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Pajareya P, Srisomwong S, Siranart N, Kaewkanha P, Chumpangern Y, Prasitlumkum N, Kewchareon J, Chokesuwattanaskul R, Tokavanich N. Implantation of a permanent pacemaker following orthotopic heart transplantation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01909-5. [PMID: 39190212 DOI: 10.1007/s10840-024-01909-5] [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: 07/22/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Orthotopic heart transplant (OHT) is among the final armamentariums for end-stage heart disease. Many patients who have had OHT require a post-transplant permanent pacemaker (PPM) implantation due to an abnormal conduction system. We aimed to evaluate the risk of mortality and acute rejection in patients with OHT who had received PPM compared to patients without PPM and to determine predictors for PPM placement in this population. METHODS We comprehensively searched for studies from MEDLINE, EMBASE, and Cochrane databases from inception to September 2023. Inclusion criteria focused on patients who had undergone OHT and PPM implantation post-transplant. Data from each study were combined using a random-effects model. Results were expressed as relative risk (RR) or odd ratios (OR) with a 95% confidence interval (CI). RESULTS A total of 9 studies were included in this meta-analysis incorporating a total of 54,848 patients (3.3% had PPM). The pooled all-cause mortality rate among patients with PPM post-OHT was 26% (95% CI: 19-33%, I2 = 1%). There were no differences between post-heart transplant patients with PPM and those without PPM in risk of all-cause mortality (RR 0.76, 95% CI: 0.43-1.34; I2 = 45%) and acute rejection (RR 1.22, 95% CI: 0.74-2.00, I2 = 59%). Bi-atrial anastomosis was associated with an increased risk of PPM implantation post-OHT (OR 7.74, 95% CI: 3.55-16.91, I2 = 0%), while pre-OHT mechanical circulatory support (MCS) was associated with a decreased risk of PPM implantation post-OHT (OR 0.45, 95% CI 0.27-0.76, I2 = 0%). CONCLUSION There were no significant differences in all-cause mortality or acute rejection between post-OHT recipients who required PPM compared to those who did not receive PPM. Further, bi-atrial anastomosis portended the need for PPM implantation, while MCS was associated with a decreased occurrence of PPM.
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Affiliation(s)
- Patavee Pajareya
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Sathapana Srisomwong
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Noppachai Siranart
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Ponthakorn Kaewkanha
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Yanisa Chumpangern
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jakrin Kewchareon
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, Michigan, USA
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Madias JE. Serial electrocardiograms at follow-up for early detection of transplanted heart rejection: A viewpoint. J Electrocardiol 2024; 82:136-140. [PMID: 38141486 DOI: 10.1016/j.jelectrocard.2023.12.008] [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: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
This viewpoint proposed that serial electrocardiograms (ECG) could be used to monitor for heart transplantation (HT) rejection, based on the expected attenuation of the amplitude of ECG QRS complexes (attQRS) engendered by the rejection-induced decrease in electrical resistance due to the underlying myocardial edema (ME). Previous work in humans has shown attQRS in the setting of a diverse array of edematous states, affecting the myocardium (i.e, ME) and the body volume conductor "enveloping" the heart. Also, animal and human experience has revealed low electrical resistance during mild/moderate HT rejection. Studies with serial correlations of endomyocardial biopsy (EMB), echocardiography, cardiac magnetic resonance imaging, and ECG are recommended, which will merely require recording of an ECG, when EMB and imaging studies are carried out for monitoring of post-HT rejection.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, and the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America.
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Gunawardene M, Münkler P, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Dinshaw L, Jungen C, Moser JM, Merbold L, Willems S, Meyer C. A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements. Europace 2020; 21:i34-i42. [PMID: 30801126 DOI: 10.1093/europace/euy273] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/10/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS A novel measure of local impedance (LI) has been found to predict lesion formation during radiofrequency current (RFC) catheter ablation. The aim of this study was to investigate the utility of this novel approach, while comparing LI to the well-established generator impedance (GI). METHODS AND RESULTS In 25 consecutive patients with a history of atrial fibrillation, catheter ablation was guided by a 3D-mapping system measuring LI in addition to GI via an ablation catheter tip with three incorporated mini-electrodes. Local impedance and GI before and during RFC applications were studied. In total, 381 RFC applications were analysed. The baseline LI was higher in high-voltage areas (>0.5 mV; LI: 110.5 ± 13.7 Ω) when compared with intermediate-voltage sites (0.1-0.5 mV; 90.9 ± 10.1 Ω, P < 0.001), low-voltage areas (<0.1 mV; 91.9 ± 16.4 Ω, P < 0.001), and blood pool LI (91.9 ± 9.9 Ω, P < 0.001). During ablation, mean LI drop (△LI; 13.1 ± 9.1 Ω) was 2.15 times higher as mean GI drop (△GI) (6.1 ± 4.2 Ω, P < 0.001). Baseline LI correlated with △LI: a mean LI of 99.9 Ω predicted a △LI of 12.9 Ω [95% confidence interval (12.1-13.6), R2 0.41; P < 0.001]. This relationship was weak for baseline GI predicting △GI (R2 0.06, P < 0.001). Catheter movements were represented by rapid LI changes. The duration of an RFC application was not predictive for catheter-tissue coupling with no further change of △LI (P = 0.247) nor △GI (P = 0.376) during prolonged ablation. CONCLUSION Local impedance can be monitored during ablation. Compared with the sole use of GI, baseline LI is a better predictor of impedance drops during ablation and may provide useful insights regarding lesion formation. However, further studies are needed to investigate if this novel approach is useful to guide catheter ablation.
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Affiliation(s)
- Melanie Gunawardene
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Julia M Moser
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | | | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
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Tomasi C, Dal Monte A, Argnani MS, Corsi C, Giannotti F, Severi S, Rubboli A. Impedance mapping with constant contact force on 3D electroanatomic map to characterize tissues at pulmonary veno-atrial junction. J Interv Card Electrophysiol 2020; 61:469-477. [DOI: 10.1007/s10840-020-00845-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
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Sulkin MS, Laughner JI, Hilbert S, Kapa S, Kosiuk J, Younan P, Romero I, Shuros A, Hamann JJ, Hindricks G, Bollmann A. Novel Measure of Local Impedance Predicts Catheter–Tissue Contact and Lesion Formation. Circ Arrhythm Electrophysiol 2018; 11:e005831. [DOI: 10.1161/circep.117.005831] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Abstract
Background:
Coupling between the ablation catheter and myocardium is critical to resistively heat tissue with radiofrequency ablation. The objective of this study was to evaluate whether a novel local impedance (LI) measurement on an ablation catheter identifies catheter–tissue coupling and is predictive of lesion formation.
Methods and Results:
LI was studied in explanted hearts (n=10 swine) and in vivo (n=10; 50–70 kg swine) using an investigational electroanatomic mapping system that measures impedance from an ablation catheter with mini-electrodes incorporated in the distal electrode (Rhythmia and IntellaNav MiFi OI, Boston Scientific). Explanted tissue was placed in a warmed (37 °C) saline bath mounted on a scale, and LI was measured 15 mm away from tissue to 5 mm of catheter–tissue compression at multiple catheter angles. Lesions were created with 31 and 50 W for 5 to 45 seconds (n=90). During in vivo evaluation of LI, measurements of myocardium (n=90) and blood pool (n=30) were guided by intracardiac ultrasound while operators were blinded to LI data. Lesions were created with 31 and 50 W for 45 seconds in the ventricles (n=72). LI of myocardium (119.7 Ω) was significantly greater than that of blood pool (67.6 Ω;
P
<0.01). Models that incorporate LI drop (ΔLI) to predict lesion size had better performance than models that incorporate force-time integral (
R
2
=0.75 versus
R
2
=0.54) and generator impedance drop (
R
2
=0.82 versus
R
2
=0.58). Steam pops displayed a significantly higher starting LI and larger ΔLI compared with successful radiofrequency applications (
P
<0.01).
Conclusions:
LI recorded from miniature electrodes provides a valuable measure of catheter–tissue coupling, and ΔLI is predictive of lesion formation during radiofrequency ablation.
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Affiliation(s)
- Matthew S. Sulkin
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Jacob I. Laughner
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Sebastian Hilbert
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Suraj Kapa
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Jedrzej Kosiuk
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Paul Younan
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Iñaki Romero
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Allan Shuros
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Jason J. Hamann
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Gerhard Hindricks
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
| | - Andreas Bollmann
- Electrophysiology, Boston Scientific Corp, St. Paul, MN (M.S.S., J.I.L., P.Y., I.R., A.S., J.J.H.); Department of Electrophysiology, University Leipzig – Heart Center, Germany (S.H., J.K., G.H., A.B.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (S.K.)
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6
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Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter. J Interv Card Electrophysiol 2015; 43:297-306. [DOI: 10.1007/s10840-015-0002-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/30/2015] [Indexed: 12/20/2022]
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7
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Tan C, Han W, Liu X, Hu X, Liu J, Cui J, Li J. Electrophysiological characteristics of left atrial diverticulum in patients with atrial fibrillation: electrograms, impedance and clinical implications. Int J Cardiol 2014; 176:48-54. [PMID: 25043219 DOI: 10.1016/j.ijcard.2014.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/15/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left atrial diverticulum (LAD) is not rare in patients with atrial fibrillation (AF). Recent reports focused on its morphology however data on its electrophysiological characteristics are lacking. Our study aims to investigate the electrogram and impedance features of LAD. METHODS This study included 24 patients (mean age, 58.5 ± 10.7 years) with LAD undergoing catheter ablation for AF and 24 gender-and-age-matched individuals without LAD as controls. A bipolar LAD electroanatomic map was acquired in sinus rhythm from all study participants. Points were acquired for diverticulum in the LAD group and for corresponding areas in the control group. Electrogram deflections were counted, bipolar voltage and impedance were measured for each point, and average ∆ impedance and highest ∆ impedance were calculated. RESULTS A total of 234 points were collected in the two groups. In the LAD vs. control group, median (Q1, Q3) of electrogram deflections was 6 (5, 7) and 4 (4, 5) (P<0.0001), respectively, voltage was not significantly different (1.58 ± 0.68 mV vs. 1.28 ± 0.65 mV, P=0.10), and average ∆ impedance was significantly higher in the LAD group (19.5 ± 9.0 Ω vs 3.9 ± 1.7 Ω, P<0.0001). A cut-off value of 9.5 Ω for ∆ impedance predicted LAD with sensitivity, specificity, and positive and negative predictive values of 83.5%, 92.8%, 92.1% and 84.9%, respectively. CONCLUSIONS Electrogram was more fractionated and impedance was higher at LAD than in corresponding areas without LAD, which might help to differentiate LAD during catheter ablation for AF.
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Affiliation(s)
- Chen Tan
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China.
| | - Wei Han
- Department of Radiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Xingpeng Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuehong Hu
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Jianguo Liu
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Junyu Cui
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Junxia Li
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
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No severe pulmonary vein stenosis after extensive encircling pulmonary vein isolation: 12-month follow-up with 3D computed tomography. Heart Vessels 2010; 26:440-8. [DOI: 10.1007/s00380-010-0073-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 07/16/2010] [Indexed: 01/23/2023]
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9
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Prieto LR. The State of the Art in Pulmonary Vein Stenosis -Diagnosis & Treatment. J Atr Fibrillation 2010. [PMID: 28640928 DOI: 10.4022/jafib.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Pulmonary vein stenosis is a rare but serious complication of pulmonary vein isolation to treat atrial fibrillation. Pulmonary vein angioplasty/stenting has emerged as the treatment of choice for significantly stenotic veins. Guidelines for post ablation evaluation of the pulmonary veins, including the timing and method of surveillance for possible stenosis, the criteria for intervention, the technical aspects of intervention, and finally the surveillance post intervention, are still being developed. The relatively high rate of restenosis after intervention in a subset of patients remains a great challenge. A better understanding of the pathophysiology underlying this syndrome is needed to appropriately answer many of the remaining questions. The goal of this manuscript is to describe what has been learned about this complication and its treatment from a relatively large experience in a single institution over the past decade, and provide a comprehensive review of the existing literature in order to shed as much light on the subject as is possible, while at the same time exposing the areas that need further study.
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10
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Pedrote A, Arana-Rueda E, García-Riesco L, Jiménez-Velasco A, Sánchez-Brotons J, Arizón-Muñoz JM, Fernández-Pérez JM, Frutos-López M. Three-dimensional impedance mapping as an aid to circumferential pulmonary vein isolation in paroxysmal atrial fibrillation. Rev Esp Cardiol 2009; 62:315-9. [PMID: 19268078 DOI: 10.1016/s1885-5857(09)71563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During circumferential pulmonary vein isolation, radiofrequency lesions are created in the transition zone between the left atrium and the pulmonary veins, outside the ostia, to avoid stenosis. Three-dimensional impedance maps were constructed for 25 patients with paroxysmal atrial fibrillation. In the first 15 patients, impedance was measured inside the pulmonary veins (165.4 +/- 7.5 Omega), the ostium (141.6 +/- 7.3 Omega) and the left atrium (131.09 +/- 8.3 Omega). An impedance of 136 Omega identified the outer limit of the atrium (area under the receiver operating characteristic curve, 0.85). In the subsequent 10 patients, a single operator who was blinded to the anatomic position of the catheter tip was able to determine, by impedance measurement alone, whether the point targeted for radiofrequency ablation was in the left atrium or the ostium of the pulmonary vein. The positive predictive value for identifying the left atrium was 91% and the negative predictive value was 73%. In patients with paroxysmal atrial fibrillation, three-dimensional impedance mapping was helpful in guiding circumferential pulmonary vein isolation.
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Affiliation(s)
- Alonso Pedrote
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, 41013 Sevilla, Spain.
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11
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Pedrote A, Arana-Rueda E, García-Riesco L, Jiménez-Velasco A, Sánchez-Brotons J, Arizón-Muñoz JM, Fernández-Pérez JM, Frutos-López M. Mapas tridimensionales de impedancia para guiar el aislamiento circunferencial de las venas pulmonares en la fibrilación auricular paroxística. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70377-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Dumas Iii JH, Himel Iv HD, Kiser AC, Quint SR, Knisley SB. Myocardial electrical impedance as a predictor of the quality of RF-induced linear lesions. Physiol Meas 2008; 29:1195-207. [PMID: 18799837 DOI: 10.1088/0967-3334/29/10/004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Production of complete (i.e. continuous and transmural) cardiac lesions by radiofrequency (RF) ablation can cure certain cardiac arrhythmias. However, a predictor of lesion completeness that is reliable and can be measured intraoperatively is needed in order to maximize effectiveness of ablation therapy. Predictors that require membrane excitation or response to stimulation are not always practical. This study tested whether changes of myocardial impedance across the lesion can predict completeness. RF energy was applied epicardially on perfused rabbit ventricles to produce linear lesions that were complete (n = 25) or incomplete (noncontinuous or nontransmural, n = 25). Before and after creation of each lesion, the magnitude and phase of impedance at 1 kHz were measured with a four-electrode epicardial array across the lesion. For 16 of the lesions, the translesion stimulus-excitation delay was also measured. Lesion completeness was evaluated with 2,3,5-triphenyltetrazolium chloride stain. Complete lesions increased resistivity by 26 Omega cm (21% of the preablation value, p = 0.0007, n = 17) when the inactive RF electrode remained on the epicardium during impedance measurements. When the RF electrode was removed during measurements, the rise of resistivity by complete lesions increased to 58 Omega cm (30% of the preablation value, p = 0.022, n = 8). For incomplete lesions, resistivity did not change significantly. Ablation did not significantly alter the phase of impedance. Accuracies of predictions of lesion completeness by the change in resistivity or the change in translesion stimulus-excitation delay were comparable (Youden's index 0.75 and 0.625, respectively, n = 16). Thus, RF ablation increases myocardial resistivity. The resistivity can predict lesion completeness and may provide an alternative to predictors based on excitation.
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Affiliation(s)
- John H Dumas Iii
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7575, USA
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PRIETO LOURDESR, SCHOENHAGEN PAUL, ARRUDA MJANINE, NATALE ANDREA, WORLEY SARAHE. Comparison of Stent Versus Balloon Angioplasty for Pulmonary Vein Stenosis Complicating Pulmonary Vein Isolation. J Cardiovasc Electrophysiol 2008; 19:673-8. [DOI: 10.1111/j.1540-8167.2008.01110.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Changes in myocardial electrical impedance in human heart graft rejection. Eur J Heart Fail 2008; 10:594-600. [PMID: 18501669 DOI: 10.1016/j.ejheart.2008.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Revised: 04/09/2008] [Accepted: 04/28/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Monitoring of post-transplant heart rejection is currently based on endomyocardial biopsy analysis. This study aimed to assess the effects of heart graft rejection on myocardial electrical impedance. METHODS AND RESULTS Twenty-nine cardiac transplant patients and 9 controls underwent measurement of myocardial electrical impedance using a specifically designed amplifying system. The module and phase angle of myocardial impedance were measured. Histopathological rejection grading was performed according to ISHLT classification. Fifty impedance tests were performed in transplanted patients. Myocardial impedance (Z) was higher in controls than in transplanted patients (p<0.001) and followed a progressive decline at increasing current frequencies (p<0.001). Likewise, the phase angle of impedance in controls ranged from positive values at low frequencies to negative values at higher frequencies (from 2.5+/-0.9 degrees at 10 kHz to -3.8+/-2.1 degrees at 300 kHz, p<0.001). Rejection was associated with a significant decrease in myocardial impedance (Z) (15+/-6.6 Omega in grade 0, 13+/-6.0 Omega in grade 1A, and 3.3+/-0.9 Omega in grade 3A at 10 kHz, p<0.003). CONCLUSIONS Mild degrees of cardiac graft rejection are associated with significant changes in myocardial electrical impedance in transplant patients. Further clinical investigation is warranted to assess the potential of cardiac impedance to detect heart graft rejection.
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Pappone C, Santinelli V. Non-fluoroscopic mapping as a guide for atrial ablation: current status and expectations for the future. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Natale A, Raviele A, Arentz T, Calkins H, Chen SA, Haïssaguerre M, Hindricks G, Ho Y, Kuck KH, Marchlinski F, Napolitano C, Packer D, Pappone C, Prystowsky EN, Schilling R, Shah D, Themistoclakis S, Verma A. Venice Chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol 2007; 18:560-80. [PMID: 17456138 DOI: 10.1111/j.1540-8167.2007.00816.x] [Citation(s) in RCA: 291] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea Natale
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, USA
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Affiliation(s)
- Larry A Latson
- Cleveland Clinic Foundation, Department of Pediatric Cardiology and Congenital Heart Diseases, 9500 Euclid Ave, M41, Cleveland, OH 44195, USA.
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KIM YOUNGHOON, LIM HONGEUY, PAK HUINAM. Use of Three-Dimensional Mapping Systems in the Catheter Ablation of Atrial Fibrillation. J Cardiovasc Electrophysiol 2006. [DOI: 10.1111/j.1540-8167.2006.00628.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Carlo Pappone
- Department of Cardiology, Electrophysiology and Cardiac Pacing Unit, San Raffaele Scientific Institute, Milan, Italy.
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