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De Ruvo E, De Luca L, Grieco D, Fagagnini A, Rebecchi M, Schillaci V, Stabile G, Arestia A, Salito A, Martino AM, Calò L, Solimene F. Tissue thickness measured with dielectric-based technology during radiofrequency catheter ablation. Eur Heart J Suppl 2023; 25:C253-C257. [PMID: 37125309 PMCID: PMC10132622 DOI: 10.1093/eurheartjsupp/suad049] [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] [Indexed: 05/02/2023]
Abstract
Radiofrequency catheter ablation of the cavotricuspid isthmus is the standard treatment for patients suffering from typical atrial flutter. The aim of this study was to test the feasibility of tissue thickness and lesion transmurality measurement by a novel dielectric system. This was a retrospective multicentric non-randomized open-label, single-arm study. The atrial wall thickness was significantly higher close to the tricuspid annulus than close to the inferior vena cava and a trend towards a progressive decrease of atrial wall thickness was observed moving the mapping catheter from the tricuspid valve to the inferior vena cava. The possibility to visualize the tissue thickness could modify the way to deliver radiofrequency energy, allowing a tailored approach in cardiac ablation procedures.
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Affiliation(s)
| | - Lucia De Luca
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
| | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
| | - Alessandro Fagagnini
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
| | - Marco Rebecchi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
| | | | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV), Italy
- Casa di Cura San Michele, Maddaloni (CE), Italy
- Department of Cardiac Electrophysiology and Pacing, Anthea Hospital, Bari, Italy
| | | | | | - Anna Maria Martino
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Roma (RM) 00169, Italy
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Sumi H, Hoshiyama T, Morihisa K, Noda K, Kaneko S, Kanazawa H, Ishii M, Fujisue K, Sueta D, Takashio S, Usuku H, Matsushita K, Tsujita K. Effect of contact vector direction on achieving cavotricuspid isthmus block. Sci Rep 2023; 13:2579. [PMID: 36781935 PMCID: PMC9925428 DOI: 10.1038/s41598-023-29738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cavotricuspid isthmus (CTI) ablation is an important treatment strategy for CTI-dependent atrial flutter (AFL). The location of the catheter contact area is confirmed by the contact vector direction (CVD) through three-dimensional mapping during the procedure. However, the relationship between CVD during radiofrequency ablation and its efficacy in achieving CTI block has not been clarified. This study aimed to investigate the relationship between CVD and efficacy in achieving CTI block. CVDs during radiofrequency ablation were divided into proximal vectors against the distal tip (P-vector) and other vectors (normal-vector). In 39 patients who underwent CTI linear ablation, the CTIs were divided into two segments: the tricuspid valve area (anterior) and inferior vena cava area (posterior). The frequency of the residual conduction gap was compared between segments in which the P- and normal-vectors were observed. P-vectors were observed in 13 of the 78 segments. The median ablation index was not significantly different between segments in which the P-vector and normal-vector were observed (398.2 [384.2-402.2] vs. 393.3 [378.3-400.1], p = 0.15). However, residual conduction gaps were significantly more frequently observed in the segment in which the P-vector was observed than those in which only the normal-vector was observed (6/13, 46.2% vs. 3/65, 4.6%; p < 0.01). During a 6-month follow-up, two patients required a second session of ablation due to AFL recurrence. A residual conduction gap was observed in one patient at the site where the P-vector was observed in the first session. Avoiding the P-vector might be an important factor in improving CTI block and reducing AFL recurrence.
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Affiliation(s)
- Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Kenji Morihisa
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Katsuo Noda
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
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Ho G, Atwood TF, Bruggeman AR, Moore KL, McVeigh E, Villongco CT, Han FT, Hsu JC, Hoffmayer KS, Raissi F, Lin GY, Schricker A, Woods CE, Cheung JP, Taira AV, McCulloch A, Birgersdotter-Green U, Feld GK, Mundt AJ, Krummen DE. Computational ECG mapping and respiratory gating to optimize stereotactic ablative radiotherapy workflow for refractory ventricular tachycardia. Heart Rhythm O2 2021; 2:511-520. [PMID: 34667967 PMCID: PMC8505208 DOI: 10.1016/j.hroo.2021.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SAbR) is an emerging therapy for refractory ventricular tachycardia (VT). However, the current workflow is complicated, and the precision and safety in patients with significant cardiorespiratory motion and VT targets near the stomach may be suboptimal. OBJECTIVE We hypothesized that automated 12-lead electrocardiogram (ECG) mapping and respiratory-gated therapy may improve the ease and precision of SAbR planning and facilitate safe radiation delivery in patients with refractory VT. METHODS Consecutive patients with refractory VT were studied at 2 hospitals. VT exit sites were localized using a 3-D computational ECG algorithm noninvasively and compared to available prior invasive mapping. Radiotherapy (25 Gy) was delivered at end-expiration when cardiac respiratory motion was ≥0.6 cm or targets were ≤2 cm from the stomach. RESULTS In 6 patients (ejection fraction 29% ± 13%), 4.2 ± 2.3 VT morphologies per patient were mapped. Overall, 7 out of 7 computational ECG mappings (100%) colocalized to the identical cardiac segment when prior invasive electrophysiology study was available. Respiratory gating was associated with smaller planning target volumes compared to nongated volumes (71 ± 7 vs 153 ± 35 cc, P < .01). In 2 patients with inferior wall VT targets close to the stomach (6 mm proximity) or significant respiratory motion (22 mm excursion), no GI complications were observed at 9- and 12-month follow-up. Implantable cardioverter-defibrillator shocks decreased from 23 ± 12 shocks/patient to 0.67 ± 1.0 (P < .001) post-SAbR at 6.0 ± 4.9 months follow-up. CONCLUSIONS A workflow including computational ECG mapping and protocol-guided respiratory gating is feasible, is safe, and may improve the ease of SAbR planning. Studies to validate this workflow in larger populations are required.
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Affiliation(s)
- Gordon Ho
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Todd F. Atwood
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Andrew R. Bruggeman
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Kevin L. Moore
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - Elliot McVeigh
- Department of Bioengineering, University of California San Diego, La Jolla, California
| | | | - Frederick T. Han
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Kurt S. Hoffmayer
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Farshad Raissi
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Grace Y. Lin
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Amir Schricker
- Department of Cardiac Electrophysiology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Christopher E. Woods
- Department of Cardiac Electrophysiology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Joey P. Cheung
- Department of Radiation Oncology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Al V. Taira
- Department of Radiation Oncology, Mills-Peninsula Medical Center, Sutter Health, Burlingame, California
| | - Andrew McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, California
| | | | - Gregory K. Feld
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
| | - Arno J. Mundt
- Department of Radiation Medicine, University of California San Diego, La Jolla, California
| | - David E. Krummen
- Department of Medicine-Cardiology, University of California San Diego, La Jolla, California
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Determination of left atrium volume by fast anatomical mapping and intracardiac echocardiography. The contribution of respiratory gating. J Interv Card Electrophysiol 2015; 42:129-34. [DOI: 10.1007/s10840-014-9968-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 01/22/2023]
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BUN SOKSITHIKUN, LATCU DECEBALGABRIEL, ALLOUCHE EMNA, ERRAHMOUNI ABDELKARIM, SAOUDI NADIR. General Anesthesia is Not Superior to Local Anesthesia for Remote Magnetic Ablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:391-7. [DOI: 10.1111/pace.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/18/2014] [Accepted: 09/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- SOK-SITHIKUN BUN
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
| | | | - EMNA ALLOUCHE
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
| | | | - NADIR SAOUDI
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
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Özcan EE, Szeplaki G, Tahin T, Osztheimer I, Szilagyi S, Apor A, Horvath PM, Vago H, Merkely B, Geller L. Impact of respiration gating on image integration guided atrial fibrillation ablation. Clin Res Cardiol 2014; 103:727-31. [PMID: 24803131 DOI: 10.1007/s00392-014-0707-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation guided by electroanatomic mapping systems is an effective therapy for atrial fibrillation. However, it may be affected by respiration movements. The aim of this study was to determine the impact of respiratory gating on procedural parameters in patients undergoing catheter ablation of atrial fibrillation (AF). METHODS AND RESULTS One-hundred forty consecutive patients undergoing pulmonary vein isolation were admitted to study. Respiratory gating module (AccuResp algorithm, Carto3, Biosense Webster) was enabled in 70 patients and disabled in 70 patients during procedures. Successful pulmonary vein isolation and sinus rhythm were obtained in all patients. A significant reduction in total procedure times [median 77, interquartile range (IQR 66-95) min vs median 82 (IQR 72-104) min, p < 0.05] and fluoroscopy times [median 14 (IQR 9-17) min vs median 16 (IQR 12-22) min, p < 0.05] were observed in the respiratory gated group. Although ablation times (duration between the first and last ablation) were significantly shorter in respiratory gated group [median 37 (IQR 32-53) min vs median 48 (IQR 39-65) min, p < 0.05], total RF application durations were not different between two groups [median 1,554 (IQR 1,213-2,196) s vs median 1,802 (IQR 1,344-2,448) s, p = 0.11]. Difference in electroanatomical map reconstruction times was not significant [median 14 (IQR 12-16) min in gated group vs median 13 (IQR 10-18) min in nongated group, p = 0.19]. CONCLUSION Respiratory gating significantly improves fluoroscopy and ablation times during electroanatomic mapping guided AF ablation. Respiratory gated maps may provide uninterrupted continuous ablation applications. Furthermore, using automatic respiratory gating module does not prolong mapping times.
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Affiliation(s)
- Emin Evren Özcan
- Heart Center, Semmelweis University, Gaál József Street 9, Budapest, 1122, Hungary
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