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Marzak H, Rivière H, Fitouchi S, Cardi T, Kanso M, Morel O, Jesel L. The influence of left atrial volume on left atrial voltage in persistent atrial fibrillation patients without low-voltage zone: outcomes of pulmonary vein isolation. Europace 2024; 26:euae190. [PMID: 39031019 PMCID: PMC11259848 DOI: 10.1093/europace/euae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/27/2024] [Indexed: 07/22/2024] Open
Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Hélène Rivière
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
- UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
- UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg, Strasbourg, France
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Georgi C, Bannehr M, Lochmann M, Reiners D, Haase-Fielitz A, Butter C, Seifert M. Left atrial low-voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures. J Cardiovasc Electrophysiol 2024; 35:1156-1164. [PMID: 38566599 DOI: 10.1111/jce.16266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Left atrial (LA) low voltage areas (LVA) are a controversial target in atrial fibrillation ablation procedures. However, LVA and LA volume are good predictors of arrhythmia recurrence in ablation-naïve patients. Their predictive value in progressively diseased pre-ablated atria is uncertain. METHODS Consecutive patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT), who were scheduled for repeat LA ablation, were enrolled in the prospective Bernau ablation registry between 2016 and 2020. All patients received a complete LA ultrahigh-density map before ablation. Maps were analyzed for LA size, LVA percentage and distribution. The predictive value of demographic, anatomic, and mapping variables on AF recurrence was analyzed. RESULTS 160 patients (50.6% male, 1.3 pre-ablations, 60% persistent AF) with complete LA voltage maps were included. Mean follow-up time was 16 ± 11 months. Mean recorded electrograms (EGMs) per map were 9754 ± 5808, mean LA volume was 176.1 ± 35.9 ml and mean rate of LVAs <0.5 mV was 30.6% ± 23.1%. During follow-up recurrence rate of AF or AT >30 s was 55.6%. Patients with recurrence had a significant higher percentage of LVAs (40.0% vs. 18.8%, p < .001) but no relevant difference in LA volume (172 vs. 178 mL, p = .299). ROC curves revealed LVA as a good predictor for recurrence (AUC = 0.79, p < .001) and a cut-off of 22% LVAs with highest sensitivity (73.0%) and specificity (71.8%). Based on this cut off, event free survival was significantly higher in the Low LVA group (p < .01). CONCLUSION Total LVA percentage has a good predictive power on arrhythmia recurrence in a cohort of advanced scarred left atria in repeat procedures independent of the applied ablation strategy. Left atrial volume seems to have minor impact on the rhythm outcome in our study cohort.
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Affiliation(s)
- Christian Georgi
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
| | - Marwin Bannehr
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
| | - Marlene Lochmann
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
| | - David Reiners
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Neuruppin, Germany
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Butter
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Martin Seifert
- Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Neuruppin, Germany
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Anwar O, Chung DU, Gunawardene MA, Jungen C, Hartmann J, Meyer C, Gessler N, Willems S, Hakmi S, Eickholt C. A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1700. [PMID: 36556902 PMCID: PMC9781762 DOI: 10.3390/medicina58121700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p < 0.0001; LA angiography: 297.9 ± 4.62 vs. PV-Angiography: 348.9 ± 11.03; p < 0.001, respectively) per vein were slightly but significantly higher in the PV angiography group. We observed no difference in late AF recurrence (24.7% LA angiography vs. 21.3% PV angiography; p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups.
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Affiliation(s)
- Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
| | - Melanie A. Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Christiane Jungen
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, 20251 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Christian Meyer
- Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, 40217 Düsseldorf, Germany
- Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Institute for Neural and Sensory Physiology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
- Department of Cardiology, Klinikum Itzehoe, 25524 Itzehoe, Germany
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Manole S, Budurea C, Pop S, Iliescu AM, Ciortea CA, Iancu SD, Popa L, Coman M, Szabó L, Coman V, Bálint Z. Correlation between Volumes Determined by Echocardiography and Cardiac MRI in Controls and Atrial Fibrillation Patients. Life (Basel) 2021; 11:life11121362. [PMID: 34947893 PMCID: PMC8707690 DOI: 10.3390/life11121362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022] Open
Abstract
Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.
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Affiliation(s)
- Simona Manole
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Claudia Budurea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Sorin Pop
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Alin M. Iliescu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Cristiana A. Ciortea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Stefania D. Iancu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Loredana Popa
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihaela Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - László Szabó
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Vasile Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Zoltán Bálint
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-264-405-300; Fax: +40-264-591-906
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Mouselimis D, Tsarouchas AS, Pagourelias ED, Bakogiannis C, Theofilogiannakos EK, Loutradis C, Fragakis N, Vassilikos VP, Papadopoulos CE. Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis. Hellenic J Cardiol 2020; 61:154-164. [DOI: 10.1016/j.hjc.2020.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/22/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022] Open
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Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015343. [PMID: 32242478 PMCID: PMC7428644 DOI: 10.1161/jaha.119.015343] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Historically, atrial fibrillation has been observed in clinical settings of prolonged hemodynamic stress, eg, hypertension and valvular heart disease. However, recently, the most prominent precedents to atrial fibrillation are metabolic diseases that are associated with adipose tissue inflammation (ie, obesity and diabetes mellitus) and systemic inflammatory disorders (ie, rheumatoid arthritis and psoriasis). These patients typically have little evidence of left ventricular hypertrophy or dilatation; instead, imaging reveals abnormalities of the structure or function of the atria, particularly the left atrium, indicative of an atrial myopathy. The left atrium is enlarged, fibrotic and noncompliant, potentially because the predisposing disorder leads to an expansion of epicardial adipose tissue, which transmits proinflammatory mediators to the underlying left atrium. The development of an atrial myopathy not only leads to atrial fibrillation, but also contributes to pulmonary venous hypertension and systemic thromboembolism. These mechanisms explain why disorders of systemic or adipose tissue inflammation are accompanied an increased risk of atrial fibrillation, abnormalities of left atrium geometry and an enhanced risk of stroke. The risk of stroke exceeds that predicted by conventional cardiovascular risk factors or thromboembolism risk scores used to guide the use of anticoagulation, but it is strongly linked to clinical evidence and biomarkers of systemic inflammation.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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Reiber JHC, Pereira GTR, Bezerra HG, De Sutter J, Schoenhagen P, Stillman AE, Van de Veire NRL. Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2019; 35:1175-1188. [DOI: 10.1007/s10554-019-01579-9] [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: 12/01/2022]
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Wei W, Shehata M, Wang X, Rao F, Zhan X, Guo H, Fang X, Liao H, Liu J, Deng H, Liu Y, Xue Y, Wu S. Invasive therapies for patients with concomitant heart failure and atrial fibrillation. Heart Fail Rev 2019; 24:821-829. [PMID: 31049749 DOI: 10.1007/s10741-019-09795-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are two clinical entities that can present either separately or concurrently. One entity can lead to the other and vice versa as AF can not only be the underlying etiology of HF but also exacerbate HF due to other cardiac diseases. Besides prevention of cerebral and systemic embolism and elimination of AF-related symptoms, restoration of sinus rhythm for AF patients helps to avoid or reduce HF, irrespective of their underlying heart disease. Successful rates of medical therapy for AF are low in persistent AF, and much lower in long-standing AF, while invasive procedures for AF yield promising results. In this review, the authors evaluate the value of invasive therapies for HF patients complicated with non-valvular AF. We examine this clinical problem by interpreting the relationships between these two entities: the mechanism of tachycardia-induced cardiomyopathy (TIC), past opinions about rhythm control and rate control of AF, discrimination of HF-related AF and AF-induced HF, how to identify the AF patients that could benefit from invasive therapies, and how to select invasive therapies for different AF patients and peri-operative treatments.
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Affiliation(s)
- Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Michael Shehata
- Heart Institute Los Angeles, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Xunzhang Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Heart Institute Los Angeles, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Fang Rao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.,Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xianzhan Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Huiming Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Jian Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Yang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China. .,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, People's Republic of China. .,Guangdong Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 96, Dongchuan Road, Guangzhou, 510080, People's Republic of China.
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The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation. Cardiol Res Pract 2019; 2018:3096261. [PMID: 30622820 PMCID: PMC6304809 DOI: 10.1155/2018/3096261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P < 0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P < 0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P < 0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.
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