1
|
Guan F, Saguner AM, Breitenstein A, Wang M, Molitor N, Brunckhorst C, Wolber T, Duru F. The effect of first step right atrial mapping (FRAM) on ablation duration and fluoroscopy exposure during cavotricuspid isthmus ablation of atrial flutter. Front Cardiovasc Med 2023; 10:1205966. [PMID: 37346289 PMCID: PMC10279846 DOI: 10.3389/fcvm.2023.1205966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Aim To investigate the clinical significance of right atrial mapping prior to cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL). Methods Clinical and ablation parameters were retrospectively assessed and compared in patients undergoing CTI ablation with or without a first-step right atrial mapping (FRAM) by using the CARTO 3D mapping system. Results CTI block by radiofrequency ablation (RFA) was achieved in all 143 patients. In the FRAM group there was a shorter ablation duration and fluoroscopy exposure compared with the non-FRAM group. CHA2DS2-VASc score was associated with higher ablation durations, more ablation applications and increased fluoroscopy exposure. Body mass index (BMI) was associated with longer ablation duration and more ablation applications. Furthermore, patients with reduced left ventricular ejection fraction (LVEF) had longer ablation durations and more fluoroscopy exposure. One patient in the non-FRAM group developed cardiac effusion after ablation. None of the patients had recurrence after 6 months of follow-up. Conclusions Patients with high BMI, high CHA2DS2-VASc score and reduced LVEF may benefit from the FRAM approach by reducing ablation duration, number of ablation applications and fluoroscopy exposure.
Collapse
Affiliation(s)
- Fu Guan
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M. Saguner
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
| | - Alexander Breitenstein
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mia Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Nadine Molitor
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Baccillieri MS, Rizzo S, De Gaspari M, Paradiso B, Thiene G, Verlato R, Basso C. Anatomy of the cavotricuspid isthmus for radiofrequency ablation in typical atrial flutter. Heart Rhythm 2019; 16:1611-1618. [DOI: 10.1016/j.hrthm.2019.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 11/25/2022]
|
3
|
Anatomical Basis for the Cardiac Interventional Electrophysiologist. BIOMED RESEARCH INTERNATIONAL 2015; 2015:547364. [PMID: 26665006 PMCID: PMC4668306 DOI: 10.1155/2015/547364] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/28/2015] [Indexed: 12/11/2022]
Abstract
The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch's triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists.
Collapse
|
4
|
Dallaglio PD, Anguera I, Jiménez-Candil J, Peinado R, García-Seara J, Arcocha MF, Macías R, Herreros B, Quesada A, Hernández-Madrid A, Alvarez M, Di Marco A, Filgueiras D, Matía R, Cequier A, Sabaté X. Impact of previous cardiac surgery on long-term outcome of cavotricuspid isthmus-dependent atrial flutter ablation. Europace 2015; 18:873-80. [PMID: 26506836 DOI: 10.1093/europace/euv237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/10/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) in adults with and without previous cardiac surgery (PCS), and predictors of these outcomes. Structural alterations of the anatomical substrate of the CTI-AFL are observed in post-operative patients, and these may have an impact on the acute success of the ablation and in the long-term. METHODS AND RESULTS Clinical records of consecutive adults undergoing RFCA of CTI-AFL were analysed. Two main groups were considered: No PCS and PCS patients, who were further subdivided into acquired heart disease (AHD: ischaemic heart disease and valvular/mixed heart disease) and congenital heart disease [CHD: ostium secundum atrial septal defect (OS-ASD) and complex CHD]. Multivariate analysis identified clinical and procedural factors that predicted acute and long-term outcomes. A total of 666 patients (73% men, age 65 ± 12 years) were included: 307 of them with PCS. Ablation was successful in 647 patients (97%), 96% in the PCS group and 98% in the No PCS group (P = 0.13). Regression analysis showed that surgically corrected complex CHD was related to failure of the procedure [odds ratio 5.6; 95% confidence interval (CI) 1.6-18, P = 0.008]. After a follow-up of 45 ± 15 months, recurrences were observed in 90 patients (14%), more frequently in the PCS group: absolute risk of recurrence 18 vs. 10.5%, relative risk 1.71, 95% CI: 1.2-2.5, P = 0.006. Multivariate analysis indicated that the types of PCS [OS-ASD vs. No PCS: hazard ratio (HR) 2.57; 95% CI: 1.1-6.2, P = 0.03 and complex CHD vs. No PCS: HR 2.75; 95% CI: 1.41-5.48, P = 0.004], female gender (HR 1.55; 95% CI: 1.04-2.4, P = 0.048), and severe LV dysfunction (HR 1.36; 95% CI: 1.06-1.67, P = 0.04) were independent predictors of long-term recurrence. CONCLUSION Radiofrequency catheter ablation of CTI-AFL after surgical correction of AHD and CHD is associated with high acute success rates. The severity of the structural alterations of the underlying heart disease and consequently the type of surgical correction correlates with higher risk for recurrence.
Collapse
Affiliation(s)
- Paolo D Dallaglio
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Ignasi Anguera
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Javier Jiménez-Candil
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Javier García-Seara
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Rosa Macías
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Benito Herreros
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | | | | | - Miguel Alvarez
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Andrea Di Marco
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | | | - Roberto Matía
- Hospital Universitario 'Ramón y Cajal' de Madrid, Madrid, Spain
| | - Angel Cequier
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Xavier Sabaté
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| |
Collapse
|