1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [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: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Deshpande S, Sawatari H, Ahmed R, Nair RG, Khan H, Khanji MY, Somers VK, Chahal CAA, Padmanabhan D. Impact of intracardiac echocardiography on readmission morbidity and mortality following atrial fibrillation ablation. J Cardiovasc Electrophysiol 2022; 33:2496-2503. [PMID: 36128625 DOI: 10.1111/jce.15683] [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: 06/15/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality. METHODS Patients undergoing catheter ablation of AF during 2010-2017 were identified using the International Classification of Diseases-9th and 10th Revision-Clinical Modification (ICD-9-CM and ICD-10-CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted. RESULTS From 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in-hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non-ICE arm (median [interquartile range, IQR]: 3 [2-6] vs. 2 [3-5] days, p < .0001) with similar healthcare-associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8-15 474.2] vs. 7339.4 [4024.8-15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83-0.94], p < .0001) with the use of ICE at 90-day follow-up, which was driven by 24% reduction in heart failure (HF) at follow-up (HR [95% CI]: 0.76 [0.60-0.96], p = .02). CONCLUSIONS ICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF-related admissions. The non-ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.
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Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Hiroyuki Sawatari
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
| | - Rakesh Gopinathan Nair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Hassan Khan
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - C Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiac Electrophysiology Section, Division of Cardiovascular Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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5
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Xu J, Gao Y, Liu C, Wang Y. Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography vs without intracardiac echocardiography: A meta-analysis of observational and randomized studies. J Cardiovasc Electrophysiol 2022; 33:897-907. [PMID: 35212079 DOI: 10.1111/jce.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). METHODS AND RESULTS PubMed/MEDLINE, Embase and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE vs without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (MD, -9.80; 95% CI, -15.57 to -4.04; I2 =99%; p <0.01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I2 =89%; p <0.01), and complications (RR, 0.90; 95% CI, 0.87 to 0.92; I2 =20%; p<0.01) vs without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (SMD, -0.91; 95% CI, -1.86 to 0.04; I2 =96%; p =0.06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98 to 1.14; I2 =0%; p =0.13) was comparable between the two groups. CONCLUSION In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications vs ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jingmiao Xu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Ying Gao
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Chunhui Liu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Yaping Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
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6
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Matsubara TJ, Fujiu K, Shimizu Y, Oshima T, Matsuda J, Matsunaga H, Oguri G, Hasumi E, Kojima T, Komuro I. Fluoroless and contrast-free catheter ablation without a lead apron in routine clinical practice. Sci Rep 2020; 10:17096. [PMID: 33051503 PMCID: PMC7553968 DOI: 10.1038/s41598-020-74165-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
The technique of catheter ablation has been improved within the past few decades, especially by three-dimensional (3D) mapping system. 3D mapping system has reduced radiation exposure but ablation procedures still require fluoroscopy. Our previous study showed the safety and efficacy of catheter ablation based on intracardiac echogram combined with CARTOSOUND/CARTO3 system, however fluoroscopy use for an average of 16 min is required for this procedure. The present study was aimed to reduce radiation exposure to zero and establish a radiation free catheter ablation method with the goal of utilizing it in routine clinical practice. We conducted single center, retrospective study during 2019 April to 2020 February. Consecutive 76 patients were enrolled. In the first 18 cases, the previously reported procedure (CARTOSOUND/CARTO3 method) was used. The remaining 58 cases were transitioned to fluoroless catheter ablation. The procedure time, success rates and complication rates were analyzed. Not only AF patients but atrial flutter (AFL), paroxysmal supraventricular tachycardia (PSVT) and ventricular arrhythmia patients were included. Catheter positioning, catheter visualization and collecting the geometry of each camber of the heart were conducted by using contact force and ICE based geometry on CARTO system without either prior computed tomography (CT) or magnetic resonance image (MRI). In fluoroless group, all catheter ablations were successfully performed without lead aprons. No complications occurred in either group. There were no significant differences in procedure time in any type of procedure (Total procedure time Fluoro-group; 149 ± 51 min vs. Fluoroless-group; 162 ± 43 min, N.S.), (PSVT 170 ± 53 min vs. 162 ± 29 min, N.S.), (AFL 110 ± 70 min vs. 123 ± 43 min, N.S.), (AF 162 ± 43 min vs. 163 ± 32 min, N.S.). The total radiation time was reduced to zero in fluoroless group. Catheter ablation with ICE and 3D mapping system guide without fluoroscopy could be safely performed with a high success rate, without any prior CT/MRI 3D images. Radiation was reduced completely for patients and staff, negating the need for protective wear for operators.
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Affiliation(s)
- Takumi J Matsubara
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan.
- Department of Cardiovascular Medicine, IMS Katsushika Heart Center, 3-30-1, Horikiri, Katsushika, Tokyo, 123-0006, Japan.
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan.
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Yu Shimizu
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Hiroshi Matsunaga
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
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Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2020; 61:559-566. [DOI: 10.1007/s10840-020-00835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
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8
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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9
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Goya M, Frame D, Gache L, Ichishima Y, Tayar DO, Goldstein L, Lee SHY. The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta-analysis of efficiency, effectiveness, and safety outcomes. J Cardiovasc Electrophysiol 2020; 31:664-673. [PMID: 31976603 PMCID: PMC7078927 DOI: 10.1111/jce.14367] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.
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Affiliation(s)
- Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Diana Frame
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | - Larry Gache
- Real World Evidence, CTI Clinical Trial & Consulting, Covington, Kentucky
| | | | | | - Laura Goldstein
- Health Economics & Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | - Stephanie Hsiao Yu Lee
- Health Economics & Market Access, Johnson & Johnson Medical Asia Pacific, Singapore, Singapore
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High-Resolution Imaging of LA Anatomy Using a Novel Wide-Band Dielectric Mapping System. JACC Clin Electrophysiol 2019; 5:1344-1354. [DOI: 10.1016/j.jacep.2019.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
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11
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Mulder HW, van Stralen M, Ren B, Haak A, van Burken G, Viergever MA, Bosch JG, Pluim JPW. Selection Strategies for Atlas-Based Mosaicing of Left Atrial 3-D Transesophageal Echocardiography Data. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1533-1543. [PMID: 29673702 DOI: 10.1016/j.ultrasmedbio.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/14/2018] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
Three-dimensional transesophageal echocardiography (TEE) provides real-time soft tissue information, but its use is hampered by its limited field of view. The mosaicing of multiple TEE views makes it possible to visualize a large structure, like the left atrium, in a single volume. To this end, an automatic registration method is required. Similarly to atlas-based segmentation approaches, atlas-based mosaicing (ABM) uses a full volume atlas set to moderate the onerous registration of the individual TEE views. The performance of ABM depends both on the quality of the involved registrations and on the selection of the optimal transformation from the candidate transformations that result from the various atlases. The study described here explored the performance of different selection strategies on multiview TEE data of the left atrium. We found that by incorporating two stages of transformation selection, using the image similarity and the conformity between the candidate transformations as selection criteria, the average registration error dropped below 3 mm with respect to manual registration of these data. Finally, we used this method for the automatic construction of a wide-view TEE volume of the left atrium.
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Affiliation(s)
- Harriët W Mulder
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijn van Stralen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ben Ren
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexander Haak
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerard van Burken
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Max A Viergever
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Josien P W Pluim
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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12
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Kaseno K, Hisazaki K, Nakamura K, Ikeda E, Hasegawa K, Aoyama D, Shiomi Y, Ikeda H, Morishita T, Ishida K, Amaya N, Uzui H, Tada H. The impact of the CartoSound® image directly acquired from the left atrium for integration in atrial fibrillation ablation. J Interv Card Electrophysiol 2018; 53:301-308. [DOI: 10.1007/s10840-018-0368-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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13
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Ciske BR, Speidel MA, Raval AN. Improving the cardiac cath-lab interventional imaging eco-system. Transl Pediatr 2018; 7:1-4. [PMID: 29441275 PMCID: PMC5803015 DOI: 10.21037/tp.2017.09.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Benjamin R Ciske
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael A Speidel
- Department of Medicine, University of Wisconsin, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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14
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Siontis KC, Kim HM, Sharaf Dabbagh G, Latchamsetty R, Stojanovska J, Jongnarangsin K, Morady F, Bogun FM. Association of preprocedural cardiac magnetic resonance imaging with outcomes of ventricular tachycardia ablation in patients with idiopathic dilated cardiomyopathy. Heart Rhythm 2017; 14:1487-1493. [DOI: 10.1016/j.hrthm.2017.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Indexed: 11/24/2022]
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15
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Shu L, Wang J, Long D, Lin C. An automatic and accurate registration method for electro-anatomical map and CT surface. Int J Med Robot 2017; 13. [PMID: 28370919 DOI: 10.1002/rcs.1818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Electro-anatomical maps (EAM) and CT surface registration are widely used for catheter navigation in atrial fibrillation ablations. However, few studies have investigated the registration algorithm. Moreover, some of them are semiautomatic, so that physicians must be proficient; some are inaccurate for catheter navigation. A both automatic and accurate registration method is needed. METHOD A Hausdorff distance based approach (HD) was proposed for EAM/CT registration. First, using principal axes based registration, EAM/CT pairs were coarsely aligned. Then, using Hausdorff distance as the fine objective function, EAM/CT pairs were finely aligned. RESULTS Six real EAM/CT pairs were collected from five patients and 38 simulated pairs were generated. Each pair was aligned using Carto-Merge, a stochastic approach (SA) and HD. Considering the balance of operability, accuracy and robustness, HD obtained the best EAM/CT registration results among the three approaches. CONCLUSION Experiments validate that the proposed method registers EAM and CT surface both automatically and accurately.
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Affiliation(s)
- Lixia Shu
- Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jin Wang
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyan Lin
- Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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16
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Mulder HW, van Stralen M, Ren B, Haak A, Viergever MA, Bosch JG, Pluim JPW. Atlas-Based Mosaicing of Left Atrial 3-D Transesophageal Echocardiography Images. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:765-774. [PMID: 28065539 DOI: 10.1016/j.ultrasmedbio.2016.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 11/11/2016] [Accepted: 11/22/2016] [Indexed: 06/06/2023]
Abstract
Transesophageal echocardiography (TEE) is a promising imaging modality used to guide cardiac interventions, such as catheter ablation for the treatment of cardiac arrhythmias. These procedures rely on good visualization of the left atrium and pulmonary veins. To visualize these structures in a single volume, the acquisition, registration and fusion of multiple TEE views of the left atrium are required. We introduce atlas-based mosaicing as a method for the registration of images that are acquired according to a standardized protocol. Inspired by atlas-based segmentation approaches, compounded data of other patients serve as atlases for the registration of new data. The performance of atlas-based mosaicing is studied on 3-D TEE data of the left atrium and compared with that of regular pairwise registration. This study indicates that improved registration robustness and smaller registration errors are achieved with atlas-based mosaicing compared with regular pairwise registration. This is an important step toward the use of TEE for interventional guidance of ablation procedures.
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Affiliation(s)
- Harriët W Mulder
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijn van Stralen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ben Ren
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexander Haak
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Max A Viergever
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Josien P W Pluim
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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17
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Integration of intracardiac echocardiography and computed tomography during atrial fibrillation ablation: Combining ultrasound contours obtained from the right atrium and ventricular outflow tract. Int J Cardiol 2017; 228:677-686. [DOI: 10.1016/j.ijcard.2016.11.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022]
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18
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Tovia-Brodie O, Belhassen B, Glick A, Shmilovich H, Aviram G, Rosso R, Michowitz Y. Use of New Imaging CARTO® Segmentation Module Software to Facilitate Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 28:240-248. [PMID: 27763695 DOI: 10.1111/jce.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A new imaging software (CARTO® Segmentation Module, Biosense Webster) allows preprocedural 3-D reconstruction of all heart chambers based on cardiac CT. We describe our initial experience with the new module during ablation of ventricular arrhythmias. METHODS AND RESULTS Eighteen consecutive patients with idiopathic ventricular arrhythmias or ischemic ventricular tachycardia (VT) were studied. In the latter group, a combined endocardial and epicardial ablation was performed. Of the 14 patients with idiopathic arrhythmias, 12 were ablated in the outflow tract (OT), 1 in the midseptal left ventricle, and 1 at the left posterior fascicular area; acute successful ablation was achieved in 11 (78.6%) patients. The procedure was discontinued due to close proximity of the arrhythmia origin to the coronary arteries (CA) in 2 patients. Acute successful uncomplicated ablation was achieved in all 4 patients with ischemic VT. During ablation in the coronary cusps commissures, the CARTO® Segmentation Module accurately defined the cusps anatomy. The precise anatomic location provided by the module assisted in successfully ablating when information from activation mapping was not optimal, by ablating at the opposite side of the cusps. In addition, by demonstrating the precise location of the CA, it allowed safe ablation of arrhythmias that originated in close proximity to the CA both in the OT area and the epicardium, eliminating the need for repeat angiography. CONCLUSIONS The CARTO® Segmentation Module is useful for accurate definition of the exact anatomic location of ventricular arrhythmias and for safely ablating them especially in close proximity to the CA.
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Affiliation(s)
- Oholi Tovia-Brodie
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bernard Belhassen
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aharon Glick
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Shmilovich
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galit Aviram
- Department of Radiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Michowitz
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Njeim M, Desjardins B, Bogun F. Multimodality Imaging for Guiding EP Ablation Procedures. JACC Cardiovasc Imaging 2016; 9:873-886. [DOI: 10.1016/j.jcmg.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/22/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
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20
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Matsubara TJ, Fujiu K, Asada K, Kojima T, Hisaki M, Yamagata K, Shimizu Y, Hasumi E, Masaru H, Akazawa H, Komuro I. Direct left atrial ICE imaging guided ablation for atrial fibrillation without employing contrast medium. Int J Cardiol 2015; 203:733-9. [PMID: 26587731 DOI: 10.1016/j.ijcard.2015.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/12/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Preoperative and intraoperative use of a contrast medium is unavoidable in catheter ablation for atrial fibrillation, which can become a particularly significant issue for patients suffering from renal impairment. OBJECTIVE The purpose of this study is to investigate the feasibility and safety of a technique for atrial fibrillation ablation without a contrast medium via intra-cardiac ultrasound imaging only. METHODS We prepared the geometry of the pulmonary vein and left atrium via a SOUNDSTAR catheter from inside the left atrium, without preoperative and intraoperative investigations using contrast mediums, for computed tomography or magnetic resonance imaging and pulmonary venography. This was followed by retrospective investigation of the success rate and complications observed in 200 successive paroxysmal and persistent atrial fibrillation cases that underwent catheter ablation from January 2011 to November 2012. The outcomes were assessed after the one-year follow-up. RESULTS Inserting a SOUNDSTAR catheter into the left atrium was successful in all cases, wherein rendering of all pulmonary veins and the left atrium was possible, and extensive encircling pulmonary vein isolation was successful in all cases. The sinus rhythm maintenance rate one year after the procedure was 90.4% for paroxysmal atrial fibrillation and 76.0% for persistent atrial fibrillation. The major complication rate was 0.5% (cardiac tamponade), with no cases presenting aggravation of renal function. CONCLUSION Atrial fibrillation ablation using an intra-cardiac ultrasound from the left atrium without employing a contrast medium was safe, with no adverse effects on renal function.
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Affiliation(s)
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Japan; Department of Ubiquitous Health Informatics, The University of Tokyo, Japan.
| | - Kazuo Asada
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Makimoto Hisaki
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | | | - Yu Shimizu
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hatano Masaru
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Japan
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Shigenaga Y, Okajima K, Ikeuchi K, Kiuchi K, Ikeda T, Shimane A, Yokoi K, Teranishi J, Aoki K, Chimura M, Yamada S, Taniguchi Y, Yasaka Y, Kawai H. Usefulness of non-contrast-enhanced MRI with two-dimensional balanced steady-state free precession for the acquisition of the pulmonary venous and left atrial anatomy pre catheter ablation of atrial fibrillation: Comparison with contrast enhanced CT in cl. J Magn Reson Imaging 2015; 43:495-503. [DOI: 10.1002/jmri.24990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/15/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yutaka Shigenaga
- Department of Radiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Katsunori Okajima
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Kazushi Ikeuchi
- Department of Radiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Kunihiko Kiuchi
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Takayuki Ikeda
- Department of Radiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Akira Shimane
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Kiminobu Yokoi
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Jin Teranishi
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Kousuke Aoki
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Misato Chimura
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Shinichiro Yamada
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Yasuyo Taniguchi
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Yoshinori Yasaka
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
| | - Hiroya Kawai
- Department of Cardiology; Himeji Cardiovascular Center; Himeji Hyogo Japan
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22
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Reents T, Buiatti A, Ammar S, Dillier R, Semmler V, Telishevska M, Bourier F, Lennerz C, Grebmer C, Kaess B, Kolb C, Hessling G, Deisenhofer I. Catheter Ablation of Ventricular Arrhythmias using a Fluoroscopy Image Integration Module. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:700-5. [PMID: 25790434 DOI: 10.1111/pace.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/15/2015] [Accepted: 03/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of the CartoUnivu™ technology (Biosense Webster, Diamond Bar, CA, USA) on fluoroscopy exposure compared to a conventional approach using electroanatomical mapping (Carto 3™) was evaluated in patients undergoing radiofrequency ablation for ventricular tachyarrhythmias (VT). METHODS AND RESULTS We prospectively evaluated 23 patients undergoing VT ablation using the CartoUnivu™ technology. The CartoUnivu™ Module integrates fluoroscopic images and cine loops into the electroanatomical mapping system. As a control group, 23 out of 88 VT patients (ablated using conventional fluoroscopy supplemented by electromagnetic mapping with the Carto 3™ System) were matched for age, gender, body surface area, operator, redo-procedure, presence of coronary artery disease, and left ventricular dysfunction using propensity score matching. A significant reduction in fluoroscopy exposure was observed in the CartoUnivu™ group when compared to the conventional group (10.57 ± 7.93 minutes vs 18.52 ± 11.24 minutes, P_= 0.008; 611 cGy/cm(2) vs 1650 cGy/cm(2) , P = 0.001). In multivariate analysis, the CartoUnivu™ module was an independent predictor of reduced fluoroscopy use. CONCLUSION This is a report on the clinical application of the CartoUnivu system for VT ablation. CartoUnivu™ markedly reduced fluoroscopy time and dose compared to conventional fluoroscopy/electroanatomical mapping.
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Affiliation(s)
- Tilko Reents
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Allessandra Buiatti
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sonia Ammar
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roger Dillier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Verena Semmler
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Grebmer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Bernhardt Kaess
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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23
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Scaglione M, Ebrille E, Clemente FD, Gaita F, Bradfield JS. Catheter Ablation of Atrial Fibrillation Without Radiation Exposure Using A 3D Mapping System. J Atr Fibrillation 2015; 7:1167. [PMID: 27957146 DOI: 10.4022/jafib.1167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 11/10/2022]
Abstract
Transcatheter ablation procedures have been traditionally performed under fluoroscopic guidance. However, x-ray exposure is afflicted by the risk of developing malignancies as well as other deterministic effects of radiation. For this reason, radiation doses in the interventional laboratory should be reduced "As Low As Reasonably Achievable", with respect to the safety of the patients and the medical staff. This is of utmost importance in atrial fibrillation (AF) ablations, which are usually lengthy procedures. With the improvement of technology, the development of additional imaging tools and the widespread of 3D electroanatomic mapping systems (EAM), near-zero fluoroscopy AF ablation procedure is becoming a reality, limiting fluoroscopy use mainly to guide transseptal puncture. In the present paper we reviewed the risks to health related to x-ray exposure and we discussed the current state of knowledge of catheter ablation of AF without fluoroscopy in the 3D EAM system era.
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Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Elisa Ebrille
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Fiorenzo Gaita
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jason S Bradfield
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
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24
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Comparison of cardiac computed tomography versus cardiac magnetic resonance for characterization of left atrium anatomy before radiofrequency catheter ablation of atrial fibrillation. Int J Cardiol 2015; 179:114-21. [DOI: 10.1016/j.ijcard.2014.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/26/2014] [Accepted: 10/18/2014] [Indexed: 01/13/2023]
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25
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Steinberg BA, Hammill BG, Daubert JP, Bahnson TD, Douglas PS, Qualls LG, Pokorney SD, Calkins H, Curtis LH, Piccini JP. Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation. Heart 2014; 100:1871-7. [PMID: 25082794 DOI: 10.1136/heartjnl-2014-306067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Catheter ablation of atrial fibrillation (AF) has become an increasingly safe and effective therapy. This has been partly attributed to the use of adjunctive imaging modalities. We aimed to describe the use and associated outcomes of periprocedural imaging for AF ablation. METHODS We studied all Medicare fee-for-service claims for AF ablation from July 2007 to December 2009, and identified associated imaging studies before and during ablation, including transoesophageal echocardiography (TEE), intracardiac echocardiography (ICE), CT and MRI. The primary outcomes were death, stroke or transient ischaemic attack (TIA), repeat ablation, and bleeding (pericardial or vascular) at 6 months. RESULTS 11 525 patients underwent AF ablation during the study period. There was significant variation in imaging use at the practice level. In addition to electroanatomic mapping, 53% (n=6060/11 525) underwent TEE, 67% (n=7715/11 525) received ICE, and 50% (n=5724/11 525) underwent a preprocedure CT or MRI. Imaging generally increased from 2007 to 2009. After adjustment, the use of preablation CT or MRI was associated with a significantly lower risk of stroke or TIA (0.4% vs 0.9%, adjusted HR 0.46, 95% CI 0.28 to 0.74, p=0.002), and the use of ICE was associated with a lower risk of repeat ablation (5.7% vs 8.5%, adjusted HR 0.59, 95% CI 0.37 to 0.92, p=0.02) but higher risk of bleeding (1.1% vs 0.7%, adjusted HR 1.76, 95% CI 1.15 to 2.70, p=0.009). CONCLUSIONS Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.
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Affiliation(s)
- Benjamin A Steinberg
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - James P Daubert
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Pamela S Douglas
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura G Qualls
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sean D Pokorney
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Durham, North Carolina, USA
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