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Dharmaprani D, Tiver K, Salari Shahrbabaki S, Jenkins EV, Chapman D, Strong C, Quah JX, Tonchev I, O’Loughlin L, Mitchell L, Tung M, Ahmad W, Stoyanov N, Aguilar M, Niederer SA, Roney CH, Nash MP, Clayton RH, Nattel S, Ganesan AN. Observable Atrial and Ventricular Fibrillation Episode Durations Are Conformant With a Power Law Based on System Size and Spatial Synchronization. Circ Arrhythm Electrophysiol 2024; 17:e012684. [PMID: 38939983 PMCID: PMC11254206 DOI: 10.1161/circep.123.012684] [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] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) and ventricular fibrillation (VF) episodes exhibit varying durations, with some spontaneously ending quickly while others persist. A quantitative framework to explain episode durations remains elusive. We hypothesized that observable self-terminating AF and VF episode lengths, whereby durations are known, would conform with a power law based on the ratio of system size and correlation length ([Formula: see text]. METHODS Using data from computer simulations (2-dimensional sheet and 3-dimensional left-atrial), human ischemic VF recordings (256-electrode sock, n=12 patients), and human AF recordings (64-electrode basket-catheter, n=9 patients; 16-electrode high definition-grid catheter, n=42 patients), conformance with a power law was assessed using the Akaike information criterion, Bayesian information criterion, coefficient of determination (R2, significance=P<0.05) and maximum likelihood estimation. We analyzed fibrillatory episode durations and [Formula: see text], computed by taking the ratio between system size ([Formula: see text], chamber/simulation size) and correlation length (xi, estimated from pairwise correlation coefficients over electrode/node distance). RESULTS In all computer models, the relationship between episode durations and [Formula: see text] was conformant with a power law (Aliev-Panfilov R2: 0.90, P<0.001; Courtemanche R2: 0.91, P<0.001; Luo-Rudy R2: 0.61, P<0.001). Observable clinical AF/VF durations were also conformant with a power law relationship (VF R2: 0.86, P<0.001; AF basket R2: 0.91, P<0.001; AF grid R2: 0.92, P<0.001). [Formula: see text] also differentiated between self-terminating and sustained episodes of AF and VF (P<0.001; all systems), as well as paroxysmal versus persistent AF (P<0.001). In comparison, other electrogram metrics showed no statistically significant differences (dominant frequency, Shannon Entropy, mean voltage, peak-peak voltage; P>0.05). CONCLUSIONS Observable fibrillation episode durations are conformant with a power law based on system size and correlation length.
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Affiliation(s)
- Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
- Australian Institute for Machine Learning (D.D.)
| | - Kathryn Tiver
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
- Department of Cardiovascular Medicine, Flinders Medical Center, Adelaide (K.T., I.T., A.N.G.)
| | - Sobhan Salari Shahrbabaki
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
| | - Evan V. Jenkins
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
| | - Darius Chapman
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
| | - Campbell Strong
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
| | - Jing X. Quah
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
| | - Ivaylo Tonchev
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
- Department of Cardiovascular Medicine, Flinders Medical Center, Adelaide (K.T., I.T., A.N.G.)
| | | | | | - Matthew Tung
- Department of Cardiovascular Medicine, Sunshine Coast University Hospital, Birtinya (M.T.)
| | - Waheed Ahmad
- Department of Cardiovascular Medicine, Princess Alexandra Hospital, Queensland (W.A.)
| | - Nik Stoyanov
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia (N.S.)
| | - Martin Aguilar
- Department of Medicine and Research Centre, Montréal Heart Institute, Canada (M.A., S.N.)
| | - Steven A. Niederer
- The National Heart and Lung Institute, Imperial College London, Alan Turing Institute (S.A.N.)
| | - Caroline H. Roney
- School of Engineering and Material Science, Queen Mary University of London, United Kingdom (C.H.R.)
| | - Martyn P. Nash
- Auckland Bioengineering Institute, University of Auckland, New Zealand (M.P.N.)
| | - Richard H. Clayton
- Insigneo Institute for in-silico Medicine, Department of Computer Science, University of Sheffield, United Kingdom (R.C.)
| | - Stanley Nattel
- Department of Medicine and Research Centre, Montréal Heart Institute, Canada (M.A., S.N.)
- Université de Montréal, QC, Canada. Pharmacology Institute, University Duisbpurg-Essen, Germany. CHU Liryc Institute, Bordeaux, France (S.N.)
| | - Anand N. Ganesan
- College of Medicine and Public Health, Flinders University (D.D., K.T., S.S.S., E.V.J., D.C., C.S., J.X.Q., I.T., A.N.G.)
- Department of Cardiovascular Medicine, Flinders Medical Center, Adelaide (K.T., I.T., A.N.G.)
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Rossi P, Cauti FM, Polselli M, Magnocavallo M, Niscola M, Fanti V, Limite LR, Evangelista A, Bellisario A, De Paolis R, Facchetti S, Quaglione R, Piccirillo G, Bianchi S. Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01721-7. [PMID: 38206451 DOI: 10.1007/s10840-023-01721-7] [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: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. METHODS Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. RESULTS Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71-2.38mV) vs 1.54mV (IQR: 0.79-2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). CONCLUSIONS All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy.
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marta Niscola
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Veronica Fanti
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | | | - Antonietta Evangelista
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | | | | | | | - Raffaele Quaglione
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
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Nagase T, Kato R, Asano S, Fukunaga H, Yoshida Y, Hayashi Y, Sekiguchi Y, Nanasato M, Nitta J, Isobe M. Spatial relationship of localized sources of persistent atrial fibrillation identified by a unipolar-based automated algorithm to complex fractionated atrial electrocardiograms and atrial low voltage areas. J Cardiovasc Electrophysiol 2023; 34:337-344. [PMID: 36423234 DOI: 10.1111/jce.15755] [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: 09/06/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Spatial characteristics of localized sources of persistent atrial fibrillation (AF) identified by unipolar-based panoramic mapping software (CARTOFINDER) remain unclear. We evaluated spatial characteristics of bi-atrial AF localized sources in relation to complex fractionated atrial electrocardiograms (CFAEs) and atrial low voltage area (LVAs) (≤0.35 mV during AF). METHODS AND RESULTS Twenty consecutive patients with persistent AF underwent bi-atrial voltage, CFAE, and CARTOFINDER mapping before the beginning of ablation (18 [90%] patients, initial procedure; 2 [10%] patients, repeat procedure). CFAEs were recorded using the interval confidence level (ICL) mode and defined as sites with a confidence level of ≥80% of maximal ICL number. We elucidated the following: (1) differences in the rate of AF localized sources and CFAEs inside or outside the atrial LVAs; (2) distribution of AF localized sources and CFAEs; and (3) distance between the closest points of AF localized sources and CFAEs. A total of 270 AF localized sources and 486 CFAEs were identified in 20 patients. AF localized sources were confirmed more often outside atrial LVAs than CFAEs (71% vs. 46% outside LVA, p < .001). AF localized sources and CFAEs were diffusely distributed without any tendency in bi-atria. Mean distance between closest AF localized sources and CFAEs was 22 ± 8 mm. CONCLUSION AF localized sources identified by CARTOFINDER are different therapeutic targets as compared to CFAEs and could be confirmed both inside and outside atrial LVAs.
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Affiliation(s)
- Takahiko Nagase
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryuichi Kato
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | - So Asano
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroshi Fukunaga
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Yosuke Hayashi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Intracardiac ECG pulse localization using overlapping block sparse reconstruction. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Metzner A, Kuck KH, Chun JKR. What we have learned: is pulmonary vein isolation still the cornerstone of atrial fibrillation ablation? Europace 2022; 24:ii8-ii13. [PMID: 35661870 DOI: 10.1093/europace/euab268] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Ablation of atrial fibrillation (AF) is an established treatment option for symptomatic patients. The cornerstone of all ablation strategies is electrical isolation of the pulmonary veins (PVs). Ablation strategies going beyond PV isolation (PVI) might be considered in the setting of recurrent AF despite durably isolated PVs. The lack of persistent PVI, however, limits the opportunities to perceive the real impact of this endpoint on AF suppression and to fully understand the benefit of extended ablation strategies going beyond. To overcome this limitation, novel and innovative ablation systems have been developed to facilitate acute PVI and to increase its durability. These systems include balloon-based ablation devices incorporating different energy sources such as cryo energy, laser, or radiofrequency current, but also new energy sources such as pulsed field ablation as a non-thermal energy source. These technologies could advance catheter ablation of AF to an early stage of the disease and to the primary treatment tool. The current manuscript focuses on the past, the present, and the future value of PVI as the cornerstone for interventional treatment of AF and on how to achieve durable PVI during the first procedure and to further improve the clinical success rates of AF ablation. It also analyses extended ablation strategies going beyond PVI and their impact.
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Kuck
- LANS Cardio, Hamburg, Germany.,University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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6
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Beyond pulmonary vein isolation for persistent atrial fibrillation: sequential high-resolution mapping to guide ablation. J Interv Card Electrophysiol 2022; 65:53-62. [PMID: 35000099 PMCID: PMC9550675 DOI: 10.1007/s10840-021-01115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Abstract
Purpose We aimed to evaluate whether outcomes with ablation in persistent (PsAF) and long-standing persistent (LsPsAF) AF can be improved beyond what can be achieved with pulmonary vein isolation (PVI) alone, using individualized mapping to guide ablation. Methods We studied 20 pts (15 M, 68 ± 11y) with PsAF (14) or LsPsAF (6) referred for first-time AF ablation. Following antral PVI, individualized mapping (IM) was performed using a high-density mapping catheter stably and fully deployed for 30 s at each of 23 ± 9 sites per patient. Activation data were reviewed, and an ablation strategy designed to intersect areas of focal and rotational activity. Mean follow-up was 429 ± 131 days. The study population was compared to a matched contemporary control cohort (CC) of 20 consecutive patients undergoing conventional ablation. Results Despite the IM group having a higher median comorbidities score, 3.5 vs. 2.5 in the CC group, indicating potentially more complex patients and more advanced substrate, cumulative freedom from AF after a single procedure was achieved in 94% of patients in the IM group vs. 75% in the CC group at 1 year and remained the same in both groups at the conclusion of the study (p = 0.02). There was a similar trend in atrial arrhythmia-free survival between both groups (84% vs. 67% at 1 year) that did not reach statistical significance. The procedure duration was longer in the IM group by a median of 31.5 min (p = 0.004). Conclusions Individualized mapping to guide AF ablation appears to achieve significantly greater AF-free survival compared to conventional PVI when applied as a primary ablation treatment. The results of this pilot study need to be confirmed in a larger, randomized trial. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01115-7.
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7
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Brook J, Kim MY, Koutsoftidis S, Pitcher D, Agha-Jaffar D, Sufi A, Jenkins C, Tzortzis K, Ma S, Jabbour RJ, Houston C, Handa BS, Li X, Chow JJ, Jothidasan A, Bristow P, Perkins J, Harding S, Bharath AA, Ng FS, Peters NS, Cantwell CD, Chowdhury RA. Development of a pro-arrhythmic ex vivo intact human and porcine model: cardiac electrophysiological changes associated with cellular uncoupling. Pflugers Arch 2020; 472:1435-1446. [PMID: 32870378 PMCID: PMC7476990 DOI: 10.1007/s00424-020-02446-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/11/2020] [Accepted: 08/06/2020] [Indexed: 01/19/2023]
Abstract
We describe a human and large animal Langendorff experimental apparatus for live electrophysiological studies and measure the electrophysiological changes due to gap junction uncoupling in human and porcine hearts. The resultant ex vivo intact human and porcine model can bridge the translational gap between smaller simple laboratory models and clinical research. In particular, electrophysiological models would benefit from the greater myocardial mass of a large heart due to its effects on far-field signal, electrode contact issues and motion artefacts, consequently more closely mimicking the clinical setting. Porcine (n = 9) and human (n = 4) donor hearts were perfused on a custom-designed Langendorff apparatus. Epicardial electrograms were collected at 16 sites across the left atrium and left ventricle. A total of 1 mM of carbenoxolone was administered at 5 ml/min to induce cellular uncoupling, and then recordings were repeated at the same sites. Changes in electrogram characteristics were analysed. We demonstrate the viability of a controlled ex vivo model of intact porcine and human hearts for electrophysiology with pharmacological modulation. Carbenoxolone reduces cellular coupling and changes contact electrogram features. The time from stimulus artefact to (-dV/dt)max increased between baseline and carbenoxolone (47.9 ± 4.1–67.2 ± 2.7 ms) indicating conduction slowing. The features with the largest percentage change between baseline and carbenoxolone were fractionation + 185.3%, endpoint amplitude − 106.9%, S-endpoint gradient + 54.9%, S point − 39.4%, RS ratio + 38.6% and (-dV/dt)max − 20.9%. The physiological relevance of this methodological tool is that it provides a model to further investigate pharmacologically induced pro-arrhythmic substrates.
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Affiliation(s)
- Joseph Brook
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Min-Young Kim
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Simos Koutsoftidis
- Faculty of Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - David Pitcher
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Danya Agha-Jaffar
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Annam Sufi
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Catherine Jenkins
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Konstantinos Tzortzis
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Suofeiya Ma
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Richard J Jabbour
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Charles Houston
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Balvinder S Handa
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Xinyang Li
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Ji-Jian Chow
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | | | - Poppy Bristow
- Royal Veterinary College, University of London, Hawkshead Lane, Hertfordshire, AL97TA, UK
| | - Justin Perkins
- Royal Veterinary College, University of London, Hawkshead Lane, Hertfordshire, AL97TA, UK
| | - Sian Harding
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Anil A Bharath
- Faculty of Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Fu Siong Ng
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Nicholas S Peters
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Chris D Cantwell
- Faculty of Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Rasheda A Chowdhury
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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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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Namino F, Yamakuchi M, Iriki Y, Okui H, Ichiki H, Maenosono R, Oketani N, Masamoto I, Miyata M, Horiuchi M, Hashiguchi T, Ohishi M, Maruyama I. Dynamics of Soluble Thrombomodulin and Circulating miRNAs in Patients with Atrial Fibrillation Undergoing Radiofrequency Catheter Ablation. Clin Appl Thromb Hemost 2019; 25:1076029619851570. [PMID: 31140290 PMCID: PMC6714917 DOI: 10.1177/1076029619851570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world and has a high risk of thromboembolism. The most effective approach, catheter ablation, requires evaluation by electrocardiography. The aim of our study was to investigate novel clinical markers that predict restoration of sinus rhythm (SR) after catheter ablation. Seventy-eight consecutive patients with AF underwent catheter ablation and were separated into 2 groups: restored SR and recurrent AF. The levels of 4 blood proteins (serum or plasma) and 3 mature microRNAs (miRNAs) and their primary miRNAs (pri-miRNAs) in serum were measured before and after ablation, and the associations between each parameter were analyzed statistically. Soluble thrombomodulin (s-TM) and plasminogen activator inhibitor-1 (PAI-1) levels increased above baseline after ablation in both the restored SR (s-TM 11.55 [2.92] vs 13.75 [3.38], P < .001; PAI-1 25.74 [15.25] vs 37.79 [19.56], P < .001) and recurrent AF (s-TM 10.28 [2.78] vs 11.67 [3.37], P < .001; PAI-1 26.16 [15.70] vs 40.74 [22.55], P < .001) groups. Levels of C-reactive protein and asymmetric dimethylarginine were not significantly changed. Pri-miR-126 levels significantly decreased after ablation in the recurrent AF group, but the other miRNAs and pri-miRNAs did not. The measurement of s-TM and pri-miR-126 in blood was a useful tool to reflect the condition of AF patients with catheter ablation.
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Affiliation(s)
- Fuminori Namino
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Munekazu Yamakuchi
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhisa Iriki
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideki Okui
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hitoshi Ichiki
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryuichi Maenosono
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Naoya Oketani
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Izumi Masamoto
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Masaaki Miyata
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masahisa Horiuchi
- 4 Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teruto Hashiguchi
- 1 Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan.,2 Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- 3 Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ikuro Maruyama
- 5 Department of Systems Biology in Thromboregulation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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10
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Kumagai K. What is the meaning of age-related change in CFAE? J Arrhythm 2019; 35:813-814. [PMID: 31844471 PMCID: PMC6898549 DOI: 10.1002/joa3.12249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/28/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Koichiro Kumagai
- Heart Rhythm Center Fukuoka Sanno Hospital Fukuoka Japan.,International University of Health and Welfare Otawara Japan
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11
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Guarguagli S, Kempny A, Cazzoli I, Barracano R, Gatzoulis MA, Dimopoulos K, Ernst S. Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease. Europace 2019; 21:1334-1344. [DOI: 10.1093/europace/euz157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.
Methods and results
We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).
Conclusion
While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Kempny
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Rosaria Barracano
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
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12
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Ohe M, Haraguchi G, Kumanomido J, Obuchi A, Hori K, Ito S, Ueno S, Fukumoto Y. New tailored approach using a revised assessment of fragmented potentials for persistent atrial fibrillation: Early area defragmentation by modified CFAE module. J Cardiovasc Electrophysiol 2019; 30:844-853. [DOI: 10.1111/jce.13888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Masatsugu Ohe
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Go Haraguchi
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Jun Kumanomido
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Aya Obuchi
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Kensuke Hori
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Shogo Ito
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Satoshi Ueno
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKurume University School of MedicineKurume Japan
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13
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Cantwell CD, Mohamied Y, Tzortzis KN, Garasto S, Houston C, Chowdhury RA, Ng FS, Bharath AA, Peters NS. Rethinking multiscale cardiac electrophysiology with machine learning and predictive modelling. Comput Biol Med 2019; 104:339-351. [PMID: 30442428 PMCID: PMC6334203 DOI: 10.1016/j.compbiomed.2018.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022]
Abstract
We review some of the latest approaches to analysing cardiac electrophysiology data using machine learning and predictive modelling. Cardiac arrhythmias, particularly atrial fibrillation, are a major global healthcare challenge. Treatment is often through catheter ablation, which involves the targeted localised destruction of regions of the myocardium responsible for initiating or perpetuating the arrhythmia. Ablation targets are either anatomically defined, or identified based on their functional properties as determined through the analysis of contact intracardiac electrograms acquired with increasing spatial density by modern electroanatomic mapping systems. While numerous quantitative approaches have been investigated over the past decades for identifying these critical curative sites, few have provided a reliable and reproducible advance in success rates. Machine learning techniques, including recent deep-learning approaches, offer a potential route to gaining new insight from this wealth of highly complex spatio-temporal information that existing methods struggle to analyse. Coupled with predictive modelling, these techniques offer exciting opportunities to advance the field and produce more accurate diagnoses and robust personalised treatment. We outline some of these methods and illustrate their use in making predictions from the contact electrogram and augmenting predictive modelling tools, both by more rapidly predicting future states of the system and by inferring the parameters of these models from experimental observations.
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Affiliation(s)
- Chris D Cantwell
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK.
| | - Yumnah Mohamied
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Konstantinos N Tzortzis
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Stef Garasto
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK
| | - Charles Houston
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Rasheda A Chowdhury
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Fu Siong Ng
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Anil A Bharath
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK
| | - Nicholas S Peters
- ElectroCardioMaths Group, Imperial College Centre for Cardiac Engineering, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
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14
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Chen Y, Li Z, Shen X, Wang W, Kang Y, Qiao Z, Wang X, Pu J. Assessment of left atrial remodeling in paroxysmal atrial fibrillation with speckle tracking echocardiography: a study with an electrophysiological mapping system. Int J Cardiovasc Imaging 2018; 35:451-459. [PMID: 30413910 DOI: 10.1007/s10554-018-1470-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
Abstract
This study aimed to evaluate left atrial (LA) remodeling and fibrosis in paroxysmal atrial fibrillation (AF) using speckle tracking echocardiography (STE) based on the findings with radiofrequency catheter ablation (RFCA) so as to predict atrial remodeling prior to ablation. A total of 40 patients with paroxysmal AF were enrolled and divided into two groups based on LA bipolar voltage detected during RFCA: those with low-voltage zone (LVZ) (LV group, n = 19) and those without LVZ (non-LV group, n = 21). The segmental and global LA reservoir, conduit and contractile strain (εs, εe, εa) were analyzed using two-dimensional STE before RFCA. The segmental and global εs, εe, εa (%) decreased in the LV group. Especially, the εs in anteroseptal upper (18.32 ± 7.94 vs. 31.61 ± 9.39) and lower segments (16.60 ± 7.23 vs. 29.23 ± 9.81), posteroseptal upper (22.24 ± 6.65 vs. 32.23 ± 10.57) and lower segments (18.24 ± 6.49 vs. 26.40 ± 7.12), and the global εs (23.85 ± 6.74 vs. 30.48 ± 8.67) significantly decreased in the LV group than in the non-LV group (all P < 0.05). The εs ≤ 24.07 in the anteroseptal upper segment was an effective parameter to differentiate the LV group (sensitivity, 84%; specificity, 81%, P < 0.001). Besides, global εs tended to be an independent determinant of the LVZ (odds ratio 1.347, P = 0.046). STE enables a noninvasive method to evaluate LA remodeling prior ablation.
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Affiliation(s)
- Yilin Chen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xuedong Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Wei Wang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yu Kang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zhiqing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xinhua Wang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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15
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Handa BS, Roney CH, Houston C, Qureshi NA, Li X, Pitcher DS, Chowdhury RA, Lim PB, Dupont E, Niederer SA, Cantwell CD, Peters NS, Ng FS. Analytical approaches for myocardial fibrillation signals. Comput Biol Med 2018; 102:315-326. [PMID: 30025847 PMCID: PMC6215772 DOI: 10.1016/j.compbiomed.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022]
Abstract
Atrial and ventricular fibrillation are complex arrhythmias, and their underlying mechanisms remain widely debated and incompletely understood. This is partly because the electrical signals recorded during myocardial fibrillation are themselves complex and difficult to interpret with simple analytical tools. There are currently a number of analytical approaches to handle fibrillation data. Some of these techniques focus on mapping putative drivers of myocardial fibrillation, such as dominant frequency, organizational index, Shannon entropy and phase mapping. Other techniques focus on mapping the underlying myocardial substrate sustaining fibrillation, such as voltage mapping and complex fractionated electrogram mapping. In this review, we discuss these techniques, their application and their limitations, with reference to our experimental and clinical data. We also describe novel tools including a new algorithm to map microreentrant circuits sustaining fibrillation.
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Affiliation(s)
- Balvinder S Handa
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Charles Houston
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Norman A Qureshi
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Xinyang Li
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - David S Pitcher
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Rasheda A Chowdhury
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Phang Boon Lim
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Emmanuel Dupont
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Steven A Niederer
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Chris D Cantwell
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom; Department of Aeronautics, Imperial College London, United Kingdom
| | - Nicholas S Peters
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Fu Siong Ng
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom.
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16
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Malki G, Zlochiver S. Cardiac spiral wave drifting due to spatial temperature gradients - A numerical study. Med Eng Phys 2018; 61:69-80. [PMID: 30201284 DOI: 10.1016/j.medengphy.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/16/2018] [Accepted: 08/26/2018] [Indexed: 01/07/2023]
Abstract
Cardiac rotors are believed to be a major driver source of persistent atrial fibrillation (AF), and their spatiotemporal characterization is essential for successful ablation procedures. However, electrograms guided ablation have not been proven to have benefit over empirical ablation thus far, and there is a strong need of improving the localization of cardiac arrhythmogenic targets for ablation. A new approach for characterize rotors is proposed that is based on induced spatial temperature gradients (STGs), and investigated by theoretical study using numerical simulations. We hypothesize that such gradients will cause rotor drifting due to induced spatial heterogeneity in excitability, so that rotors could be driven towards the ablating probe. Numerical simulations were conducted in single cell and 2D atrial models using AF remodeled kinetics. STGs were applied either linearly on the entire tissue or as a small local perturbation, and the major ion channel rate constants were adjusted following Arrhenius equation. In the AF-remodeled single cell, recovery time increased exponentially with decreasing temperatures, despite the marginal effect of temperature on the action potential duration. In 2D models, spiral waves drifted with drifting velocity components affected by both temperature gradient direction and the spiral wave rotation direction. Overall, spiral waves drifted towards the colder tissue region associated with global minimum of excitability. A local perturbation with a temperature of T = 28 °C was found optimal for spiral wave attraction for the studied conditions. This work provides a preliminary proof-of-concept for a potential prospective technique for rotor attraction. We envision that the insights from this study will be utilize in the future in the design of a new methodology for AF characterization and termination during ablation procedures.
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Affiliation(s)
- Guy Malki
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Ramat-Aviv, Tel-Aviv 69978, Israel
| | - Sharon Zlochiver
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Ramat-Aviv, Tel-Aviv 69978, Israel.
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17
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Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Hirao K. Influence of substrate modification in catheter ablation of atrial fibrillation on the incidence of acute complications: Analysis of 10 795 procedures in J-CARAF Study 2011-2016. J Arrhythm 2018; 34:435-440. [PMID: 30167015 PMCID: PMC6111468 DOI: 10.1002/joa3.12081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/27/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE In expectation of better outcome of catheter ablation of atrial fibrillation (AF), several strategies of extra-PV (pulmonary vein) substrate modification have been utilized. We assessed whether substrate modification or ablation of extra-PV source is a predictor of complications. METHODS Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent AF ablation. RESULTS The data of 10 795 AF ablation cases (age; 63.8 ± 10.6 years) treated during 2011-2016 were registered. Pericardial effusion (n = 105), massive bleeding (n = 108), stroke (n = 6), atrial-esophageal fistula (n = 2), and other 114 complications occurred in 323 patients (3.0%). Univariate analysis revealed that age ≧ 65 years, female gender, heart failure, CHA2DS2-VASc≧3, hemodialysis, deep sedation, and complex fractionated atrial electrogram (CFAE)-guided ablation ([+] vs [-] = 4.3% vs 2.8%, P = .005) were related with the higher incidence of complications. Redo session, 3-D imaging system ([+] vs [-]: 4.4% vs 2.9%, P = .017), and periprocedural dabigatran were related with the lower incidence of complications. None of the linear ablation of the left atrium, ganglionated plexi ablation, and superior vena cava ablation affected the incidence of complications. Multiple logistic regression analysis showed that in addition to 3-D imaging system, age ≧ 65 years, redo session, and deep sedation, CFAE ablation was an independent predictor of the risk of complications (OR 1.78, P = .001). Specifically, implantation of a permanent pacemaker due to emerging sinus node dysfunction was frequent after CFAE ablation (CFAE [+] vs [-] = 4/1047 vs 2/9748, P < .001). CONCLUSIONS Among extra-PV ablation strategies, CFAE-guided ablation is a predictor of ablation-related complications.
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Affiliation(s)
- Yuji Murakawa
- Fourth Department of Internal MedicineTeikyo University School of MedicineKawasakiJapan
| | - Teiichi Yamane
- The Department of CardiologyThe Jikei University School of MedicineTokyoJapan
| | - Masahiko Goya
- Heart Rhythm CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Koichi Inoue
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Shigeto Naito
- Division of CardiologyGunma Prefectural Cardiovascular CenterGunmaJapan
| | | | | | - Norishige Morita
- Division of CardiologyTokai University Hachioji HospitalHachiojiJapan
| | - Akihiko Nogami
- Cardiovascular DivisionFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Ken Okumura
- Division of CardiologySaiseikai Kumamoto HospitalKumamotoJapan
| | - Kenzo Hirao
- Heart Rhythm CenterTokyo Medical and Dental UniversityTokyoJapan
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18
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Left atrial appendage ligation and atrial fibrillation: A tool to “snare” greater success? Heart Rhythm 2018. [DOI: 10.1016/j.hrthm.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Alagoz C, Cohen AR, Frisch DR, Tunç B, Phatharodom S, Guez A. Spiral waves characterization: Implications for an automated cardiodynamic tissue characterization. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 161:15-24. [PMID: 29852958 DOI: 10.1016/j.cmpb.2018.04.006] [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: 02/27/2017] [Revised: 02/25/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Spiral waves are phenomena observed in cardiac tissue especially during fibrillatory activities. Spiral waves are revealed through in-vivo and in-vitro studies using high density mapping that requires special experimental setup. Also, in-silico spiral wave analysis and classification is performed using membrane potentials from entire tissue. In this study, we report a characterization approach that identifies spiral wave behaviors using intracardiac electrogram (EGM) readings obtained with commonly used multipolar diagnostic catheters that perform localized but high-resolution readings. Specifically, the algorithm is designed to distinguish between stationary, meandering, and break-up rotors. METHODS The clustering and classification algorithms are tested on simulated data produced using a phenomenological 2D model of cardiac propagation. For EGM measurements, unipolar-bipolar EGM readings from various locations on tissue using two catheter types are modeled. The distance measure between spiral behaviors are assessed using normalized compression distance (NCD), an information theoretical distance. NCD is a universal metric in the sense it is solely based on compressibility of dataset and not requiring feature extraction. We also introduce normalized FFT distance (NFFTD) where compressibility is replaced with a FFT parameter. RESULTS Overall, outstanding clustering performance was achieved across varying EGM reading configurations. We found that effectiveness in distinguishing was superior in case of NCD than NFFTD. We demonstrated that distinct spiral activity identification on a behaviorally heterogeneous tissue is also possible. CONCLUSIONS This report demonstrates a theoretical validation of clustering and classification approaches that provide an automated mapping from EGM signals to assessment of spiral wave behaviors and hence offers a potential mapping and analysis framework for cardiac tissue wavefront propagation patterns.
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Affiliation(s)
- Celal Alagoz
- ECE Department, Drexel University, Philadelphia, PA 19104, USA.
| | - Andrew R Cohen
- ECE Department, Drexel University, Philadelphia, PA 19104, USA
| | - Daniel R Frisch
- Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Birkan Tunç
- Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Allon Guez
- ECE Department, Drexel University, Philadelphia, PA 19104, USA.
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20
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Sample Entropy Analysis of Noisy Atrial Electrograms during Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:1874651. [PMID: 30008796 PMCID: PMC6020546 DOI: 10.1155/2018/1874651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/12/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
Abstract
Most cardiac arrhythmias can be classified as atrial flutter, focal atrial tachycardia, or atrial fibrillation. They have been usually treated using drugs, but catheter ablation has proven more effective. This is an invasive method devised to destroy the heart tissue that disturbs correct heart rhythm. In order to accurately localise the focus of this disturbance, the acquisition and processing of atrial electrograms form the usual mapping technique. They can be single potentials, double potentials, or complex fractionated atrial electrogram (CFAE) potentials, and last ones are the most effective targets for ablation. The electrophysiological substrate is then localised by a suitable signal processing method. Sample Entropy is a statistic scarcely applied to electrograms but can arguably become a powerful tool to analyse these time series, supported by its results in other similar biomedical applications. However, the lack of an analysis of its dependence on the perturbations usually found in electrogram data, such as missing samples or spikes, is even more marked. This paper applied SampEn to the segmentation between non-CFAE and CFAE records and assessed its class segmentation power loss at different levels of these perturbations. The results confirmed that SampEn was able to significantly distinguish between non-CFAE and CFAE records, even under very unfavourable conditions, such as 50% of missing data or 10% of spikes.
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21
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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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22
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Soor N, Morgan R, Varela M, Aslanidi OV. Towards patient-specific modelling of lesion formation during radiofrequency catheter ablation for atrial fibrillation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:489-492. [PMID: 28261003 DOI: 10.1109/embc.2016.7590746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Radiofrequency catheter ablation procedures are a first-line method of clinical treatment for atrial fibrillation. However, they suffer from suboptimal success rates and are also prone to potentially serious adverse effects. These limitations can be at least partially attributed to the inter- and intra- patient variations in atrial wall thickness, and could be mitigated by patient-specific approaches to the procedure. In this study, a modelling approach to optimising ablation procedures in subject-specific 3D atrial geometries was applied. The approach enabled the evaluation of optimal ablation times to create lesions for a given wall thickness measured from MRI. A nonliner relationship was revealed between the thickness and catheter contact time required for fully transmural lesions. Hence, our approach based on MRI reconstruction of the atrial wall combined with subject-specific modelling of ablation can provide useful information for improving clinical procedures.
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Affiliation(s)
- Navjeevan Soor
- Department of Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom ( ; ; ; ; phone: +44 (0) 20 7188 7188)
| | - Ross Morgan
- Department of Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom ( ; ; ; ; phone: +44 (0) 20 7188 7188)
| | - Marta Varela
- Department of Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom ( ; ; ; ; phone: +44 (0) 20 7188 7188)
| | - Oleg V Aslanidi
- Department of Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom ( ; ; ; ; phone: +44 (0) 20 7188 7188)
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23
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Alcaine A, Mase M, Cristoforetti A, Ravelli F, Nollo G, Laguna P, Martinez JP, Faes L. A Multi-Variate Predictability Framework to Assess Invasive Cardiac Activity and Interactions During Atrial Fibrillation. IEEE Trans Biomed Eng 2017; 64:1157-1168. [DOI: 10.1109/tbme.2016.2592953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Boles U, Gul EE, Enriquez A, Lee H, Riegert D, Andres A, Baranchuk A, Redfearn D, Glover B, Simpson C, Abdollah H, Michael K. High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2017; 9:1517. [PMID: 29250270 DOI: 10.4022/jafib.1517] [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: 12/17/2016] [Revised: 12/19/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022]
Abstract
Background Ablation of the pulmonary vein (PV) antrum using an electroanatomic mapping system is standard of care for point-by-point pulmonary vein isolation (PVI). Focused ablation at critical areas is more likely to achieve intra-procedural PV isolation and decrease the likelihood for reconnection and recurrence of atrial fibrillation (AF). Therefore this prospective pilot study is to investigate the short-term outcome of a voltage-guided circumferential PV ablation (CPVA) strategy. Methods We recruited patients with a history of paroxysmal atrial fibrillation (AF). The EnSite NavX system (St. Jude Medical, St Paul, Minnesota, USA) was employed to construct a three-dimensional geometry of the left atrium (LA) and voltage map. CPVA was performed; with radiofrequency (RF) targeting sites of highest voltage first in a sequential clockwise fashion then followed by complete the gaps in circumferential ablation. Acute and short-term outcomes were compared to a control group undergoing conventional standard CPVA using the same 3D system. Follow-up was scheduled at 3, 6 and 12 months. Results Thirty-four paroxysmal AF patients with a mean age of 40 years were included. Fourteen patients (8 male) underwent voltage mapping and 20 patients underwent empirical, non-voltage guided standard CPVA. A mean of 54 ± 12 points per PV antrum were recorded. Mean voltage for right and left PVs antra were 1.7±0.1 mV and 1.9±0.2 mV, respectively. There was a trend towards reduced radiofrequency time (40.9±17.4 vs. 48.1±15.5 mins; p=0.22). Conclusion Voltage-guided CPVA is a promising strategy in targeting critical points for PV isolation with a lower trend of AF recurrence compared with a standard CPVA in short-term period. Extended studies to confirm these findings are warranted.
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Affiliation(s)
- Usama Boles
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Enes E Gul
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Howard Lee
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Dave Riegert
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | - Adrian Andres
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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25
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Yoshimura A, Iriki Y, Ichiki H, Oketani N, Okui H, Maenosono R, Namino F, Miyata M, Ohishi M. Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation. J Cardiol 2017; 69:228-235. [DOI: 10.1016/j.jjcc.2016.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
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26
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Goldberger JJ. Substrate Ablation for Treatment of Atrial Fibrillation: Back to Basics. J Cardiovasc Electrophysiol 2016; 28:156-158. [PMID: 27957770 DOI: 10.1111/jce.13149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Reentry and Ectopic Pacemakers Emerge in a Three-Dimensional Model for a Slab of Cardiac Tissue with Diffuse Microfibrosis near the Percolation Threshold. PLoS One 2016; 11:e0166972. [PMID: 27875591 PMCID: PMC5119821 DOI: 10.1371/journal.pone.0166972] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023] Open
Abstract
Arrhythmias in cardiac tissue are generally associated with irregular electrical wave propagation in the heart. Cardiac tissue is formed by a discrete cell network, which is often heterogeneous. Recently, it was shown in simulations of two-dimensional (2D) discrete models of cardiac tissue that a wave crossing a fibrotic, heterogeneous region may produce reentry and transient or persistent ectopic activity provided the fraction of conducting connections is just above the percolation threshold. Here, we investigate the occurrence of these phenomena in three-dimensions by simulations of a discrete model representing a thin slab of cardiac tissue. This is motivated (i) by the necessity to study the relevance and properties of the percolation-related mechanism for the emergence of microreentries in three dimensions and (ii) by the fact that atrial tissue is quite thin in comparison with ventricular tissue. Here, we simplify the model by neglecting details of tissue anatomy, e. g. geometries of atria or ventricles and the anisotropy in the conductivity. Hence, our modeling study is confined to the investigation of the effect of the tissue thickness as well as to the comparison of the dynamics of electrical excitation in a 2D layer with the one in a 3D slab. Our results indicate a strong and non-trivial effect of the thickness even for thin tissue slabs on the probability of microreentries and ectopic beat generation. The strong correlation of the occurrence of microreentry with the percolation threshold reported earlier in 2D layers persists in 3D slabs. Finally, a qualitative agreement of 3D simulated electrograms in the fibrotic region with the experimentally observed complex fractional atrial electrograms (CFAE) as well as strong difference between simulated electrograms in 2D and 3D were found for the cases where reentry and ectopic activity were triggered by the micro-fibrotic region.
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28
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Ugarte JP, Tobón C, Orozco-Duque A, Becerra MA, Bustamante J. Effect of the electrograms density in detecting and ablating the tip of the rotor during chronic atrial fibrillation: an in silico study. Europace 2016; 17 Suppl 2:ii97-104. [PMID: 26842123 DOI: 10.1093/europace/euv244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Identification in situ of arrhythmogenic mechanisms could improve the rate of ablation success in atrial fibrillation (AF). Our research group reported that rotors could be located through dynamic approximate entropy (DApEn) maps. However, it is unknown how much the spatial resolution of catheter electrodes could affect substrates localization. The present work looked for assessing the electrograms (EGMs) spatial resolution needed to locate the rotor tip using DApEn maps. METHODS AND RESULTS A stable rotor in a two-dimensional computational model of human atrial tissue was simulated using the Courtemanche electrophysiological model and implementing chronic AF features. The spatial resolution is 0.4 mm (150 × 150 EGM). Six different lower resolution arrays were obtained from the initial mesh. For each array, DApEn maps were constructed using the inverse distance weighting (IDW) algorithm. Three simple ablation patterns were applied. The full DApEn map detected the rotor tip and was able to follow the small meander of the tip through the shape of the area containing the tip. Inverse distance weighting was able to reconstruct DApEn maps after applying different spatial resolutions. These results show that spatial resolutions from 0.4 to 4 mm accurately detect the rotor tip position. An ablation line terminates the rotor only if it crosses the tip and ends at a tissue boundary. CONCLUSION A previous work has shown that DApEn maps successfully detected simulated rotor tips using a high spatial resolution. In this work, it was evinced that DApEn maps could be applied using a spatial resolution similar to that available in commercial catheters, by adding an interpolation stage. This is the first step to translate this tool into medical practice with a view to the detection of ablation targets.
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Affiliation(s)
- Juan P Ugarte
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Catalina Tobón
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia GI2B, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Andrés Orozco-Duque
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia GI2B, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Miguel A Becerra
- GEA, Institución Universitaria Salazar y Herrera, Medellín, Colombia
| | - John Bustamante
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia
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29
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Ablation of complex fractionated electrograms is useful for catheter ablation of persistent atrial fibrillation: Protagonist point of view. Heart Rhythm 2016; 13:2098-100. [DOI: 10.1016/j.hrthm.2016.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Indexed: 11/21/2022]
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30
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AKSU TOLGA, GULER TÜMERERDEM, YALIN KIVANC, OTO ALI. Unanswered Questions in Complex Fractionated Atrial Electrogram Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1269-1278. [DOI: 10.1111/pace.12944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/15/2016] [Accepted: 08/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- TOLGA AKSU
- Department of Cardiology; Kocaeli Derince Education and Research Hospital; Kocaeli Turkey
| | - TÜMER ERDEM GULER
- Department of Cardiology; Kocaeli Derince Education and Research Hospital; Kocaeli Turkey
| | - KIVANC YALIN
- Department of Cardiology; Bayrampasa Kolan Hospital; Istanbul Turkey
| | - ALI OTO
- Department of Cardiology; Ankara Memorial Hospital; Ankara Turkey
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31
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Lüker J, Sultan A, Sehner S, Hoffmann B, Servatius H, Willems S, Steven D. Use of antiarrhythmic drugs during ablation of persistent atrial fibrillation: observations from a large single-centre cohort. Heart Vessels 2015; 31:1669-75. [PMID: 26546306 DOI: 10.1007/s00380-015-0771-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/30/2015] [Indexed: 01/09/2023]
Abstract
Catheter ablation of complex fractionated atrial electrograms (CFAE), also known as defragmentation ablation, may be considered for the treatment of persistent atrial fibrillation (AF) beyond pulmonary vein isolation (PVI). Concomitant antiarrhythmic drug (AAD) therapy is common, but the relevance of AAD administration and its optimal timing during ablation remain unclear. Therefore, we investigated the use and timing of AADs during defragmentation ablation and their possible implications for AF termination and ablation success in a large cohort of patients. Retrospectively, we included 200 consecutive patients (age: 61 ± 12 years, LA diameter: 47 ± 8 mm) with persistent AF (episode duration 47 ± 72 weeks) who underwent de novo ablation including CFAE ablation. In all patients, PVI was performed prior to CFAE ablation. The use and timing of AADs were registered. The follow-ups consisted of Holter ECGs and clinical visits. Termination of AF was achieved in 132 patients (66 %). Intraprocedural AADs were administered in 168/200 patients (84 %) 45 ± 27 min after completion of PVI. Amiodarone was used in the majority of the patients (160/168). The timing of AAD administration was predicted by the atrial fibrillation cycle length (AFCL). At follow-up, 88 patients (46 %) were free from atrial arrhythmia. Multivariate logistic regression analysis revealed that administration of AAD early after PVI, LA size, duration of AF history, sex and AFCL were predictors of AF termination. The administration of AAD and its timing were not predictive of outcome, and age was the sole independent predictor of AF recurrence. The administration of AAD during ablation was common in this large cohort of persistent AF patients. The choice to administer AAD therapy and the timing of the administration during ablation were influenced by AFCL, and these factors did not significantly influence the moderate single procedure success rate in this retrospective analysis.
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Affiliation(s)
- Jakob Lüker
- Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Arian Sultan
- Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Susanne Sehner
- University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany
| | - Boris Hoffmann
- University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany
| | | | - Stephan Willems
- University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany
| | - Daniel Steven
- Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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32
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Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:713058. [PMID: 26583127 PMCID: PMC4637158 DOI: 10.1155/2015/713058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/08/2015] [Accepted: 05/17/2015] [Indexed: 11/18/2022]
Abstract
The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies.
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33
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Frequent neurally mediated reflex syncope in a young patient with dextrocardia: Efficacy of catheter ablation of the superior vena cava-aorta ganglionated plexus. J Arrhythm 2015; 31:172-6. [PMID: 26336554 DOI: 10.1016/j.joa.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 11/20/2022] Open
Abstract
Neurally mediated reflex syncope is the most common cause of syncope in young individuals without cardiac or neurological pathology. We report a case of successful catheter ablation in a 17-year-old male with neurally mediated syncope (NMS) of the cardioinhibitory type. The patient had dextrocardia situs inversus totalis with a mirror-image reversal of the thoracic and abdominal organs. Because he experienced multiple syncope episodes despite pharmacological intervention, we performed endocardial ablation of the superior vena cava-aorta ganglionated plexus. Shortly afterwards, his heart rate increased from 40 to 76 beats per minutes. He has not experienced syncope during the 1-year follow-up.
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TAKIGAWA MASATERU, TAKAHASHI ATSUSHI, KUWAHARA TAISHI, OKUBO KENJI, TAKAHASHI YOSHIHIDE, NAKASHIMA EMIKO, WATARI YUJI, YAMAO KAZUYA, NAKAJIMA JUN, TAKAGI KATSUMASA, KIMURA SHIGEKI, HIKITA HIROYUKI, HIRAO KENZO, ISOBE MITSUAKI. Impact of Non-Pulmonary Vein Foci on the Outcome of the Second Session of Catheter Ablation for Paroxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 26:739-46. [DOI: 10.1111/jce.12681] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 03/14/2015] [Accepted: 03/27/2015] [Indexed: 01/09/2023]
Affiliation(s)
- MASATERU TAKIGAWA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
- Heart Rhythm Center; Tokyo Medical and Dental University; Tokyo Japan
- Department of Cardiovascular Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | | | - TAISHI KUWAHARA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - KENJI OKUBO
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | | | - EMIKO NAKASHIMA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - YUJI WATARI
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - KAZUYA YAMAO
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - JUN NAKAJIMA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | | | - SHIGEKI KIMURA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - HIROYUKI HIKITA
- Cardiovascular Center; Yokosuka Kyosai Hospital; Yokosuka Japan
| | - KENZO HIRAO
- Heart Rhythm Center; Tokyo Medical and Dental University; Tokyo Japan
| | - MITSUAKI ISOBE
- Department of Cardiovascular Medicine; Tokyo Medical and Dental University; Tokyo Japan
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Left atrial electrophysiologic feature specific for the genesis of complex fractionated atrial electrogram during atrial fibrillation. Heart Vessels 2015; 31:773-82. [PMID: 25854621 DOI: 10.1007/s00380-015-0672-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Complex fractionated atrial electrogram (CFAE) has been suggested to contribute to the maintenance of atrial fibrillation (AF). However, electrophysiologic characteristics of the left atrial myocardium responsible for genesis of CFAE have not been clarified. Non-contact mapping of the left atrium was performed at 37 AF onset episodes in 24 AF patients. Electrogram amplitude, width, and conduction velocity were measured during sinus rhythm, premature atrial contraction (PAC) with long- (L-PAC), short- (S-PAC) and very short-coupling intervals (VS-PAC). These parameters were compared between CFAE and non-CFAE regions. Unipolar electrogram amplitude was higher in CFAE than non-CFAE during sinus rhythm, L-, S- and VS-PAC (1.82 ± 0.73 vs. 1.13 ± 0.38, p < 0.001; 1.44 ± 0.54 vs. 0.92 ± 0.35, p < 0.001; 1.09 ± 0.40 vs. 0.70 ± 0.27, p < 0.001; 0.76 ± 0.30 vs. 0.53 ± 0.25 mV, p < 0.001). Laplacian bipolar electrogram amplitude was also higher in CFAE than non-CFAE during sinus rhythm, L-, S- and VS-PAC. Unipolar electrogram width was similar in CFAE and non-CFAE. Laplacian bipolar electrogram width was wider in CFAE than non-CFAE during L-, S- and VS-PAC (85.5 ± 6.8 vs. 79.6 ± 4.5, p < 0.001; 96.1 ± 9.7 vs. 84.5 ± 5.9, p < 0.001; 122.4 ± 16.0 vs. 99.6 ± 9.6 ms, p < 0.001), but not during sinus rhythm. The conduction velocity was slower in CFAE during sinus rhythm, L-, S- and VS-PAC than non-CFAE (1.7 ± 0.3 vs. 2.4 ± 0.4, p < 0.001; 1.4 ± 0.3 vs. 2.0 ± 0.5, p < 0.001; 1.2 ± 0.3 vs. 1.7 ± 0.5, p < 0.001; and 0.9 ± 0.3 vs. 1.4 ± 0.4 m/s, p < 0.001). CFAE was generated in the high amplitude atrial myocardium with slow and non-uniform conduction properties which were pronounced associated with premature activation, suggesting that heterogeneous conduction produced in high amplitude region contributes to the genesis of CFAE.
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Sueda T. History and development of surgical procedures for atrial fibrillation. Surg Today 2015; 45:1475-80. [DOI: 10.1007/s00595-015-1140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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Orozco-Duque A, Martinez-Vargas JD, Novak D, Bustamante J, Castellanos-Dominguez G. Feature selection for discrimination of fractionation levels in atrial electrograms. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1595-8. [PMID: 25570277 DOI: 10.1109/embc.2014.6943909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms (CFAE) is associated with a high AF termination rate in paroxysmal AF, but not in persistent. CFAE does not always identify favorable sites for persistent AF ablation. Studies suggest that only high fractionation level should be used as a target site for ablation. Nonetheless, there are not a standardized criterion to defined fractionation levels. Therefore, a better characterization of the signal is required providing a set of more powerful features that should be extracted from CFAE. Due to the apparent difference among fractionation classes in terms of their stochastic variability, we test time-domain and time-frequency based feature extraction approaches. Also, we carried out the symmetrical uncertainty-based feature selection to determine the most relevant features which improve discrimination of fractionation levels. Obtained results on a tested real electrogram database show that most relevant features in time-domain are related with time intervals and not with amplitudes. Nonetheless, time-frequency features obtained more information from the signal and this representation is likely a better suitable discriminating approach, particularly to detect high fractionated electrograms with a sensitivity and specificity of 83.0% and 93.6%, respectively.
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Ugarte JP, Orozco-Duque A, Tobón C, Kremen V, Novak D, Saiz J, Oesterlein T, Schmitt C, Luik A, Bustamante J. Dynamic approximate entropy electroanatomic maps detect rotors in a simulated atrial fibrillation model. PLoS One 2014; 9:e114577. [PMID: 25489858 PMCID: PMC4260907 DOI: 10.1371/journal.pone.0114577] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022] Open
Abstract
There is evidence that rotors could be drivers that maintain atrial fibrillation. Complex fractionated atrial electrograms have been located in rotor tip areas. However, the concept of electrogram fractionation, defined using time intervals, is still controversial as a tool for locating target sites for ablation. We hypothesize that the fractionation phenomenon is better described using non-linear dynamic measures, such as approximate entropy, and that this tool could be used for locating the rotor tip. The aim of this work has been to determine the relationship between approximate entropy and fractionated electrograms, and to develop a new tool for rotor mapping based on fractionation levels. Two episodes of chronic atrial fibrillation were simulated in a 3D human atrial model, in which rotors were observed. Dynamic approximate entropy maps were calculated using unipolar electrogram signals generated over the whole surface of the 3D atrial model. In addition, we optimized the approximate entropy calculation using two real multi-center databases of fractionated electrogram signals, labeled in 4 levels of fractionation. We found that the values of approximate entropy and the levels of fractionation are positively correlated. This allows the dynamic approximate entropy maps to localize the tips from stable and meandering rotors. Furthermore, we assessed the optimized approximate entropy using bipolar electrograms generated over a vicinity enclosing a rotor, achieving rotor detection. Our results suggest that high approximate entropy values are able to detect a high level of fractionation and to locate rotor tips in simulated atrial fibrillation episodes. We suggest that dynamic approximate entropy maps could become a tool for atrial fibrillation rotor mapping.
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Affiliation(s)
- Juan P. Ugarte
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia
- * E-mail:
| | - Andrés Orozco-Duque
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Catalina Tobón
- GI²B, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Vaclav Kremen
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Daniel Novak
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Javier Saiz
- I3BH, Universitat Politècnica de València, Valencia, Spain
| | - Tobias Oesterlein
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Clauss Schmitt
- Medizinische Klinik IV, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Armin Luik
- Medizinische Klinik IV, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - John Bustamante
- Centro de Bioingeniería, Universidad Pontificia Bolivariana, Medellín, Colombia
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Faustino M, Pizzi C, Capuzzi D, Agricola T, Costa GM, Flacco ME, Marzuillo C, Nocciolini M, Capasso L, Manzoli L. Impact of atrial fibrillation termination mode during catheter ablation procedure on maintenance of sinus rhythm. Heart Rhythm 2014; 11:1528-35. [DOI: 10.1016/j.hrthm.2014.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Indexed: 11/26/2022]
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Ravelli F, Masè M, Cristoforetti A, Marini M, Disertori M. The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:186-97. [PMID: 25077410 DOI: 10.1016/j.pbiomolbio.2014.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Abstract
The identification of suitable markers for critical patterns during atrial fibrillation (AF) may be crucial to guide an effective ablation treatment. Single parameter maps, based on dominant frequency and complex fractionated electrograms, have been proposed as a tool for electrogram-guided ablation, however the specificity of these markers is debated. Experimental studies suggest that AF critical patterns may be identified on the basis of specific rate and organization features, where rapid organized and rapid fragmented activities characterize respectively localized sources and critical substrates. In this paper we introduce the logical operator map, a novel mapping tool for a point-by-point identification and localization of AF critical sites. Based on advanced signal and image processing techniques, the approach combines in a single map electrogram-derived rate and organization features with tomographic anatomical detail. The construction of the anatomically-detailed logical operator map is based on the time-domain estimation of atrial rate and organization in terms of cycle length and wave-similarity, the logical combination of these indexes to obtain suitable markers of critical sites, and the multimodal integration of electrophysiological and anatomical information by segmentation and registration techniques. Logical operator maps were constructed in 14 patients with persistent AF, showing the capability of the combined rate and organization markers to identify with high selectivity the subset of electrograms associated with localized sources and critical substrates. The precise anatomical localization of these critical sites revealed the confinement of rapid organized sources in the left atrium with organization and rate gradients towards the surrounding tissue, and the presence of rapid fragmented electrograms in proximity of the sources. By merging in a single map the most relevant electrophysiological and anatomical features of the AF process, the logical operator map may have significant clinical impact as a direct, comprehensive tool to understand arrhythmia mechanisms in the single patient and guide more conservative, step-wise ablation.
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Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy.
| | - Michela Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | | | | | - Marcello Disertori
- Division of Cardiology, S. Chiara Hospital, Trento, Italy; Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
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WI JIN, LEE HYEJEONG, UHM JAESUN, KIM JONGYOUN, PAK HUINAM, LEE MOONHYOUNG, KIM YOUNGJIN, JOUNG BOYOUNG. Complex Fractionated Atrial Electrograms Related to Left Atrial Wall Thickness. J Cardiovasc Electrophysiol 2014; 25:1141-9. [DOI: 10.1111/jce.12473] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/05/2014] [Accepted: 06/09/2014] [Indexed: 01/02/2023]
Affiliation(s)
- JIN WI
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
| | - HYE-JEONG LEE
- Department of Radiology; Research Institute of Radiological Science; Yonsei University College of Medicine; Seoul Republic of Korea
| | - JAE-SUN UHM
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
| | - JONG-YOUN KIM
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
| | - HUI-NAM PAK
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
| | - MOONHYOUNG LEE
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
| | - YOUNG JIN KIM
- Department of Radiology; Research Institute of Radiological Science; Yonsei University College of Medicine; Seoul Republic of Korea
| | - BOYOUNG JOUNG
- Division of Cardiology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Republic of Korea
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Ammar S, Hessling G, Paulik M, Reents T, Dillier R, Buiatti A, Semmler V, Kolb C, Haller B, Deisenhofer I. Impact of baseline atrial fibrillation cycle length on acute and long-term outcome of persistent atrial fibrillation ablation. J Interv Card Electrophysiol 2014; 41:253-9. [PMID: 25008255 DOI: 10.1007/s10840-014-9927-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A short baseline atrial fibrillation (AF) cycle length (CL) has been associated with a worse outcome after catheter ablation for AF, whereas the impact of a long baseline AFCL is unknown. We investigated the influence of AFCL on acute and long-term success in a large series of patients undergoing catheter ablation for persistent AF. METHODS Overall, 177 consecutive patients undergoing catheter ablation of persistent AF using a sequential ablation approach were included in the analysis. AFCL was measured in the left atrial appendage (LAA) at baseline and following each ablation step. The primary endpoint was freedom from any atrial arrhythmia off antiarrhythmic drugs (AAD) with a single ablation procedure after 12 months. RESULTS Mean AFCL was 164 ± 24 ms. A shorter AFCL was associated with longer AF duration, larger LA diameter, and longer procedure duration. Termination to sinus rhythm (SR) was achieved in 57 (32 %) patients. Baseline AFCL was shorter (161 ± 24 ms) in patients without AF termination compared to patients with AF termination (169 ± 23 m, p = 0.03). The primary endpoint was reached less frequently in patients with a short (<155 ms) AFCL (18 vs. 38.5 %, p = 0.006). Patients with an AFCL between 155 and 200 ms had the best outcome compared to patients with AFCL <155 or ≥200 ms (40 vs. 18 %, p = 0.003). CONCLUSIONS Patients with a baseline AFCL between 155 and 200 ms have the best outcome after a single ablation procedure for persistent AF compared to patients with an AFCL of <155 or ≥200 ms.
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Affiliation(s)
- S Ammar
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany,
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Namino F, Iriki Y, Maenosono R, Ichiki H, Okui H, Yoshimura A, Oketani N, Matsushita M, Ohishi M, Hashiguchi T. The optimal setting of complex fractionated atrial electrogram software in substrate ablation for atrial fibrillation. J Arrhythm 2014; 31:6-11. [PMID: 26336516 DOI: 10.1016/j.joa.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Complex fractionated atrial electrogram (CFAE)-targeted catheter ablation (CFAE ablation) requires a high rate of atrial fibrillation (AF) termination to provide good outcomes. We determined the optimal settings of CFAE software. METHODS In our 430 consecutive patients, AF was terminated in 97 (234/242) and 79% (149/188) of patients with paroxysmal and persistent AF, respectively, by CFAE ablation combined with (31%) or without (69%) pulmonary vein isolation, occasionally with nifekalant infusion. We analyzed 109 consecutive patients who underwent CFAE ablation to determine the optimal settings for comparing subjective versus objective decisions by the CFAE software on CARTO3. We compared three settings: the default setting (0.05-0.15 mV, 50-120 ms) and two modified settings (#1: 0.05-0.30 mV, 40-70 ms, #2: 0.05-0.13 mV, 10-20 ms). We retrospectively analyzed 11,425 points during left atrial mapping before ablation and 10,306 points that were subjectively detected and ablated as CFAE points. An interval confidence level ≥6 denoted a site with CFAE. RESULTS With the default setting, the accuracy, sensitivity, specificity, positive productive value, and negative productive values were 67, 42, 77, 48, and 73%, respectively. With modified setting #1, the values were 78, 55, 87, 74, and 77%, respectively, versus 64, 82, 60, 53, and 91%, respectively, for modified setting #2. CONCLUSION These data suggest that setting #1 was generally superior to the default setting, whereas setting #2 was optimal for excluding areas not requiring ablation. The optimal CFAE software setting was a voltage of 0.05-0.30 mV and an interval parameter of 40-70 ms.
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Affiliation(s)
- Fuminori Namino
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan ; Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhisa Iriki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Ryuichi Maenosono
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Hitoshi Ichiki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hideki Okui
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Akino Yoshimura
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Naoya Oketani
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Teruto Hashiguchi
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan ; Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Ravelli F, Masè M. Computational mapping in atrial fibrillation: how the integration of signal-derived maps may guide the localization of critical sources. ACTA ACUST UNITED AC 2014; 16:714-23. [DOI: 10.1093/europace/eut376] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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45
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Burnett LA, Kocheril AG. Putative Role of Right Atrial Ablation in Atrial Fibrillation. J Atr Fibrillation 2014; 6:1085. [PMID: 27957069 DOI: 10.4022/jafib.1085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Lindsey A Burnett
- College of Medicine, University of Illinois at Urbana Champaign, Urbana, IL
| | - Abraham G Kocheril
- College of Medicine, University of Illinois at Urbana Champaign, Urbana, IL; Christie Clinic, Champaign, IL; Presence Covenant Medical Center, Urbana, IL
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Wu SH, Jiang WF, Gu J, Zhao L, Wang YL, Liu YG, Zhou L, Gu JN, Xu K, Liu X. Benefits and risks of additional ablation of complex fractionated atrial electrograms for patients with atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol 2013; 169:35-43. [PMID: 24083885 DOI: 10.1016/j.ijcard.2013.08.083] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/27/2013] [Accepted: 08/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits and risks of additional complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) remain unclear. METHODS Trials were identified in PubMed, Embase, Web of Science, and Cochrane Database, reviews, and reference lists of relevant papers. The primary end point was the recurrence of atrial arrhythmias after a single ablation. RESULTS We meta-analyzed 11 studies (total, n=983) using random-effects model to compare PVI (n=478) with PVI plus CFAE ablation (PVI+CFAE) (n=505). Additional CFAE ablation reduced recurrence of atrial tachyarrhythmia after a single procedure (pooled RR 0.73; 95% CI 0.61, 0.88; P=0.0007) at ≥ 3-month follow-up. There was no evidence of heterogeneity among studies (I(2)=33%). Subgroup analysis demonstrated that additional CFAE ablation reduced rates of recurrence in nonparoxysmal AF (RR 0.68; 95% CI 0.47, 0.99; P=0.05), whereas had no effect on patients with paroxysmal AF (RR 0.79; 95% CI 0.59, 1.06; P=0.12). Eight studies reported results of post-procedure ATs. The addition of CFAE ablation increased the rate of post-procedure ATs (RR 1.77; 95% CI 1.02, 3.07; P=0.04). Additional CFAE ablation significantly increased mean procedural times (245.4+75.7 vs. 189.5+62.3 min, P<0.001), mean fluoroscopy (72.1+25.6 vs. 59.5+19.3 min, P<0.001), and mean RF energy application times (75.3+38.6 vs. 53.2+27.5 min, P<0.001). CONCLUSIONS The adjunctive CFAE ablation could provide additional benefit in terms of reducing recurrence of atrial tachyarrhythmia for patients with nonparoxysmal AF but not for patients with paroxysmal AF after a single procedure with or without antiarrhythmic drugs (AADs). The main risk of adjunctive CFAE ablation is the increasing rate of untraceable postablation ATs.
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Affiliation(s)
- Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital affiliated to Shanghai Jiaotong University, China
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ICHIKI HITOSHI, OKETANI NAOYA, ISHIDA SANEMASA, IRIKI YASUHISA, OKUI HIDEKI, MAENOSONO RYUICHI, NAMINO FUMINORI, NINOMIYA YUICHI, MIYATA MASAAKI, HAMASAKI SHUICHI, TEI CHUWA. The Incidence of Asymptomatic Cerebral Microthromboembolism after Atrial Fibrillation Ablation: Comparison of Warfarin and Dabigatran. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1328-35. [PMID: 23952291 DOI: 10.1111/pace.12195] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/22/2013] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- HITOSHI ICHIKI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - NAOYA OKETANI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - SANEMASA ISHIDA
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - YASUHISA IRIKI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - HIDEKI OKUI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - RYUICHI MAENOSONO
- Clinical Laboratory Unit; Kagoshima University Hospital; Kagoshima Japan
| | - FUMINORI NAMINO
- Clinical Laboratory Unit; Kagoshima University Hospital; Kagoshima Japan
| | - YUICHI NINOMIYA
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - MASAAKI MIYATA
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - SHUICHI HAMASAKI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
| | - CHUWA TEI
- Department of Cardiovascular, Respiratory and Metabolic Medicine; Graduate School of Medicine; Kagoshima University; Kagoshima Japan
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DENEKE THOMAS, SCHADE ANJA, MÜGGE ANDREAS. Dominant Frequency and Complex Fractionated Atrial Electrogram Ablation in Atrial Fibrillation: Regularizing Chaos. J Cardiovasc Electrophysiol 2013; 24:984-6. [DOI: 10.1111/jce.12184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- THOMAS DENEKE
- Heart Center Bad Neustadt; Clinic for Invasive Electrophysiology; Bad Neustadt Germany
- Ruhr-University Bochum; Bochum Germany
| | - ANJA SCHADE
- Heart Center Bad Neustadt; Clinic for Invasive Electrophysiology; Bad Neustadt Germany
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Ravelli F, Masè M, Cristoforetti A, Del Greco M, Centonze M, Marini M, Disertori M. Anatomic localization of rapid repetitive sources in persistent atrial fibrillation: fusion of biatrial CT images with wave similarity/cycle length maps. JACC Cardiovasc Imaging 2013; 5:1211-20. [PMID: 23236970 DOI: 10.1016/j.jcmg.2012.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/12/2012] [Accepted: 08/01/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the anatomic distribution of critical sources in patients with atrial fibrillation (AF) by fusion of biatrial computed tomography (CT) images with cycle length (CL) and wave similarity (WS) maps. BACKGROUND Experimental and clinical studies show that atrial fibrillation (AF) may originate from rapid and repetitive (RR) sources of activation. Localization of RR sources may be crucial for an effective ablation treatment. Atrial electrograms showing rapid and repetitive activations can be identified by combining WS and CL analysis. METHODS Patients with persistent AF underwent biatrial electroanatomic mapping and pre-procedural CT cardiac imaging. WS and CL maps were constructed in 17 patients by calculating the degree of repetitiveness of activation waveforms (similarity index [S]) and the cycle length at each atrial site. WS/CL maps were then integrated with biatrial 3-dimensional CT reconstructions by a stochastic approach. RESULTS Repetitive sources of activation (S ≥ 0.5) were present in most patients with persistent AF (94%) and were mainly located at the pulmonary veins (82% of patients), at the superior caval vein (41%), on the anterior wall of the right atrium (23%), and at the left atrial appendage (23%). Potential driver sources showing both rapid and repetitive activations (CL = 140.7 ± 25.1 ms, S = 0.65 ± 0.15) were present only in a subset of patients (65%) and were confined to the pulmonary vein region (47% of patients) and left atrial appendage (12%). Differently, the repetitive activity of the superior caval vein was characterized by a slow activation rate (CL = 184.7 ± 14.6 ms). CONCLUSIONS The identification and localization of RR sources is feasible by fusion of biatrial anatomic images with WS/CL maps. Potential driver sources are present only in a subset of patients with persistent AF and are mainly located in the pulmonary vein region.
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Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Trento, Italy.
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50
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What is essential for the elimination of persistent or chronic atrial fibrillation? Surg Today 2013; 44:211-2. [PMID: 23525636 DOI: 10.1007/s00595-013-0551-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Dr. James Cox devised the maze procedure as a radical intervention for lone atrial fibrillation (AF) based on the multiple reentry theory. Dr. Micheal Haissaguerre discovered ectopic foci from the pulmonary veins were the trigger for paroxysmal AF. We demonstrated the efficacy of the pulmonary vein box isolation procedure for chronic AF. Dr. Koonlfawee Nademanee reported the complex fractionated atrial electrogram (CFAE) procedure to eliminate the substrate of chronic AF, which is distributed around the pulmonary veins. The complete isolation of all pulmonary veins is essential for the elimination of AF.
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