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Park J, Seo B, Jeong Y, Park I. A Review of Recent Advancements in Sensor-Integrated Medical Tools. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307427. [PMID: 38460177 PMCID: PMC11132050 DOI: 10.1002/advs.202307427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/26/2023] [Indexed: 03/11/2024]
Abstract
A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.
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Affiliation(s)
- Jaeho Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
| | - Bokyung Seo
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
| | - Yongrok Jeong
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
- Radioisotope Research DivisionKorea Atomic Energy Research Institute (KAERI)Daejeon34057South Korea
| | - Inkyu Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
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Chen S, Wang Z, Xuan F, Liang M, Jin Z, Ding J, Sun M, Zhang P, Han Y. One-year outcomes of wide antral cryoballoon ablation guided by high-density mapping vs. conventional cryoballoon ablation for atrial fibrillation: a propensity score-matched study. Front Cardiovasc Med 2024; 11:1327639. [PMID: 38361587 PMCID: PMC10867262 DOI: 10.3389/fcvm.2024.1327639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Background Pulmonary vein isolation with wide antral ablation leads to better clinical outcomes for the treatment of atrial fibrillation, but the isolation lesion is invisible in conventional cryoballoon ablation. In this study, we aim to investigate the efficacy of the wide pulmonary vein isolation technique that includes the intervenous carina region, guided by high-density mapping, compared with pulmonary vein isolation alone without the mapping system. Methods We conducted a propensity score-matched comparison of 74 patients who underwent a wide cryoballoon ablation guided by high-density mapping (mapping group) and 74 controls who underwent conventional cryoballoon ablation in the same period (no-mapping group). The primary outcome was a clinical recurrence of documented atrial arrhythmias for >30 s during the 1-year follow-up. Results Of 74 patients in the mapping group, residual local potential in the pulmonary vein antrum was found in 30 (40.5%) patients, and additional cryothermal applications were performed to achieve a wide pulmonary vein isolation. Compared with the no-mapping group, the use of the mapping system in the mapping group was associated with a longer fluoroscopic time (26.97 ± 8.07 min vs. 23.76 ± 8.36 min, P = 0.023) and greater fluoroscopic exposure [339 (IQR181-586) mGy vs. 224 (IQR133-409) mGy, P = 0.012]. However, no significant differences between the two groups were found in terms of procedural duration and left atrial dwell time (104.10 ± 18.76 min vs. 102.45 ± 21.01 min, P = 0.619; 83.52 ± 17.01 min vs. 79.59 ± 17.96 min, P = 0.177). The rate of 12-month freedom from clinical atrial arrhythmia recurrence was 85.1% in the mapping group and 70.3% in the no-mapping group (log-rank P = 0.029). Conclusion Voltage and pulmonary vein potential mapping after cryoballoon pulmonary vein isolation can identify residual potential in the pulmonary vein antrum, and additional cryoablation guided by mapping leads to improved freedom from atrial arrhythmias compared with conventional pulmonary vein isolation without the mapping system. Clinical Trial Registration Number ChiCTR2200064383.
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Affiliation(s)
- Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Fengqi Xuan
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Ming Liang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Ding
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ping Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
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Fu L, Xue Y. High density mapping of complex atrial tachycardia in patients after cardiac surgery. Pacing Clin Electrophysiol 2023; 46:1341-1347. [PMID: 37846820 DOI: 10.1111/pace.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
To provide an overview of the current application of high-density mapping (HDM) in the mechanism of complex atrial tachycardias (ATs). Complex ATs are frequently scar-related, after history of previous cardiac surgery and large scars. These scar-related ATs are difficult to manage medically and frequently recur after electrical cardioversion. HDM technologies have enabled rigorous elucidation of AT mechanisms in patients post cardiac surgery. This article showed the application of HDM technology in complex ATs from the mechanisms of complex ATs, the development of HDM technology, and the identification of scars or critical isthmus from HDM. HDM-guided approach is highly effective for identifying the ATs mechanism and critical isthmus.
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Affiliation(s)
- Lu Fu
- Department of Cardiology, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Kim YJ, Wi D, Kim J, Choi J. Determination of online thin film buckling configuration by parametric optimization for flexible sensor application. Sci Rep 2023; 13:10817. [PMID: 37402750 DOI: 10.1038/s41598-023-37666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
A mini basket type mapping catheter consists of thin film flexible sensors and is applied in the medical field to measure the electrocardiography (ECG) signals in order to localize and quantize the physiological condition/status of heart. The flexible nature of the thin film changes the configuration with respect to the contact boundary conditions when it contacts a target surface. Therefore, to accurately localize the flexible sensor, the thin film flexible sensor's configuration must be determined accurately in an on-line fashion. As a study of localizing the thin film flexible sensor, this study proposes an on-line thin film buckling configuration determination method using parametric optimization and interpolation technique. With the specific modulus of elasticity and dimensions of the thin film flexible sensor of the mapping catheter prototype, the buckling configuration with two point boundary condition under axial load can be calculated in desktop environment. The proposed calculation method is validated by mapping catheter sensor prototype test. The calculation/test results showed that the maximum overall length L, x[Formula: see text], and y[Formula: see text] value error between the calculation and experiment are approximately 0.16 mm, - 0.12 mm. - 0.10 mm in 50 ms calculation time. The calculation result of the proposed method is also compared with that of the numerical simulation by FEM, which has approximately 0.44 mm y[Formula: see text] value error compared with that of the experiment.
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Affiliation(s)
- Yeoun-Jae Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Daehan Wi
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jingyu Kim
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jaesoon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
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Atrial conduction velocity mapping: clinical tools, algorithms and approaches for understanding the arrhythmogenic substrate. Med Biol Eng Comput 2022; 60:2463-2478. [PMID: 35867323 PMCID: PMC9365755 DOI: 10.1007/s11517-022-02621-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/02/2022]
Abstract
Characterizing patient-specific atrial conduction properties is important for understanding arrhythmia drivers, for predicting potential arrhythmia pathways, and for personalising treatment approaches. One metric that characterizes the health of the myocardial substrate is atrial conduction velocity, which describes the speed and direction of propagation of the electrical wavefront through the myocardium. Atrial conduction velocity mapping algorithms are under continuous development in research laboratories and in industry. In this review article, we give a broad overview of different categories of currently published methods for calculating CV, and give insight into their different advantages and disadvantages overall. We classify techniques into local, global, and inverse methods, and discuss these techniques with respect to their faithfulness to the biophysics, incorporation of uncertainty quantification, and their ability to take account of the atrial manifold.
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Patterns and Characteristics of SKYLINE-Lumipoint Feature in the Catheter Ablation of Atypical Atrial Flutter: Insight from a Novel Lumipoint Module of Rhythmia Mapping System. J Pers Med 2022; 12:jpm12071102. [PMID: 35887599 PMCID: PMC9320486 DOI: 10.3390/jpm12071102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Atypical atrial flutter (aAFL) is not uncommon, especially after a prior cardiac surgery or extensive ablation in atrial fibrillation (AF). Aims: To revisit aAFL, we used a novel Lumipoint algorithm in the Rhythmia mapping system to evaluate tachycardia circuit by the patterns of global activation histogram (GAH, SKYLINE) in assisting aAFL ablation. Methods: Fifteen patients presenting with 20 different incessant aAFL, including two naïve, six with a prior AF ablation, and seven with prior cardiac surgery were studied. Results: Reentry aAFL in SKYLINE typically was a multi-deflected peak with 1.5 GAH-valleys. Valleys were sharp and narrow-based. Most reentry aAFL (18/20, 90%) lacked a plateau and displayed a steep GAH-valley with 2 GAH-valleys per tachycardia. Each GAH-valley highlighted 1.9 areas in the map. Successful sites of ablation all matched one of the highlighted areas based on GAH-valleys < 0.4. These sites corresponded with the areas highlighted by GAH-score < 0.4 in reentry aAFL, and by GAH-score < 0.2 in localized-reentry aAFL. Conclusions: The present study showed benefits of the LumipointTM module applied to the RhythmiaTM mapping system. The results were the efficient detection of the slow conduction, better identification of ablation sites, and fast termination of the aAFL with favorable outcomes.
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Schleberger R, Schwarzl JM, Moser J, Nies M, Höller A, Münkler P, Dinshaw L, Jungen C, Lemoine MD, Maury P, Sacher F, Martin CA, Wong T, Estner HL, Jaïs P, Willems S, Eickholt C, Meyer C. The impact of ultra-high-density mapping on long-term outcome after catheter ablation of ventricular tachycardia. Sci Rep 2022; 12:9139. [PMID: 35650230 PMCID: PMC9160260 DOI: 10.1038/s41598-022-12918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
Ultra-high-density (UHD) mapping can improve scar area detection and fast activation mapping in patients undergoing catheter ablation of ventricular tachycardia (VT). The aim of the present study was to compare the outcome after VT ablation guided by UHD and conventional point-by-point 3D-mapping. The acute and long-term ablation outcome of 61 consecutive patients with UHD mapping (64-electrode mini-basket catheter) was compared to 61 consecutive patients with conventional point-by-point 3D-mapping using a 3.5 mm tip catheter. Patients, whose ablation was guided by UHD mapping had an improved 24-months outcome in comparison to patients with conventional mapping (cumulative incidence estimate of the combination of recurrence or disease-related death of 52.4% (95% confidence interval (CI) [36.9-65.7]; recurrence: n = 25; disease-related death: n = 4) versus 69.6% (95% CI [55.9-79.8]); recurrence: n = 31; disease-related death n = 11). In a cause-specific Cox proportional hazards model, UHD mapping (hazard ratio (HR) 0.623; 95% CI [0.390-0.995]; P = 0.048) and left ventricular ejection fraction > 30% (HR 0.485; 95% CI [0.290-0.813]; P = 0.006) were independently associated with lower rates of recurrence or disease-related death. Other procedural parameters were similar in both groups. In conclusion, UHD mapping during VT ablation was associated with fewer VT recurrences or disease-related deaths during long-term follow-up in comparison to conventional point-by-point mapping. Complication rates and other procedural parameters were similar in both groups.
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Affiliation(s)
- Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc D Lemoine
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Frederic Sacher
- LIRYC Institute, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Claire A Martin
- Royal Papworth Hospital, National Health Service Foundation Trust, Cambridge, UK
| | - Tom Wong
- Heart Rhythm Center, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Heidi L Estner
- Department of Internal Medicine I - Cardiology, University Hospital Munich, Ludwig-Maximilian University Munich, Munich, Germany
| | - Pierre Jaïs
- LIRYC Institute, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Stephan Willems
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany. .,Department of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany. .,Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Solimene F, Stabile G, Ramos P, Segreti L, Cauti FM, De Sanctis V, Maggio R, Ramos-Maqueda J, Mont L, Schillaci V, Malacrida M, Garcia-Bolao I. Improved procedural workflow for catheter ablation of paroxysmal AF with high-density mapping system and advanced technology: Rationale and study design of a multicenter international study. Clin Cardiol 2022; 45:597-604. [PMID: 35446440 PMCID: PMC9175242 DOI: 10.1002/clc.23806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. METHODS The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single-arm, international post-market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post-ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post-ablation to proactively detect and manage any recurrences within the 90-day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post-ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. DISCUSSION The DELETE AF trial will provide additional knowledge on long-term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at ClinicalTrials.gov (NCT05005143).
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Affiliation(s)
| | | | - Pablo Ramos
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | | | - Javier Ramos-Maqueda
- Department of Cardiology, Section for Electrophysiology, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
| | - Lluis Mont
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Ignacio Garcia-Bolao
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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de Groot NMS, Shah D, Boyle PM, Anter E, Clifford GD, Deisenhofer I, Deneke T, van Dessel P, Doessel O, Dilaveris P, Heinzel FR, Kapa S, Lambiase PD, Lumens J, Platonov PG, Ngarmukos T, Martinez JP, Sanchez AO, Takahashi Y, Valdigem BP, van der Veen AJ, Vernooy K, Casado-Arroyo Co-Chair R. Critical appraisal of technologies to assess electrical activity during atrial fibrillation: a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology. Europace 2021; 24:313-330. [PMID: 34878119 DOI: 10.1093/europace/euab254] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying target sites for AF therapy and (ii) AF detection, to optimize usage of technologies, stimulate research aimed at closing knowledge gaps, and developing ideal AF recording and processing technologies. Recording and processing techniques for assessment of electrical activity during AF essential for diagnosis and guiding ablative therapy including body surface electrocardiograms (ECG) and endo- or epicardial electrograms (EGM) are evaluated. Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types of EGM involving signal processing techniques including isochronal-, voltage- fractionation-, dipole density-, and rotor mapping, enabling derivation of parameters like atrial rate, entropy, conduction velocity/direction, (iv) value of epicardial and optical mapping, (v) AF detection by cardiac implantable electronic devices containing various detection algorithms applicable to stored EGMs, (vi) contribution of machine learning (ML) to further improvement of signals processing technologies. Recording and processing of EGM (or ECG) are the cornerstones of (body surface) mapping of AF. Currently available AF recording and processing technologies are mainly restricted to specific applications or have technological limitations. Improvements in AF mapping by obtaining highest fidelity source signals (e.g. catheter-electrode combinations) for signal processing (e.g. filtering, digitization, and noise elimination) is of utmost importance. Novel acquisition instruments (multi-polar catheters combined with improved physical modelling and ML techniques) will enable enhanced and automated interpretation of EGM recordings in the near future.
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Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Delft University of Technology, Delft the Netherlands
| | - Dipen Shah
- Cardiology Service, University Hospitals Geneva, Geneva, Switzerland
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich and Technical University of Munich, Munich, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhon-klinikum Campus Bad Neustadt, Germany
| | - Pascal van Dessel
- Department of Cardiology, Medisch Spectrum Twente, Twente, the Netherlands
| | - Olaf Doessel
- Karlsruher Institut für Technologie (KIT), Karlsruhe, Germany
| | - Polychronis Dilaveris
- 1st University Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Suraj Kapa
- Department of Cardiology, Mayo Clinic, Rochester, USA
| | | | - Joost Lumens
- Cardiovascular Research Institute Maastricht (CARIM) Maastricht University, Maastricht, the Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Juan Pablo Martinez
- Aragon Institute of Engineering Research/IIS-Aragon and University of Zaragoza, Zaragoza, Spain, CIBER Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Alejandro Olaya Sanchez
- Department of Cardiology, Hospital San José, Fundacion Universitaia de Ciencas de la Salud, Bogota, Colombia
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bruno P Valdigem
- Department of Cardiology, Hospital Rede D'or São Luiz, hospital Albert einstein and Dante pazzanese heart institute, São Paulo, Brasil
| | - Alle-Jan van der Veen
- Department Circuits and Systems, Delft University of Technology, Delft, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
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Yvorel C, Da Costa A, Lerebours C, Guichard JB, Viallon G, Romeyer C, Ferreira T, Benali K, Isaaz K. Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping and automated velocity measurements. J Cardiovasc Electrophysiol 2021; 32:2127-2139. [PMID: 34041809 DOI: 10.1111/jce.15111] [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: 04/11/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. OBJECTIVES We sought to compare CW and CCW CTI-dependent AFL in pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. METHODS AND RESULTS Thirty-three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p = .7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p = .9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p = .9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p = .2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p = .6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. CONCLUSION The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.
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Affiliation(s)
- Cedric Yvorel
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Chloe Lerebours
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Jean B Guichard
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Gregory Viallon
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Cécile Romeyer
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Thomas Ferreira
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karim Benali
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karl Isaaz
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
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11
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Schwarzl JM, Schleberger R, Kahle AK, Höller A, Schwarzl M, Schaeffer BN, Münkler P, Moser J, Akbulak RÖ, Eickholt C, Dinshaw L, Dickow J, Maury P, Sacher F, Martin CA, Wong T, Estner HL, Jaïs P, Willems S, Meyer C. Specific electrogram characteristics impact substrate ablation target area in patients with scar-related ventricular tachycardia-insights from automated ultrahigh-density mapping. J Cardiovasc Electrophysiol 2021; 32:376-388. [PMID: 33368769 DOI: 10.1111/jce.14859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Substrate-based catheter ablation approaches to ventricular tachycardia (VT) focus on low-voltage areas and abnormal electrograms. However, specific electrogram characteristics in sinus rhythm are not clearly defined and can be subject to variable interpretation. We analyzed the potential ablation target size using automatic abnormal electrogram detection and studied findings during substrate mapping in the VT isthmus area. METHODS AND RESULTS Electrogram characteristics in 61 patients undergoing scar-related VT ablation using ultrahigh-density 3D-mapping with a 64-electrode mini-basket catheter were analyzed retrospectively. Forty-four complete substrate maps with a mean number of 10319 ± 889 points were acquired. Fractionated potentials detected by automated annotation and manual review were present in 43 ± 21% of the entire low-voltage area (<1.0 mV), highly fractionated potentials in 7 ± 8%, late potentials in 13 ± 15%, fractionated late potentials in 7 ± 9% and isolated late potentials in 2 ± 4%, respectively. Highly fractionated potentials (>10 ± 1 fractionations) were found in all isthmus areas of identified VT during substrate mapping, while isolated late potentials were distant from the critical isthmus area in 29%. CONCLUSION The ablation target area varies enormously in size, depending on the definition of abnormal electrograms. Clear linking of abnormal electrograms with critical VT isthmus areas during substrate mapping remains difficult due to a lack of specificity rather than sensitivity. However, highly fractionated, low-voltage electrograms were found to be present in all critical VT isthmus sites.
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Affiliation(s)
- Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Institute of Medical Biometry and Epidemiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Benjamin N Schaeffer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Julia Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannis Dickow
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, National Health Service Foundation Trust, Cambridge, UK
| | - Tom Wong
- Heart Rhythm Center, Imperial College London, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Heidi L Estner
- Department of Internal Medicine I - Cardiology, University Hospital Munich, Ludwig-Maximilian University Munich, Munich, Germany
| | - Pierre Jaïs
- Department of Cardiac Electrophysiology, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Stephan Willems
- DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany.,Institute for Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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12
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Tomii N, Yamazaki M, Ashihara T, Nakazawa K, Shibata N, Honjo H, Sakuma I. Spatial phase discontinuity at the center of moving cardiac spiral waves. Comput Biol Med 2021; 130:104217. [PMID: 33516959 DOI: 10.1016/j.compbiomed.2021.104217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Precise analysis of cardiac spiral wave (SW) dynamics is essential for effective arrhythmia treatment. Although the phase singularity (PS) point in the spatial phase map has been used to determine the cardiac SW center for decades, quantitative detection algorithms that assume PS as a point fail to trace complex and rapid PS dynamics. Through a detailed analysis of numerical simulations, we examined our hypothesis that a boundary of spatial phase discontinuity induced by a focal conduction block exists around the moving SW center in the phase map. METHOD In a numerical simulation model of a 2D cardiac sheet, three different types of SWs (short wavelength; long wavelength; and low excitability) were induced by regulating ion channels. Discontinuities of all boundaries among adjacent cells at each instance were evaluated by calculating the phase bipolarity (PB). The total amount of phase transition (PTA) in each cell during the study period was evaluated. RESULTS Pivoting, drifting, and shifting SWs were observed in the short-wavelength, low-excitability, and long-wavelength models, respectively. For both the drifting and shifting cases, long high-PB edges were observed on the SW trajectories. In all cases, the conduction block (CB) was observed at the same boundaries. These were also identical to the boundaries in the PTA maps. CONCLUSIONS The analysis of the simulations revealed that the conduction block at the center of a moving SW induces discontinuous boundaries in spatial phase maps that represent a more appropriate model of the SW center than the PS point.
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Affiliation(s)
- Naoki Tomii
- Faculty of Medicine, The University of Tokyo, 7 -3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masatoshi Yamazaki
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Takashi Ashihara
- Shiga University of Medical Science, Setatsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Kazuo Nakazawa
- Morinomiya University of Medical Sciences, 1-26-16 Minami-Kohoku, Suminoe-ku, Osaka City, 559-8611, Japan
| | - Nitaro Shibata
- Shinjuku Mitsui Building Clinic, 2-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-0404, Japan
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University, Furo-cho Chikusa-ku, Nagoya City, Aichi, 464-8601, Japan
| | - Ichiro Sakuma
- School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
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13
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Laţcu DG, Bun SS, Casado Arroyo R, Wedn AM, Benaich FA, Hasni K, Enache B, Saoudi N. Scar identification, quantification, and characterization in complex atrial tachycardia: a path to targeted ablation? Europace 2020; 21:i21-i26. [PMID: 30801130 DOI: 10.1093/europace/euy182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/23/2018] [Indexed: 01/21/2023] Open
Abstract
Successful catheter ablation of scar-related atrial tachycardia depends on correct identification of the critical isthmus. Often, this is a represented by a small bundle of viable conducting tissue within a low-voltage area. It's identification depends on the magnitude of the signal/noise ratio. Ultra-high density mapping, multipolar catheters with small (eventually unidirectional) and closely-spaced electrodes improves low-voltage electrogram detection. Background noise limitation is also of major importance for improving the signal/noise ratio. Electrophysiological properties of the critical isthmus and the characteristics of the local bipolar electrograms have been recently demonstrated as hallmarks of successful ablation sites in the setting of scar-related atrial tachycardia.
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Affiliation(s)
| | - Sok-Sithikun Bun
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Ruben Casado Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ahmed Moustfa Wedn
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | | | - Karim Hasni
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Bogdan Enache
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Nadir Saoudi
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
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14
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Kashyap V, Caprio A, Doshi T, Jang SJ, Liu CF, Mosadegh B, Dunham S. Multilayer fabrication of durable catheter-deployable soft robotic sensor arrays for efficient left atrial mapping. SCIENCE ADVANCES 2020; 6:6/46/eabc6800. [PMID: 33188028 PMCID: PMC7673747 DOI: 10.1126/sciadv.abc6800] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/23/2020] [Indexed: 05/19/2023]
Abstract
Devices that perform cardiac mapping and ablation to treat atrial fibrillation provide an effective means of treatment. Current devices, however, have limitations that either require tedious point-by-point mapping of a cardiac chamber or have limited ability to conform to the complex anatomy of a patient's cardiac chamber. In this work, a detailed, scalable, and manufacturable technique is reported for fabrication of a multielectrode, soft robotic sensor array. These devices exhibit high conformability (~85 to 90%) and are equipped with an array of stretchable electronic sensors for voltage mapping. The form factor of the device is intended to match that of the entire left atrium and has a hydraulically actuated soft robotic structure whose profile facilitates deployment from a 13.5-Fr catheter. We anticipate that the methods described in this paper will serve a new generation of conformable medical devices that leverage the unique characteristics of stretchable electronics and soft robotics.
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Affiliation(s)
- Varun Kashyap
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Alexandre Caprio
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Tejas Doshi
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Sun-Joo Jang
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Christopher F Liu
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Bobak Mosadegh
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA.
| | - Simon Dunham
- Dalio Institute for Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA.
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15
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Conte G, Soejima K, de Asmundis C, Bruno J, Cattaneo F, Chierchia GB, Miwa Y, Caputo ML, Sieira J, Regoli F, Moccetti T, Brugada P, Auricchio A. High-density mapping in patients undergoing ablation of atrial fibrillation with the fourth-generation cryoballoon and the new spiral mapping catheter. Europace 2020; 22:1653-1658. [PMID: 32830231 DOI: 10.1093/europace/euaa160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the value of high-density mapping (HDM) in revealing undetected incomplete pulmonary vein isolation (PVI) after the fourth-generation cryoballoon (CB4G) ablation compared to the previous cryoballoon's versions. METHODS AND RESULTS Consecutive patients with paroxysmal or early-persistent atrial fibrillation (AF) undergoing CB ablation as the index procedure, assisted by HDM, were retrospectively included in this study. A total of 68 patients (52 males; mean age: 60 ± 12 years, 58 paroxysmal AF) were included, and a total of 272 veins were mapped. Fourth-generation cryoballoon with the new spiral mapping catheter (SMC) was used in 35 patients (51%). Time to PVI was determined in 102/132 (77%) and in 112/140 (80%) veins during second-generation cryoballoon/third-generation cryoballoon (CB2G/CB3G) and CB4G ablation, respectively (P = 0.66). There was a statistically significant difference in terms of discrepancy rate between the SMC and the mini-basket catheter in PV detection after CB4G and CB2G/CB3G ablation(1.4% vs. 7.6%; P = 0.01). A total of 57 patients (84%) remained free of symptomatic AF during a mean follow-up of 9.8 ± 4.6 months. CONCLUSION High-density mapping after cryoballoon ablation using CB4G and the new SMC identifies incomplete PVI, not detected by the new SMC, in a significantly lower proportion of veins compared to HDM performed after the other generation CB ablation.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jolie Bruno
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Fabio Cattaneo
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - François Regoli
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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16
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De Simone A, Anselmino M, Scaglione M, Stabile G, Solimene F, De Bellis A, Pepe M, Panella A, Ferraris F, Malacrida M, Maddaluno F, Gaita F, García-Bolao I. Is the mid-diastolic isthmus always the best ablation target for re-entrant atrial tachycardias? J Cardiovasc Med (Hagerstown) 2020; 21:113-122. [PMID: 31895131 DOI: 10.2459/jcm.0000000000000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry. METHODS A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs. RESULTS In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66). CONCLUSION Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.
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Affiliation(s)
| | - Matteo Anselmino
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | | | | | | | | | | | | | - Federico Ferraris
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | | | | | - Fiorenzo Gaita
- Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
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17
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Derval N, Takigawa M, Frontera A, Mahida S, Konstantinos V, Denis A, Duchateau J, Pillois X, Yamashita S, Berte B, Thompson N, Hooks D, Pambrun T, Sacher F, Hocini M, Bordachar P, Jaïs P, Haïssaguerre M. Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping. JACC Clin Electrophysiol 2020; 6:815-826. [DOI: 10.1016/j.jacep.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
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18
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra-high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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19
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Rottner L, Bellmann B, Lin T, Reissmann B, Tönnis T, Schleberger R, Nies M, Jungen C, Dinshaw L, Klatt N, Dickow J, Münkler P, Meyer C, Metzner A, Rillig A. Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives. Cardiol Ther 2020; 9:45-58. [PMID: 31898209 PMCID: PMC7237603 DOI: 10.1007/s40119-019-00158-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high rates of morbidity and mortality. Maintenance of stable sinus rhythm (SR) is the intended treatment target in symptomatic patients, and catheter ablation aimed at isolating the pulmonary veins provides the most effective treatment option, supported by encouraging clinical outcome data. A variety of energy sources and devices have been developed and evaluated. In this review, we summarize the current state of the art of catheter ablation of AF and describe future perspectives. RECENT FINDINGS Catheter ablation is a well-established treatment option for patients with symptomatic AF and is more successful at maintaining SR than antiarrhythmic drugs. Antral pulmonary vein isolation (PVI) as a stand-alone ablation strategy results in beneficial clinical outcomes and is therefore recommended as first-line strategy for both paroxysmal and persistent AF. While radiofrequency-based PVI in conjunction with a three-dimensional mapping system was for many years considered to be the "gold standard", the cryoballoon has emerged as the most commonly used alternative AF ablation tool, especially in patients with paroxysmal AF. Patients with persistent or long-standing persistent AF and with arrhythmia recurrence after previous PVI may benefit from additional ablation strategies, such as substrate modification of various forms or left atrial appendage isolation. New technologies and techniques, such as identification of the AF sources and magnetic resonance imaging-guided substrate modification, are on the way to further improve the success rates of catheter ablation for selected patients and might help to further reduce arrhythmia recurrence. CONCLUSIONS Pulmonary vein isolation is the treatment of choice for symptomatic patients with paroxysmal and persistent drug-refractory AF. The reconnection of previously isolated pulmonary veins remains the major cause of AF recurrence. Novel ablation tools, such as balloon technologies or alternative energy sources, might help to overcome this limitation. Patients with non-paroxysmal AF and with AF recurrence might benefit from alternative ablation strategies. However, further studies are warranted to further improve our knowledge of the underlying mechanisms of AF and to obtain long-term clinical outcomes on new ablation techniques.
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Affiliation(s)
- Laura Rottner
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Tina Lin
- GenesisCare, East Melbourne, VIC, Australia
| | - Bruno Reissmann
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Tönnis
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Moritz Nies
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Leon Dinshaw
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Klatt
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Jannis Dickow
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
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20
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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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21
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Siebermair J, Kochhäuser S, Kupusovic J, Köhler MI, Pesch E, Vonderlin N, Kaya E, Janosi RA, Rassaf T, Wakili R. Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience. J Cardiovasc Electrophysiol 2020; 31:1631-1639. [PMID: 32314838 DOI: 10.1111/jce.14505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Simon Kochhäuser
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Jana Kupusovic
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Miriam I. Köhler
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elena Pesch
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Nadine Vonderlin
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elif Kaya
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Rolf A. Janosi
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
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22
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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23
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[Catheter ablation of atrial fibrillation : Status quo]. Herzschrittmacherther Elektrophysiol 2019; 30:343-348. [PMID: 31713025 DOI: 10.1007/s00399-019-00655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is a standard part of treatment with respect to rhythm control. In this article, the authors provide a review of the state-of-the-art knowledge of AF catheter ablation including current indications, possible energy forms, procedural methods and endpoints as well as follow-up and further anticoagulation.
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24
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Solimene F, Maddaluno F, Malacrida M, Schillaci V. Is this vein isolated or not? How a new advanced algorithm helps find unconventional far-field sources. HeartRhythm Case Rep 2019; 5:494-496. [PMID: 31700792 PMCID: PMC6831753 DOI: 10.1016/j.hrcr.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Impact of mapping points in high-density mapping of the left atrium. J Interv Card Electrophysiol 2019; 58:347-353. [PMID: 31578703 DOI: 10.1007/s10840-019-00621-z] [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] [Received: 02/12/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Currently, high-density mapping techniques are being discussed for more precise voltage mapping, lesion validation after pulmonary vein isolation (PVI) and superior left atrial tachycardia (LAT) mapping. However, the quality of high-density maps varies according to different mapping systems, multipolar catheter (MPC) types and numbers of mapping points. The aim of this study was to evaluate the impact of different numbers of mapping points in high-density mapping on validity. METHODS From February 2016 to August 2018, 154 patients with previous PVI ablation and recurrent atrial fibrillation (AF) or left atrial tachycardia (LAT) were mapped by Orion™ multipolar catheter and Rhythmia HDx™ mapping system at our centre. Of those, 90 maps from 25 patients [11 male patients/14 female patients; age 76 ± 12 years] with 8000 to 16,000 mapping points in the primary map were collected. All maps were evaluated offline by two independent and blinded electrophysiologists regarding the following issues: (1) Is PVI observable in all veins? (2) Does voltage map cover the whole left atrium? (3) Does activation map display one or more isthmuses? The 90 maps consist of 30 maps with deactivated 24 of 64 electrodes of MPC with < 1000 mapping points (A), 30 maps with deactivated 16 of 64 electrodes of MPC and 2000 to 6000 mapping points (B) and 30 primary maps with 8000 to 16,000 mapping points (C). RESULTS For (A), only in one map (3.3%), for (B) in 20 maps (66.7%, p < 0.05) and for (C) in 24 maps (80%) both investigators agreed with evaluable PVI in all veins. Investigators were able to assess whether the voltage map covered the whole left atrium and the same low voltage areas in (A) in 0 maps, in (B) in 16 maps (53%, p < 0.05) and in (C) in 23 maps (77%, p < 0.05). Also, investigators were able to locate the same critical isthmuses in the activation maps in (A) in 0 maps, in (B) in 2 maps (7%) and in (C) in 20 maps (67%, p < 0.05). CONCLUSIONS In order to achieve comparable high-density maps which are verified by independent investigators, a minimum of 2000 to 6000 mapping points are required in the majority of voltage maps to evaluate PVI and low voltage areas. To define the critical isthmuses in activations maps, 8000 mapping points or more might be necessary. High-density maps with more than 8000 points increase the interrater reliability.
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26
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Alken FA, Klatt N, Muenkler P, Scherschel K, Jungen C, Akbulak RO, Kahle AK, Gunawardene M, Jularic M, Dinshaw L, Hartmann J, Eickholt C, Willems S, Stute F, Mueller G, Blankenberg S, Rickers C, Sinning C, Zengin-Sahm E, Meyer C. Advanced mapping strategies for ablation therapy in adults with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S247-S263. [PMID: 31737533 DOI: 10.21037/cdt.2019.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity. Methods We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied. Results In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted. Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest. This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps. Conclusions Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Paula Muenkler
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Melanie Gunawardene
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Fridrike Stute
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Goetz Mueller
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Carsten Rickers
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,Adults with Congenital Heart Disease Section, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Elvin Zengin-Sahm
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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27
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Meyer C. High-density mapping-based ablation strategies of cardiac rhythm disorders: the RHYTHMIA™ experience at new horizons. Europace 2019; 21:iii7-iii10. [DOI: 10.1093/europace/euz154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christian Meyer
- Department of Cardiology with Emphasis on Electrophysiology. cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Centre, University Hospital Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
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28
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Siebermair J, Neumann B, Risch F, Riesinger L, Vonderlin N, Koehler M, Lackermaier K, Fichtner S, Rizas K, Sattler SM, Sinner MF, Kääb S, Estner HL, Wakili R. High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation - Two-year clinical outcome of a single center experience. Sci Rep 2019; 9:8830. [PMID: 31222008 PMCID: PMC6586935 DOI: 10.1038/s41598-019-45115-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation dose (866.0 ± 1003.3 vs. 1731.2 ± 1978.4 cGy; p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials.
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Affiliation(s)
- J Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - B Neumann
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - F Risch
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - L Riesinger
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - N Vonderlin
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - M Koehler
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - K Lackermaier
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - S Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - K Rizas
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S M Sattler
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - H L Estner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany. .,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany. .,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
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Nakahara S, Hori Y, Fukuda R, Nishiyama N, Kobayashi S, Sakai Y, Taguchi I. Characterization of Residual Conduction Gaps After HotBalloon-Based Antral Ablation of Atrial Fibrillation ― Evidence From Ultra-High-Resolution 3-Dimensional Mapping ―. Circ J 2019; 83:1206-1213. [DOI: 10.1253/circj.cj-18-1051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Yoshihiko Sakai
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center
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Bhardwaj R, Koruth JS. Novel Ablation Approaches for Challenging Atrial Fibrillation Cases (Mapping, Irrigation, and Catheters). Cardiol Clin 2019; 37:207-219. [DOI: 10.1016/j.ccl.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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Holmqvist F, Kesek M, Englund A, Blomström-Lundqvist C, Karlsson LO, Kennebäck G, Poçi D, Samo-Ayou R, Sigurjónsdóttir R, Ringborn M, Herczku C, Carlson J, Fengsrud E, Tabrizi F, Höglund N, Lönnerholm S, Kongstad O, Jönsson A, Insulander P. A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes. Eur Heart J 2019; 40:820-830. [PMID: 30452631 PMCID: PMC6403459 DOI: 10.1093/eurheartj/ehy709] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/10/2018] [Accepted: 10/11/2018] [Indexed: 12/18/2022] Open
Abstract
AIMS Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported. METHODS AND RESULTS Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%). CONCLUSION Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.
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Affiliation(s)
- Fredrik Holmqvist
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Milos Kesek
- Department of Cardiology, Umeå University Hospital, SE-901 89, Umeå, Sweden
| | - Anders Englund
- Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, SE-118 61, Stockholm, Sweden
| | | | - Lars O Karlsson
- Department of Cardiology, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, SE-171 76, Solna, Sweden
| | - Dritan Poçi
- Department of Cardiology, University Hospital Örebro, SE-701 85, Örebro, Sweden
| | - Romeo Samo-Ayou
- Department of Cardiology, Skaraborg Hospital, SE-541 42, Skövde, Sweden
| | - Runa Sigurjónsdóttir
- Department of Cardiology, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
| | - Michael Ringborn
- Thoracic Center, Blekinge County Hospital, S-371 85, Karlskrona, Sweden
| | - Csaba Herczku
- Department of Cardiology, Norra Älvsborg County Hospital, SE-461 73, Trollhättan, Sweden
| | - Jonas Carlson
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Espen Fengsrud
- Department of Cardiology, University Hospital Örebro, SE-701 85, Örebro, Sweden
| | - Fariborz Tabrizi
- Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, SE-118 61, Stockholm, Sweden
| | - Niklas Höglund
- Department of Cardiology, Umeå University Hospital, SE-901 89, Umeå, Sweden
| | - Stefan Lönnerholm
- Department of Cardiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Ole Kongstad
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Anders Jönsson
- Department of Cardiology, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, SE-171 76, Solna, Sweden
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Jilek C, Ullah W. Pulmonary vein reconnections or substrate in the left atrium: what is the reason for atrial fibrillation recurrences? A dialogue on a pressing clinical situation. Europace 2019; 21:i12-i20. [DOI: 10.1093/europace/euy289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/05/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Clemens Jilek
- Internistisches Klinikum München Süd, Peter-Osypka-Heart Centre, Munich, Germany
| | - Waqas Ullah
- Cardiology Department, University Hospital Southampton, National Health Service Foundation Trust, Southampton, UK
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Sroubek J, Rottmann M, Barkagan M, Leshem E, Shapira‐Daniels A, Brem E, Fuentes‐Ortega C, Malinaric J, Basu S, Bar‐Tal M, Anter E. A novel octaray multielectrode catheter for high‐resolution atrial mapping: Electrogram characterization and utility for mapping ablation gaps. J Cardiovasc Electrophysiol 2019; 30:749-757. [DOI: 10.1111/jce.13867] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jakub Sroubek
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
| | - Markus Rottmann
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
| | - Michael Barkagan
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
| | - Eran Leshem
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
| | - Ayelet Shapira‐Daniels
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
| | - Erez Brem
- Research and DevelopmentBiosense Webster Irwindale California
| | | | | | - Shubhayu Basu
- Research and DevelopmentBiosense Webster Irwindale California
| | - Meir Bar‐Tal
- Research and DevelopmentBiosense WebsterHaifa Israel
| | - Elad Anter
- Cardiovascular Division, Department of Medicine, Deaconess Medical Center, Harvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBoston Massachusetts
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Ruiz-Granell R, Ballesteros G, Andreu D, Erkiaga A, Ferrero-De-Loma-Osorio A, Ramos P, Martínez-Brotons A, Vives-Rodríguez E, Izquierdo-de-Francisco M, García-Bolao I. Differences in scar lesion formation between radiofrequency and cryoballoon in atrial fibrillation ablation: a comparison study using ultra-high-density mapping. Europace 2019; 21:250-258. [PMID: 30321320 DOI: 10.1093/europace/euy208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is usually associated to conduction gaps in pulmonary veins (PVs). Our objective was to characterize gaps in patients with recurrences after a first radiofrequency (RF) or cryoballoon (CB) PVI procedure, using a high-density mapping (HDM) system. Methods and results Fifty patients with AF recurrence after a first PVI procedure (pre-RF 25 patients; pre-CB 25 patients) were included at two centres. Activation map (AM) and voltage map (VM) of the left atrium and PVs were built using the HDM Rhythmia® system. Superior PVs were reconnected more frequently in both groups. Right PVs were reconnected more frequently in pre-RF patients. Pre-RF patients had more reconnected veins than pre-CB patients (mean ± standard deviation: 3.00 ± 0.96 vs. 1.88 ± 1.13; P < 0.001) and more gaps (4.84 ± 2.06 vs. 2.16 ± 1.49; P < 0.001). Gaps in the VM were wider in pre-CB patients (16.5 ± 9.5 mm vs. 12.1 ± 4.8 mm; P = 0.006). There was a gap in 179 of the 800 PV segments analysed (22%); 52% were identified in both AM and VM maps; 39% only in the AM and 8% only in the VM. The highest sensitivity and specificity for gap detection was obtained with VM in pre-CB patients and with AM in pre-RF patients. Conclusion In conclusion, HDM seems to be a useful and precise tool to detect conduction gaps after a first PVI procedure. The anatomical pattern and location of gaps depends on the technique used previously, usually being multiple, smaller, and better detected by AM after RF, and fewer, wider, and better detected by VM after CB.
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Affiliation(s)
- Ricardo Ruiz-Granell
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Gabriel Ballesteros
- Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Ane Erkiaga
- Boston Scientific Corporation, Madrid, Spain
| | - Angel Ferrero-De-Loma-Osorio
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Pablo Ramos
- Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Angel Martínez-Brotons
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Enrique Vives-Rodríguez
- Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Maite Izquierdo-de-Francisco
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Ignacio García-Bolao
- Arrhythmia Unit, Department of Cardiology and Cardiac Surgery, Clinica Universidad de Navarra, Pamplona, Spain
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Ernst S, Cazzoli I, Guarguagli S. An initial experience of high-density mapping-guided ablation in a cohort of patients with adult congenital heart disease. Europace 2019; 21:i43-i53. [PMID: 30801127 PMCID: PMC6388091 DOI: 10.1093/europace/euy188] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS In the management of both ventricular and supraventricular tachycardia in patients with congenital heart disease (CHD) catheter ablation has now been recognized as one of the mainstays. METHODS AND RESULTS We review our initial experience of using the Rhythmia mapping system in a cohort of 12 adult CHD patients presenting with multiple arrhythmia substrates. A total of 78 arrhythmia maps were attempted in a total of 15 procedures, but possible due to the dilatation of the target chamber only 44% of maps were able to reconstruct the entire arrhythmia. All patients underwent pre-procedure 3D imaging (either cardiac magnetic resonance or computed tomography), but image integration was suboptimal. A median of two maps per patient were finally analysed and acquisition took in median 22 min with a median number of 12 574 (8230-18 167) mapping points. Procedural data with a total duration amounting to in median 285 (194-403) min, with a median total fluoroscopy exposure of 7.5 (5.2-10.7) min. After a median of 1.5 procedures [median of 12 (8-16 months)], nine patients remained in stable sinus rhythm or atrial paced rhythm, while three patients had further sustained recurrences. One of these passed away in end-staged heart failure. CONCLUSION This initial experience of using high-density mapping for arrhythmia management in patients with CHD allowed rapid acquisition of multiple maps with high accuracy to identify surgical scars and fibrosis, however, it was limited by large atrial volumes and a high percentage of incomplete maps resulting in modest clinical success.
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MESH Headings
- Cardiac Imaging Techniques
- Catheter Ablation/methods
- Electrophysiologic Techniques, Cardiac
- Female
- Fluoroscopy
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Male
- Middle Aged
- Recurrence
- Tachycardia, Supraventricular/diagnostic imaging
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/surgery
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
- Division Of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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36
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Bourier F, Martin R, Martin CA, Takigawa M, Kitamura T, Frontera A, Cheniti G, Lam A, Vlachos K, Duchateau J, Pambrun T, Derval N, Denis A, Klotz N, Hocini M, Haïssaguerre M, Jaïs P, Cochet H, Sacher F. Is it feasible to offer 'targeted ablation' of ventricular tachycardia circuits with better understanding of isthmus anatomy and conduction characteristics? Europace 2019; 21:i27-i33. [PMID: 30801128 DOI: 10.1093/europace/euy173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Successful mapping and ablation of ventricular tachycardias remains a challenging clinical task. Whereas conventional entrainment and activation mapping was for many years the gold standard to identify reentrant circuits in ischaemic ventricular tachycardia ablation procedures, substrate mapping has become the cornerstone of ventricular tachycardia ablation. In the last decade, technology has dramatically improved. In parallel to high-density automated mapping, cardiac imaging and image integration tools are increasingly used to assess the structural ventricular tachycardia substrate. The aim of this review is to describe the technologies underlying these new mapping systems and to discuss their possible role in providing new insights into identification and visualization of reentrant tachycardia mechanisms.
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Affiliation(s)
- Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
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Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Lin CY, Te ALD, Lin YJ, Chang SL, Lo LW, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang TY, Yamada S, Van Ba V, Salim S, Vicera JJB, Huang TC, Wu CI, Liu CM, Chen SA. High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter. Int J Cardiol 2018; 272:90-96. [DOI: 10.1016/j.ijcard.2018.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022]
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39
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Kottmaier M, Bourier F, Wünscher S, Kornmayer M, Semmler V, Lengauer S, Telishevska M, Koch-Büttner K, Risse E, Brooks S, Hessling G, Deisenhofer I, Reents T. Repeat ablation for paroxysmal atrial fibrillation - Does adenosine play a role in predicting pulmonary vein reconnection patterns? Indian Pacing Electrophysiol J 2018; 18:203-207. [PMID: 30290206 PMCID: PMC6302775 DOI: 10.1016/j.ipej.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. METHODS We included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. RESULTS Fifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). CONCLUSIONS In repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.
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Affiliation(s)
- M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany.
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Wünscher
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - V Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - K Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Brooks
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
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40
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Conte G, Soejima K, de Asmundis C, Chierchia GB, Badini M, Miwa Y, Caputo ML, Özkartal T, Maffessanti F, Sieira J, Degreef Y, Stroker E, Regoli F, Moccetti T, Brugada P, Auricchio A. Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation. Int J Cardiol 2018; 270:136-142. [PMID: 29929934 DOI: 10.1016/j.ijcard.2018.05.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping. METHODS Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study. RESULTS A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months. CONCLUSION Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matteo Badini
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Tardu Özkartal
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Francesco Maffessanti
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Degreef
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Stroker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - François Regoli
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland; Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
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41
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Takigawa M, Martin R, Cheniti G, Kitamura T, Vlachos K, Frontera A, Martin CA, Bourier F, Lam A, Pillois X, Duchateau J, Klotz N, Pambrun T, Denis A, Derval N, Hocini M, Haïssaguerre M, Sacher F, Jaïs P, Cochet H. Detailed comparison between the wall thickness and voltages in chronic myocardial infarction. J Cardiovasc Electrophysiol 2018; 30:195-204. [PMID: 30288836 DOI: 10.1111/jce.13767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between the local electrograms (EGMs) and wall thickness (WT) heterogeneity within infarct scars has not been thoroughly described. The relationship between WT and voltages and substrates for ventricular tachycardia (VT) was examined. METHODS In 12 consecutive patients with myocardial infarction and VT, WT, defined by a multidetector computed tomography, and voltage were compared. In multicomponent EGMs, amplitudes of both far- and near-field components were manually measured, and the performance of the three-dimensional-mapping system automatic voltage measurement was assessed. RESULTS Of 15 748 points acquired, 2677 points within 5 mm of the endocardial surface were analyzed. In total, 909 (34.0%) multicomponent EGMs were identified; 785 (86.4%) and 883 (97.1%) were distributed in the WT less than 4 and 5 mm, respectively. Far-field EGM voltages increased linearly from 0.14 mV (0.08-0.28 mV) in the WT: 0 to 1 mm to 0.70 mV (0.43-2.62 mV) in the WT: 4 to 5 mm (ρ = 0.430; P < 0.001), and a significant difference was demonstrated between any two WT-groups (P ≤ 0.001). In contrast, near-field EGM voltages varied from 0.27 mV (0.11-0.44 mV) in the WT: 0 to 1 mm to 0.29 mV (0.17-0.53 mV) in the WT: 4 to 5 mm with a poorer correlation (ρ = 0.062, P = 0.04). The proportion of points where the system automatically measured the voltage on near-field EGMs increased from less than 10% in areas of WT: 4 to 5 mm to 50% in areas less than 2 mm. Of 21 VTs observed, seven hemodynamically stable VTs were mapped and terminated in WT: 1 to 4 mm area. CONCLUSIONS Although far-field voltages gradually increase with the WT, near-field does not. The three-dimensional-mapping system preferentially annotates the near-field components in thinner areas (center of the scar) and the far-field component in thicker areas when building a voltage map. Critical sites of VT are distributed in WT: 1 to 4 mm areas.
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Affiliation(s)
- Masateru Takigawa
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Ruairidh Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France.,Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ghassen Cheniti
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Takeshi Kitamura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Konstantinos Vlachos
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Antonio Frontera
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Claire A Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Felix Bourier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Anna Lam
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Xavier Pillois
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Josselin Duchateau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Klotz
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Thomas Pambrun
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Frédéric Sacher
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Hubert Cochet
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
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42
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Ellermann C, Frommeyer G, Eckardt L. [High-resolution 3D mapping : Opportunities and limitations of the Rhythmia™ mapping system]. Herzschrittmacherther Elektrophysiol 2018; 29:284-292. [PMID: 30019115 DOI: 10.1007/s00399-018-0580-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 06/08/2023]
Abstract
Three-dimensional mapping systems are used for the characterization and treatment of complex arrhythmias, such as atrial reentrant tachycardias, atrial fibrillation, or ventricular tachycardia. The Rhythmia™ mapping system (Boston Scientific, Natick, MA, USA) belongs to a novel generation of mapping systems that are able to rapidly create high-density and high-resolution three-dimensional maps in an automated manner. Mapping is performed with a magnetic- and impedance-based tracked bidirectional deflectable 64-pole basket catheter (IntellaMap Orion™, Boston Scientific). Based on previous studies, the system is effective and safe for the treatment of complex atrial and ventricular arrhythmias.
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Affiliation(s)
- Christian Ellermann
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland.
| | - Gerrit Frommeyer
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland
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43
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Lackermair K, Kellner S, Kellnar A, Riesinger LM, Wakili R, Sinner MF, Rizas KD, Fichtner S, Estner HL. Initial single centre experience with the novel Rhythmia© high density mapping system in an all comer collective of 400 electrophysiological patients. Int J Cardiol 2018; 272:168-174. [PMID: 30126655 DOI: 10.1016/j.ijcard.2018.07.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/10/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel, automatically annotating ultra-high density mapping system (Rhythmia©, Boston Scientific) collects a high number and quality of electrograms (EGMs). So far, data on general use in the electrophysiological laboratory are sparse. METHODS We retrospectively analyzed all our ablations using Rhythmia and recorded patient clinical data, procedural parameters, and mapping parameters including the count of EGMs, mapping time, and mapping volume. Where appropriate, procedural parameters were compared over time to assess a learning curve. RESULTS 400 patients underwent ablation of atrial fibrillation (n = 202), typical (n = 16) or atypical atrial flutter (n = 49), VT (n = 48), PVC (n = 35), accessory pathways (n = 14), AVNRT (n = 4), and focal atrial tachycardia (n = 32). System use was feasible, as no procedure had to be stopped for technical reasons and no ablation had to be withheld because of mapping failure, and safe, with an overall complication rate of 2.25%. Initial restrictions in manoeuvrability of the mapping catheter were overcome rapidly, as indicated by a significant decrease of fluoroscopy time (20 vs. 14 min, p = 0.02), use of contrast agent (50 vs. 40 ml; p < 0.01), and (not significant) lower procedure times (194 vs. 170 min; p = 0.12; comparing the first with the last third of patients undergoing pulmonary vein isolation only procedure). Ablation of complex left atrial, focal and ventricular tachycardias benefited from the reliable automatic annotation of a high number of EGMs. CONCLUSION The use of the Rhythmia is feasible and safe. Initial restrictions in manoeuvrability of the Orion mapping catheter were overcome rapidly. The procedures that benefit the most from ultra-high density mapping are complex left atrial tachycardias, focal tachycardias, and ventricular tachycardias.
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Affiliation(s)
- Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | - Stefanie Kellner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Lisa M Riesinger
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Reza Wakili
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Konstantinos D Rizas
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany; German Cardiovascular Research Centre (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Stephanie Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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44
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Tanaka Y, Takahashi A, Takagi T, Nakajima J, Takagi K, Hikita H, Goya M, Hirao K. Novel Ablation Strategy for Isolating the Superior Vena Cava Using Ultra High-Resolution Mapping. Circ J 2018; 82:2007-2015. [DOI: 10.1253/circj.cj-17-1352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Jun Nakajima
- The Cardiovascular Center, Yokosuka Kyosai Hospital
| | | | | | - Masahiko Goya
- The Heart Rhythm Center, Tokyo Medical and Dental University
| | - Kenzo Hirao
- The Heart Rhythm Center, Tokyo Medical and Dental University
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45
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[Modern mapping technologies : Technical background and clinical use]. Herzschrittmacherther Elektrophysiol 2018; 29:271-277. [PMID: 29946889 DOI: 10.1007/s00399-018-0576-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
Successful mapping and ablation of arrhythmias can be a challenging clinical task. For many years, conventional pacing maneuvers and activation mapping were the gold standard to identify underlying arrhythmia mechanisms in ablation procedures. In the last decade, technology has dramatically improved. In parallel to high-density automated mapping, cardiac imaging and image integration tools are increasingly used to assess the arrhythmia substrate and identify reentrant circuits. The aim of this review is to describe the technologies underlying these new mapping systems and to discuss their possible role in providing new insights into identification and visualization of arrhythmia mechanisms.
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46
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 703] [Impact Index Per Article: 117.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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47
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1365] [Impact Index Per Article: 195.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Sau A, Sikkel MB, Luther V, Wright I, Guerrero F, Koa-Wing M, Lefroy D, Linton N, Qureshi N, Whinnett Z, Lim PB, Kanagaratnam P, Peters NS, Davies DW. The sawtooth EKG pattern of typical atrial flutter is not related to slow conduction velocity at the cavotricuspid isthmus. J Cardiovasc Electrophysiol 2017; 28:1445-1453. [DOI: 10.1111/jce.13323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Arunashis Sau
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Markus B. Sikkel
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Vishal Luther
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Ian Wright
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | | | - Michael Koa-Wing
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - David Lefroy
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Nicholas Linton
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Norman Qureshi
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Zachary Whinnett
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Phang Boon Lim
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Prapa Kanagaratnam
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - Nicholas S. Peters
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
| | - D. Wyn Davies
- Imperial Centre for Translational and Experimental Medicine; Imperial College London; London UK
- Department of Cardiology; Imperial College Healthcare NHS Trust; London UK
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Radiofrequency Catheter Ablation For Atrial Fibrillation: Approaches And Outcomes. Heart Lung Circ 2017; 26:941-949. [DOI: 10.1016/j.hlc.2017.05.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/27/2023]
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50
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Ballesteros G, Ramos P, Neglia R, Menéndez D, García-Bolao I. Ablación de fibrilación auricular guiada por un nuevo sistema de navegación no fluoroscópica. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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