M, Jais P, Haissaguerre M. Noninvasive mapping to guide atrial fibrillation ablation. Card Electrophysiol Clin 2015; 7:89-98. [PMID: 25784025 DOI: 10.1016/j.ccep.2014.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Atrial fibrillation (AF) is a dynamic rhythm. Noninvasive mapping overcomes many previous barriers to mapping such a dynamic rhythm, by providing a beat-to-beat, biatrial, panoramic view of the AF process. Catheter ablation of AF drivers guided by noninvasive mapping has yielded promising clinical results and has advanced understanding of the underlying pathophysiologic processes of this common heart rhythm disorder.
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Affiliation(s)
- Han S Lim
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Stephan Zellerhoff
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Seigo Yamashita
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Benjamin Berte
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Saagar Mahida
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Darren Hooks
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nora Aljefairi
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Ashok J Shah
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Frédéric Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Pierre Jais
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
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112
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Gutbrod SR, Walton R, Gilbert S, Meillet V, Jaïs P, Hocini M, Haïssaguerre M, Dubois R, Bernus O, Efimov IR. Quantification of the transmural dynamics of atrial fibrillation by simultaneous endocardial and epicardial optical mapping in an acute sheep model. Circ Arrhythm Electrophysiol 2015; 8:456-65. [PMID: 25713215 DOI: 10.1161/circep.114.002545] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Therapy strategies for atrial fibrillation based on electric characterization are becoming viable personalized medicine approaches to treat a notoriously difficult disease. In light of these approaches that rely on high-density surface mapping, this study aims to evaluate the presence of 3-dimensional electric substrate variations within the transmural wall during acute episodes of atrial fibrillation. METHODS AND RESULTS Optical signals were simultaneously acquired from the epicardial and endocardial tissue during acute fibrillation in ovine isolated left atria. Dominant frequency, regularity index, propagation angles, and phase dynamics were assessed and correlated across imaging planes to gauge the synchrony of the activation patterns compared with paced rhythms. Static frequency parameters were well correlated spatially between the endocardium and the epicardium (dominant frequency, 0.79 ± 0.06 and regularity index, 0.93 ± 0.009). However, dynamic tracking of propagation vectors and phase singularity trajectories revealed discordant activity across the transmural wall. The absolute value of the difference in the number, spatial stability, and temporal stability of phase singularities between the epicardial and the endocardial planes was significantly >0 with a median difference of 1.0, 9.27%, and 19.75%, respectively. The number of wavefronts with respect to time was significantly less correlated and the difference in propagation angle was significantly larger in fibrillation compared with paced rhythms. CONCLUSIONS Atrial fibrillation substrates are dynamic 3-dimensional structures with a range of discordance between the epicardial and the endocardial tissue. The results of this study suggest that transmural propagation may play a role in atrial fibrillation maintenance mechanisms.
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Affiliation(s)
- Sarah R Gutbrod
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Richard Walton
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Stephen Gilbert
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Valentin Meillet
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Pierre Jaïs
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Mélèze Hocini
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Michel Haïssaguerre
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Rémi Dubois
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Olivier Bernus
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.)
| | - Igor R Efimov
- From the Department of Biomedical Engineering, Washington University in Saint Louis, MO (S.R.G., I.R.E.); L'Institut de Rythmologie et Modélisation Cardiaque LIRYC, Université de Bordeaux, France (S.R.G., R.W., S.G., V.M., P.J., M.H., M.H., R.D., O.B., I.R.E.); Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France (R.W., V.M., P.J., M.H., M.H., R.D., O.B.); CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France (V.M., P.J., M.H., M.H.); and Max Delbrück Center for Molecular Medicine, Berlin, Germany (S.G.).
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113
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Revishvili AS, Wissner E, Lebedev DS, Lemes C, Deiss S, Metzner A, Kalinin VV, Sopov OV, Labartkava EZ, Kalinin AV, Chmelevsky M, Zubarev SV, Chaykovskaya MK, Tsiklauri MG, Kuck KH. Validation of the mapping accuracy of a novel non-invasive epicardial and endocardial electrophysiology system. Europace 2015; 17:1282-8. [PMID: 25643987 PMCID: PMC4535554 DOI: 10.1093/europace/euu339] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/03/2014] [Indexed: 11/21/2022] Open
Abstract
Aims Use of a non-invasive electrocardiographic mapping system may aid in rapid diagnosis of atrial or ventricular arrhythmias or the detection of ventricular dyssynchrony. The aim of the present study was to validate the mapping accuracy of a novel non-invasive epi- and endocardial electrophysiology system (NEEES). Methods and results Patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were merged with the data obtained from the NEEES during pacing from implanted pacemaker leads or pacing from endocardial sites using an electroanatomical mapping system (CARTO 3, Biosense Webster). The earliest activation as denoted on the NEEES three-dimensional heart model was compared with the true anatomic location of the tip of the pacemaker lead or the annotated pacing site on the CARTO 3 map. Twenty-nine patients [mean age: 62 ± 11 years, 6/29 (11%) female, 21/29 (72%) with ischaemic cardiomyopathy] were enrolled into the pacemaker verification group. The mean distance from the non-invasively predicted pacing site to the anatomic reference site was 10.8 ± 5.4 mm for the right atrium, 7.7 ± 5.8 mm for the right ventricle, and 7.9 ± 5.7 mm for the left ventricle activated via the coronary sinus lead. Five patients [mean age 65 ± 4 years, 2 (33%) females] underwent CARTO 3 verification study. The mean distance between non-invasively reconstructed pacing site and the reference pacing site was 7.4 ± 2.7 mm for the right atrium, 6.9 ± 2.3 mm for the left atrium, 6.5 ± 2.1 mm for the right ventricle, and 6.4 ± 2.2 for the left ventricle, respectively. Conclusion The novel NEEES was able to correctly identify the site of pacing from various endo- and epicardial sites with high accuracy.
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Affiliation(s)
- Amiran S Revishvili
- Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Science, Moscow, Russia
| | - Erik Wissner
- Stereotaxis Laboratory, Asklepios Klinik St Georg, II. Medizinische Abteilung, Lohmühlenstraße 5, Hamburg 20099, Germany
| | | | - Christine Lemes
- Stereotaxis Laboratory, Asklepios Klinik St Georg, II. Medizinische Abteilung, Lohmühlenstraße 5, Hamburg 20099, Germany
| | - Sebastian Deiss
- Stereotaxis Laboratory, Asklepios Klinik St Georg, II. Medizinische Abteilung, Lohmühlenstraße 5, Hamburg 20099, Germany
| | - Andreaas Metzner
- Stereotaxis Laboratory, Asklepios Klinik St Georg, II. Medizinische Abteilung, Lohmühlenstraße 5, Hamburg 20099, Germany
| | - Vitaly V Kalinin
- Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Science, Moscow, Russia
| | - Oleg V Sopov
- Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Science, Moscow, Russia
| | - Eugeny Z Labartkava
- Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Science, Moscow, Russia
| | - Alexander V Kalinin
- Institute for Information Transmission Problems of the Russian Academy of Science, Moscow, Russia
| | | | | | | | | | - Karl-Heinz Kuck
- Stereotaxis Laboratory, Asklepios Klinik St Georg, II. Medizinische Abteilung, Lohmühlenstraße 5, Hamburg 20099, Germany
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114
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Scherr D, Khairy P, Miyazaki S, Aurillac-Lavignolle V, Pascale P, Wilton SB, Ramoul K, Komatsu Y, Roten L, Jadidi A, Linton N, Pedersen M, Daly M, O’Neill M, Knecht S, Weerasooriya R, Rostock T, Manninger M, Cochet H, Shah AJ, Yeim S, Denis A, Derval N, Hocini M, Sacher F, Haissaguerre M, Jais P. Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint. Circ Arrhythm Electrophysiol 2015; 8:18-24. [DOI: 10.1161/circep.114.001943] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background—
This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point.
Methods and Results—
One hundred fifty patients (57±10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3%±3.9%, 28.0%±3.7%, and 16.8%±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7%±2.5%, 79.8%±3.4%, and 62.9%±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43–73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070–7.143;
P
<0.001), left atrial diameter ≥50 mm (hazard ratio 2.083; 95% confidence interval, 1.078–4.016;
P
=0.03), continuous AF duration ≥18 months (hazard ratio 1.984; 95% confidence interval, 1.024–3.846;
P
<0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037–3.388;
P
=0.04) predicted arrhythmia recurrence.
Conclusions—
In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation.
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Affiliation(s)
- Daniel Scherr
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Paul Khairy
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Shinsuke Miyazaki
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Valerie Aurillac-Lavignolle
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Patrizio Pascale
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Stephen B. Wilton
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Khaled Ramoul
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Yuki Komatsu
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Laurent Roten
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Amir Jadidi
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Nick Linton
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Michala Pedersen
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Matthew Daly
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Mark O’Neill
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Sebastien Knecht
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Rukshen Weerasooriya
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Thomas Rostock
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Martin Manninger
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Hubert Cochet
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Ashok J. Shah
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Sunthareth Yeim
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Arnaud Denis
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Nicolas Derval
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Meleze Hocini
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Frederic Sacher
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Michel Haissaguerre
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
| | - Pierre Jais
- From the Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, Pessac, France (D.S., P.K., S.M., V.A.-L., P.P., S.B.W., K.R., Y.K., L.R., A.J., N.L., M.P., M.D., M.O’N., S.K., R.W., T.R., H.C., A.J.S., S.Y., A.D., N.D., M.H., F.S., M.H., P.J.); and Division of Cardiology, Department of Medicine, Medical University of Graz, Austria (D.S., M.M.)
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Metzner A, Wissner E, Fink T, Ouyang F, Kuck KH. [Innovative techniques in atrial fibrillation therapy]. Herz 2015; 40:37-44. [PMID: 25585587 DOI: 10.1007/s00059-014-4194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pulmonary vein isolation (PVI) is the established cornerstone in most catheter-based ablation treatment strategies for atrial fibrillation (AF); however, it is still a challenge to create contiguous, transmural and permanent ablation lesions using radiofrequency current in combination with three-dimensional mapping systems. To overcome these limitations, innovative spiral mapping and ablation catheters as well as balloon-based ablation catheters incorporating alternative energy sources, such as cryoenergy and laser were developed and evaluated and have proved their potential for safe and clinically effective PVI. In addition, novel ablation strategies, such as identification and ablation of AF-inducing foci and/or AF-perpetuating rotors using either endocardial or epicardial mapping systems were introduced and are currently under clinical evaluation. The identification and modulation of atrial ganglionic plexi (GP) and, therefore, of the autonomous nervous system is another additive ablation approach which requires further clinical evaluation.
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Affiliation(s)
- A Metzner
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland,
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116
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Catheter Ablation of Atrial Fibrillation. J Am Coll Cardiol 2015; 65:196-206. [DOI: 10.1016/j.jacc.2014.10.034] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/12/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022]
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117
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Lim HS, Derval N, Denis A, Zellerhoff S, Haissaguerre M. Distinct localized reentrant drivers in persistent atrial fibrillation identified by noninvasive mapping: relation to f-wave morphology. Card Electrophysiol Clin 2014; 7:153-5. [PMID: 25784030 DOI: 10.1016/j.ccep.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noninvasive mapping overcomes previous barriers to provide panoramic beat-to-beat mapping during atrial fibrillation (AF). This article demonstrates the utility of noninvasive mapping in identifying localized driving sources in persistent AF. Reentrant driver activity detected by noninvasive mapping from specific regions correlated with distinct f-wave morphologies. Ablation targeting these drivers resulted in progressive AF cycle length prolongation and termination of the arrhythmia.
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Affiliation(s)
- Han S Lim
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Stephan Zellerhoff
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
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118
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Deisenhofer I. [Catheter ablation of persistent atrial fibrillation : Current state]. Herzschrittmacherther Elektrophysiol 2014; 25:220-225. [PMID: 25143227 DOI: 10.1007/s00399-014-0338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
The invasive treatment of persistent atrial fibrillation (AF) is one of the biggest challenges in modern electrophysiology. Treatment strategies are diverse and include pulmonary vein isolation (PVI) alone, left atrial ablation lines, local electrogram-based ablation of complex fractionated electrograms (CFAE) or various combinations of these techniques. New approaches comprise fibrosis-guided ablation or the localisation and ablation of AF sustaining rotors. Different ablation techniques reflect a different understanding of what the most important pathophysiological mechanism of persistent AF might be. Multiple wavelets, repetitive focal discharges (mostly from the pulmonary veins), instable micro-reentries, anatomically fixed slow conduction zones close to atrial scarring or (relatively stable) rotors have been proposed as AF sustaining factors. It has become evident that conventional ablation strategies often involve more than one ablation procedure to reach acceptable success rates, whereas new methods of fibrosis-guided ablation and rotor ablation are still under evaluation.
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Affiliation(s)
- Isabel Deisenhofer
- Abteilung Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland,
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119
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Hasun M, Gatterer E, Weidinger F. Atrial fibrillation: state of the art. Wien Klin Wochenschr 2014; 126:692-704. [PMID: 25409952 DOI: 10.1007/s00508-014-0667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
Abstract
Atrial fibrillation (AF) is by far the most frequent heart rhythm disorder and is associated with a significantly increased risk of stroke, heart failure and death. Despite improvements in prevention and treatment, the prognosis has not changed significantly. To use new and promising pharmacological and interventional concepts for thromboembolic prophylaxis and treatment of AF, as well as prevention of recurrence, patient compliance has to be improved, physicians have to be trained and experience hast to be gained. A consistently carried 'anticoagulation pass' might be a promising piece of the puzzle.
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Affiliation(s)
- Matthias Hasun
- 2. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
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120
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Ganesan AN, Kuklik P, Gharaviri A, Brooks A, Chapman D, Lau DH, Roberts-Thomson KC, Sanders P. Origin and characteristics of high Shannon entropy at the pivot of locally stable rotors: insights from computational simulation. PLoS One 2014; 9:e110662. [PMID: 25401331 PMCID: PMC4234245 DOI: 10.1371/journal.pone.0110662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022] Open
Abstract
Background Rotors are postulated to maintain cardiac fibrillation. Despite the importance of bipolar electrograms in clinical electrophysiology, few data exist on the properties of bipolar electrograms at rotor sites. The pivot of a spiral wave is characterized by relative uncertainty of wavefront propagation direction compared to the periphery. The bipolar electrograms used in electrophysiology recording encode information on both direction and timing of approaching wavefronts. Objective To test the hypothesis that bipolar electrograms from the pivot of rotors have higher Shannon entropy (ShEn) than electrograms recorded at the periphery due to the spatial dynamics of spiral waves. Methods and Results We studied spiral wave propagation in 2-dimensional sheets constructed using a simple cell automaton (FitzHugh-Nagumo), atrial (Courtemanche-Ramirez-Nattel) and ventricular (Luo-Rudy) myocyte cell models and in a geometric model spiral wave. In each system, bipolar electrogram recordings were simulated, and Shannon entropy maps constructed as a measure of electrogram information content. ShEn was consistently highest in the pivoting region associated with the phase singularity of the spiral wave. This property was consistently preserved across; (i) variation of model system (ii) alterations in bipolar electrode spacing, (iii) alternative bipolar electrode orientation (iv) bipolar electrogram filtering and (v) in the presence of rotor meander. Directional activation plots demonstrated that the origin of high ShEn at the pivot was the directional diversity of wavefront propagation observed in this location. Conclusions The pivot of the rotor is consistently associated with high Shannon entropy of bipolar electrograms despite differences in action potential model, bipolar electrode spacing, signal filtering and rotor meander. Maximum ShEn is co-located with the pivot for rotors observed in the bipolar electrogram recording mode, and may be an intrinsic property of spiral wave dynamic behaviour.
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Affiliation(s)
- Anand N. Ganesan
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- * E-mail:
| | - Pawel Kuklik
- Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Electrophysiology, University Heart Center, Hamburg, Germany
| | - Ali Gharaviri
- Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anthony Brooks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Darius Chapman
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H. Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kurt C. Roberts-Thomson
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Shah AJ, Lim HS, Yamashita S, Zellerhoff S, Berte B, Mahida S, Hooks D, Aljefairi N, Derval N, Denis A, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M. Non Invasive ECG Mapping To Guide Catheter Ablation. J Atr Fibrillation 2014; 7:1139. [PMID: 27957124 DOI: 10.4022/jafib.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/23/2014] [Accepted: 08/23/2014] [Indexed: 11/10/2022]
Abstract
Since more than 100 years, 12-lead electrocardiography (ECG) is the standard-of-care tool, which involves measuring electrical potentials from limited sites on the body surface to diagnose cardiac disorder, its possible mechanism and the likely site of origin. Several decades of research has led to the development of a 252-lead-ECG and CT-scan based, three dimensional, electro-imaging modality to non-invasively map abnormal cardiac rhythms including fibrillation. These maps provide guidance towards ablative therapy and thereby help advance the management of complex heart rhythm disorders. Here, we describe the clinical experience obtained using non-invasive technique in mapping the electrical disorder and guide the catheter ablation of atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beats) and ventricular pre-excitation (Wolff-Parkinson-White syndrome).
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Affiliation(s)
- Ashok J Shah
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Han S Lim
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Stephan Zellerhoff
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Darren Hooks
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Nora Aljefairi
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Remi Dubois
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
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Schricker AA, Lalani GG, Krummen DE, Rappel WJ, Narayan SM. Human atrial fibrillation initiates via organized rather than disorganized mechanisms. Circ Arrhythm Electrophysiol 2014; 7:816-24. [PMID: 25217042 PMCID: PMC4206587 DOI: 10.1161/circep.113.001289] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unknown how atrial fibrillation (AF) is actually initiated by triggers. Based on consistencies in atrial structure and function in individual patients between episodes of AF, we hypothesized that human AF initiates when triggers interact with deterministic properties of the atria and may engage organized mechanisms. METHODS AND RESULTS In 31 patients with AF, we mapped AF initiation after spontaneous triggers or programmed stimulation. We used 64-pole basket catheters to measure regional dynamic conduction slowing and to create biatrial activation maps during transitions to AF. Sixty-two AF initiations were recorded (spontaneous, n=28; induced, n=34). Notably, AF did not initiate by disorganized mechanisms, but by either a dominant reentrant spiral wave (76%) or a repetitive focal driver. Both mechanisms were located 21±17 mm from their triggers. AF-initiating spirals formed at the site showing the greatest rate-dependent slowing in each patient. Accordingly, in 10 of 12 patients with multiple observed AF episodes, AF initiated using spatially conserved mechanisms despite diverse triggers. CONCLUSIONS Human AF initiates from triggers by organized rather than disorganized mechanisms, either via spiral wave re-entry at sites of dynamic conduction slowing or via repetitive focal drivers. The finding that diverse triggers initiate AF at predictable, spatially conserved functional sites in each individual provides a novel deterministic paradigm for AF with therapeutic implications.
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Affiliation(s)
- Amir A Schricker
- From the Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego and the Veterans Administration San Diego Healthcare System, San Diego, CA (A.A.S., G.G.L., D.E.K., S.M.N.), and the Center for Theoretical Biological Physics, Department of Physics, University of California, San Diego, CA (W.J.R.)
| | - Gautam G Lalani
- From the Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego and the Veterans Administration San Diego Healthcare System, San Diego, CA (A.A.S., G.G.L., D.E.K., S.M.N.), and the Center for Theoretical Biological Physics, Department of Physics, University of California, San Diego, CA (W.J.R.)
| | - David E Krummen
- From the Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego and the Veterans Administration San Diego Healthcare System, San Diego, CA (A.A.S., G.G.L., D.E.K., S.M.N.), and the Center for Theoretical Biological Physics, Department of Physics, University of California, San Diego, CA (W.J.R.)
| | - Wouter-Jan Rappel
- From the Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego and the Veterans Administration San Diego Healthcare System, San Diego, CA (A.A.S., G.G.L., D.E.K., S.M.N.), and the Center for Theoretical Biological Physics, Department of Physics, University of California, San Diego, CA (W.J.R.)
| | - Sanjiv M Narayan
- From the Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego and the Veterans Administration San Diego Healthcare System, San Diego, CA (A.A.S., G.G.L., D.E.K., S.M.N.), and the Center for Theoretical Biological Physics, Department of Physics, University of California, San Diego, CA (W.J.R.).
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123
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Miller JM, Kowal RC, Swarup V, Daubert JP, Daoud EG, Day JD, Ellenbogen KA, Hummel JD, Baykaner T, Krummen DE, Narayan SM, Reddy VY, Shivkumar K, Steinberg JS, Wheelan KR. Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry. J Cardiovasc Electrophysiol 2014; 25:921-929. [PMID: 24948520 PMCID: PMC4282180 DOI: 10.1111/jce.12474] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/05/2014] [Accepted: 05/28/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. METHODS We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View(TM) ; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI. RESULTS Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89). CONCLUSIONS Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ≈80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center's first cases.
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Affiliation(s)
- John M Miller
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert C Kowal
- Heartplace, Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | - John D Day
- Intermountain Heart Institute, Murray, Utah, USA
| | | | | | - Tina Baykaner
- Veterans Affairs Medical Center, University of California, San Diego, California, USA
| | - David E Krummen
- Veterans Affairs Medical Center, University of California, San Diego, California, USA
| | - Sanjiv M Narayan
- Veterans Affairs Medical Center, University of California, San Diego, California, USA
| | | | | | | | - Kevin R Wheelan
- Heartplace, Baylor University Medical Center, Dallas, Texas, USA
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Weerasooriya R, Shah AJ, Hocini M, Jaïs P, Haïssaguerre M. Contemporary Challenges of Catheter Ablation for Atrial Fibrillation. Clin Ther 2014; 36:1145-50. [DOI: 10.1016/j.clinthera.2014.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/08/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
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125
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A B Zaman Ma Bm BChir J, Schricker Md A, G Lalani Md G, Trikha Bs R, E Krummen Md D, M Narayan Md PhD S. Focal Impulse And Rotor Mapping (FIRM): Conceptualizing And Treating Atrial Fibrillation. J Atr Fibrillation 2014; 7:1103. [PMID: 27957100 DOI: 10.4022/jafib.1103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 06/29/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022]
Abstract
Current approaches for the ablation of atrial fibrillation are often effective, but only partially rooted in mechanistic understanding. Accordingly, they are unable to predict whether a given patient will or will not do well, or which lesions sets should or should not be performed - in any given patient. This goal would require clearer mechanistic definition of what sustains AF after it has been triggered (i.e. electrophysiological substrates). There are two schools of thought. The first proposes disorganized activity that self-sustains with no 'driver', and the second describes drivers that then cause disorganization. Interestingly, these mechanisms can be separated in human studies by mapping approach - proponents of the disorganized hypothesis studying small atrial areas at high resolution, and proponents of the driver model studying wide fields-of-view at varying resolutions. Focal impulse and rotor modulation (FIRM) mapping combines a wide field of view with physiologically based signal filtering and phase analysis, and has revealed that human AF is often sustained by rotors. In the CONFIRM Trial, targeting stable AF rotors/sources for ablation improved the single-procedure efficacy for paroxysmal and persistent AF over conventional ablation alone, as now confirmed by independent laboratories. FIRM mapping gives a mechanistic foundation to predict whether any selected lesions should intersect AF sources in any given patient and which mechanisms may cause recurrence. Rotors of varying characteristics have now been shown by many groups. These insights have reinvigorated interest in AF mapping, and rationalizing these findings will likely translate into improved therapy for our patients.
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Affiliation(s)
| | | | | | - Rishi Trikha Bs
- National Heart and Lung Institute, Imperial College London, UK
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126
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Haissaguerre M, Hocini M, Denis A, Shah AJ, Komatsu Y, Yamashita S, Daly M, Amraoui S, Zellerhoff S, Picat MQ, Quotb A, Jesel L, Lim H, Ploux S, Bordachar P, Attuel G, Meillet V, Ritter P, Derval N, Sacher F, Bernus O, Cochet H, Jais P, Dubois R. Driver Domains in Persistent Atrial Fibrillation. Circulation 2014; 130:530-8. [PMID: 25028391 DOI: 10.1161/circulationaha.113.005421] [Citation(s) in RCA: 525] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michel Haissaguerre
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Meleze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Arnaud Denis
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Ashok J. Shah
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Yuki Komatsu
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Seigo Yamashita
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Matthew Daly
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Sana Amraoui
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Stephan Zellerhoff
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Marie-Quitterie Picat
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Adam Quotb
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Laurence Jesel
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Han Lim
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Sylvain Ploux
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Pierre Bordachar
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Guillaume Attuel
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Valentin Meillet
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Philippe Ritter
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Frederic Sacher
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Olivier Bernus
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Hubert Cochet
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Pierre Jais
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
| | - Remi Dubois
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, France (M. Haissaguerre, M. Hocini, A.D., A.J.S., Y.K., S.Y., M.D., S.A., S.Z., L.J., H.L., S.P., P.B., P.R., N.D., F.S., H.C., P.J.); INSERM U897 – ISPED-Epidémiologie-Biostatistique, Bordeaux, France (M.-Q.P.); and INSERM U1045 –LIRYC L’Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France (A.Q., G.A., V.M., O.B., R.D.)
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Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev 2014; 3:107-12. [PMID: 26835075 PMCID: PMC4711538 DOI: 10.15420/aer.2014.3.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Ashok Shah
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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128
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Narayan SM, Jalife J. CrossTalk proposal: Rotors have been demonstrated to drive human atrial fibrillation. J Physiol 2014; 592:3163-6. [PMID: 25085968 PMCID: PMC4146362 DOI: 10.1113/jphysiol.2014.271031] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjiv M Narayan
- Department of Medicine/Cardiology, University of California, San Diego, CA, USA Veterans Affairs Medical Center, San Diego, CA, USA
| | - José Jalife
- Center for Arrhythmia Research and Department of Internal Medicine/Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia targeted by catheter ablation. Despite significant advances in our understanding of AF, ablation outcomes remain suboptimal, and this is due in large part to an incomplete understanding of the underlying sustaining mechanisms of AF. Recent developments of patient-tailored and physiology-based computational mapping systems have identified localized electrical spiral waves, or rotors, and focal sources as mechanisms that may represent novel targets for therapy. This report provides an overview of Focal Impulse and Rotor Modulation (FIRM) mapping, which reveals that human AF is often not actually driven by disorganized activity but instead that disorganization is secondary to organized rotors or focal sources. Targeted ablation of such sources alone can eliminate AF and, when added to pulmonary vein isolation, improves long-term outcome compared with conventional ablation alone. Translating mechanistic insights from such patient-tailored mapping is likely to be crucial in achieving the next major advances in personalized medicine for AF.
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Affiliation(s)
- Amir A. Schricker
- Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA 92161, USA
| | - Gautam G. Lalani
- Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA 92161, USA
| | - David E. Krummen
- Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA 92161, USA
| | - Sanjiv M. Narayan
- Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA 92161, USA
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130
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Lemery R. Treatment of atrial fibrillation: should we advocate life-style changes or ablation strategies to maintain sinus rhythm? Boot cAMP for atrial fibrillation. J Cardiovasc Electrophysiol 2014; 25:939-940. [PMID: 24946695 DOI: 10.1111/jce.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert Lemery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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131
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Impact of biatrial defragmentation in patients with paroxysmal atrial fibrillation: results from a randomized prospective study. Heart Rhythm 2014; 11:1536-42. [PMID: 24907643 DOI: 10.1016/j.hrthm.2014.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Single procedure success rates of pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are still unsatisfactory. In patients with persistent atrial fibrillation (AF), ablation of complex fractionated atrial electrograms (CFAEs) after PVI results in improved outcomes. OBJECTIVE We aimed to investigate if PAF-patients with intraprocedurally sustained AF after PVI might benefit from additional CFAE ablation. METHODS A total of 1134 consecutive patients underwent a first catheter ablation procedure of PAF between June 2008 and December 2012. In most patients, AF was either not inducible or terminated during PVI. In 68 patients (6%), AF sustained after successful PVI. These patients were randomized to either cardioversion (PVI-alone group; n = 33) or additional CFAE ablation (PVI+CFAE group; n = 35) and followed up every 1-3 months and serial Holter recordings were also obtained. The primary end point was the recurrence of AF/atrial tachycardia (AT) after a blanking period of 3 months. RESULTS Procedure duration (127 ± 6 minutes vs 174 ± 10 minutes), radiofrequency application time (44 ± 3 minutes vs 74 ± 5 minutes), and fluoroscopy time (26 ± 2 minutes vs 41 ± 3 minutes) were longer in the PVI+CFAE group (all P < .001). In 30 of 35 patients (86%) in the PVI+CFAE group, ablation terminated AF. There was no significant group difference with respect to freedom from AF/AT (22 of 33 [67%] vs 22 of 35 [63%]; P = .66). Subsequently, 10 of 11 patients in the PVI-alone group (91%) and 11 of 13 patients in PVI+CFAE group (85%) underwent repeat ablation (P = 1.00). Overall, 29 of 33 [88%] vs 30 of 35 [86%] patients (P = 1.00) were free from AF/AT after 1.4 ± 0.1 vs 1.4 ± 0.2 (P = .87) procedures. CONCLUSION Patients with sustained AF after PVI in a PAF cohort are rare. Regarding AF/AT recurrence, these patients did not benefit from further CFAE ablation compared to PVI alone, but are exposed to longer procedure duration, fluoroscopy time, and radiofrequency application time.
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Rodrigo M, Guillem MS, Climent AM, Pedrón-Torrecilla J, Liberos A, Millet J, Fernández-Avilés F, Atienza F, Berenfeld O. Body surface localization of left and right atrial high-frequency rotors in atrial fibrillation patients: a clinical-computational study. Heart Rhythm 2014; 11:1584-91. [PMID: 24846374 DOI: 10.1016/j.hrthm.2014.05.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ablation is an effective therapy in patients with atrial fibrillation (AF) in which an electrical driver can be identified. OBJECTIVE The aim of this study was to present and discuss a novel and strictly noninvasive approach to map and identify atrial regions responsible for AF perpetuation. METHODS Surface potential recordings of 14 patients with AF were recorded using a 67-lead recording system. Singularity points (SPs) were identified in surface phase maps after band-pass filtering at the highest dominant frequency (HDF). Mathematical models of combined atria and torso were constructed and used to investigate the ability of surface phase maps to estimate rotor activity in the atrial wall. RESULTS The simulations show that surface SPs originate at atrial SPs, but not all atrial SPs are reflected at the surface. Stable SPs were found in AF signals during 8.3% ± 5.7% vs. 73.1% ± 16.8% of the time in unfiltered vs. HDF-filtered patient data, respectively (P < .01). The average duration of each rotational pattern was also lower in unfiltered than in HDF-filtered AF signals (160 ± 43 ms vs. 342 ± 138 ms; P < .01), resulting in 2.8 ± 0.7 rotations per rotor. Band-pass filtering reduced the apparent meandering of surface HDF rotors by reducing the effect of the atrial electrical activity occurring at different frequencies. Torso surface SPs representing HDF rotors during AF were reflected at specific areas corresponding to the fastest atrial location. CONCLUSION Phase analysis of surface potential signals after HDF filtering during AF shows reentrant drivers localized to either the left atrium or the right atrium, helping in localizing ablation targets.
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Affiliation(s)
- Miguel Rodrigo
- Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain
| | - María S Guillem
- Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain.
| | - Andreu M Climent
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - José Millet
- Bio-ITACA, Universitat Politécnica de Valencia, Valencia, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan
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Lankveld TAR, Zeemering S, Crijns HJGM, Schotten U. The ECG as a tool to determine atrial fibrillation complexity. Heart 2014; 100:1077-84. [DOI: 10.1136/heartjnl-2013-305149] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Narayan SM, Baykaner T, Clopton P, Schricker A, Lalani GG, Krummen DE, Shivkumar K, Miller JM. Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation). J Am Coll Cardiol 2014; 63:1761-8. [PMID: 24632280 PMCID: PMC4008643 DOI: 10.1016/j.jacc.2014.02.543] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to determine if ablation that targets patient-specific atrial fibrillation (AF)-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrence. BACKGROUND Late recurrence substantially limits the efficacy of pulmonary vein isolation for AF and is associated with pulmonary vein reconnection and the emergence of new triggers. METHODS Three-year follow-up was performed of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation [FIRM]) and then conventional ablation in 27 patients (FIRM guided) and conventional ablation alone in 65 patients (FIRM blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients). RESULTS FIRM mapping revealed a median of 2 (interquartile range: 1 to 2) rotors or focal sources in 97.7% of patients during AF. During a median follow-up period of 890 days (interquartile range: 224 to 1,563 days), compared to FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2 ± 0.4 procedures (median 1; interquartile range: 1 to 1) (77.8% vs. 38.5%, p = 0.001) and a single procedure (p < 0.001) and higher freedom from all atrial arrhythmias (p = 0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p < 0.001). CONCLUSIONS FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. (The Dynamics of Human Atrial Fibrillation; NCT01008722).
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Affiliation(s)
- Sanjiv M Narayan
- Department of Medicine, University of California, San Diego, San Diego, California; Veterans Affairs Medical Center, San Diego, California.
| | - Tina Baykaner
- Department of Medicine, University of California, San Diego, San Diego, California; Veterans Affairs Medical Center, San Diego, California
| | - Paul Clopton
- Veterans Affairs Medical Center, San Diego, California
| | - Amir Schricker
- Department of Medicine, University of California, San Diego, San Diego, California; Veterans Affairs Medical Center, San Diego, California
| | - Gautam G Lalani
- Department of Medicine, University of California, San Diego, San Diego, California; Veterans Affairs Medical Center, San Diego, California
| | - David E Krummen
- Department of Medicine, University of California, San Diego, San Diego, California; Veterans Affairs Medical Center, San Diego, California
| | | | - John M Miller
- The Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana
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Ravelli F, Masè M. Computational mapping in atrial fibrillation: how the integration of signal-derived maps may guide the localization of critical sources. ACTA ACUST UNITED AC 2014; 16:714-23. [DOI: 10.1093/europace/eut376] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Woods CE, Olgin J. Atrial fibrillation therapy now and in the future: drugs, biologicals, and ablation. Circ Res 2014; 114:1532-46. [PMID: 24763469 PMCID: PMC4169264 DOI: 10.1161/circresaha.114.302362] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/03/2014] [Indexed: 01/26/2023]
Abstract
Atrial fibrillation (AF) is a complex disease with multiple inter-relating causes culminating in rapid, seemingly disorganized atrial activation. Therapy targeting AF is rapidly changing and improving. The purpose of this review is to summarize current state-of-the-art diagnostic and therapeutic modalities for treatment of AF. The review focuses on reviewing treatment as it relates to the pathophysiological basis of disease and reviews preclinical and clinical evidence for potential new diagnostic and therapeutic modalities, including imaging, biomarkers, pharmacological therapy, and ablative strategies for AF. Current ablation and drug therapy approaches to treating AF are largely based on treating the arrhythmia once the substrate occurs and is more effective in paroxysmal AF rather than persistent or permanent AF. However, there is much research aimed at prevention strategies, targeting AF substrate, so-called upstream therapy. Improved diagnostics, using imaging, genetics, and biomarkers, are needed to better identify subtypes of AF based on underlying substrate/mechanism to allow more directed therapeutic approaches. In addition, novel antiarrhythmics with more atrial specific effects may reduce limiting proarrhythmic side effects. Advances in ablation therapy are aimed at improving technology to reduce procedure time and in mechanism-targeted approaches.
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Affiliation(s)
- Christopher E Woods
- From the Division of Cardiology, University of California at San Francisco (C.E.W., J.O.); and Division of Cardiology Research, AUST Development, LLC, Mountain View, CA (C.E.W.)
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Miyazaki S, Kusa S, Taniguchi H, Iwasawa J, Kuroi A, Hachiya H, Hirao K, Iesaka Y. Confined thoracic vein fibrillation: prevalence and electrophysiological properties. Am Heart J 2014; 167:610-9. [PMID: 24655712 DOI: 10.1016/j.ahj.2013.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Confined thoracic vein fibrillation (cTVT) is a finding that suggests that thoracic vein acts as a rapid driver to maintain atrial fibrillation (AF). However, little is known about the cTVT. METHODS AND RESULTS Among consecutive 655 patients (age 62 ± 0 years, 492 men, 421 paroxysmal) who underwent circumferential pulmonary vein (PV) antrum isolation for AF, cTVT was identified in 28 (4.3%) patients. The prevalence was significantly higher in patients with paroxysmal AF than in those with nonparoxysmal AF (5.9% vs 1.3%, P = .002). The cTVT was observed in left PVs in 15 (53.6%), right PVs in 11 (39.3%), and superior vena cava in 2 (7.1%) patients. The median cycle length of cTVT was 150 (110-170) ms. The cTVT was recognized when sinus rhythm was restored from AF during vein isolation in 14 patients. Dissociated activity was seen after the termination of cTVT in 23 (82.1%) patients, and cTVT reinitiated spontaneously after the dissociated activity. In 2 patients, AF was not terminated by multiple cardioversions before the isolation, even with a maximal energy delivery. At a median follow-up of 12.0 (7.5-20.5) months, 26 patients (92.9%) were free from AF without antiarrhythmic drugs after a mean of 1.4 ± 0.5 procedures per patient. Notably, recurrent arrhythmia was not observed in any patient (n = 6), wherein cTVT was terminated by additional radiofrequency applications inside an isolated area after the achievement of vein isolation. CONCLUSIONS Confined thoracic vein fibrillation is not a rare finding in patients with paroxysmal AF, and its elimination results in an excellent clinical outcome.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
| | - Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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El Haddad M, Houben R, Tavernier R, Duytschaever M. Stable reentrant circuit with spiral wave activation driving atrial tachycardia. Heart Rhythm 2014; 11:716-8. [DOI: 10.1016/j.hrthm.2014.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Indexed: 11/24/2022]
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139
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Revisiting heart activation-conduction physiology, part I: atria. J Interv Card Electrophysiol 2014; 40:9-15. [PMID: 24671296 DOI: 10.1007/s10840-014-9884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
This discussion paper re-examines the conduction-activation of the atria, based on observations, with respect to the complexity of the heart as an organ with a brain, and its evolution from a peristaltic tube. The atria do not require a specialized conduction system because they use the subendocardial layer to produce centripetal transmural activation fronts, regardless of the anatomical and histological organization of the transmural atrial wall. This has been described as "two-layer" physiology which provides robust transmission of activation from the sinus to the AV node via a centripetal transmural activation front. New productive insights can come from re-examining the physiology, not only during sinus rhythm but also during atrial tachycardias, in particular atrial flutter and atrial fibrillation (AF). During common flutter, the areas of slow conduction, in the isthmus and following trabeculations, particularly the subendocardial layer confines conduction through the trabeculations which supports re-entry. During experimental or postoperative flutter, the circular 2D activation around the obstacle follows the physiological transmural activation. Understanding this physiology offers insights into AF. During acute or protracted AF, the presence of stationary or drifting rotors is characteristic and consistent with normal physiological 2D atrial activation, suggesting that suppressing physiological transmural activation of AF will permanently restore normal sinus node atrial activation. In contrast, during permanent AF, normal 2D activation is abolished; the presence of transmural, serpentine, and chaotic atrial activation suggests that the normal physiological activation pattern has been replaced by a new, irreversible variety of atrial conduction that is a new physiology, which is consistent with evolution of complex systems.
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Mapping and ablating stable sources for atrial fibrillation: summary of the literature on Focal Impulse and Rotor Modulation (FIRM). J Interv Card Electrophysiol 2014; 40:237-44. [DOI: 10.1007/s10840-014-9889-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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van der Graaf AM, Bhagirath P, Ramanna H, van Driel VJ, de Hooge J, de Groot NM, Götte MJ. Noninvasive imaging of cardiac excitation: current status and future perspective. Ann Noninvasive Electrocardiol 2014; 19:105-13. [PMID: 24620843 PMCID: PMC6932091 DOI: 10.1111/anec.12140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Noninvasive imaging of cardiac excitation using body surface potential mapping (BSPM) data and inverse procedures is an emerging technique that enables estimation of myocardial depolarization and repolarization. Despite numerous reports on the possible advantages of this imaging technique, it has not yet advanced into daily clinical practice. This is mainly due to the time consuming nature of data acquisition and the complexity of the mathematics underlying the used inverse procedures. However, the popularity of this field of research has increased and noninvasive imaging of cardiac electrophysiology is considered a promising tool to complement conventional invasive electrophysiological studies. Furthermore, the use of appropriately designed electrode vests and more advanced computers has greatly reduced the procedural time. This review provides descriptive overview of the research performed thus far and the possible future directions. The general challenges in routine application of BSPM and inverse procedures are discussed. In addition, individual properties of the biophysical models underlying the inverse procedures are illustrated.
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Affiliation(s)
| | - Pranav Bhagirath
- Department of CardiologyHaga Teaching HospitalThe HagueThe Netherlands
| | - Hemanth Ramanna
- Department of CardiologyHaga Teaching HospitalThe HagueThe Netherlands
| | | | - Jacques de Hooge
- Department of CardiologyHaga Teaching HospitalThe HagueThe Netherlands
| | | | - Marco J.W. Götte
- Department of CardiologyHaga Teaching HospitalThe HagueThe Netherlands
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Santulli G, Iaccarino G, De Luca N, Trimarco B, Condorelli G. Atrial fibrillation and microRNAs. Front Physiol 2014; 5:15. [PMID: 24478726 PMCID: PMC3900852 DOI: 10.3389/fphys.2014.00015] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/08/2014] [Indexed: 12/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, especially in the elderly, and has a significant genetic component. Recently, several independent investigators have demonstrated a functional role for small non-coding RNAs (microRNAs) in the pathophysiology of this cardiac arrhythmia. This report represents a systematic and updated appraisal of the main studies that established a mechanistic association between specific microRNAs and AF, focusing both on the regulation of electrical and structural remodeling of cardiac tissue.
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Affiliation(s)
- Gaetano Santulli
- Department of Advanced Biomedical Sciences, "Federico II" University Hospital Naples, Italy ; Department of Translational Medical Sciences, "Federico II" University Hospital Naples, Italy ; Columbia University Medical Center, College of Physicians & Surgeons, New York Presbyterian Hospital - Manhattan New York, NY, USA
| | - Guido Iaccarino
- Department of Medicine and Surgery, University of Salerno Salerno, Italy ; IRCCS "Multimedica," Milano, Italy
| | - Nicola De Luca
- Department of Translational Medical Sciences, "Federico II" University Hospital Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, "Federico II" University Hospital Naples, Italy
| | - Gianluigi Condorelli
- Humanitas Clinical and Research Center Rozzano (Milan), Italy ; University of Milan Milan, Italy
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MIYAZAKI SHINSUKE, TAKIGAWA MASATERU, KUSA SHIGEKI, KUWAHARA TAISHI, TANIGUCHI HIROSHI, OKUBO KENJI, NAKAMURA HIROAKI, HACHIYA HITOSHI, HIRAO KENZO, TAKAHASHI ATSUSHI, IESAKA YOSHITO. Role of Arrhythmogenic Superior Vena Cava on Atrial Fibrillation. J Cardiovasc Electrophysiol 2014; 25:380-386. [DOI: 10.1111/jce.12342] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/22/2013] [Accepted: 11/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - SHIGEKI KUSA
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Ibaraki Japan
| | - TAISHI KUWAHARA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Kanagawa Japan
| | | | - KENJI OKUBO
- Cardiovascular Center; Yokosuka Kyosai Hospital; Kanagawa Japan
| | | | - HITOSHI HACHIYA
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Ibaraki Japan
| | - KENZO HIRAO
- Heart Rhythm Center; Tokyo Medical and Dental University; Tokyo Japan
| | | | - YOSHITO IESAKA
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Ibaraki Japan
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144
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Affiliation(s)
- Gautam G. Lalani
- University of California Medical Center, Veterans Affairs San Diego
- Stanford University
| | - Rishi Trikha
- University of California Medical Center, Veterans Affairs San Diego
- Stanford University
| | - David E. Krummen
- University of California Medical Center, Veterans Affairs San Diego
- Stanford University
| | - Sanjiv M. Narayan
- University of California Medical Center, Veterans Affairs San Diego
- Stanford University
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Allessie M, de Groot N. Wave-mapping as a guide for ablation of atrial fibrillation: a daydream? Circ Arrhythm Electrophysiol 2013; 6:1056-8. [PMID: 24347598 DOI: 10.1161/circep.113.001131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Maurits Allessie
- Department of Physiology, University of Maastricht, Maastricht, The Netherlands
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146
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Cochet H, Dubois R, Sacher F, Derval N, Sermesant M, Hocini M, Montaudon M, Haïssaguerre M, Laurent F, Jaïs P. Cardiac arrythmias: multimodal assessment integrating body surface ECG mapping into cardiac imaging. Radiology 2013; 271:239-47. [PMID: 24475841 DOI: 10.1148/radiol.13131331] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To demonstrate the feasibility of comprehensive assessment of cardiac arrhythmias by combining body surface electrocardiographic (ECG) mapping (BSM) and imaging. MATERIALS AND METHODS This study was approved by the institutional review board, and all patients gave written informed consent. Twenty-seven patients referred for electrophysiologic procedures in the context of ventricular tachycardia (VT) (n = 9), Wolff-Parkinson-White (WPW) syndrome (n = 2), atrial fibrillation (AF) (n = 13), or scar-related ventricular fibrillation (VF) (n = 3) were examined. Patients underwent BSM and imaging with multidetector computed tomography (CT) (n = 12) and/or delayed enhanced magnetic resonance (MR) imaging (n = 23). BSM was performed by using a 252-electrode vest that enabled the computation of epicardial electrograms from body surface potentials. The epicardial geometry used for BSM was registered to the epicardial geometry segmented from imaging data by using an automatic algorithm. The output was a three-dimensional cardiac model that integrated cardiac anatomy, myocardial substrate, and epicardial activation. RESULTS Acquisition, segmentation, and registration were feasible in all patients. In VT, this enabled a noninvasive assessment of the arrhythmia mechanism and its location with respect to the myocardial substrate, coronary vessels, and phrenic nerve. In WPW syndrome, this enabled understanding of complex accessory pathways resistant to previous ablation. In AF and VF, this enabled the noninvasive assessment of arrhythmia mechanisms and the analysis of rotor trajectories with respect to the myocardial substrate. In all patients, models were successfully integrated in navigation systems and used to guide mapping and ablation. CONCLUSION By combining information on anatomy, substrate, and electrical activation, the fusion of BSM and imaging enables comprehensive noninvasive assessment of cardiac arrhythmias, with potential applications for diagnosis, prognosis, and ablation targeting. Online supplemental material is available for this article.
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Affiliation(s)
- Hubert Cochet
- From the Departments of Cardiovascular Imaging (H.C., M.M., F.L.) and Cardiac Pacing and Electrophysiology (F.S., N.D., M. Hocini, M. Haïssaguerre, P.J.), Centre Hospitalier Universitaire/Université de Bordeaux, Hopital Cardiologique Haut Lévêque, Avenue de Magellan, 33604 Pessac, France; L'Institut de Rythmologie et de Modélisation Cardiaque-Equipex Multimodal Platform for Specific Imaging in Cardiology, Centre Hospitalier Universitaire/Université de Bordeaux/Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France (H.C., R.D., F.S., N.D., M.H., M.M., M.H., F.L., P.J.); and Institut National de Recherche en Informatique et Automatique Asclepios Research Team-Institut National de Recherche en Informatique et Automatique Sophia Antipolis, Sophia Antipolis, France (M.S.)
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Rostock T, Salukhe TV, Hoffmann BA, Steven D, Berner I, Müllerleile K, Theis C, Bock K, Servatius H, Sultan A, Willems S. Prognostic Role of Subsequent Atrial Tachycardias Occurring During Ablation of Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:1059-65. [DOI: 10.1161/circep.113.001019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Thomas Rostock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Tushar V. Salukhe
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Boris A. Hoffmann
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Daniel Steven
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Imke Berner
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Kai Müllerleile
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Cathrin Theis
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Karsten Bock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Helge Servatius
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Arian Sultan
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Stephan Willems
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
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Miyazaki S, Taniguchi H, Kusa S, Uchiyama T, Nakamura H, Hachiya H, Hirao K, Iesaka Y. Impact of atrial fibrillation termination site and termination mode in catheter ablation on arrhythmia recurrence. Circ J 2013; 78:78-84. [PMID: 24189505 DOI: 10.1253/circj.cj-13-0838] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) termination has been reported as a predictor of clinical outcome after persistent AF (PsAF) ablation, the relationship between AF termination site and mode and clinical outcome has not been fully evaluated. METHODS AND RESULTS A total of 135 patients (62±9 years) underwent their first ablation procedure for PsAF (76 longstanding PsAF). With an endpoint of AF termination, the ablation procedure was performed sequentially in the following order: pulmonary vein (PV) antrum isolation, and left atrial and right atrial substrate modification. AF termination was achieved in 69 patients (51%; 24 at the PV antrum, and 45 in the atrium; direct conversion to sinus rhythm in 21, and atrial tachycardia [AT] in 48). With a mean of 1.7±0.7 procedures/patient, 100 patients (74%) were free from atrial tachyarrhythmia (ATa) during a median of 15.0 months of follow-up. During the initial procedure, the AF termination site (atrium vs. PV antrum, hazard ratio [HR], 1.38; 95% confidence interval [CI]: 0.72-3.77; no termination vs. PV antrum, HR, 2.32; 95% CI: 1.26-6.30; P=0.023) and mode (AT vs. sinus rhythm, HR, 1.47; 95% CI: 0.77-4.01; no termination vs. sinus rhythm, HR, 2.38; 95% CI: 1.26-6.46; P=0.017) were independent predictors of ATa recurrence after the last ablation procedure. CONCLUSIONS The site and mode of AF termination during the index ablation procedure predict ATa recurrence following multiple catheter ablation procedures for PsAF.
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Affiliation(s)
- Maurits Allessie
- Department of Physiology, University of Maastricht, The Netherlands
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Gillis AM, Krahn AD, Skanes AC, Nattel S. Management of Atrial Fibrillation in the Year 2033: New Concepts, Tools, and Applications Leading to Personalized Medicine. Can J Cardiol 2013; 29:1141-6. [DOI: 10.1016/j.cjca.2013.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/10/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022] Open
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