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Li K, Wu S, Wang X, Han B, Qin M, Hou X, Liu X. A multicenter, cohort study of catheter ablation for persistent atrial fibrillation with/without atrial fibrillation termination (the termination-atrial fibrillation study). Europace 2024; 26:euae085. [PMID: 38573506 PMCID: PMC11022747 DOI: 10.1093/europace/euae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Kaige Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xinhua Wang
- Department of Cardiology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xumin Hou
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
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Sousonis V, Voglimacci-Stephanopoli Q, Zeriouh S, Boveda S, Albenque JP. Pulsed field ablation of spatiotemporal electrogram dispersion following pulmonary vein isolation and left atrial linear lesions for persistent atrial fibrillation: a case report. Eur Heart J Case Rep 2024; 8:ytae085. [PMID: 38405199 PMCID: PMC10894002 DOI: 10.1093/ehjcr/ytae085] [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: 10/09/2023] [Revised: 12/10/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Background Ablation of persistent atrial fibrillation (AF) remains challenging, with atrial substrate modification often being performed as an adjunct to pulmonary vein isolation (PVI). Pulsed field ablation (PFA) is a novel ablation modality that carries a favourable safety profile, which could facilitate complex procedures. Case summary We present the case of a 60-year-old male undergoing catheter ablation for symptomatic persistent AF. The procedure was performed with the Farapulse™ PFA system in a stepwise manner, including PVI and linear lesions for the isolation of the posterior left atrial wall and the ablation of the mitral isthmus. The final step of the procedure included the ablation of areas exhibiting spatiotemporal electrogram dispersion, identified with the help of artificial intelligence-based software (VX1, Volta Medical) in both atria. Sinus rhythm was restored after the abolition of an electrogram dispersion zone in the right atrium. The procedure was carried out without any complications. Discussion Complex ablation procedures for persistent AF can be successfully performed with PFA. In the context of such extensive ablation strategies, PFA is an attractive energy source, given its non-thermal nature that is known to prevent damage to surrounding tissue and result in less chronic fibrosis. However, caution should be exercised to avoid excessive ablation when using the currently available multispline PFA catheter, as it may inadvertently target adjacent areas of healthy myocardium.
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Affiliation(s)
- Vasileios Sousonis
- Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31300 Toulouse, France
| | | | - Sarah Zeriouh
- Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31300 Toulouse, France
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31300 Toulouse, France
| | - Jean Paul Albenque
- Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31300 Toulouse, France
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Segan L, Chieng D, Prabhu S, Hunt A, Watts T, Klys B, Voskoboinik A, Sugumar H, Ling LH, Lee G, Morton J, Pathak RK, Chandh Raja D, Sterns L, Ginks M, Sanders P, Kalman JM, Kistler PM. Posterior Wall Isolation Improves Outcomes for Persistent AF With Rapid Posterior Wall Activity: CAPLA Substudy. JACC Clin Electrophysiol 2023; 9:2536-2546. [PMID: 37702654 DOI: 10.1016/j.jacep.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is less effective in persistent atrial fibrillation (PerAF) than in paroxysmal atrial fibrillation (AF). However, the CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA randomized clinical trial) of PVI vs posterior wall isolation (PWI) did not support empiric PWI in PerAF. We examined pulmonary vein (PV) and posterior wall (PW) electrical characteristics to determine if select patients may benefit from additional PWI. OBJECTIVES This study sought to determine the impact of PV and PW electrical characteristics on AF ablation outcomes in the CAPLA randomized study. METHODS Participants in spontaneous AF at the time of ablation were included from the CAPLA study. The mean, shortest, and longest PV, PW, and left atrial (LA) appendage cycle length measurements were annotated preablation using a multipolar catheter for 100 consecutive cycles. Next, cardioversion was performed with a high-density LA voltage map completed. Cox proportional hazards regression was utilized to determine clinical and electroanatomic predictors of AF recurrence overall and according to ablation strategy. Follow-up included twice daily single-lead electrocardiograms or continuous monitoring for 12 months. RESULTS A total of 151 patients (27% female, age 65 ± 9 years, 18% long-standing PerAF, LA volume index 52 ± 16 mL/m2, median AF duration 5 months [IQR: 2-10 months]) were in AF on the day of procedure and were randomized to PVI alone (50%) or PVI+PWI (50%) according to the CAPLA randomized clinical trial protocol. Baseline clinical, echocardiographic, and electroanatomic parameters were comparable between groups (all P > 0.05) including PV and PW characteristics. After 12 months, freedom from AF off antiarrhythmic drug therapy was 51.7% in PVI and 49.7% in PVI+PWI (log-rank P = 0.564). Rapid PW activity was defined as less than the median of the shortest PW cycle length (140 ms) and rapid PV activity was defined as less than the median of the shortest PV cycle length (126 ms). In those with rapid PW activity, the addition of PWI was associated with greater arrhythmia-free survival (56.4%) vs PVI alone (38.6%) (HR: 0.78; 95% CI: 0.67-0.94; log-rank P = 0.030). Moreover, in those undergoing PVI only, the risk of AF recurrence was higher in those with rapid PW activity (55.3% vs 46.5% in slower PW activity; HR: 1.50, 95%CI 1.11-2.26; log-rank P = 0.036). Rapid PV activity and PV cycle length (individual PVs or average of all 4 PVs) were not associated with outcome (all P > 0.05) regardless of ablation strategy. There was no correlation between PW cycle length and posterior low voltage (r = -0.06, P = 0.496). The addition of PWI did not improve arrhythmia-free survival in subgroups with LA enlargement (LA volume index >34 mL/m2) (HR: 0.69; 95% CI: 0.39-1.25; P = 0.301), posterior low-voltage zone (HR: 1.06; 95% CI: 0.68-1.66; P = 0.807), or long-standing PerAF (HR: 1.10; 95% CI: 0.71-1.72; P = 0.669). CONCLUSIONS Rapid PW activity is associated with an increased risk of AF recurrence post-catheter ablation. The addition of PWI in this subgroup was associated with a significant improvement in freedom from AF compared with PVI alone. The presence of rapid PW activity may identify patients with PerAF likely to benefit from PWI.
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Affiliation(s)
- Louise Segan
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - David Chieng
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Sandeep Prabhu
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Troy Watts
- Royal Melbourne Hospital, Melbourne, Australia
| | - Brian Klys
- Melbourne Private Hospital, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Hariharan Sugumar
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Liang-Han Ling
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Geoff Lee
- University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia
| | - Joseph Morton
- University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia
| | - Rajeev K Pathak
- Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Deep Chandh Raja
- Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Laurence Sterns
- Royal Jubilee Hospital, Vancouver Island, British Columbia, Canada
| | | | - Prashanthan Sanders
- Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Jonathan M Kalman
- University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia
| | - Peter M Kistler
- Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia.
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Betts TR, Good WW, Melki L, Metzner A, Grace A, Verma A, Murray S, James S, Wong T, Boersma LVA, Steven D, Sultan A, Busch S, Neužil P, de Asmundis C, Lee J, Szili-Török T. Treatment of pathophysiologic propagation outside of the pulmonary veins in retreatment of atrial fibrillation patients: RECOVER AF study. Europace 2023; 25:euad097. [PMID: 37072340 PMCID: PMC10228624 DOI: 10.1093/europace/euad097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/23/2023] [Indexed: 04/20/2023] Open
Abstract
AIMS RECOVER AF evaluated the performance of whole-chamber non-contact charge-density mapping to guide the ablation of non-pulmonary vein (PV) targets in persistent atrial fibrillation (AF) patients following either a first or second failed procedure. METHODS AND RESULTS RECOVER AF was a prospective, non-randomized trial that enrolled patients scheduled for a first or second ablation retreatment for recurrent AF. The PVs were assessed and re-isolated if necessary. The AF maps were used to guide the ablation of non-PV targets through elimination of pathologic conduction patterns (PCPs). Primary endpoint was freedom from AF on or off antiarrhythmic drugs (AADs) at 12 months. Patients undergoing retreatment with the AcQMap System (n = 103) were 76% AF-free at 12 months [67% after single procedure (SP)] on or off AADs (80% free from AF on AADs). Patients who had only received a pulmonary vein isolation (PVI) prior to study treatment of non-PV targets with the AcQMap System were 91% AF-free at 12 months (83% SP). No major adverse events were reported. CONCLUSION Non-contact mapping can be used to target and guide the ablation of PCPs beyond the PVs in persistent AF patients returning for a first or second retreatment with 76% freedom from AF at 12 months. The AF freedom was particularly high, 91% (43/47), for patients enrolled having only a prior de novo PVI, and freedom from all atrial arrhythmias for this cohort was 74% (35/47). These early results are encouraging and suggest that guiding individualized targeted ablation of PCPs may therefore be advantageous to target at the earliest opportunity in patients with persistent AF.
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Affiliation(s)
- Timothy R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | | | - Lea Melki
- R&D Algorithms, Acutus Medical, Carlsbad, CA, USA
| | - Andreas Metzner
- Cardiac Electrophysiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andrew Grace
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Atul Verma
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Stephen Murray
- Cardiology Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Simon James
- Cardiology Department, The James Cook University Hospital, Middlesbrough, UK
| | - Tom Wong
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Lucas V A Boersma
- Cardiology Department, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Sonia Busch
- Department Cardiology and Angiology, Klinikum Coburg, Coburg, Germany
| | - Petr Neužil
- Department of Cardiology, Homolka Hospital (Na Homolce Hospital), Prague, Czech Republic
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Justin Lee
- Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tamás Szili-Török
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Shi WR, Wu SH, Zou GC, Xu K, Jiang WF, Zhang Y, Qin M, Liu X. A novel approach for quantitative electrogram analysis for driver identification: Implications for ablation in persistent atrial fibrillation. Front Cardiovasc Med 2022; 9:1049854. [DOI: 10.3389/fcvm.2022.1049854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
ObjectiveThis study sought to study the feasibility, efficacy, and safety of using multiscale entropy (MSE) analysis to guide catheter ablation for persistent atrial fibrillation (PsAF) and predict ablation outcomes.MethodsWe prospectively enrolled 108 patients undergoing initial ablation for PsAF. MSE was calculated based on bipolar intracardiac electrograms (iEGMs) to measure the dynamical complexity of biological signals. The iEGMs data were exported after pulmonary vein isolation (PVI), then calculated in a customed platform, and finally re-annotated into the CARTO system. After PVI, regions of the highest mean MSE (mMSE) values were ablated in descending order until AF termination, or three areas had been ablated.ResultsBaseline characteristics were evenly distributed between the AF termination (n = 38, 35.19%) and the non-termination group. The RA-to-LA mean MSE (mMSE) gradient demonstrated a positive gradient in the non-termination group and a negative gradient in the termination group (0.105 ± 0.180 vs. −0.235 ± 0.256, P < 0.001). During a 12-month follow-up, 29 patients (26.9%) had arrhythmia recurrence after single ablation, and 18 of them had AF (62.1%). The termination group had lower rates of arrhythmia recurrence (15.79 vs. 32.86%, Log-Rank P = 0.053) and AF recurrence (10.53 vs. 20%, Log-Rank P = 0.173) after single ablation and a lower rate of arrhythmia recurrence (7.89 vs. 27.14%, Log-Rank P = 0.018) after repeated ablation. Correspondingly, subjects with negative RA-to-LA mMSE gradient had lower incidences of arrhythmia (16.67 vs. 35%, Log-Rank P = 0.028) and AF (16.67 vs. 35%, Log-Rank P = 0.032) recurrence after single ablation and arrhythmia recurrence after repeated ablation (12.5 vs. 26.67%, Log-Rank P = 0.062). Marginal peri-procedural safety outcomes were observed.ConclusionMSE analysis-guided driver ablation in addition to PVI for PsAF could be feasible, efficient, and safe. An RA < LA mMSE gradient before ablation could predict freedom from arrhythmia. The RA-LA MSE gradient could be useful for guiding ablation strategy selection.
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Lin J, Jiang CX, Long DY, He L, Sang CH, Yu RH, Tang RB, Li SN, Guo XY, Wang W, Liu N, Du X, Dong JZ, Ma CS. Repeat ablation strategy for recurrent persistent atrial fibrillation: A propensity-matched score comparison between "2C3L" and "extensive ablation" approach. Pacing Clin Electrophysiol 2022; 45:1349-1356. [PMID: 36112388 DOI: 10.1111/pace.14595] [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: 02/24/2022] [Revised: 08/17/2022] [Accepted: 09/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Debates exist in the repeat ablation strategy for patients with recurrence presenting as persistent atrial fibrillation (AF) after initial persistent AF ablation. OBJECTIVE To compare the outcome between the "2C3L" and "extensive ablation" approach in patients undergoing repeat procedures for recurrent persistent AF. METHODS Propensity-score matching was performed in 196 patients with AF recurrence undergoing repeat ablation, and 79 patients treated with "2C3L" strategy were matched to 79 patients treated with "extensive ablation" strategy. The "2C3L" approach included pulmonary vein isolation, mitral isthmus, left atrial roof, and cavotricuspid isthmus ablation, while the "extensive ablation" strategy included extensive ablation of a variety of other targets aiming to terminate the AF. The primary outcome was freedom from any atrial tachyarrhythmia after 24-h ambulatory monitoring follow-up for 12 months. RESULTS No statistically significant difference was found between the primary outcome between the "2C3L" and the "extensive ablation" group [70.9% vs. 69.6%, p = .862; 95% confidence interval (CI) -12.8 to 15.3], although the "extensive ablation" group had a significantly high proportion of AF termination (19.0% for "2C3L" vs. 41.8% for "extensive ablation" group, p = .002; 95% CI 8.5-35.9). And AF termination was not related to the primary outcome in multifactorial regression. At 40 ± 22 months after the repeat procedure, the primary outcome was also comparable (57.0 % for "2C3L" vs. 48.1% for "extensive ablation" group, p = .265; 95% CI -6.6 to 23.7). CONCLUSION The outcome between the "2C3L" and "extensive ablation" approaches was comparable in patients undergoing repeat procedures for recurrent persistent AF.
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Affiliation(s)
- Jing Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China.,Cardiovascular Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Coronary sinus electrogram characteristics predict termination of AF with ablation and long-term clinical outcome. J Cardiovasc Electrophysiol 2022; 33:2139-2151. [PMID: 35775822 PMCID: PMC9796101 DOI: 10.1111/jce.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Markers predicting atrial fibrillation (AF) termination and freedom from AF/atrial tachycardia (AT) has been proposed. This study aimed to evaluate the role of novel coronary sinus (CS) electrogram characteristics in predicting the acute ablation response and freedom from AF/AT during follow-up. METHODS Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals mapping study were included. Novel CS electrogram characteristics including CS cycle length variability (CLV) and CS activation pattern stability (APS) and proportion of low voltage zones (LVZs) were reviewed as potential predictors for AF termination on ablation and freedom from AF/AT during follow-up. The relationship between localized driver characteristics and CS electrogram characteristics was also assessed. RESULTS Sixty-five patients were included. AF termination was achieved in 51 patients and 80% of patients were free from AF/AT during a follow-up of 29.5 ± 3.7 months. CS CLV of <30 ms, CS APS of ≥30% and proportion of LVZ < 30% showed high diagnostic accuracy in predicting AF termination on ablation and freedom from AF/AT during follow-up (CS CLV odds ratio [OR] 25.6, area under the curve [AUC] 0.91; CS APS OR 15.9, AUC 0.94; proportion of LVZs OR 21.4, AUC 0.88). These markers were independent predictors of AF termination on ablation and AF/AT recurrence during follow-up. Ablation of a smaller number of drivers that demonstrate greater dominance strongly correlate with greater CS organization. CONCLUSION Novel CS electrogram characteristics were independent predictors of AF termination and AF/AT recurrence during follow-up. These markers can potentially aid in predicting outcomes and guide ablation and follow-up strategies.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Richard J. Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Emily Keating
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Malcolm Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Ross J. Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
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Park JI, Park SW, Kwon MJ, Lee J, Kim HJ, Lee CH, Shin DG. Surface ECG-based complexity parameters for predicting outcomes of catheter ablation for nonparoxysmal atrial fibrillation: efficacy of fibrillatory wave amplitude. Medicine (Baltimore) 2022; 101:e29949. [PMID: 35945788 PMCID: PMC9351908 DOI: 10.1097/md.0000000000029949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Catheter ablation (CA) is a well-established therapy for rhythm control in atrial fibrillation (AF). However, CA outcomes for persistent AF remain unsatisfactory because of the high recurrence rate despite time-consuming efforts and the latest ablation technology. Therefore, the selection of good responders to CA is necessary. Surface electrocardiography (sECG)-based complexity parameters were tested for the predictive ability of procedural termination failure during CA and late recurrence of atrial arrhythmias (AA) after CA. A total of 130 patients with nonparoxysmal AF who underwent CA for the first time were investigated. A 10-second sECG of 4 leads (leads I, II, V1, and V6) was analyzed to compute the fibrillatory wave amplitude (FWA), dominant frequency (DF), spectral entropy (SE), organization index (OI), and sample entropy (SampEn). The study endpoints were procedural termination failure during CA and late (≥1 year) AA recurrence after CA. In the multivariate analysis, FWA in lead V1 and DF in lead I were independent predictors of successful AF termination during CA (P <.05). The optimal cut-off values for FWA in lead V1 and DF in lead I were 60.38 μV (area under the curve [AUC], 0.672; P = .001) and 5.7 Hz (AUC, 0.630; P = .016), respectively. The combination of FWA of lead V1 and DF of lead I had a more powerful odds ratio for predicting procedural termination failure (OR, 8.542; 95% CI, 2.938-28.834; P < .001). FWA in lead V1 was the only independent predictor of late recurrence after CA. The cut-off value is 65.73 μV which was 0.634 of the AUC (P = .009). These sECG parameters, FWA in lead V1 and DF in lead I, predicted AF termination by CA in patients with nonparoxysmal AF. In particular, FWA in lead V1 was an independent predictor of late recurrence of AA after CA.
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Affiliation(s)
- Jong-Il Park
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | | | - Min-Ji Kwon
- Yeungnam University College of Medicine, Daegu, Korea
| | - Jeon Lee
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hong-Ju Kim
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chan-Hee Lee
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Gu Shin
- Yeungnam University College of Medicine, Daegu, Korea
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
- *Correspondence: Dong-Gu Shin, Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea (e-mail: )
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Wu S, Li H, Yi S, Yao J, Chen X. Comparing the efficacy of catheter ablation strategies for persistent atrial fibrillation: a Bayesian analysis of randomized controlled trials. J Interv Card Electrophysiol 2022; 66:757-770. [PMID: 35788940 DOI: 10.1007/s10840-022-01246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Catheter ablation has been recommended as the first-line treatment option for selected patients with atrial fibrillation (AF). However, a widely accepted ablation strategy for persistent AF (perAF) has not yet been established. The benefits of ablation strategies are not conclusive for perAF. There is an urgent need to systematically analyze the results of previous studies and rank these treatment strategies to guide clinical practice. METHODS Randomized controlled trials (RCTs) on ablation for perAF were included. The primary outcome was recurrence of atrial tachyarrhythmia (AT) after a single ablation procedure. A Bayesian random-effects network meta-analysis model was fitted. RESULTS Twenty-three studies were included in the analysis. A total of 3394 patients and 22 ablation strategies were found in the involved studies. The ablation strategy of pulmonary vein isolation (PVI) + electrical box isolation of the left atrial posterior wall (PBOX) + non-PV trigger ablation (NPV) showed the best treatment effect in terms of the primary outcome. The individualized ablation strategies of mapping and ablation combined with PVI, such as PVI + rotors, PVI + dispersion areas, and PVI + low voltage zone (LVZ) also showed a better ablation effect in perAF. CONCLUSIONS PVI ablation is a widely used strategy in perAF and is recognized as a cornerstone procedure for perAF. The PVI + PBOX + NPV strategy showed the highest rank in our analysis. Mapping and ablation strategies that could provide individualized substrate modification also showed a better rank in our analysis and are believed to be a promising direction for the treatment of perAF.
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Affiliation(s)
- Sijia Wu
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Hongkai Li
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Shaolei Yi
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jingwulu Jinan 250010, Jinan, Shandong Province, China.
| | - Jianming Yao
- Department of Cardiology, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Xueming Chen
- People's Hospital of Shizhong District, Zaozhuang, China
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10
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Chang TY, Lin CY, Lin YJ, Wu CI, Chang SL, Lo LW, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Kuo L, Liu CM, Chen SA. Long-term Outcome of Patients with Long-standing Persistent Atrial Fibrillation undergoing Ablation Guided by a Novel High-Density Panoramic Mapping System - A Propensity Score Matching Study. Heart Rhythm O2 2022; 3:269-278. [PMID: 35734294 PMCID: PMC9207729 DOI: 10.1016/j.hroo.2022.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Catheter ablation is a current therapeutic approach for atrial fibrillation (AF). However, its efficacy for long-standing persistent AF remains suboptimal. Objective The purpose of this study was to test the hypothesis that a panoramic mapping system (CARTOFINDER, Biosense Webster) can guide pulmonary vein (PV) isolation and additional potential AF drivers. Methods A total of 76 patients with nonparoxysmal AF referred for ablation guided by a novel high-density panoramic mapping system with CARTOFINDER were prospectively enrolled. Of this cohort, 40 patients (52.6%) had long-standing persistent AF (CARTOFINDER group). We then retrospectively screened the patients with long-standing persistent AF undergoing conventional PV isolation and elimination of non-PV triggers during the contemporary period (conventional group). They were matched at a 1:2 ratio (40 patients in group 1 received ablation guided by CARTOFINDER; 80 patients in group 2 receiving conventional PV isolation and elimination of non-PV triggers). Results During follow-up, patients in group 1 had a lower recurrence AF rate than those in group 2 (P = .040). There was no difference in recurrence of atrial flutter (P = .996) and atrial tachycardia (P = .525). In Cox proportional hazards regression analysis, AF duration and PV isolation along with AF driver ablation using a panoramic mapping system with CARTOFINDER both were independent predictors of recurrent AF after catheter ablation of long-standing persistent AF. Conclusion Identification of the potential drivers in long-standing AF is crucial. Compared with conventional PV isolation and elimination of non-PV triggers, ablation guided by a high-density panoramic mapping system (CARTOFINDER) might have a better outcome in patients with long-standing persistent AF.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Address reprint requests and correspondence: Dr Yenn-Jiang Lin, Division of Cardiology, Internal Medicine Department, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, Taiwan 112.
| | - Cheng-I Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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11
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Pope MT, Betts TR. Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF. Arrhythm Electrophysiol Rev 2022; 11:e06. [PMID: 35755327 PMCID: PMC9204651 DOI: 10.15420/aer.2021.64] [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: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 11/04/2022] Open
Abstract
Results from catheter ablation for persistent AF are suboptimal, with no strategy other than pulmonary vein isolation showing clear benefit. Recently employed empirical strategies beyond pulmonary vein isolation involve widespread atrial ablation in all patients and do not take into account patient-specific differences in AF mechanisms or phenotype. Charge density mapping using the non-contact AcQMap system (Acutus Medical) allows visualisation of whole-chamber activation during AF and reveals localised patterns of complex activation thought to represent important mechanisms for AF maintenance that can be targeted with focal ablation. In this review, the authors outline the fundamentals of this technology, the initial data exploring the mechanistic role of activation patterns seen and the application to ablation of persistent AF.
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Affiliation(s)
- Michael Tb Pope
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department for Human Development and Health, University of Southampton, Southampton, UK
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Biomedical Research Centre, Oxford, UK
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12
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Gillis K, O'Neill L, Wielandts JY, Hilfiker G, Almorad A, Lycke M, El Haddad M, le Polain de Waroux JB, Tavernier R, Duytschaever M, Knecht S. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation. JACC Clin Electrophysiol 2022; 8:367-376. [PMID: 35331432 DOI: 10.1016/j.jacep.2021.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block. BACKGROUND Achieving MI block with the use of RF ablation is challenging. METHODS Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMFIRST group) vs RF ablation as a first step preceding VOMEt (RFFIRST group). The study end point was incidence of MI block after RF ablation and after the 2 steps. RESULTS In VOMFIRST, VOMEt was successful in 30/35 patients (86%) resulting in a low-voltage area of 12 ± 7.4 cm2 and MI block in 2/35 patients (6%). VOMFIRST, compared with RFFIRST, was associated with higher incidence of MI block after endocardial (46% vs 11%; P < 0.001) and epicardial ablation (94% vs 43%; P < 0.001), with fewer endocardial applications (4 vs 11 vs 4; P < 0.001) and similar epicardial applications (7 vs 8; P = 0.68). Incidence of MI block after the 2 steps was 94% vs 63% (P = 0.001) in VOMFIRST vs RFFIRST, respectively. Additional touch-up RF ablation in both groups resulted in final MI block in all but 1 patient (99%). CONCLUSIONS VOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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Affiliation(s)
- Kris Gillis
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
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13
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Roney CH, Sim I, Yu J, Beach M, Mehta A, Alonso Solis-Lemus J, Kotadia I, Whitaker J, Corrado C, Razeghi O, Vigmond E, Narayan SM, O’Neill M, Williams SE, Niederer SA. Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models. Circ Arrhythm Electrophysiol 2022; 15:e010253. [PMID: 35089057 PMCID: PMC8845531 DOI: 10.1161/circep.121.010253] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. METHODS Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. RESULTS We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). CONCLUSION A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation.
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Affiliation(s)
- Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- School of Engineering and Materials Science, Queen Mary University of London, United Kingdom (C.H.R.)
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jin Yu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Marianne Beach
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Arihant Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jose Alonso Solis-Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- The Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (J.W.)
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (E.V.)
- Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France (E.V.)
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA (S.M.N.)
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- Centre for Cardiovascular Science, College of Medicine and Veterinary Medicine, University of Edinburgh (S.E.W.)
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
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14
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Honarbakhsh S, Dhillon G, Abbas H, Waddingham PH, Dennis A, Ahluwalia N, Welch S, Daw H, Sporton S, Chow A A, Earley MJ, Lambiase PD, Hunter RJ. Non-invasive Electrocardiographic Imaging guided targeting of drivers of persistent atrial fibrillation: the TARGET-AF1 trial. Heart Rhythm 2022; 19:875-884. [DOI: 10.1016/j.hrthm.2022.01.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/12/2022]
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15
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Ehnesh M, Li X, Almeida TP, Chu GS, Dastagir N, Stafford PJ, Ng GA, Schlindwein FS. Evaluating spatial disparities of rotor sites and high dominant frequency regions during catheter ablation for PersAF patients targeting high dominant frequency sites using non-contacting mapping. Front Physiol 2022; 13:946718. [PMID: 35991173 PMCID: PMC9389330 DOI: 10.3389/fphys.2022.946718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose: Several studies have emphasised the significance of high dominant frequency (HDF) and rotors in the perpetuation of AF. However, the co-localisation relationship between both attributes is not completely understood yet. In this study, we aim to evaluate the spatial distributions of HDF regions and rotor sites within the left atrium (LA) pre and post HDF-guided ablation in PersAF. Methods: This study involved 10 PersAF patients undergoing catheter ablation targeting HDF regions in the LA. 2048-channels of atrial electrograms (AEG) were collected pre- and post-ablation using a non-contact array (EnSite, Abbott). The dominant frequency (DF, 4-10 Hz) areas with DF within 0.25 Hz of the maximum out of the 2048 points were defined as "high" DF (HDF). Rotors were defined as PSs that last more than 100 ms and at a similar location through subsequent phase frames over time. Results: The results indicated an extremely poor spatial correlation between the HDF regions and sites of the rotors in pre-versus post-ablation cases for the non-terminated (pre: CORR; 0.05 ± 0.17. vs. post: CORR; -0.030 ± 0.19, and with terminated patients (pre: CORR; -0.016 ± 0.03. post: CORR; -0.022 ± 0.04). Rotors associated with AF terminations had a long-lasting life-span post-ablation (non-terminated vs. terminated 120.7 ± 6.5 ms vs. 139.9 ± 39.8 ms), high core velocity (1.35 ± 1.3 mm/ms vs. 1.32 ± 0.9 mm/ms), and were less meandering (3.4 ± 3.04 mm vs. 1.5 ± 1.2 mm). Although the results suggest a poor spatial overlapping between rotors' sites and sites of AFCL changes in terminated and non-terminated patients, a higher correlation was determined in terminated patients (spatial overlapping percentage pre: 25 ± 4.2% vs. 17 ± 3.8% vs. post: 8 ± 4.2% vs. 3.7 ± 1.7% p < 0.05, respectively). Conclusion: Using non-contact AEG, it was noted that the correlation is poor between the spatial distribution of HDF regions and sites of rotors. Rotors were longer-lasting, faster and more stationary in patients with AF termination post-ablation. Rotors sites demonstrated poor spatial overlapping with sites of AFCL changes that lead to AF termination.
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Affiliation(s)
- Mahmoud Ehnesh
- School of Engineering, University of Leicester, Leicester, United Kingdom
- *Correspondence: Mahmoud Ehnesh,
| | - Xin Li
- School of Engineering, University of Leicester, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
| | - Tiago P. Almeida
- School of Engineering, University of Leicester, Leicester, United Kingdom
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
| | - Gavin S. Chu
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - Nawshin Dastagir
- Department of International Foundation, Massey University, Auckland, New Zealand
| | - Peter J. Stafford
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - G. André Ng
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
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16
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Pithon A, McCann A, Buttu A, Vesin JM, Pascale P, Le Bloa M, Herrera C, Park CI, Roten L, Kühne M, Spies F, Knecht S, Sticherling C, Pruvot E, Luca A. Dynamics of Intraprocedural Dominant Frequency Identifies Ablation Outcome in Persistent Atrial Fibrillation. Front Physiol 2021; 12:731917. [PMID: 34712148 PMCID: PMC8546232 DOI: 10.3389/fphys.2021.731917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The role of dominant frequency (DF) in tracking the efficiency of a stepwise catheter ablation (step-CA) in persistent atrial fibrillation (peAF) remains poorly studied. We hypothesized that the DF time-course during step-CA displays divergent patterns between patients in whom a step-CA successfully restores long-term sinus rhythm (SR) and those with recurrence. Methods: This study involved 40 consecutive patients who underwent a step-CA for peAF (sustained duration 19 ± 11 months). Dominant frequency was computed on electrograms recorded from the right and left atrial appendages (RAA; LAA) and the coronary sinus before and during the step-CA synchronously to the 12-lead ECG. Dominant frequency was defined as the highest peak within the power spectrum. Results: Persistent atrial fibrillation was terminated by a step-CA in 28 patients [left-terminated (LT)], whereas 12 patients remaining in AF after ablation [not left-terminated (NLT)] were cardioverted. Over a mean follow-up of 34 ± 14 months, all NLT patients had a recurrence. Among the 28 LT patients, 20 had a recurrence, while 8 remained in SR throughout follow-up. The RAA and V1 DF had the best predictive values of the procedural failure to terminate AF (area under the curve; AUC 0.84, p < 0.05). A decision tree model including a decrease in LAA DF ≥ 6.61% during the first 20 min following pulmonary vein isolation (PVI) and a baseline RAA DF <5.6 Hz predicted long-term SR restoration with a sensitivity of 83% and a specificity of 93% (p < 0.05). Conclusion: This study found that high baseline DF values are predictive of unfavorable ablation outcomes. The reduction of the LAA DF at early ablation steps following PVI is associated with procedural AF termination and long-term SR maintenance.
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Affiliation(s)
- Alain Pithon
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anna McCann
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Andréa Buttu
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Patrizio Pascale
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mathieu Le Bloa
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Claudia Herrera
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Chan-Il Park
- Department of Cardiology, Hôpital de La Tour, Geneva, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | | | - Etienne Pruvot
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Adrian Luca
- Service of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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17
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Sebag FA, Simeon E, Miled M, Jorrot P, Villejoubert O, Darondel JM, Hamon D, Lellouche N, Mignot N. Single-catheter simplified stepwise approach to persistent atrial fibrillation ablation: A feasibility study. Arch Cardiovasc Dis 2021; 114:707-714. [PMID: 34620575 DOI: 10.1016/j.acvd.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary vein isolation. AIM To evaluate the feasibility of this approach to performing persistent atrial fibrillation ablation, including pulmonary vein isolation and atrial lines, if needed. METHODS We prospectively included 159 consecutive patients referred to our centre for a first persistent atrial fibrillation ablation between January 2018 and December 2018. All patients underwent pulmonary vein isolation. If the patient was still in atrial fibrillation (spontaneously or inducible), we subsequently performed a stepwise approach, including roof line, anterior mitral line, posterior box lesion and cavotricuspid isthmus line. Finally, if patient remained in atrial fibrillation at the end of the procedure, a synchronized direct-current cardioversion was applied to restore sinus rhythm. RESULTS At baseline, 54 patients were in sinus rhythm and underwent pulmonary vein isolation. For patients in atrial fibrillation, after pulmonary vein isolation and ablation of additional lines, if needed, 18 patients were converted to atrial tachycardia and one directly to sinus rhythm; 96 were still in atrial fibrillation and underwent direct-current cardioversion. After a mean follow-up of 17±6 months, 57 patients (36%) experienced atrial arrhythmia recurrence. No deaths, tamponades or phrenic nerve injuries were observed following the procedure. The main mode of arrhythmia recurrence was atrial fibrillation in 75% of cases and atrial tachycardia in 25% of cases. CONCLUSION A single-catheter approach, including pulmonary vein isolation and atrial lines, is feasible and safe in patients undergoing persistent atrial fibrillation ablation, with an acceptable success rate of 64% at mid-term follow-up.
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Affiliation(s)
- Frédéric A Sebag
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - Edouard Simeon
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Manel Miled
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Pierre Jorrot
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Olivier Villejoubert
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Jean-Marc Darondel
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - David Hamon
- Service de Cardiologie, Hôpital Henri Mondor, 94000 Créteil, France
| | | | - Nicolas Mignot
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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18
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Roney CH, Child N, Porter B, Sim I, Whitaker J, Clayton RH, Laughner JI, Shuros A, Neuzil P, Williams SE, Razavi RS, O'Neill M, Rinaldi CA, Taggart P, Wright M, Gill JS, Niederer SA. Time-Averaged Wavefront Analysis Demonstrates Preferential Pathways of Atrial Fibrillation, Predicting Pulmonary Vein Isolation Acute Response. Front Physiol 2021; 12:707189. [PMID: 34646149 PMCID: PMC8503618 DOI: 10.3389/fphys.2021.707189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Electrical activation during atrial fibrillation (AF) appears chaotic and disorganised, which impedes characterisation of the underlying substrate and treatment planning. While globally chaotic, there may be local preferential activation pathways that represent potential ablation targets. This study aimed to identify preferential activation pathways during AF and predict the acute ablation response when these are targeted by pulmonary vein isolation (PVI). In patients with persistent AF (n = 14), simultaneous biatrial contact mapping with basket catheters was performed pre-ablation and following each ablation strategy (PVI, roof, and mitral lines). Unipolar wavefront activation directions were averaged over 10 s to identify preferential activation pathways. Clinical cases were classified as responders or non-responders to PVI during the procedure. Clinical data were augmented with a virtual cohort of 100 models. In AF pre-ablation, pathways originated from the pulmonary vein (PV) antra in PVI responders (7/7) but not in PVI non-responders (6/6). We proposed a novel index that measured activation waves from the PV antra into the atrial body. This index was significantly higher in PVI responders than non-responders (clinical: 16.3 vs. 3.7%, p = 0.04; simulated: 21.1 vs. 14.1%, p = 0.02). Overall, this novel technique and proof of concept study demonstrated that preferential activation pathways exist during AF. Targeting patient-specific activation pathways that flowed from the PV antra to the left atrial body using PVI resulted in AF termination during the procedure. These PV activation flow pathways may correspond to the presence of drivers in the PV regions.
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Affiliation(s)
- Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nicholas Child
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Richard H. Clayton
- INSIGNEO Institute for In Silico Medicine and Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | | | - Allan Shuros
- Boston Scientific Corp, St. Paul, MN, United States
| | - Petr Neuzil
- Department of Cardiology, Na Holmolce Hospital, Prague, Czechia
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Reza S. Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Matt Wright
- Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jaswinder S. Gill
- Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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19
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He SN, Tian Y, Shi L, Wang YJ, Xie BQ, Li XX, Zeng LJ, Yang XC, Liu XP. Identification of circumferential pulmonary vein isolation responders among patients with persistent atrial fibrillation: clinical value of the sequential low-dose ibutilide test. Europace 2021; 22:1197-1205. [PMID: 32514560 DOI: 10.1093/europace/euaa095] [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: 11/13/2019] [Accepted: 04/24/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Circumferential pulmonary vein isolation can be effective as sole treatment for persistent atrial fibrillation. However, identifying those patients who will respond to this therapy remains a challenge. We investigated the clinical value of the sequential low-dose ibutilide test for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation is effective as sole therapy. METHODS AND RESULTS In a prospective cohort of 180 consecutive patients with persistent atrial fibrillation, intravenous low-dose (0.004 mg/kg) ibutilide was administered 3 days before ablation and after the completion of circumferential pulmonary vein isolation. In patients in whom ibutilide did not terminate atrial fibrillation pre-procedurally, but successfully terminated it intraprocedurally, no further atrial substrate modification was performed. Pre-procedural low-dose ibutilide failed to terminate the arrhythmia in all patients with persistent atrial fibrillation, while pulmonary vein isolation ± low-dose ibutilide terminated persistent atrial fibrillation in 55 (30.6%) of them (PsAF group 1). The remaining 125 (69.4%) patients underwent electrogram-based ablation (PsAF Group 2). The control group comprised 379 consecutive patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation over the same period. At 24 months follow-up, 39 (70.9%) patients in PsAF Group 1 and 276 (72.8%) patients in the control group were free from atrial tachyarrhythmias (P = NS); the arrhythmia-free rates in both groups were higher than that in PsAF group 2 (58.4%, P = 0.005). CONCLUSION The sequential low-dose ibutilide test is a simple method for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation alone is an appropriate treatment strategy.
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Affiliation(s)
- Shu-Nan He
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China.,Heart Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Liang Shi
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Yan-Jiang Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Bo-Qia Xie
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xue-Xun Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
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20
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Rosa GL, Quintanilla JG, Salgado R, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Villacastín J, Pérez-Castellano N, Jalife J, Filgueiras-Rama D. Mapping Technologies for Catheter Ablation of Atrial Fibrillation Beyond Pulmonary Vein Isolation. Eur Cardiol 2021; 16:e21. [PMID: 34093742 PMCID: PMC8157391 DOI: 10.15420/ecr.2020.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Catheter ablation remains the most effective and relatively minimally invasive therapy for rhythm control in patients with AF. Ablation has consistently shown a reduction of arrhythmia-related symptoms and significant improvement in patients’ quality of life compared with medical treatment. The ablation strategy relies on a well-established anatomical approach of effective pulmonary vein isolation. Additional anatomical targets have been reported with the aim of increasing procedure success in complex substrates. However, larger ablated areas with uncertainty of targeting relevant regions for AF initiation or maintenance are not exempt from the potential risk of complications and pro-arrhythmia. Recent developments in mapping tools and computational methods for advanced signal processing during AF have reported novel strategies to identify atrial regions associated with AF maintenance. These novel tools – although mainly limited to research series – represent a significant step forward towards the understanding of complex patterns of propagation during AF and the potential achievement of patient-tailored AF ablation strategies for the near future.
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Affiliation(s)
- Giulio La Rosa
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain
| | - Ricardo Salgado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC) Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC) Madrid, Spain
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain
| | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid, Spain
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21
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Kiuchi K, Fukuzawa K, Takami M, Watanabe Y, Izawa Y, Shigeru M, Oonishi H, Suehiro H, Akita T, Takemoto M, Yatomi A, Nakamura T, Sakai J, Nakasone K, Sonoda Y, Yamamoto K, Takahara H, Negi N, Kyotani K, Kono A, Hirata KI. Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late-gadolinium enhancement areas. J Cardiovasc Electrophysiol 2021; 32:1014-1023. [PMID: 33527586 DOI: 10.1111/jce.14925] [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: 10/29/2020] [Revised: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. METHODS A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden-matched pulmonary vein isolation (PVI) group. RESULTS Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow-up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log-rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. CONCLUSIONS FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Division of Radiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | | | - Hideya Suehiro
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomomi Akita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Takemoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsusuke Yatomi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Sakai
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazutaka Nakasone
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Sonoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Yamamoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Takahara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Katsusuke Kyotani
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Atsushi Kono
- Division of Radiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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22
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Aksu T, Guler TE, Bozyel S, Yalin K, Lakkireddy D, Gopinathannair R. Initial experience with fractionation mapping-guided ablation strategy in patients with long-standing persistent atrial fibrillation. J Interv Card Electrophysiol 2020; 61:405-413. [PMID: 32712899 DOI: 10.1007/s10840-020-00834-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to define the role of extended pulmonary vein isolation (PVI), posterior wall isolation, and mitral isthmus lines to eliminate electrograms exhibiting fractionation pattern during stepwise ablation on acute atrial fibrillation (AF) termination rate in patients with long-standing persistent AF (LSPAF). METHODS Twelve patients with LSPAF underwent ablation during AF. Using the fractionation mapping tool of the Ensite™ (Abbott Medical, Chicago, USA) system, sites exhibiting discrete atrial complexes and consistent activation sequence were mapped. The areas with a fractionation score above 4 were accepted as potential drivers for AF. During stepwise ablation consisting of circumferential PVI, roof and floor lines for posterior wall isolation, and mitral isthmus lines, ablation lines were extended toward potential AF drivers on the fractionation map as much as possible until sinus was achieved by ablation. RESULTS Fractionation-guided ablation caused acute AF termination in 8 of 12 patients. In 6 of 12 cases, AF returned to sinus rhythm during the extended ablation. In 2 patients, AF shifted to sinus after cavotricuspid isthmus ablation. Sinus was achieved by cardioversion in 3 of cases. Procedural failure was seen in one case with significant scar tissue. During a mean follow-up of 31.5 ± 11 months, overall arrhythmia-free survival was 92% with 2 procedures. CONCLUSIONS This pilot study demonstrates that fractionation mapping-guided ablation may provide an adjunctive benefit in terms of acute AF termination in patients with LSPAF. These results should be confirmed by larger, randomized, comparison studies between linear ablation and extended ablation without elimination of electrograms (EGMs) with fractionation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey. .,Department of Cardiology, Kocaeli Derince Education and Research Hospital, 41500, Derince, Kocaeli, Turkey.
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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23
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Aksu T, Guler TE, Bozyel S, Yalin K. Usage of a new mapping algorithm to detect possible critical substrate for continuity of atrial fibrillation: fractionation mapping in preliminary experience. J Interv Card Electrophysiol 2020; 58:29-34. [PMID: 31984467 DOI: 10.1007/s10840-019-00693-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/19/2019] [Indexed: 01/02/2023]
Abstract
Although treatment of atrial fibrillation (AF) classically focuses on eliminating the pulmonary vein (PV) triggers, isolation of PVs is associated with limited success rates in patients with persistent AF. The role of the left atrial appendage (LAA) as both trigger and driver in arrhythmogenesis of AF was previously demonstrated. In the present case, fractionation mapping software of Ensite system was firstly tested to detect critical substrate during AF. Focusing on the width and continuity of fractionation pattern, the LAA was accepted as main driver for maintenance of AF. Ablation in fractionated electrograms around the LAA caused acute AF termination. After isolation of the LAA, no AF was inducible with atrial stimulation with and without isoproterenol infusion. Fractionation mapping may be used to detect potential importance of the LAA in AF continuity.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey.
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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24
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Kistler PM, Chieng D. Persistent atrial fibrillation in the setting of pulmonary vein isolation-Where to next? J Cardiovasc Electrophysiol 2019; 31:1857-1860. [PMID: 31778259 DOI: 10.1111/jce.14298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 01/07/2023]
Abstract
Catheter ablation for atrial fibrillation (AF) is indicated in symptomatic patients who are intolerant or refractory to antiarrhythmic therapy. However, outcomes from catheter ablation remain suboptimal in patients with persistent AF. Pulmonary vein antral isolation (PVAI) is established as the cornerstone of AF ablation strategies. The landmark STAR AF II study demonstrated a lack of incremental benefit with adjunctive linear and complex fractionated electrogram ablation beyond PVAI. Randomized studies thus far have failed to consistently show favorable outcomes from other trigger/substrate-based ablation approaches over PVAI alone. In this issue of the journal, we pose an interesting clinical scenario-of a middle-aged female who presents with recurrent persistent AF but was found to have enduring PVAI on repeat electrophysiologic study. Which approach should be undertaken next? In this review article, we aim to provide an overview of ablation strategies beyond PVAI. Finally in light of scant randomized data to guide decision making we have approached leading experts in the field to provide their approach to this scenario.
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Affiliation(s)
- Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David Chieng
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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25
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Li F, Tu X, Li D, Jiang Y, Cheng Y, Jia Y, Zhang X, Fu H, Hu H, Jiang J, Zeng R. Is ablation to atrial fibrillation termination of persistent atrial fibrillation the end point?: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18045. [PMID: 31764827 PMCID: PMC6882606 DOI: 10.1097/md.0000000000018045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ideal ablation strategy and end point for persistent atrial fibrillation (AF) have not been well founded. Defining periprocedural AF termination as the end point of catheter ablation is still controversial. This meta-analysis aimed to analyze the differences between periprocedural AF termination and non-termination in the long-term AF recurrence rate and postoperative complications. METHODS Randomized controlled trials (RCTs) were identified by a systematic search of electronic databases including PubMed, EMBASE, and Cochrane library from January 2008 to August 2019. The primary outcome was freedom from AF or any atrial arrhythmia without antiarrhythmic drugs at the long-term (≥12 months) follow-up. The secondary outcome was overall postoperative complication rates. The risk ratio (RR) with 95% confidence interval (CI) was pooled for these outcomes. A forest plot, fixed-effects model or random-effect model, Q test, I statistic, and Egger funnel plot were used in the statistical analysis. RESULTS Fourteen RCTs were included in this meta-analysis. Overall, no significant difference was found in freedom from AF at the long-term follow-up between patients in whom AF termination was achieved and not achieved (RR = 0.93, 95% CI = 0.78-1.09, P = .36, I = 69%). Patients with AF non-termination had a lower complication occurrence rate than those with AF termination (RR = 1.74, 95% CI = 1.11-2.73, P = .02, I = 0%). CONCLUSION Our meta-analysis suggests that AF termination is not a reliable procedural end point during ablation of persistent AF.
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Affiliation(s)
| | | | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
| | | | | | - Yu Jia
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
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26
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Tomaiko E, Tseng A, Reichert WB, Su WW. Approach and strategy for repeat catheter ablation of recurrent atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:1874-1876. [PMID: 31626351 DOI: 10.1111/jce.14238] [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: 08/18/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Abstract
Patients with atrial fibrillation often undergo repeat catheter ablation for the recurrence of tachyarrhythmia. If the pulmonary veins were isolated in prior procedure, the operator should focus on substrate homogenization with identification and ablation of only arrhythmogenic areas.
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Affiliation(s)
- Emrie Tomaiko
- Department of Cardiology, Banner-University Medical Center, Phoenix, Arizona
| | - Andrew Tseng
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - William B Reichert
- Department of Cardiology, Banner-University Medical Center, Phoenix, Arizona
| | - Wilber W Su
- Department of Cardiology, Banner-University Medical Center, Phoenix, Arizona.,Department of Cardiology, University of Arizona College of Medicine, Tucson, Arizona.,Department of Cardiology, Stanford University Medical Center, Stanford, California
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Johner N, Namdar M, Shah DC. Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints. Arrhythm Electrophysiol Rev 2019; 8:184-190. [PMID: 31463056 PMCID: PMC6702473 DOI: 10.15420/aer.2019.33.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but studies have reported improved efficacy with high rates of repeat procedures. Because of the large interindividual variability in the underlying electrical and anatomical substrate, achieving optimal outcomes requires an individualised approach. This includes optimal candidate selection as well as defined ablation strategies with objective procedure endpoints beyond PVI. Candidate selection is traditionally based on coarse and sometimes arbitrary clinical stratification such as AF type, but finer predictors of treatment efficacy including biomarkers, advanced imaging and electrocardiographic parameters have shown promise. Numerous ancillary ablation strategies beyond PVI have been investigated, but the absence of a clear mechanistic and evidence-based endpoint, unlike in other arrhythmias, has remained a universal limitation. Potential endpoints include functional ones such as AF termination or non-inducibility and substrate-based endpoints such as isolation of low-voltage areas. This review summarises the relevant literature and proposes guidance for clinical practice and future research.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
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28
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Leef G, Shenasa F, Bhatia NK, Rogers AJ, Sauer W, Miller JM, Swerdlow M, Tamboli M, Alhusseini MI, Armenia E, Baykaner T, Brachmann J, Turakhia MP, Atienza F, Rappel WJ, Wang PJ, Narayan SM. Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 12:e006835. [PMID: 31352796 DOI: 10.1161/circep.118.006835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation. METHODS We recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps. RESULTS Each patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium). CONCLUSIONS Wavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation.
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Affiliation(s)
- George Leef
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Fatemah Shenasa
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Neal K Bhatia
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Albert J Rogers
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - William Sauer
- Department of Medicine, University of Colorado, Denver (W.S., E.A.)
| | - John M Miller
- Department of Medicine, University of Indiana, Indianapolis (J.M.M.)
| | - Mark Swerdlow
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Mallika Tamboli
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Mahmood I Alhusseini
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Erin Armenia
- Department of Medicine, University of Colorado, Denver (W.S., E.A.)
| | - Tina Baykaner
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | | | - Mintu P Turakhia
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (M.P.T.)
| | - Felipe Atienza
- Departamento de Cardiologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain (F.A.)
| | | | - Paul J Wang
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
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Patel NJ, Maradey JA, Bhave PD. Atrial Fibrillation Ablation: Indications and Techniques. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:43. [PMID: 31342171 DOI: 10.1007/s11936-019-0747-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) predisposes to embolic strokes and reduced quality of life. Ablation (catheter-based or surgically performed) can be employed to promote the maintenance of sinus rhythm in a carefully selected subset of patients with AF. The goal of this review is to discuss the indications and techniques for AF ablation, as well as post-procedural outcomes. RECENT FINDINGS Atrial fibrillation ablation improves quality of life in patients with atrial fibrillation although no clear reduction in stroke or overall mortality has been shown. Familiarity with the indications for AF ablation is important for all cardiologists, as is having a sound understanding of the efficacy of the procedure and potential complications. Furthermore, acquiring a grasp of the different modalities of AF ablation (including percutaneous endocardial techniques and surgical ablation approaches) will help to facilitate effective and appropriate referrals.
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Affiliation(s)
- Neel J Patel
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Joan A Maradey
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Prashant D Bhave
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Spittler R, Bahlke F, Hoffmann BA, Theis C, Mollnau H, Marx A, Ocete BQ, Ilioska P, Lange B, Konrad T, Rostock T. Predictors of successful complex catheter ablation for persistent atrial fibrillation despite failure of targeted procedural arrhythmia termination. J Cardiovasc Electrophysiol 2019; 30:1026-1035. [PMID: 30977168 DOI: 10.1111/jce.13947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/14/2019] [Accepted: 04/07/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Procedural atrial fibrillation (AF) termination is considered as a predictor of long-term success after catheter ablation for persistent AF (persAF). However, some patients remain free of arrhythmia recurrences despite failure to achieve AF termination. The objective of this study was to assess long-term outcome and prognostic factors in patients undergoing complex ablation without procedural AF termination. METHODS AND RESULTS This study comprised 419 patients (63.8 ± 10.2 years, 63.4% male) undergoing complex ablation for persAF. Patients without procedural AF termination (n = 137, 64.2 ± 9.7 years, 63.5% male) were categorized into patients who remained in sinus rhythm (SR) in long-term outcome (SR-group) and patients with recurrence of AF or atrial tachycardia (AT) (AR-group). During a follow-up (FU) of 19.6 ± 14.6 months, the SR-group consisted of 65 (47.5%) and the AR-group of 69 (50.4%) patients. Three patients (2.2%) were lost to FU. Left atrial appendage (LAA) flow velocity and left atrium volume index (LAVI) could be identified as predictors for long-term success. LAA flow velocity and baseline AF cycle length (AFCL) were significantly associated with the type of arrhythmia recurrence (AF vs AT), ie, higher values of both are predictive for AT rather than AF recurrences. Patients with a LAVI < 34.4 mL/m² and significant AFCL increase during the ablation procedure had rather AT than AF recurrences. CONCLUSION Patients with an arrhythmia-free outcome despite failure of procedural AF termination during complex ablation for persAF are characterized by specific morphological and functional properties that are easy to obtain.
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Affiliation(s)
- Raphael Spittler
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Fabian Bahlke
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Boris A Hoffmann
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Cathrin Theis
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Hanke Mollnau
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Alexandra Marx
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Blanca Quesada Ocete
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Pamela Ilioska
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Björn Lange
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Torsten Konrad
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
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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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32
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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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33
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Kawaji T, Shizuta S, Yamagami S, Aizawa T, Komasa A, Yoshizawa T, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Clinical Utility of Intravenous Nifekalant Injection during Radiofrequency catheter Ablation for Persistent Atrial Fibrillation. J Atr Fibrillation 2018; 11:1839. [PMID: 30455835 DOI: 10.4022/jafib.1839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and results We retrospectively enrolled 157 consecutive persistentAF patientsundergoing first RFCA procedure withcomplex fractionated atrial electrogram (CFAE)ablation after pulmonary veins isolation and compared outcomes between patientswith (NFK group: N=79) and without (No-NFK group: N=78)additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF terminationwas significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P<0.001). Arrhythmia-free survival, however, was not significantly different between 2 groups (61.5% versus 54.1%, P=0.63).There was no significant difference between 2 groups in the prevalence of recurrent atrial tachycardia(25.0% versus 23.5%, P=0.89). Arrhythmia-free survivalin patients with AF termination during procedure was significantly higher thanthose without (73.0% versus 41.0%, P=0.002; adjusted hazard ratio 0.48, 95% confidence interval 0.17-0.84, P=0.02) amongNFK group,but not amongNo-NFK group (66.7% versus 53.2%, P=0.53). Conclusions Intravenous nifekalant injection during additional CFAE ablation did not improve sinus maintenancerate after RFCA procedure for AF, but AF termination by nifekalant injection could be a clinical predictor of better success rates after procedure.
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Affiliation(s)
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shintaro Yamagami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Akihiro Komasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yoshizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Verma A, Sarkozy A, Skanes A, Duytschaever M, Bulava A, Urman R, Amos YA, Potter TD. Characterization and significance of localized sources identified by a novel automated algorithm during mapping of human persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:1480-1488. [DOI: 10.1111/jce.13742] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Atul Verma
- Department of Cardiology, Southlake Regional Health Center, University of Toronto Canada
| | | | - Allan Skanes
- Department of Cardiology, London Health Sciences CenterLondon Canada
| | | | - Alan Bulava
- Department of Cardiology, University of South BohemiaCeske Budejovice Czech Republic
| | - Roy Urman
- Haifa Technology Center, Biosense WebsterHaifa Israel
| | - Yariv A. Amos
- Haifa Technology Center, Biosense WebsterHaifa Israel
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35
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Holmqvist F, Bahnson TD. Atrial fibrillation mapping strategies: The hunt is on. Heart Rhythm 2018; 15:1304-1305. [PMID: 29753945 DOI: 10.1016/j.hrthm.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Fredrik Holmqvist
- Duke Center for Atrial Fibrillation, Duke University Health System, Clinical Cardiac Electrophysiology Section, Duke University, Duke Clinical Research Institute, Durham, North Carolina; Department of Cardiology, Lund University, Lund, Sweden
| | - Tristram D Bahnson
- Duke Center for Atrial Fibrillation, Duke University Health System, Clinical Cardiac Electrophysiology Section, Duke University, Duke Clinical Research Institute, Durham, North Carolina.
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36
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Yazaki K, Watarai M, Enta K, Kahata M, Kumagai A, Inoue K, Koganei H, Otsuka M, Ishii Y. Clinical Factors Relevant to the Recurrence of Atrial Tachyarrhythmia after Extensive Defragmentation Followed by Thoracic Vein Isolation. J Atr Fibrillation 2018; 10:1843. [PMID: 29988245 DOI: 10.4022/jafib.1843] [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: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022]
Abstract
Introduction The efficacy of thoracic vein isolation (TVI), an approach to trigger atrial fibrillation (AF), for the management of AF has been established. Our goal was to identify the predictors for late recurrence of atrial tachyarrhythmias (ATAs), for which the patients and procedural and/or echocardiographic parameters were retrospectively analyzed. Although substrate modification in the atrium for the treatment of AF ablation remains controversial, the background associated with the outcome has not been fully investigated. We retrospectively studied 33 patients with paroxysmal AF and 21 with persistent AF undergoing defragmentation followed by TVI. We evaluated the late/early recurrences, defined as ATA at 3 months after/within the single procedure. Methods and Results During a median follow-up period of 22 (11-37) months, 28 patients (52%) experienced a late recurrence. There was a higher incidence of late recurrences in the patients with disease durations of ≥12.4 months, which was the optimal cut-off point measured in the receiver operating characteristic curve analysis, or in those with left atrial diameter >50 mm or with earlier recurrences than the others (19% versus 72%, p=0.01; 0% versus 37%, p=0.02; or 13% versus 53%, p<0.0001 by the log-rank test, respectively). Moreover, there was a trend toward a higher atrial tachycardia (AT)-free rate in the patients with AF termination during the procedure (75% versus 54%, p=0.07 by the log-rank test). A multivariate analysis based on the Cox proportional hazard model showed that disease duration ≥12.4 months or early recurrence was highly associated with the outcomes (HR 3.72, 95%CI 1.42-12.79, p<0.006; HR 4.80, 95%CI 2.24-10.56, p<0.0001). Conclusion The AF duration and early ATA recurrence are the peri-procedural factors significantly relevant to the outcome after extensive defragmentation followed by TVI.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Masahiro Watarai
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Kenji Enta
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Mitsuru Kahata
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Asako Kumagai
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Koji Inoue
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Hiroshi Koganei
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Masato Otsuka
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Yasuhiro Ishii
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
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37
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Takahashi Y, Yamashita S, Suzuki M, Yabe K, Hirao K. Efficacy of catheter ablation of focal sources in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:559-565. [PMID: 29315991 DOI: 10.1111/jce.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/15/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent studies suggest that atrial fibrillation (AF) is maintained by electrical activity arising from focal sources. We sought to test whether catheter ablation that targets focal sources can improve on current ablation protocols for persistent AF. METHODS AND RESULTS In patients with persistent AF whose AF did not terminate with pulmonary vein (PV) isolation, the left atrium was mapped with a 20-pole high-density mapping catheter using CARTO® 3 navigation. If a site demonstrated centrifugal activation over at least three consecutive cycles, it was deemed a focal source and ablated. If AF remained, defragmentation was performed until AF was terminated. Freedom from atrial tachyarrhythmia was compared between the study patients and propensity score matched historical controls who had undergone conventional stepwise ablation. Of the 68 study patients, 2.9 ± 1.9 focal sources were identified in 60 patients. Focal sources displayed transient centrifugal activation patterns for a median of six consecutive cycles. Total radiofrequency duration was shorter in the study group (62 ± 16 minutes vs. 75 ± 24 minutes, P = 0.0003). During a 1-year follow-up period, 39 (57%) and 26 (38%) patients were free from atrial tachyarrhythmias in the absence of antiarrhythmic drugs in the study and control groups, respectively (hazard ratio: 1.85, 95% confidence interval: 1.17-2.96, P = 0.009). Improvement of clinical outcome was mainly driven by a decrease in recurrence of atrial tachycardia in the study patients (22% vs. 40%, P = 0.047). CONCLUSION The results of this study suggest that focal sources are appropriate ablation targets in addition to the PVs in persistent AF.
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Affiliation(s)
- Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Cardiology, Disaster Medical Center, Tokyo, Japan
| | - Syu Yamashita
- Department of Cardiology, Disaster Medical Center, Tokyo, Japan
| | - Masahito Suzuki
- Department of Cardiology, Disaster Medical Center, Tokyo, Japan
| | - Kento Yabe
- Department of Cardiology, Disaster Medical Center, Tokyo, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.,Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
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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: 708] [Impact Index Per Article: 118.0] [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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Sugumar H, Thomas SP, Prabhu S, Voskoboinik A, Kistler PM. How to perform posterior wall isolation in catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2017; 29:345-352. [DOI: 10.1111/jce.13397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Hariharan Sugumar
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Stuart P. Thomas
- Westmead Hospital; University of Sydney and Macquarie University; Sydney New South Wales Australia
| | - Sandeep Prabhu
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Aleksandr Voskoboinik
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Peter M. Kistler
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
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40
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Fink T, Schlüter M, Kuck KH, Ouyang F. Procedural endpoints of catheter ablation for atrial fibrillation: Arrhythmia termination or end of CFAE ablation? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:179-181. [PMID: 29044648 DOI: 10.1111/pace.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Fink
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Michael Schlüter
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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41
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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: 1370] [Impact Index Per Article: 195.7] [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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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Prabhu S, Voskoboinik A, McLellan AJ, Peck KY, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Lee G, Mariani J, Ling LH, Taylor AJ, Kalman JM, Kistler PM. A comparison of the electrophysiologic and electroanatomic characteristics between the right and left atrium in persistent atrial fibrillation: Is the right atrium a window into the left? J Cardiovasc Electrophysiol 2017; 28:1109-1116. [DOI: 10.1111/jce.13297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sandeep Prabhu
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Alex J.A. McLellan
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Kah Y. Peck
- Department of Cardiology; Alfred Hospital; Victoria Australia
| | - Bhupesh Pathik
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Chrishan J. Nalliah
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Geoff R. Wong
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Sonia M. Azzopardi
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
| | - Geoffrey Lee
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
| | - Justin Mariani
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
| | - Liang-Han Ling
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Andrew J. Taylor
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
| | - Jonathan M. Kalman
- Cardiology Department; Royal Melbourne Hospital; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
| | - Peter M. Kistler
- Department of Cardiology; Alfred Hospital; Victoria Australia
- Baker Heart and Diabetes Institute; Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria Australia
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Guler TE, Aksu T, Yalin K, Golcuk SE, Mutluer FO, Bozyel S. Combined Cryoballoon and Radiofrequency Ablation Versus Radiofrequency Ablation Alone for Long-Standing Persistent Atrial Fibrillation. Am J Med Sci 2017; 354:586-596. [PMID: 29208256 DOI: 10.1016/j.amjms.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND To achieve sinus rhythm, ablation of long-standing persistent atrial fibrillation (LSPAF) usually requires substrate modification in addition to pulmonary vein isolation (PVI). In the present article, we aimed to compare clinical and substrate modification effects of 2 distinct PVI strategies during stepwise ablation in patients with LSPAF: (1) Combined approach: cryoballoon (CB) for PVI and radiofrequency (RF) ablation for substrate modification and (2) RF-only approach: RF ablation for both PVI and substrate modification. MATERIALS AND METHODS A total of 34 patients were divided into 2 groups: 19 in the combined group and 15 in the RF group. Left atrial (LA) complex fractionated atrial electrogram (CFAE) maps were acquired before and after PVI and compared between groups. The groups were compared for acute atrial fibrillation termination (AFT) rates and long-term arrhythmia-free survival. RESULTS A significant reduction on total LA CFAE area was observed with PVI in both groups. In the CB group, when pulmonary veins were excluded, the reduction of LA CFAE area was the most significant on the posterior wall of left atrium and which was greater than in the RF group. Although the ratio of AFT was higher in the CB group (44% versus 33%, respectively), single-procedure arrhythmia-free survival at 1 year was comparable between groups (68% in the CB group versus 66% in the RF group). Times of total procedure, fluoroscopy and post-PVI RF were all shorter in the CB group. CONCLUSIONS CB may cause greater substrate modification on the posterior wall and increase AFT rate during LSPAF ablation.
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Affiliation(s)
- Tümer Erdem Guler
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Tolga Aksu
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey.
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Usak University of Usak, Usak, Turkey
| | - Sukriye Ebru Golcuk
- Department of Cardiology, Faculty of Medicine, Balıkesir University, Balikesir, Turkey
| | | | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey
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Katritsis DG. End points for catheter ablation of persistent atrial fibrillation. Heart Rhythm 2017; 14:484-485. [PMID: 28089875 DOI: 10.1016/j.hrthm.2017.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Indexed: 11/28/2022]
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