101
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Yang B, Jiang C, Lin Y, Yang G, Chu H, Cai H, Lu F, Zhan X, Xu J, Wang X, Ching CK, Singh B, Kim YH, Chen M. STABLE-SR (Electrophysiological Substrate Ablation in the Left Atrium During Sinus Rhythm) for the Treatment of Nonparoxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005405. [PMID: 29141843 DOI: 10.1161/circep.117.005405] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Bing Yang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Chenyang Jiang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Yazhou Lin
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Gang Yang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Huimin Chu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Heng Cai
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Fengmin Lu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Xianzhang Zhan
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Jian Xu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Xinhua Wang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Chi-Keong Ching
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Balbir Singh
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Young-Hoon Kim
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Minglong Chen
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
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102
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Moser F, Schreiber D, Rieger A, Trofin M, Pönisch C, Kottkamp H. Box Isolation of fibrotic areas: A substrate modification approach in atrial fibrillation patients. Rev Port Cardiol 2017; 36 Suppl 1:25-27. [PMID: 29100747 DOI: 10.1016/j.repc.2017.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022] Open
Abstract
In the last years, atrial fibrosis was shown to be an independent predictor of procedural failure in patients with paroxysmal and persistent atrial fibrillation. Ablation strategies have been developed to improve the outcome of catheter ablation by targeting detected areas of fibrosis, based either on endocardial voltage mapping or cardiac magnetic resonance. Box isolation of fibrotic areas (BIFA) is a new and promising patient-tailored ablation strategy for atrial fibrillation patients targeting substantial fibrotic areas by circumferential isolation of left atrial fibrosis.
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Affiliation(s)
- Fabian Moser
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Doreen Schreiber
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Andreas Rieger
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Monica Trofin
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Christian Pönisch
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland.
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103
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Saini A, Huizar JF, Tan A, Koneru JN, Ellenbogen KA, Kaszala K. Scar Homogenization in Atrial Fibrillation Ablation: Evolution and Practice. J Atr Fibrillation 2017; 10:1645. [PMID: 29250241 DOI: 10.4022/jafib.1645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/19/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) ablation has emerged as the preferred rhythm control strategy for symptomatic paroxysmal AF refractory or intolerant to at least one class I or III antiarrhythmic medication. Since the initial observation by Haissaguerre and colleagues, of pulmonary vein triggers initiating atrial fibrillation (AF), pulmonary vein isolation (PVI) has become the cornerstone for paroxysmal AF ablation therapy.
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Affiliation(s)
- Aditya Saini
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jose F Huizar
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Alex Tan
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Jayanthi N Koneru
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
| | - Karoly Kaszala
- Division of Cardiology, Hunter Holmes McGuire VAMC and Virginia Commonwealth University, Richmond, VA
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104
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm 2017; 14:e445-e494. [DOI: 10.1016/j.hrthm.2017.07.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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105
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1402] [Impact Index Per Article: 200.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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106
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm 2017; 33:369-409. [PMID: 29021841 PMCID: PMC5634725 DOI: 10.1016/j.joa.2017.08.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- Ablation
- Anticoagulation
- Arrhythmia
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- CB, cryoballoon
- CFAE, complex fractionated atrial electrogram
- Catheter ablation
- LA, left atrial
- LAA, left atrial appendage
- LGE, late gadolinium-enhanced
- LOE, level of evidence
- MRI, magnetic resonance imaging
- OAC, oral anticoagulation
- RF, radiofrequency
- Stroke
- Surgical ablation
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Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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107
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Vlachos K, Efremidis M, Letsas KP, Bazoukis G, Martin R, Kalafateli M, Lioni L, Georgopoulos S, Saplaouras A, Efremidis T, Liu T, Valkanas K, Karamichalakis N, Asvestas D, Sideris A. Low-voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1393-1402. [PMID: 28884923 DOI: 10.1111/jce.13321] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/30/2017] [Accepted: 08/14/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the extent of atrial fibrosis in paroxysmal atrial fibrillation (AF) and the correlation with ablation outcomes after pulmonary vein antral isolation (PVΑI) using a mapping system with high-resolution and high-spatial sampling. METHODS AND RESULTS We prospectively enrolled 80 consecutive patients (45 males, median age 60.26 years) with symptomatic paroxysmal AF who were scheduled for PVAI. Prior to PVAI, high-density bipolar voltage mapping (median number of 2,485 points) was carried out during sinus rhythm in all patients. Criteria for an adequate left atrium (LA) shell were > 2,000 points. Each acquired point was classified according to the peak-to-peak bipolar voltage electrogram based on two criteria (criterion A: healthy > 0.8 mV, border zone: 0.4-0.8 mV and scarred: < 0.4 mV, criterion Β: healthy: > 0.5 mV, border zone: 0.25-0.5 mV and scarred: < 0.25 mV). The extent of low-voltage area < 0.4 mV significantly predicted atrial tachyarrhythmia recurrence after the blanking period (P = 0.002). In univariate analysis, the presence of LA voltage areas < 0.4 mV more than 10% of the total surface area was the only significant predictor of arrhythmia recurrence. The analysis based on window B cutoff values failed to demonstrate any predictors of arrhythmia recurrence. CONCLUSION These data demonstrate that the existence of LA voltage areas < 0.4 mV more than 10% of the total LA surface area predicts arrhythmia recurrence following PVAI for paroxysmal AF.
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Affiliation(s)
- Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Maria Kalafateli
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Louiza Lioni
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Theodore Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Kosmas Valkanas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Nikolaos Karamichalakis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Dimitrios Asvestas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
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108
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Can We Identify the Extra-Pulmonary Vein Substrate in Paroxysmal Atrial Fibrillation Using Incremental Atrial Pacing? JACC Clin Electrophysiol 2017; 3:1018-1019. [DOI: 10.1016/j.jacep.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
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109
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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110
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Williams SE, Linton N, O'Neill L, Harrison J, Whitaker J, Mukherjee R, Rinaldi CA, Gill J, Niederer S, Wright M, O'Neill M. The effect of activation rate on left atrial bipolar voltage in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1028-1036. [PMID: 28639747 PMCID: PMC5639376 DOI: 10.1111/jce.13282] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bipolar voltage is used during electroanatomic mapping to define abnormal myocardium, but the effect of activation rate on bipolar voltage is not known. We hypothesized that bipolar voltage may change in response to activation rate. By examining corresponding unipolar signals we sought to determine the mechanisms of such changes. METHODS AND RESULTS LA extrastimulus mapping was performed during CS pacing in 10 patients undergoing first time paroxysmal atrial fibrillation ablation. Bipolar and unipolar electrograms were recorded using a PentaRay catheter (4-4-4 spacing) and indifferent IVC electrode, respectively. An S1S2 pacing protocol was delivered with extrastimulus coupling interval reducing from 350 to 200 milliseconds. At each recording site (119 ± 37 per LA), bipolar peak-to-peak voltage, unipolar peak to peak voltage and activation delay between unipole pairs was measured. Four patterns of bipolar voltage/extrastimulus coupling interval curves were seen: voltage attenuation with plateau voltage >1 mV (48 ± 15%) or <1 mV (22 ± 15%), and voltage unaffected by coupling interval with plateau voltage >1 mV (17 ± 10%) or <1 mV (13 ± 8%). Electrograms showing bipolar voltage attenuation were associated with significantly greater unipolar voltage attenuation at low (25 ± 28 mV/s vs. 9 ± 11 mV/s) and high (23 ± 29 mV/s vs. 6 ± 12 mV/s) plateau voltage sites (P < 0.001). There was a small but significant increase in conduction delay between unipole pairs at sites showing bipolar voltage attenuation (P = 0.026). CONCLUSIONS Bipolar electrogram voltage is dependent on activation rate at a significant proportion of sites. Changes in unipolar voltage and timing underlie these effects. These observations have important implications for use of voltage mapping to delineate abnormal atrial substrate.
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Affiliation(s)
- Steven E Williams
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - Nick Linton
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - Louisa O'Neill
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - James Harrison
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - John Whitaker
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - Rahul Mukherjee
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical ImagingKing's College London
- Cardiovascular DivisionGuy's and St. Thomas’ NHS Foundation Trust
| | - Jaswinder Gill
- Cardiovascular DivisionGuy's and St. Thomas’ NHS Foundation Trust
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical ImagingKing's College London
| | - Matthew Wright
- Division of Imaging Sciences and Biomedical ImagingKing's College London
- Cardiovascular DivisionGuy's and St. Thomas’ NHS Foundation Trust
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical ImagingKing's College London
- Cardiovascular DivisionGuy's and St. Thomas’ NHS Foundation Trust
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111
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Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Chen SA. Beyond Pulmonary Vein Isolation: the Role of Additional Sites in Catheter Ablation of Atrial Fibrillation. Curr Cardiol Rep 2017; 19:86. [PMID: 28795289 DOI: 10.1007/s11886-017-0884-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the long-term procedural outcome remains suboptimal and there is a frequent need for repeat ablation procedure, especially in patients with non-paroxysmal AF. The review article summarizes the rationales, recent evidences, and strategies of ablation of extra-PV sites and its clinical outcomes. RECENT FINDINGS It is a consensus that durable PV isolations are a definite therapy in patients with paroxysmal AF. In non-paroxysmal AF, many laboratories still believe that adequate substrate ablation outside PVs is definitely required. Empirical linear ablation is not recommended because of difficulty in achieving complete linear block, unless macro-reentry atrial tachycardia developed during procedure. Most of laboratories applied complex fractionated atrial electrogram (CFAE) ablation after PV isolation in non-paroxysmal AF, but the efficacy is limited in the long-term follow-up studies. A combined approach using CFAE, non-linear similarity, and phase mapping strategy to identify rotors or focal sources for substrate modification increases the ablation outcome, when compared to CFAE ablation alone. Provocative test with mapping of non-PV triggers is also recommended in all patients to improve long-term ablation success. Ablation beyond PV isolation is important, especially in non-paroxysmal AF patients, to modify the diseased atrial substrate and eliminate the non-PV triggers, which in turn improve the ablation outcome.
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Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
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Mody BP, Raza A, Jacobson J, Iwai S, Frenkel D, Rojas R, Aronow WS. Ablation of long-standing persistent atrial fibrillation. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:305. [PMID: 28856145 DOI: 10.21037/atm.2017.05.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in the clinical setting affecting nearly 6 million people in United States and the numbers are only expected to rise as the population continues to age. Broadly it is classified into paroxysmal, persistent and longstanding persistent AF. Electrical, structural and autonomic remodeling are some of the diverse pathophysiological mechanisms that contribute to the persistence of AF. Our review article emphasizes particularly on long standing persistent atrial fibrillation (LSPAF) aspect of the disease which poses a great challenge for electrophysiologists. While pulmonary vein isolation (PVI) has been established as a successful ablation strategy for paroxysmal AF, same cannot be said for LSPAF owing to its long duration, complexity of mechanisms, multiple triggers and substrate sites that are responsible for its perpetuation. The article explains different approaches currently being adopted to achieve freedom from atrial arrhythmias. These mainly include ablation techniques chiefly targeting complex fractionated atrial electrograms (CFAE), rotors, linear lesions, scars and even considering hybrid approaches in a few cases while exploring the role of delayed enhancement magnetic resonance imaging (deMRI) in the pre-procedural planning to improve the overall short and long term outcomes of catheter ablation.
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Affiliation(s)
- Behram P Mody
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Anoshia Raza
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Jason Jacobson
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Sei Iwai
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Daniel Frenkel
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rhadames Rojas
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Iso K, Watanabe I, Kogawa R, Okumura Y, Nagashima K, Takahashi K, Watanabe R, Arai M, Ohkubo K, Nakai T, Hirayama A, Nikaido M. Wavefront direction and cycle length affect left atrial electrogram amplitude. J Arrhythm 2017; 33:269-274. [PMID: 28765756 PMCID: PMC5529329 DOI: 10.1016/j.joa.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/27/2016] [Accepted: 01/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationship between atrial electrogram (EGM) characteristics in atrial fibrillation (AF) and those in sinus rhythm (SR) are generally unknown. The activation rate and direction may affect EGM characteristics. We examined characteristics of left atrial (LA) EGMs obtained during pacing from different sites. METHODS The study included 10 patients undergoing pulmonary vein isolation for AF. Atrial EGMs were recorded from a 64-pole basket catheter placed in the LA, and bipolar EGM amplitudes from the distal electrode pair (1-2) and proximal electrode pair (6-7) from 8 splines were averaged. The high right atrium (HRA), proximal coronary sinus (CSp), and distal coronary sinus (CSd) were paced at 600 ms and 300 ms. RESULTS When the LA voltage at SR was ≥1.5 mV, bipolar voltages of the HRA were greater than those of the CSp, which were greater than those of the CSd, regardless of the pacing cycle length. The shorter pacing cycle length resulted in a reduction of the LA EGM voltage at sites of SR voltage ≥1.5 mV, but no significant difference was seen at sites where the SR EGM amplitude was between >0.5 and <1.5 mV. No significant differences were seen in intra-basket conduction times between pacing cycle lengths of 600 ms and 300 ms at any pacing site. CONCLUSION The rate and direction-dependent reduction of the amplitude of atrial EGMs may explain, in part, the voltage discordance during SR and AF.
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Affiliation(s)
- Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Keiko Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
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Nakahara S, Hori Y, Nishiyama N, Okumura Y, Fukuda R, Kobayashi S, Komatsu T, Sakai Y, Taguchi I. Influence of the left atrial contact areas on fixed low-voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1259-1268. [PMID: 28727202 DOI: 10.1111/jce.13301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atrial low-voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear. OBJECTIVE To assess whether CoA regions were involved in atrial substrate properties maintaining PsAF. METHODS A total of 50 patients with PsAF (36 long-lasting) were analyzed. Three representative CoA detection areas (ascending aorta-anterior-LA, descending aorta-left pulmonary vein antrum, and vertebrae-posterior-LA) were registered on the mapping geometry. Electrograms during AF and sinus rhythm (SR) were acquired, and the fractionated electrograms (CFE; < 80milliseconds) and voltages were analyzed regarding the CoAs. RESULTS After SR conversion, 76% (38/50) had a significant LVZ (>5% of the total LA surface area). Patients with long-lasting PsAF versus PsAF had larger CoA areas (7.7 ± 3.0 vs. 4.5 ± 2.5cm2 , P < 0.05) and overlapped-LVZs (8.2 [3.2-11.0] vs. 2.1 [0.7-3.7] cm2 , P = 0.0126) between the SR-LVZs (<0.5 mV) and AF-LVZs (<0.2 mV). Overlapped-LVZs were frequently observed in CoA regions (anterior 76.4%; LIPV antrum 78.8%, and vertebrae 39.2%), and those LVZs had smaller unipolar voltages than those distant from the CoA regions (0.64 ± 0.16 vs. 2.5 ± 1.5 mV, P < 0.0001). SR-LVZ targeted ablation, including of CoA regions, rendered AF termination (n = 8, 21%), and 88% of the sites were not located immediately above, but adjacent to, the overlapped-LVZs. Significant AF slowing (6.0 ± 0.6 to 5.6 ± 0.6 Hz; P < 0.05) accompanied by unintentional CFE elimination (9.8-1.8 cm2 ; P < .0001) was achieved in patients without termination. CONCLUSION Our data suggested that external structures in contact with the LA are involved in the creation of localized diseased myocardium necessary for PsAF maintenance.
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Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Takaaki Komatsu
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yoshihiko Sakai
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
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Huang S, Xue YM, Zhang WC, Ding CH, Li QY, Zhan XZ. Biatrial Macroreentry Atrial Tachycardia after Atrial Fibrillation Ablation. Chin Med J (Engl) 2017; 129:2250-2. [PMID: 27625100 PMCID: PMC5022349 DOI: 10.4103/0366-6999.189906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shen Huang
- Arrhythmia Center, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou, Guangdong 510006, China
| | - Yu-Mei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Wen-Chang Zhang
- Arrhythmia Center, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou, Guangdong 510006, China
| | - Chun-Hua Ding
- Arrhythmia Center, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou, Guangdong 510006, China
| | - Qi-Yan Li
- Arrhythmia Center, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou, Guangdong 510006, China
| | - Xian-Zhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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Schreiber D, Rieger A, Moser F, Kottkamp H. Catheter ablation of atrial fibrillation with box isolation of fibrotic areas: Lessons on fibrosis distribution and extent, clinical characteristics, and their impact on long-term outcome. J Cardiovasc Electrophysiol 2017. [PMID: 28635186 DOI: 10.1111/jce.13278] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The BIFA concept (box isolation of fibrotic areas) supplementing pulmonary vein isolation (PVI) was implemented in atrial fibrillation (AF) patients with fibrotic atrial cardiomyopathy (FACM) to improve catheter ablation outcomes. METHODS AND RESULTS Ninety-two patients with FACM underwent PVI + BIFA. We investigated patient characteristics (58 persistent/34 paroxysmal, 68 ± 8 years, LA 44 ± 7 mm, CHA2 DS2 -VASc 2.6 ± 1.3, FACM I: 15.2%, II: 53.3%, III: 26.1%, IV: 5.4%), periprocedural data concerning fibrosis extent/distribution, and their impact on outcome. Based on severe fibrosis areas (SFAs) of 13.5 ± 13.9 cm2 detected by voltage mapping, 1.4 ± 0.5 boxes (n = 1-3, 2.2-35.3 cm2 ) were applied in the left atrium. With higher grade FACM, SFAs increased and maximum voltage decreased (I/IV: 6.29/3.18 mV). Anterior (ant.) SFAs were found to be more common and larger than posterior (post.) SFAs (58.3% vs. 42.6%, ant. 8.0 ± 8.0 vs. post. 4.7 ± 6.8 cm2 ). In 40 of 92 (43%) patients, both atrial walls were affected with rare cases of solely post. fibrosis (6 of 92, 6.6%). Women (39 of 92, 42%) showed FACM III+IV more often than men (P = 0.022) and can still present paroxysmal while persistent males are more likely to have FACM I-II. Single and multiple procedure (1.2/patient) success was 69% and 83% after 16 ± 8 months with an unfavorable impact of large SFA size, both-sided fibrosis and reduced maximum voltage, independently of patient characteristics and AF type. CONCLUSION FACM patients are a challenging AF subgroup for catheter ablation. Women seem to show FACM III+IV more often than men. The distribution of left atrial fibrosis is variable but more pronounced anteriorly. Atrial disease is characterized by SFA size but also maximum voltage reduction, both with implications on ablation outcome. Using BIFA, success rates of patients without fibrosis can be approached but are limited in FACM III+IV.
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Affiliation(s)
- Doreen Schreiber
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Andreas Rieger
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Fabian Moser
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
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Therapeutic Approaches to Atrial Fibrillation Ablation Targeting Atrial Fibrosis. JACC Clin Electrophysiol 2017; 3:643-653. [DOI: 10.1016/j.jacep.2017.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022]
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Kik C, Mouws EMJP, Bogers AJJC, de Groot NMS. Intra-operative mapping of the atria: the first step towards individualization of atrial fibrillation therapy? Expert Rev Cardiovasc Ther 2017; 15:537-545. [PMID: 28591518 DOI: 10.1080/14779072.2017.1340156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF), an age-related progressive disease, is becoming a worldwide epidemic with a prevalence rate of 33 million. Areas covered: In this expert review, an overview of important results obtained from previous intra-operative mapping studies is provided. In addition, our novel intra-operative high resolution mapping studies, its surgical considerations and data analyses are discussed. Furthermore, the importance of high resolution mapping studies of both sinus rhythm and AF for the development of future AF therapy is underlined by our most recent results. Expert commentary: Progression of AF is determined by the extensiveness of electropathology which is defined as conduction disorders caused by structural damage of atrial tissue. The severity of electropathology is a major determinant of therapy failure. At present, we do not have any diagnostic tool to determine the degree of electropathology in the individual patient and we can thus not select the most optimal treatment modality for the individual patient. An intra-operative, high resolution scale, epicardial mapping approach combined with quantification of electrical parameters may serve as a diagnostic tool to stage AF in the individual patient and to provide patient tailored therapy.
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Affiliation(s)
- Charles Kik
- b Department of Cardiothoracic Surgery , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Elisabeth M J P Mouws
- a Department of Cardiology , Erasmus Medical Center , Rotterdam , The Netherlands.,b Department of Cardiothoracic Surgery , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Ad J J C Bogers
- b Department of Cardiothoracic Surgery , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Natasja M S de Groot
- a Department of Cardiology , Erasmus Medical Center , Rotterdam , The Netherlands
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Chen M. Scar homogenization in AF ablation: Evolution and practice. J Atr Fibrillation 2017; 10:1618. [PMID: 29250226 PMCID: PMC5673332 DOI: 10.4022/jafib.1618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/10/2022]
Abstract
Laboratory studies, histology studies, image studies and the clinical studies all prove the positive correlation between atrial fibrillation and atrial fibrosis from different perspectives. Atrial fibrosis, by separating myocardial cell coupling, diminishing conduction velocity and promoting anisotropic conduction, produce the substrate to sustain atrial fibrillation (AF). These fibrotic areas can be translated into signal abnormalities (low voltage and complex electrgram), and be depicted by electroanatomic high density map. Ablation targeting these areas after circumferential pulmonary vein produces isolation as the additional substrate modification strategy has proved its beneficial results. However, the unified methodology regarding the scar definition, the mapping rhythm (AF or sinus rhythm) and the modification endpoint is yet to be negotiated. Large-scale clinical trials, long-term follow-up results are needed to prove its contribution to the overall success rate of AF ablation.
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Affiliation(s)
- Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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Yagishita A, Sparano D, Cakulev I, Gimbel JR, Phelan T, Mustafa H, De Oliveira S, Mackall J, Arruda M. Identification and electrophysiological characterization of early left atrial structural remodeling as a predictor for atrial fibrillation recurrence after pulmonary vein isolation. J Cardiovasc Electrophysiol 2017; 28:642-650. [DOI: 10.1111/jce.13211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Atsuhiko Yagishita
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Dina Sparano
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Ivan Cakulev
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - J. Rod Gimbel
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Timothy Phelan
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Hossam Mustafa
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Samer De Oliveira
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Judith Mackall
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
| | - Mauricio Arruda
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University; School of Medicine; Cleveland OH USA
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MASUDA MASAHARU, FUJITA MASASHI, IIDA OSAMU, OKAMOTO SHIN, ISHIHARA TAKAYUKI, NANTO KIYONORI, KANDA TAKASHI, SUNAGA AKIHIRO, TSUJIMURA TAKUYA, MATSUDA YASUHIRO, OHASHI TAKUYA, UEMATSU MASAAKI. Comparison of Left Atrial Voltage between Sinus Rhythm and Atrial Fibrillation in Association with Electrogram Waveform. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:559-567. [DOI: 10.1111/pace.13051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/25/2017] [Accepted: 02/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- MASAHARU MASUDA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - MASASHI FUJITA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - OSAMU IIDA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - SHIN OKAMOTO
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | | | - KIYONORI NANTO
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - TAKASHI KANDA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - AKIHIRO SUNAGA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - TAKUYA TSUJIMURA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - YASUHIRO MATSUDA
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - TAKUYA OHASHI
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
| | - MASAAKI UEMATSU
- Cardiovascular Center; Kansai Rosai Hospital; Amagasaki Hyogo Japan
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BLANDINO ALESSANDRO, BIANCHI FRANCESCA, GROSSI STEFANO, BIONDI-ZOCCAI GIUSEPPE, CONTE MARIAROSA, GAIDO LUCA, GAITA FIORENZO, SCAGLIONE MARCO, RAMETTA FRANCESCO. Left Atrial Substrate Modification Targeting Low-Voltage Areas for Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Pacing Clin Electrophysiol 2017; 40:199-212. [PMID: 28054377 DOI: 10.1111/pace.13015] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/07/2016] [Accepted: 12/18/2016] [Indexed: 02/05/2023]
Affiliation(s)
- ALESSANDRO BLANDINO
- Division of Cardiology, Department of Internal Medicine; S. Andrea Hospital; Vercelli Italy
| | | | - STEFANO GROSSI
- Division of Cardiology; Mauriziano Umberto I Hospital; Turin Italy
| | - GIUSEPPE BIONDI-ZOCCAI
- Department of Medico-Surgical Sciences and Biotechnologies; Sapienza University of Rome; Latina Italy
- Department of AngioCardioNeurology; IRCCS Neuromed; Pozzilli Italy
| | - MARIA ROSA CONTE
- Division of Cardiology; Mauriziano Umberto I Hospital; Turin Italy
| | - LUCA GAIDO
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza; University of Turin; Turin Italy
| | - FIORENZO GAITA
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza; University of Turin; Turin Italy
| | - MARCO SCAGLIONE
- Division of Cardiology, Department of Internal Medicine; Cardinal Gugliemo Massaia Hospital; Asti Italy
| | - FRANCESCO RAMETTA
- Division of Cardiology, Department of Internal Medicine; S. Andrea Hospital; Vercelli Italy
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124
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Han X, Li J. Catheter Ablation of Atrial Fibrillation: Where Are We? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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126
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YAGISHITA ATSUHIKO, GIMBEL JROD, DE OLIVEIRA SAMER, MANYAM HARISH, SPARANO DINA, CAKULEV IVAN, MACKALL JUDITH, ARRUDA MAURICIO. Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy. J Cardiovasc Electrophysiol 2016; 28:147-155. [DOI: 10.1111/jce.13122] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 01/30/2023]
Affiliation(s)
- ATSUHIKO YAGISHITA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - J. ROD GIMBEL
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - SAMER DE OLIVEIRA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - HARISH MANYAM
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - DINA SPARANO
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - IVAN CAKULEV
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - JUDITH MACKALL
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
| | - MAURICIO ARRUDA
- University Hospitals Harrington Heart and Vascular Institute; Case Western Reserve University; School of Medicine; Cleveland Ohio United States
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127
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Jadidi AS, Lehrmann H, Keyl C, Sorrel J, Markstein V, Minners J, Park CI, Denis A, Jais P, Hocini M, Potocnik C, Allgeier J, Hochholzer W, Herrera-Siklody C, Kim S, El Omri Y, Neumann FJ, Weber R, Haissaguerre M, Arentz T. Response to Letter Regarding Article, “Ablation of Persistent Atrial Fibrillation Targeting Low-Voltage Areas With Selective Activation Characteristics”. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004312. [DOI: 10.1161/circep.116.004312] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amir S. Jadidi
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Cornelius Keyl
- Department of Anesthesiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Jérémie Sorrel
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Viktor Markstein
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Jan Minners
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Chan-il Park
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Arnaud Denis
- Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France
| | - Pierre Jais
- Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France
| | - Mélèze Hocini
- Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France
| | - Clemens Potocnik
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Juergen Allgeier
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Claudia Herrera-Siklody
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Youssef El Omri
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Reinhold Weber
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Michel Haissaguerre
- Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France
| | - Thomas Arentz
- Arrhythmia Division, Department of Cardiology & Angiology 2, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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128
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Gaita F, Castagno D. Electrophysiologically Guided Substrate Modification During Sinus Rhythm: Personalized Approach to Nonparoxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:e003832. [PMID: 26857910 DOI: 10.1161/circep.116.003832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fiorenzo Gaita
- From the Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy.
| | - Davide Castagno
- From the Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
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