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Yan QD, Gong KZ, Chen XH, Chen JH, Xu Z, Wang WW, Zhang FL. Comparison of Second-Generation Cryoballoon Ablation and Quantitative Radiofrequency Ablation Guided by Ablation Index for Atrial Fibrillation. Angiology 2024; 75:462-471. [PMID: 36809222 DOI: 10.1177/00033197231159254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We compared the efficacy and complication rates of quantitative radiofrequency ablation guided by ablation index (RFCA-AI) with those of second-generation cryoballoon ablation (CBA-2). Consecutive patients (n = 230) with symptomatic atrial fibrillation (AF) undergoing a first ablation CBA-2 (92 patients) or RFCA-AI (138 patients) procedure were enrolled in this study. The late recurrence rate in the CBA-2 group was higher than that in the RFCA-AI group (P = .012). Subgroup analysis showed the same result in patients with paroxysmal AF (PAF) (P = .039), but no difference was found in patients with persistent AF (P = .21). The average operation duration in the CBA-2 group (85 [75-99.5] minutes) was shorter than that in the RFCA-AI group (100 [84.5-120] minutes) (P < .0001), but the average exposure time (17.36(13.87-22.49) vs 5.49(4.00-8.24) minutes) in the CBA-2 group and X-ray dose (223.25(149.15-336.95) vs 109.15(80.75-168.7) mGym) were significantly longer than those in RFCA-AI group (P < .0001). Multivariate logistic regression analysis showed that left atrial diameter (LAD), early recurrence, and methods of ablation (cryoballoon ablation) were independent risk factors for late recurrence after AF ablation. Early recurrence of AF and LAD were independent risk factors for predicting late recurrence after AF ablation.
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Affiliation(s)
- Qin-Dan Yan
- Department of Rehabilitation, Xiamen Humanity Rehabilitation Hospital, Xiamen, China
| | - Ke-Zeng Gong
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xue-Hai Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Hua Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhe Xu
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei-Wei Wang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fei-Long Zhang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
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2
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Dzhinsov KR. Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation. Folia Med (Plovdiv) 2023; 65:713-719. [PMID: 38351752 DOI: 10.3897/folmed.65.e103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/16/2023] [Indexed: 02/16/2024] Open
Abstract
The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure.
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3
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Sasaki T, Nakamura K, Minami K, Take Y, Naito S. How to map and ablate a pulmonary vein-to-right atrium breakthrough during simultaneous persistent pulmonary vein fibrillation and organized atrial fibrillation using an automated high-resolution mapping system. HeartRhythm Case Rep 2021; 7:43-47. [PMID: 33505854 PMCID: PMC7813795 DOI: 10.1016/j.hrcr.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Kohki Nakamura
- Address reprint requests and correspondence: Dr Kohki Nakamura, Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan.
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4
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Martins RP, Galand V, Behar N, Daubert JC, Mabo P, Leclercq C, Pavin D. Localization of Residual Conduction Gaps After Wide Antral Circumferential Ablation of Pulmonary Veins. JACC Clin Electrophysiol 2020; 5:753-765. [PMID: 31320003 DOI: 10.1016/j.jacep.2019.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 01/15/2023]
Abstract
Ablation of atrial fibrillation (AF) is the cornerstone therapy for patients with symptomatic AF resistant to anti-arrhythmic drugs or as first-line therapy, and is based on permanent pulmonary vein (PV) isolation. The presence of a conduction gap in a wide antral circumferential ablation lesion around PVs is often sufficient to transform an initially successful ablation into a procedural failure, thus necessitating a redo intervention. The strategy during a redo procedure is based on the detection and ablation of the reconnection gap. Finding gaps is often simple, but also sometimes challenging, because gaps may be difficult to detect, resulting in unnecessary radiofrequency delivery. The present review aimed to describe the various techniques published thus far to detect residual reconnections along the encircling ablation lines around PVs, to help electrophysiologists to detect and ablate reconnection gaps.
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Affiliation(s)
- Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France.
| | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Nathalie Behar
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | | | - Philippe Mabo
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
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5
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Tahara M, Kato R, Ikeda Y, Goto K, Asano S, Mori H, Iwanaga S, Muramatsu T, Matsumoto K. Differential Atrial Pacing to Detect Reconnection Gaps After Pulmonary Vein Isolation in Atrial Fibrillation. Int Heart J 2020; 61:503-509. [PMID: 32418967 DOI: 10.1536/ihj.19-584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High-resolution mapping is useful to identify reconnection gaps in the pulmonary vein after pulmonary vein isolation for atrial fibrillation. However, it is sometimes difficult to differentiate pulmonary vein potentials from far-field potentials because of very low amplitudes. Our purpose was to evaluate the usefulness of a novel differential atrial pacing method to differentiate reconnected pulmonary vein potentials from isolated pulmonary vein potentials. This retrospective observational study included 34 patients with atrial fibrillation (22 men; mean age, 64 ± 14 years; 28 with paroxysmal atrial fibrillation) who underwent radiofrequency or cryoballoon ablation. Following pulmonary vein isolation, we created a high-resolution activation map during pacing from both the coronary sinus and left atrial appendage. We compared the characteristics of the pulmonary vein potentials and the pattern of activation between the reconnected and isolated pulmonary veins. We analyzed 131 pulmonary veins and found reconnections in 41 pulmonary veins (R group); 90 pulmonary veins had no reconnection (NR group). The R group had a significantly shorter distance between the earliest pulmonary vein activation sites in both activation maps, compared with the NR group (5.22 ± 0.53 mm versus 17.08 ± 0.36 mm, respectively; P < 0.0001). The amplitude of the pulmonary vein potentials was higher in the R group versus the NR group (0.61 ± 0.05 mV versus 0.04 ± 0.03 mV, respectively; P < 0.0001). Six gaps (14%) in the R group that were unrecognized using a conventional method were identified using our novel method. In conclusion, differential atrial pacing was useful to identify pulmonary vein reconnection gaps during ablation using a novel high-resolution mapping system.
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Affiliation(s)
- Mai Tahara
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Koji Goto
- Department of Cardiology, Saitama Medical University International Medical Center
| | - So Asano
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center
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Barrio-Lopez MT, Sanchez-Quintana D, Garcia-Martinez J, Betancur A, Castellanos E, Arceluz M, Ortiz M, Nevado-Medina J, Garcia F, Almendral J. Epicardial Connections Involving Pulmonary Veins. Circ Arrhythm Electrophysiol 2020; 13:e007544. [DOI: 10.1161/circep.119.007544] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background:
The presence of epicardial connections (ECs) between pulmonary veins (PVs) and other anatomic structures may hinder PV isolation. In this study, we analyzed their prevalence, location, associated factors, and clinical implications.
Methods:
Five hundred thirty-four consecutive patients with atrial fibrillation undergoing radiofrequency ablation were included. We considered that an EC was present if: (1) the first pass around the PV antrum did not produce PV isolation and (2) subsequent atrial activation during PV pacing showed that the earliest site was located away from the ablation line and later activation sites were observed near the ablation line. Clinical and electrophysiological variables were collected from all patients. Patients were followed during 12.9±9.4 months, and any documented atrial tachyarrhythmia after the 3-month blanking period was classified as a recurrence.
Results:
Out of the 534 patients included, 72 (13.5%) were found to have 81 ECs. There was a significant association between the presence of ECs and structural heart disease (15.3% in patients without ECs versus 36.5% in patient with ECs;
P
<0.001) and patent foramen ovale (4.6% versus 13.5%;
P
=0.002). The presence of a left common trunk was significantly associated with the absence of ECs (29.6% in patients without ECs versus 16.2% in patients with ECs;
P
=0.014). Patients with ECs had lower acute success in PV isolation compared with patients without ECs (99.1% versus 86.1%;
P
<0.001). After adjusting for age, sex, type of atrial fibrillation, left atrium area, hypertension, structural heart disease, presence of left common trunk, patent foramen ovale, and time for atrial fibrillation diagnosis to the ablation, we found a significantly higher risk of atrial tachyarrhythmia recurrences in patients with ECs compared with patients without ECs (hazard ratio, 1.7 [95% CI, 1.1–2.9];
P
=0.04).
Conclusions:
ECs between PVs and other adjacent structures are frequent in patient with atrial fibrillation (prevalence: 13.5%). Structural heart disease and a patent foramen ovale are strongly associated with the presence of ECs. ECs reduce the acute and chronic success of PV isolation.
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Affiliation(s)
- Maria Teresa Barrio-Lopez
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Damian Sanchez-Quintana
- Anatomy and Cell Biology Department, School of Medicine, University of Badajoz, Spain (D.S.-Q., J.N.-M.)
| | - Joaquin Garcia-Martinez
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Andres Betancur
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Eduardo Castellanos
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Martín Arceluz
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Mercedes Ortiz
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Jorge Nevado-Medina
- Anatomy and Cell Biology Department, School of Medicine, University of Badajoz, Spain (D.S.-Q., J.N.-M.)
| | - Fermin Garcia
- Cardiac Electrophysisology Program, Hospital of the Univeristy of Pennsylvania, Perlman School of Medicine, Philadelphia (F.G.)
| | - Jesús Almendral
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
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7
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Gabriels J, Beldner S, Donnelly J, Willner J, Epstein LM, Patel A. Escape mapping to achieve bidirectional block: A case series. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:470-473. [DOI: 10.1111/pace.13551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/16/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- James Gabriels
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Stuart Beldner
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Joseph Donnelly
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Jonathan Willner
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Laurence M. Epstein
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Apoor Patel
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
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8
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Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure. J Interv Card Electrophysiol 2018; 53:195-205. [DOI: 10.1007/s10840-018-0371-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/06/2018] [Indexed: 10/16/2022]
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9
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A novel method for localization and ablation of conduction gaps after wide antral circumferential ablation of pulmonary veins. Arch Cardiovasc Dis 2018; 111:340-348. [DOI: 10.1016/j.acvd.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/30/2017] [Accepted: 07/29/2017] [Indexed: 11/20/2022]
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10
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Ni H, Zhuge Y, Li L, Li W, Zhao C, Wang Y, Wang F. Rabbit model to simulate the residual conduction gaps after radiofrequency ablation on the anterior wall of left atrial appendage. J Interv Card Electrophysiol 2018; 53:1-8. [PMID: 29637377 DOI: 10.1007/s10840-018-0353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/04/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Radiofrequency ablation (RFA) is widely used to treat patients with atrial fibrillation (AF), but its recurrence rate is still high mainly due to pulmonary vein reconnection and residual conduction gaps. We aim to establish a rabbit model to simulate the residual conduction gaps after ablation. METHODS Sixty-nine adult New Zealand white rabbits were randomly assigned to six groups. RFA on the anterior wall of left atrial appendage (LAA) were performed with the ablation power from 6 to 21 W. The electrophysiological pacing and mapping technology was used to evaluate the bidirectional conduction of LAA. Histological study and fluorescence techniques were used to evaluate the effect of RFA and the accumulation of drug-loaded liposome on the loop ablation lesions of LAA. RESULTS Typical loop ablation lesions of LAA could be observed in vivo and vitro of rabbit models. Histological evaluation revealed coagulative necrosis on the loop ablation lesions. Electrical conduction between inside and outside loop lesions recovered after 1 or 2 weeks after initial unidirectional conduction block. The recurrence rates were significantly different among six groups with varying ablation powers (p < 0.05). Compared with exit conduction block, entrance conduction block was significantly different at 5 min after ablation (p = 0.02). IR-775-loaded liposomes were accumulated on the loop ablation lesions at 48 h after RFA. CONCLUSIONS RFA associated with electrophysiological pacing and mapping technology successfully established a novel rabbit model to simulate the residual conduction gaps after RFA.
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Affiliation(s)
- Huaner Ni
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai, 200800, People's Republic of China
| | - Ying Zhuge
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai, 200800, People's Republic of China
| | - Lin Li
- Department of Pharmaceutics, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Weifeng Li
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai, 200800, People's Republic of China
| | - Congcong Zhao
- Department of Pharmaceutics, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Yujie Wang
- Department of Pharmaceutics, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Fang Wang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai, 200800, People's Republic of China.
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