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Chugh A. Confirmation of posterior wall isolation: elegance versus brute force. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01798-8. [PMID: 38861232 DOI: 10.1007/s10840-024-01798-8] [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: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Aman Chugh
- Section of Cardiac Electrophysiology, Division of Cardiology, Cardiovascular Center, University of Michigan Medical Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5853, USA.
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Xu C, Zhang F, Chen W, Chen N, Zhang Y, Zhu X, Liu Y, Jiang W, Wu S, Liu X, Qin M. Adjunctive Right Atrial Ablation for Persistent Atrial Fibrillation With Right Atrial Enlargement: A Pilot Study. Can J Cardiol 2024; 40:564-572. [PMID: 37981042 DOI: 10.1016/j.cjca.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Persistent atrial fibrillation (PerAF) is often associated with right atrial (RA) enlargement. We investigated the efficacy of RA intervention in patients with PerAF and RA enlargement. METHODS Patients with PerAF and RA enlargement were randomised (1:1) to receive adjunctive RA ablation (left atrial [LA] + RA group; n = 60) or to receive LA ablation alone (LA-only group; n = 60). In the LA + RA group, RA ablation was performed if LA ablation failed to terminate AF. The primary end point was freedom from AF/atrial tachycardia (AT) recurrence at 12 months after a single ablation procedure without antiarrhythmic drug therapy. RESULTS In the LA + RA group, 40 patients (67%) required RA ablation. The LA + RA group had a higher rate of acute AF termination than the LA-only group (63.3% vs 36.7%; P = 0.003). At the end of 12-month follow-up, 42 patients (70%) in the LA + RA group were free of AF/AT recurrence, compared with 31 (51.7%) in the LA-only group (log rank P = 0.034; hazard ratio 0.549, 95% confidence interval 0.310-0.974). The rate of freedom from AF recurrence was also higher in the LA + RA group than in the LA-only group (81.7% vs 63.3%; log rank P = 0.019). The 2 groups had similar rates of adverse events (5% vs 3.3%; P = 0.648). CONCLUSIONS Adjunctive RA ablation increased the success rate of a single ablation in patients with PerAF and RA enlargement. CHINESE CLINICAL TRIAL REGISTRATION ChiCTR220056844.
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Affiliation(s)
- Changhao Xu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenbo Chen
- Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nannan Chen
- Department of Cardiology, Shanghai Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiyao Zhu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yang Liu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weifeng Jiang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Chou A, Jongnarangsin K, Yokokawa M, Ghannam M, Liang JJ, Oral H, Morady F, Chugh A. Posterior left atrial isolation is associated with a lower incidence of atrial tachycardia in patients with persistent atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01769-z. [PMID: 38411857 DOI: 10.1007/s10840-024-01769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients may develop atrial tachycardia (AT) after left atrial (LA) ablation of persistent atrial fibrillation (AF). METHODS The population consisted of 101 consecutive patients (age = 64.3 ± 8.7 years, 70 males (69%), LA = 4.6 ± 0.8 cm, ejection fraction = 48.5 ± 16%) undergoing their initial procedure for persistent AF. After pulmonary vein isolation, patients either underwent posterior LA isolation (n = 50; study group) or linear ablation at the LA roof with verification of conduction block (n = 51; control group). RESULTS A repeat procedure was performed in 17 (34%) and 28 (55%) patients in the study and control groups, respectively (p = 0.02). Patients in the study group were less likely to develop AT (9/50 [18%] vs. 18/51 [35%]; p = 0.02), roof-dependent (1/50 [2%] vs. 8/51 [16%]; p = 0.008), and multi-loop AT (6/50 [12%] vs. 14/51 [27%]; p = 0.03) as compared to controls. Among various factors, only posterior LA isolation was associated with a lower likelihood of AT recurrence and roof tachycardia at redo procedure (OR, 0.37; 95% CI, 0.1 to 1.00, p = 0.05, and OR, 0.1, 95% CI, 0.01 to 0.96; p < 0.05, respectively). CONCLUSIONS In patients with persistent AF, posterior LA isolation is associated with a lower risk of a redo procedure, roof-dependent macro-reentry, and post-ablation AT in general as compared to controls who only received roof ablation. Posterior LA isolation also obviates the need for pacing maneuvers, and may be a more definitive endpoint than linear ablation at the LA roof.
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Affiliation(s)
- Andrew Chou
- Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI, 48109, USA
| | - Krit Jongnarangsin
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Miki Yokokawa
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Michael Ghannam
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jackson J Liang
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Hakan Oral
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Fred Morady
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aman Chugh
- Section of Cardiac Electrophysiology, University of Michigan Medical Center, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Kim YS, Jeong HG, Hwang IC, Kim BJ, Kwon JM, Bae HJ, Han MK. Tricuspid regurgitation: a hidden risk factor for atrial fibrillation related stroke? Front Cardiovasc Med 2023; 10:1135069. [PMID: 37547251 PMCID: PMC10400321 DOI: 10.3389/fcvm.2023.1135069] [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: 12/31/2022] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Background and purpose Tricuspid regurgitation (TR) is a common but overlooked valvular disease, and its association with the etiologic subtypes of ischemic stroke is unclear. We explored the relationship between TR and atrial fibrillation (AF) in patients with acute ischemic stroke. Methods This retrospective analysis of ongoing stroke registry assessed 6,886 consecutive acute ischemic stroke patients who underwent transthoracic echocardiography during their in-hospital care. Multivariable logistic regression models adjusted for age, sex, stroke characteristics, and echocardiographic indices were used to investigate the association between TR and total AF, and newly diagnosed AF during hospitalization and a 1-year follow-up period, respectively. Results TR was present in 877 (12.7%) patients (mild, 9.9%; moderate, 2.4%; severe, 0.5%). AF was identified in 24.1% (medical history, 11.1%; first detected in the emergency room, 6.6%; newly diagnosed after admission, 6.4%). TR was associated with AF [adjusted odds ratio (aOR) 4.87 (95% confidence interval (CI), 2.63-9.03)], compared with no/trivial TR. The association between TR and AF was consistent regardless of severity (aOR [95% CI], 4.57 [2.63-7.94] for mild and 7.05 [2.57-19.31] for moderate-to-severe TR) or subtype of TR (5.44 [2.91-10.14] for isolated and 3.81 [2.00-7.28] for non-isolated TR). Among the AF-naïve patients at admission, TR was associated with newly diagnosed AF during hospitalization and a 1-year follow-up period (aOR [95% CI], 2.68 [1.81-3.97]). Conclusions TR is associated with AF in acute ischemic stroke patients regardless of severity and subtypes of TR. TR is also associated with newly diagnosed AF after stroke.
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Affiliation(s)
- Yong Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Han-Gil Jeong
- Division of Neurocritical Care, Department Of Neurosurgery and Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joon-Myung Kwon
- Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Qin M, Liu T, Shi SB, Xie SL, Qi XY. Editorial: Novel strategies for persistent atrial fibrillation ablation and AF driver mapping. Front Cardiovasc Med 2023; 10:1144723. [PMID: 37265561 PMCID: PMC10230011 DOI: 10.3389/fcvm.2023.1144723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Tao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shao-bo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuang-lun Xie
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-yan Qi
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
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Kawaji T, Aizawa T, Hojo S, Yaku H, Nakatsuma K, Kaneda K, Kato M, Yokomatsu T, Miki S. Reproducibility and stability of atrial fibrillation drivers identified by an automated algorithm: CARTOFINDER. J Interv Card Electrophysiol 2022; 65:461-470. [PMID: 35596106 DOI: 10.1007/s10840-022-01254-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The characteristics of atrial fibrillation (AF) drivers identified by CARTOFINDER have not been thoroughly evaluated. Therefore, the current study was sought to validate the reliability of AF drivers. METHODS The reliability of focal and rotational activation identified by CARTOFINDER during AF was assessed by the sequential recordings in each site before and after pulmonary vein isolation (PVI) in 27 persistent AF patients. The primary outcome measures were the reproducibility rate during the sequential recordings and the stability rate between pre- and post-PVI. RESULTS Among 32,135 points in 509 sites, focal activation was identified in 1775 points (5.5%) with a repetition of 11 (6-26) times during the recording. Rotational activation was identified in 132 points (0.4%) with a repetition number of 21 (14-21) times. AF drivers had significantly higher voltage and shorter AF cycle length than non-AF driver sites. The reproducibility rate of focal activation during the sequential recordings was 57.8% and increased with the repetition number. The reproducibility rate of rotational activation was 37.4%. The prevalence and the reproducibility rate of focal activation in post-PVI were significantly lower than pre-PVI (5.3% versus 6.0%, P = 0.02; 53.4% versus 63.6%, P < 0.001). The stability rate of focal activation between pre- and post-PVI was only 28.3% but increased with the repetition number. There was no stable rotational activation between pre- and post-PVI. CONCLUSIONS The reproducibility of AF drivers, especially focal activation, identified by CARTOFINDER is relatively favorable, but the stability between pre- and post-PVI was poor. These results depended on the repetition number during the recording.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan.
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shun Hojo
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Kazuhisa Kaneda
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Takafumi Yokomatsu
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
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Right atrial appendage: an important structure to drive atrial fibrillation. J Interv Card Electrophysiol 2022; 65:73-82. [PMID: 35179671 PMCID: PMC9550756 DOI: 10.1007/s10840-021-01106-8] [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: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
Purpose Understanding of the atrial fibrillation (AF) driven by right atrial appendage (RAA) is limited. This study aimed to understand the characteristics of the AF driven by RAA and explore ablation methods. Methods This was a retrospective study and patients who were identified as having the AF driven by RAA were reviewed. Ablation was performed during AF. Potential maps of the left and right atrium, electrophysiological examinations, and ablation methods were studied. Results Among the 20 identified patients (mean age 67.0 ± 11.2 years; ejection fraction 62.9 ± 6.0%; LA diameter 43.1 ± 4.9 mm; RA diameter 51.7 ± 8.3 × 42.9 ± 3.7 mm), the AF cycle length in RAA (134.0 ± 10.9 ms) was the shortest, and the fastest frequency potentials were located in the RAA in 65% of patients. For the left atrium, the AF cycle length of the roof (145.5 ± 14.9 ms) was the shortest, followed by the left atrial appendage (153.7 ± 17.1 ms) and bottom (154.8 ± 11.8 ms). High-frequency potentials of RAA could be rapidly conducted to left atrium via sagittal bundle and Bachmann’s bundle, and the conduction time (55.0 ± 5.0 ms) was significantly shorter than the mean bi-atrial activation time (176.7 ± 10.3 ms, P < 0.0001). AF could be terminated after ablation at the RAA base (17 patients) or mechanical stimulation within the RAA (3 patients). To date, only two patients had recurrent atrial flutter, while the remaining patients maintained sinus rhythm. Conclusion The AF driven by RAA is characterized by high-frequency potentials in RAA, and ablation at the RAA base can achieve a satisfactory therapeutic effect. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01106-8.
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