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Rossi P, Magnocavallo M, Cauti FM, Polselli M, Niscola M, Della Rocca DG, Del Greco A, Iaia L, Quaglione R, Gianfranco P, Bianchi S. Functional substrate analysis in patients with persistent atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01819-6. [PMID: 38811500 DOI: 10.1007/s10840-024-01819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES The aim of this study was to describe the correlation between atrial electrogram duration map (AEDUM), spatiotemporal electrogram dispersion (STED) and low voltage areas (LVA) in patients with persistent atrial fibrillation (PsAF). BACKGROUND The degree of left atrial (LA) tissue remodelling and augmented anisotropic conduction is one of the major issues related to PsAF ablation outcome. METHODS This study enrolled consecutive patients with PsAF undergoing pulmonary vein isolation. In all patients, voltage, AEDUM and STED maps were created, and the correlation was reported between these three mapping methods. RESULTS A total of 40 patients with PsAF were enrolled. The mean age was 62.2 ± 7.4 years, and males were 72.5% (n = 29). The overall bipolar voltage of the LA was 3.06 ± 1.87 mV. All patients had at least one AEDUM area (overall AEDUM area: 21.8 ± 8.2 cm2); the mean longest electrogram (EGMs) duration was 90 ± 19 ms. STED areas with < 120 ms was 46.3 ± 20.2 cm2 which covered 45 ± 22% of the LA surface. AEDUM and STED areas were most frequently reported on the roof, the anterior wall and the septum. The extension of the AEDUM areas was significantly smaller than STED areas with CL < 120 ms (21.8 ± 8.2 vs 46.3 ± 20.2; p-value < 0.0001). In 24 patients (60%), AEDUM areas was entirely included in the STED areas with CL < 120 ms. In the three (7.5%) patients with LVA, no correspondence with STED and AEDUM was noted. CONCLUSION AEDUM and STED maps allow to identify areas of conductive dysfunction as a possible atrial substrate even if a normal voltage is detected.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Isola Tiberina - Gemelli Isola, Rome, Italy.
| | | | - Filippo Maria Cauti
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Polselli
- Arrhythmology Unit, Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Marta Niscola
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard - Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ambra Del Greco
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Luigi Iaia
- Arrhythmology Unit, Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Raffaele Quaglione
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Piccirillo Gianfranco
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Isola Tiberina - Gemelli Isola, Rome, Italy
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Khawajakhail R, Khan RU, Gondal MUR, Toru HK, Malik M, Iqbal A, Malik J, Faraz M, Awais M. Advancements in gene therapy approaches for atrial fibrillation: Targeted delivery, mechanistic insights and future prospects. Curr Probl Cardiol 2024; 49:102431. [PMID: 38309546 DOI: 10.1016/j.cpcardiol.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Atrial fibrillation (AF) remains a complex and challenging arrhythmia to treat, necessitating innovative therapeutic strategies. This review explores the evolving landscape of gene therapy for AF, focusing on targeted delivery methods, mechanistic insights, and future prospects. Direct myocardial injection, reversible electroporation, and gene painting techniques are discussed as effective means of delivering therapeutic genes, emphasizing their potential to modulate both structural and electrical aspects of the AF substrate. The importance of identifying precise targets for gene therapy, particularly in the context of AF-associated genetic, structural, and electrical abnormalities, is highlighted. Current studies employing animal models, such as mice and large animals, provide valuable insights into the efficacy and limitations of gene therapy approaches. The significance of imaging methods for detecting atrial fibrosis and guiding targeted gene delivery is underscored. Activation mapping techniques offer a nuanced understanding of AF-specific mechanisms, enabling tailored gene therapy interventions. Future prospects include the integration of advanced imaging, activation mapping, and percutaneous catheter-based techniques to refine transendocardial gene delivery, with potential applications in both ventricular and atrial contexts. As gene therapy for AF progresses, bridging the translational gap between preclinical models and clinical applications is imperative for the successful implementation of these promising approaches.
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Affiliation(s)
| | | | | | - Hamza Khan Toru
- Department of Medicine, King's Mill Hospital, Nottinghamshire, United Kingdom
| | - Maria Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Arham Iqbal
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Maria Faraz
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Muhammad Awais
- Department of Cardiology, Islamic International Medical College, Rawalpindi, Pakistan.
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Bahlke F, Englert F, Popa M, Bourier F, Reents T, Lennerz C, Kraft H, Martinez AT, Kottmaier M, Syväri J, Tydecks M, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Erhard N. First clinical data on artificial intelligence-guided catheter ablation in long-standing persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:406-414. [PMID: 38197476 DOI: 10.1111/jce.16184] [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: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Despite advanced ablation strategies and major technological improvements, treatment of persistent atrial fibrillation (AF) remains challenging and the underlying pathophysiology is not fully understood. This study analyzed the multiple procedure outcome and safety of catheter ablation of spatiotemporal dispersions (DISPERS) detected by artificial intelligence (AI)-guided software in patients with long-standing persistent AF. METHODS AND RESULTS The Volta VX1 software was used for 50 consecutive patients undergoing catheter ablation for persistent AF. First, high-density mapping (78% biatrial) with a multipolar mapping catheter was performed. In addition to pulmonary vein isolation (PVI), ablation of DISPERS was performed aiming at homogenizing, dissecting, isolating, or connecting DISPERS areas to nonconducting anatomical structures. Follow-up contained regular visits at our outpatient clinic at 1, 3, 6, and 12 months including 7-day Holter electrocardiograms. Patients were mainly suffering from long-standing persistent AF (mean AF duration 50.30 ± 54.28 months). Following PVI, ablation of left atrial and right atrial DISPERS areas led to AF cycle length prolongation (mean of 162.0 ± 16.6 to 202.2 ± 21.6 ms after) and AF termination to atrial tachycardia (AT) or sinus rhythm (SR) in 12 patients (24%). No stroke or pericardial effusion occurred; major groin complications (pseudoaneurysm n = 1, atrioventricular fistula n = 1) were detected in two patients. After a blanking period of 6 weeks, recurrence of any atrial arrhythmia was documented in 26 patients (52%). The majority of patients presented with organized AT (n = 15) while AF was present in n = 9 patients and AT/AF was observed in n = 2 patients. Twenty-two patients underwent reablation. During a mean follow-up of 363.14 ± 187.42 days and after an average of 1.46 ± 0.68 procedures, 82% of patients remained in stable SR. CONCLUSION DISPERS-guided ablation using machine learning software (the Volta VX1 software) in addition to PVI in long-standing persistent AF ablation resulted in high long-term success rates regarding AF and AT elimination. Most arrhythmia recurrences were reentrant AT. After a total of 1.46 ± 0.68 procedures, freedom from AF/AT was 82%. Despite prolonged procedure times complication rates were low. Randomized studies are necessary to evaluate long-term efficacy of dispersion-guided ablation using AI.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alex Tunsch Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Robaye B, Deceuninck O, Blommaert D, Godeaux V, Dormal F, Collet B, Ballant E, Huys F, Purnode P, Xhaët O. Method, safety, and outcomes of persistent AF ablation without a circular mapping catheter: 3 years experience of a Belgian Tertiary Centre. Acta Cardiol 2024:1-8. [PMID: 38334112 DOI: 10.1080/00015385.2022.2135240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND We aimed to share our methods and experience of persistent AF ablation without a circular mapping catheter (CMC), thereby avoiding femoral venous and transseptal punctures, decreasing the cost of the procedure, and possibly reducing the duration of the procedure and fluoroscopy time. METHODS We report our experience with 261 persistent AF ablations performed without a CMC over the past 3 years. RESULTS The procedures were performed with no apparent loss of efficacy or safety. Freedom from recurrence was defined as a 1-year absence of AF/atrial flutter (AFL) episodes >30 s, beyond the 3-month blanking period. At 1 year, 72% of the patients were free from arrythmias. CONCLUSIONS Persistent AF ablation is feasible without a CMC, reducing the need for venous and transseptal punctures and the cost of the procedure. We suggest that prospective studies should aim to characterise the reduction in procedure and fluoroscopy times as a result of this technique.
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Affiliation(s)
- Benoit Robaye
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Olivier Deceuninck
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Department of Cardiology, CHR Namur, Namur, Belgium
| | - Dominique Blommaert
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Veronique Godeaux
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Fabien Dormal
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Benoit Collet
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Elisabeth Ballant
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Florence Huys
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Philippe Purnode
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Olivier Xhaët
- Service de Cardiologie, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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Sun J, Chen S, Liang M, Zhang Q, Zhang P, Sun M, Ding J, Jin Z, Han Y, Wang Z. Bachmann's Bundle Modification in Addition to Circumferential Pulmonary Vein Isolation for Atrial Fibrillation: A Novel Ablation Strategy. Cardiol Res Pract 2023; 2023:2870188. [PMID: 37927390 PMCID: PMC10624549 DOI: 10.1155/2023/2870188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 06/23/2023] [Indexed: 11/07/2023] Open
Abstract
Background Bachmann's bundle (BB) is the main pathway of interatrial connection that could be involved in the development of atrial fibrillation (AF). Based on this hypothesis, we raised a novel ablation strategy, BB modification in addition to circumferential pulmonary vein isolation (CPVI-BB) in patients with AF. Methods A retrospective cohort of patients with AF who underwent CPVI-BB or CPVI alone from March 2018 to July 2021 was enrolled in our study. Propensity score matching was performed in patients with paroxysmal AF and persistent AF, respectively, to reduce the risk of selection bias between the treatment strategies (CPVI-BB or CPVI alone). The primary endpoint was overall freedom from atrial arrhythmia recurrence through 12 months of follow-up. Results Our propensity score-matched cohort included 82 patients with paroxysmal AF (CPVI group: n = 41; CPVI-BB group: n = 41) and 168 patients with persistent AF (CPVI group: n = 84; CPVI-BB group: n = 84). Among patients with persistent AF, one-year freedom from atrial arrhythmia recurrence rate was 83.3% in the CPVI-BB group and 70.2% in the CPVI group (log-rank P = 0.047). Among patients with paroxysmal AF, no significant difference was found in the primary endpoint between two groups (85.4% in the CPVI-BB group vs. 80.5% in the CPVI group; log-rank P = 0.581). In addition, procedure-related complications and recurrence of atrial tachycardia or atrial flutter were similar between the two treatment groups, regardless of the type of AF. Conclusions BB modification in addition to CPVI is an effective approach in increasing the maintenance of sinus rhythm in patients with persistent AF, while it does not improve the clinical outcomes of radiofrequency catheter ablation in patients with paroxysmal AF.
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Affiliation(s)
- Jiaqi Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Qi Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ping Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Ding
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
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Dai W, Zhang J, Wang Y, Zhou J, Dai Q, Lv J. The balance between CD4+ T helper 17 and T-cell immunoglobulin and mucin domain 3 is involved in the pathogenesis and development of atrial fibrillation. Afr Health Sci 2023; 23:607-615. [PMID: 38357157 PMCID: PMC10862566 DOI: 10.4314/ahs.v23i3.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background To investigate the expression of Th17, T lymphocyte immunoglobulin mucin 3 (TIM-3+) cells and their related cytokines in atrial fibrillation (AF) and their clinical significance. Methodology A total of 90 patients with AF were divided into paroxysmal group (n=45) and chronic group (n=45), and 45 healthy volunteers were selected as the control group. The proportion of Th17 cells and Tim-3 + cells in the peripheral blood were detected. The concentrations of related cytokines in peripheral blood serum were determined. The correlation between Th17 / Tim-3+ cells and related cytokines was analysed. Results Compared with the control group, the proportion of Th17 cells and the concentration of related cytokines (IL-17, IL-6 and Matrix metalloproteinase (MMP9)) in peripheral blood of patients with paroxysmal and chronic AF increased significantly, while the proportion of tim3 + cells and the concentration of related cytokines decreased significantly. Compared with the paroxysmal group, the proportion of Th17 cells and the concentration of related cytokines in the peripheral blood of patients in the chronic group increased significantly, while the proportion of tim3 + cells and the concentration of related cytokines decreased significantly. Conclusion Th17 / Tim-3 + cell balance is involved in AF, and can be used as a target for AF treatment.
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Affiliation(s)
- Wenjing Dai
- Department of Cardiovasology, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Jun Zhang
- Department of Critical Care Medicine, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Yang Wang
- Department of Cardiovasology, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Jingqun Zhou
- Department of Medicine, China Three Gorges University, Yichang, China
| | - Qiuting Dai
- Department of Cardiovasology, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Jianfeng Lv
- Department of Cardiovasology, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
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Zheng D, Zhang Y, Huang D, Wang M, Guo N, Zhu S, Zhang J, Ying T. Incremental predictive utility of a radiomics signature in a nomogram for the recurrence of atrial fibrillation. Front Cardiovasc Med 2023; 10:1203009. [PMID: 37636308 PMCID: PMC10451088 DOI: 10.3389/fcvm.2023.1203009] [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: 04/10/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
Background Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains a challenge today. Although it is believed that evaluating the structural and functional remodeling of the left atrium (LA) may be helpful in predicting AF recurrence, there is a lack of consensus on prediction accuracy. Ultrasound-based radiomics is currently receiving increasing attention because it might aid in the diagnosis and prognosis prediction of AF recurrence. However, research on LA ultrasound radiomics is limited. Objective We aim to investigate the incremental predictive utility of LA radiomics and construct a radiomics nomogram to preoperatively predict AF recurrence following CA. Methods A training cohort of 232 AF patients was designed for nomogram construction, while a validation cohort (n = 100) served as the model performance test. AF recurrence during a follow-up period of 3-12 months was defined as the endpoint. The radiomics features related to AF recurrence were extracted and selected to create the radiomics score (rad score). These rad scores, along with other morphological and functional indicators for AF recurrence, were included in the multivariate Cox analysis to establish a nomogram for the prediction of the likelihood of AF recurrence within 1 year following CA. Results In the training and validation cohorts, AF recurrence rates accounted for 32.3% (75/232) and 25.0% (25/100), respectively. We extracted seven types of radiomics features associated with AF recurrence from apical four-chamber view echocardiography images and established a rad score for each patient. The radiomics nomogram was built with the rad score, AF type, left atrial appendage emptying flow velocity, and peak atrial longitudinal strain. It outperformed the nomogram building without the rad score in terms of the predictive efficacy of CA outcome and showed favorable performance in both cohorts. Conclusion We revealed the incremental utility of a radiomics signature in the prediction of AF recurrence and preliminarily developed and validated a radiomics nomogram for identifying patients who were at high risk of post-CA recurrence, which contributed to an appropriate management strategy for AF.
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Affiliation(s)
- Dongyan Zheng
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yueli Zhang
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Man Wang
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ning Guo
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Shu Zhu
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Juanjuan Zhang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Tao Ying
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Okuyama Y, Ozawa T, Nishikawa T, Fujii Y, Kato K, Sugimoto Y, Nakagawa Y, Ashihara T. Association with the nonparoxysmal atrial fibrillation duration and outcome of ExTRa Mapping-guided rotor ablation. J Arrhythm 2023; 39:531-538. [PMID: 37560288 PMCID: PMC10407168 DOI: 10.1002/joa3.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023] Open
Abstract
Background Additional ablation strategies after pulmonary vein isolation (PVI) for patients with nonparoxysmal atrial fibrillation (non-PAF) lasting ≥2 years have not been fully effective. This is presumably because of insufficient identification of non-PAF maintenance mechanisms. In this study, we employed a novel online and real-time phase mapping system, ExTRa Mapping, to identify and modulate rotors as one of the non-PAF maintenance mechanisms in patients with non-PAF sustained after PVI. We investigated the relationship between outcomes of ExTRa Mapping-guided rotor ablation (ExTRa-ABL) and non-PAF duration prior to this procedure. Methods This study consisted of 73 non-PAF patients (63 ± 8 years, non-PAF duration 31 ± 37 months) who underwent the first ExTRa-ABL in patients with non-PAF sustained after completion of PVI. Results Freedom from non-PAF/atrial tachycardia (AT) recurrence at 12 months after ExTRa-ABL was achieved in 50 (69%) of patients. The non-PAF duration prior to ExTRa-ABL was significantly longer in patients with non-PAF/AT recurrence after ExTRa-ABL compared with those without (56 ± 50 vs. 19 ± 22 months, p = .001). In patients with non-PAF duration of ≤60 months prior to ExTRa-ABL, compared with >60 months, non-PAF/AT-free rate was significantly higher (68.9% vs. 23.1%, p < .001), during the follow-up of 36 ± 18 months. Conclusions A non-PAF duration of ≤60 months prior to ExTRa-ABL was associated with a better outcome. The effect of ExTRa-ABL was considered to be limited in patients with >60 months of non-PAF duration.
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Affiliation(s)
- Yusuke Okuyama
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Tomoya Ozawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Takuma Nishikawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Yusuke Fujii
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Koichi Kato
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Yoshihisa Sugimoto
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
- Department of Medical Informatics and Biomedical EngineeringShiga University of Medical ScienceOtsuJapan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
| | - Takashi Ashihara
- Department of Cardiovascular MedicineShiga University of Medical ScienceOtsuJapan
- Department of Medical Informatics and Biomedical EngineeringShiga University of Medical ScienceOtsuJapan
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Pongratz J, Riess L, Hartl S, Brueck B, Tesche C, Ebersberger U, Helmberger T, Crispin A, Wankerl M, Dorwarth U, Hoffmann E, Straube F. Left atrial appendage volume is an independent predictor of atrial arrhythmia recurrence following cryoballoon pulmonary vein isolation in persistent atrial fibrillation. Front Cardiovasc Med 2023; 10:1190860. [PMID: 37404733 PMCID: PMC10315839 DOI: 10.3389/fcvm.2023.1190860] [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: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Purpose Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in persistent AF (persAF), and cryoballoon PVI emerged as an initial ablation strategy. Symptomatic atrial arrhythmia recurrence following successful PVI in persAF is observed more frequently than in paroxysmal AF. Predictors for arrhythmia recurrence following cryoballoon PVI for persAF are not well described, and the role of left atrial appendage (LAA) anatomy is uncertain. Methods Patients with symptomatic persAF and pre-procedural cardiac computed tomography angiography (CCTA) images undergoing initial second-generation cryoballoon (CBG2) were enrolled. Left atrial (LA), pulmonary vein (PV) and LAA anatomical data were assessed. Clinical outcome and predictors for atrial arrhythmia recurrence were evaluated by univariate and multivariate regression analysis. Results From May 2012 to September 2016, 488 consecutive persAF patients underwent CBG2-PVI. CCTA with sufficient quality for measurements was available in 196 (60.4%) patients. Mean age was 65.7 ± 9.5 years. Freedom from arrhythmia was 58.2% after a median follow-up of 19 (13; 29) months. No major complications occurred. Independent predictors for arrhythmia recurrence were LAA volume (HR 1.082; 95% CI, 1.032 to 1.134; p = 0.001) and mitral regurgitation ≥ grade 2 (HR, 2.49; 95% CI 1.207 to 5.126; p = 0.013). LA volumes ≥110.35 ml [sensitivity: 0.81, specificity: 0.40, area under the curve (AUC) = 0.62] and LAA volumes ≥9.75 ml (sensitivity: 0.56, specificity 0.70, AUC = 0.64) were associated with recurrence. LAA-morphology, classified as chicken-wing (21.9%), windsock (52.6%), cactus (10.2%) and cauliflower (15.3%), did not predict outcome (log-rank, p = 0.832). Conclusion LAA volume and mitral regurgitation were independent predictors for arrhythmia recurrence following cryoballoon ablation in persAF. LA volume was less predictive and correlated with LAA volume. LAA morphology did not predict the clinical outcome. To improve outcomes in persAF ablation, further studies should focus on treatment strategies for persAF patients with large LAA and mitral regurgitation.
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Affiliation(s)
- J. Pongratz
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - L. Riess
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - S. Hartl
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - B. Brueck
- Kardiologie Praxis Erkelenz, Erkelenz, Germany
| | - C. Tesche
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
| | | | - T. Helmberger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - A. Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | - M. Wankerl
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - U. Dorwarth
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - E. Hoffmann
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - F. Straube
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
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10
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Del Monte A, Almorad A, Pannone L, Della Rocca DG, Bisignani A, Monaco C, Mouram S, Ramak R, Gauthey A, Overeinder I, Bala G, Sorgente A, Ströker E, Sieira J, Brugada P, La Meir M, Chierchia GB, de Asmundis C. Pulmonary vein isolation with the radiofrequency balloon catheter: a single centre prospective study. Europace 2023; 25:896-904. [PMID: 36738245 PMCID: PMC10062286 DOI: 10.1093/europace/euad017] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS The multielectrode radiofrequency balloon catheter (RFB) has been developed to achieve safe and effective pulmonary vein isolation (PVI) for atrial fibrillation (AF) ablation. This single-centre study aimed to evaluate the midterm clinical outcome and predictors of single-shot PVI with the novel RFB. METHODS AND RESULTS All consecutive patients with symptomatic paroxysmal or persistent AF undergoing first-time PVI with the RFB were prospectively included. Clinical and procedural parameters were systematically collected. The primary safety endpoint was defined as any major periprocedural complications. The primary efficacy endpoint consisted of freedom from any atrial tachyarrhythmias (ATas) lasting >30 s during the follow-up after a 3-month blanking period. Persistent single-shot PVI was defined as PVI achieved with a single RFB application without acute reconnection. A total of 104 consecutive patients (mean age 64.3 ± 11.4 years, 56.7% males) were included. 15 patients (14.4%) presented with persistent AF. The procedure time was 59.0 min with a dwell time of 20.0 min. One major complication occurred in one patient. At a mean follow-up of 10.1 ± 5.3 months, freedom from ATas was 82.9%. ATas occurred in 14 patients, 11/69 patients (15.9%) with paroxysmal AF and 3/13 (23.1%) with persistent AF. The best cut-offs to predict persistent single-shot PVI were impedance drop >19.2 Ω [area under the receiver operator characteristic curve (AUC) 0.74] and temperature rise >11.1° C (AUC 0.77). CONCLUSION In a large cohort of patients undergoing PVI with the RFB, the complication rate was 1%. At a mid-term follow-up of 10.1 ± 5.3 months, freedom from ATas was 82.9%. Specific cut-offs of impedance drop and temperature rise may be useful to predict persistent single-shot isolation.
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Affiliation(s)
- Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
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11
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Wada R, Shinohara M, Fujino T, Matsumoto S, Yao S, Yano K, Dobashi S, Akitsu K, Koike H, Ohara H, Kinoshita T, Yuzawa H, Nakanishi R, Ikeda T. Significance of mitral L-waves in predicting late recurrences of atrial fibrillation after radiofrequency catheter ablation. Pacing Clin Electrophysiol 2023; 46:73-83. [PMID: 36433647 DOI: 10.1111/pace.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mitral L-wave, a prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction. The relationship between the mitral L-wave and outcome of catheter ablation (CA) in patients with atrial fibrillation (AF) has not been established. This study aimed to evaluate the predictive value of mitral L-waves on AF recurrence after CA. METHODS This was a retrospective and observational study in a single center. One hundred forty-six patients (mean age; 63.9 [56.0-72.0] years, 71.9% male) including 66 non-paroxysmal AF patients (45.2%) who received a first CA were enrolled. The mitral L-waves were defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave in the echocardiographic examinations before CA. The patients enrolled were divided into groups with (n = 31, 21.2%) and without (n = 115, 78.8%) mitral L-waves. Univariate and multivariate analyses were carried out to determine the predictive factors of late recurrences of AF (LRAFs), which meant AF recurrence later than 3 months after the CA. RESULTS During a follow-up of 28.8 (15.0-35.8) months, the ratio of LRAFs in patients with mitral L-waves was significantly higher than that in those without mitral L-waves (15 [46.9%] vs. 16 [14.0%], p < .001). A multivariate analysis using a Cox proportional hazard model revealed that the mitral L-waves were a significant predictive factor of LRAFs (hazard ratio: 3.09, 95% confidence interval: 1.53-6.24, p = .002). CONCLUSION The appearance of mitral L-waves could predict LRAFs after CA.
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Affiliation(s)
- Ryo Wada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masaya Shinohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Yao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kensuke Yano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Dobashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Katsuya Akitsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideki Koike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hiroshi Ohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Toshio Kinoshita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hitomi Yuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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12
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Spartalis M. Genome Editing and Atrial Fibrillation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1396:129-137. [DOI: 10.1007/978-981-19-5642-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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13
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Is there an association between left atrial outpouching structures and recurrence of atrial fibrillation after catheter ablation? PLoS One 2022; 17:e0276369. [PMID: 36301863 PMCID: PMC9612428 DOI: 10.1371/journal.pone.0276369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of left atrial diverticula (LADs), left sided septal pouches (LSSPs) and middle right pulmonary veins (MRPVs) on recurrent atrial fibrillation (rAF) in patients undergoing laser pulmonary vein isolation procedure (PVI). Material and methods This retrospective study enrolled 139 patients with pre-procedural multiple detector computed tomography (MDCT) imaging and 12 months follow-up examination. LADs, LSSPs and MRPV were identified by two radiologists on a dedicated workstation using multiplanar reconstructions and volume rendering technique. Univariate and bivariate regression analyses with patient demographics and cardiovascular risk factors as covariates were performed to reveal independent factors associated with rAF. Results LADs were recorded in 41 patients (29%), LSSPs in 20 (14%) and MRPVs in 15 (11%). The right anterosuperior wall of the left atrium was the most prevalent location of LADs (68%). rAF occured in 20 patients, thereof, 15 exhibited an outpouching structure of the left atrium (LAD: 9, LSSP: 2 and MRPV: 3). Presence of an LAD (HR: 2.7, 95%CI: 1.0–8.4, p = 0.04) and permanent AF (HR: 4.8, 95%CI: 1.5–16.3, p = 0.01) were independently associated with rAF. Conclusions LAD, LSSP and MRPV were common findings on pre-procedural cardiac computed tomography. LADs were revealed as potential independent risk factor of rAF, which might be considered for treatment planning and post-treatment observation.
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14
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Sazonova SI, Varlamova JV, Nikitin NA, Minin SM, Kisteneva IV, Batalov RE, Mishkina AI, Ilushenkova YN, Zavadovsky KV, Popov SV, Romanov AB. Cardiac 123I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation. J Nucl Cardiol 2022; 29:2220-2231. [PMID: 34046802 DOI: 10.1007/s12350-021-02658-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/20/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. METHODS 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months. RESULTS Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA. CONCLUSION Pre-CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.
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Affiliation(s)
- S I Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation.
| | - J V Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - N A Nikitin
- E. Meshalkin National Medical Research Center Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - S M Minin
- E. Meshalkin National Medical Research Center Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - I V Kisteneva
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - R E Batalov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - A I Mishkina
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - Y N Ilushenkova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - K V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - S V Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Cardiology Research Institute, Tomsk NRMC, Tomsk, Russian Federation
| | - A B Romanov
- E. Meshalkin National Medical Research Center Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
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15
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Kamada H, Mori K, Ueda N, Wakamiya A, Nakajima K, Kamakura T, Wada M, Ishibashi K, Yamagata K, Inoue Y, Miyamoto K, Nagase S, Noda T, Izumi C, Noguchi T, Kusano K, Aiba T. Impact of Pre-Ablation Direct Current Cardioversion for Persistent Atrial Fibrillation to Predict Recurrence of Atrial Fibrillation after Catheter Ablation. Int Heart J 2022; 63:828-836. [DOI: 10.1536/ihj.22-135] [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]
Affiliation(s)
- Hiroyuki Kamada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuki Mori
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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16
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Han W, Liu Y, Sha R, Liu H, Liu A, Maduray K, Ge J, Ma C, Zhong J. A prediction model of atrial fibrillation recurrence after first catheter ablation by a nomogram: HASBLP score. Front Cardiovasc Med 2022; 9:934664. [PMID: 36158848 PMCID: PMC9497656 DOI: 10.3389/fcvm.2022.934664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background At present, catheter ablation is an effective method for rhythm control in patients with atrial fibrillation (AF). However, AF recurrence is an inevitable problem after catheter ablation. To identify patients who are prone to relapse, we developed a predictive model that allows clinicians to closely monitor these patients and treat them with different personalized treatment plans. Materials and methods A total of 1,065 patients who underwent AF catheter ablation between January 2015 and December 2018 were consecutively included in this study, which examines the results of a 2-year follow-up. Patients with AF were divided into development cohort and validation cohort. Univariate and multivariate analyses were carried out on the potential risk factors. Specific risk factors were used to draw the nomogram according to the above results. Finally, we verified the performance of our model compared with CHADS2 and CHA2DS2-Vasc scores by receiver operating characteristic (ROC) curve and calibration curve and plotted the decision analysis curve (DAC). Results A total of 316 patients experienced AF recurrence. After univariate and multivariate analyses, AF history (H), age (A), snoring (S), body mass index (BMI) (B), anteroposterior diameter of left atrial (LA) (L), and persistent AF (P) were included in our prediction model. Our model showed a better performance compared with CHADS2 and CHA2DS2-Vasc scores, and the area under ROC curve (95%CI) was 0.7668 (0.7298–0.8037) vs. 0.6225 (0.5783–0.6666) and 0.6267 (0.5836–0.6717). Conclusion We established a nomogram (HASBLP score) for predicting AF recurrence after the first catheter ablation at a 2-year follow-up, which can be used as a tool to guide future follow-up of patients. However, its usefulness needs further validation.
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Affiliation(s)
- Wenqiang Han
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Liu
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Rina Sha
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Huiyu Liu
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Aihua Liu
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kellina Maduray
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Junye Ge
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanzhen Ma
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
- *Correspondence: Jingquan Zhong,
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Ilyushenkova J, Sazonova S, Popov E, Zavadovsky K, Batalov R, Archakov E, Moskovskih T, Popov S, Minin S, Romanov A. Radiomic phenotype of epicardial adipose tissue in the prognosis of atrial fibrillation recurrence after catheter ablation in patients with lone atrial fibrillation. J Arrhythm 2022; 38:682-693. [PMID: 36237852 PMCID: PMC9535779 DOI: 10.1002/joa3.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Epicardial adipose tissue (EAT) has been considered as one of the probable triggers of atrial fibrillation (AF). CT‐rediomics is a perspective noninvasive method of assessment of EAT. We evaluate the radiomic phenotype of EAT in patients with lone AF in the prognosis of AF recurrence after catheter ablation. Methods A total of 43 patients with lone AF referred for CA and 20 out‐hospital patients without arrhythmia underwent multidetector computed tomography coronary angiography. Segmentation of EAT and extraction radiomic features were performed on calcium scoring series using by 3D‐Slicer. Clinical follow‐up was performed for 12 months period after the CA. Results EAT in patients with lone AF had a distinct radiomic phenotype. Thus, 45 of 93 calculated radiomic features, volume and attenuation of EAT were significantly different between patients with lone AF and persons without any arrhythmia. In addition, 17 radiomic features were significantly different in subgroups with and without AF recurrence. Multivariate regression analysis demonstrated that only gray level nonuniformity normalized (GLSZM) was an independent predictor of AF recurrence (OR 1.0027, 95%CI 1.0009–1.0044, p = 0.002). ROC analysis data showed that GLSZM >1227.4 indicates high probability of AF recurrence during 12 months (sensitivity 89.4%, specificity 70.8%, AUC: 0.809; p = 0.001). Conclusion The radiomic parameter GLSZM is associated with late AF recurrence after CA in patients with lone AF. In current study GLSZM was a stronger predictor of lone AF recurrence in multivariate analysis comparing with other established risk factors and EAT volume and attenuation.
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Affiliation(s)
- Julia Ilyushenkova
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Svetlana Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Evgeny Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Konstantin Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Roman Batalov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Evgeny Archakov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Tatyana Moskovskih
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Sergey Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre Russian Academy of Sciences Tomsk Russian Federation
| | - Stanislav Minin
- E. Meshalkin National Medical Research Ministry of Health of the Russian Federation Novosibirsk Russian Federation
| | - Alexander Romanov
- E. Meshalkin National Medical Research Ministry of Health of the Russian Federation Novosibirsk Russian Federation
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Catheter ablation of atrial fibrillation: What we can say after more than 20 years of worldwide experience. Rev Port Cardiol 2022; 41:649-651. [DOI: 10.1016/j.repc.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Miki Y, Uchida Y, Tanaka A, Tobe A, Sakakibara K, Kataoka T, Niwa K, Furusawa K, Ichimiya H, Watanabe J, Kanashiro M, Ishii H, Ichimiya S, Murohara T. Clinical Significance of the Left Atrial Appendage Orifice Area. Intern Med 2022; 61:1801-1807. [PMID: 34776484 PMCID: PMC9259814 DOI: 10.2169/internalmedicine.8301-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. Methods A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, ≥median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. Results The median LAA orifice area among all patients was 4.09 cm2 (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. Conclusion Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice.
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Affiliation(s)
- Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
- Department of Cardiology, Yokkaichi Municipal Hospital, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Keisuke Sakakibara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, Japan
| | | | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Kawajiri K, Ihara K, Sasano T. Gene therapy to terminate tachyarrhythmias. Expert Rev Cardiovasc Ther 2022; 20:431-442. [PMID: 35655364 DOI: 10.1080/14779072.2022.2085686] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION To date, the treatment option for tachyarrhythmia is classified into drug therapy, catheter ablation, and implantable device therapy. However, the efficacy of the antiarrhythmic drugs is limited. Although the indication of catheter ablation is expanding, several fatal tachyarrhythmias are still refractory to ablation. Implantable cardioverter-defibrillator increases survival, but it is not a curable treatment. Therefore, a novel therapy for tachyarrhythmias refractory to present treatments is desired. Gene therapy is being developed as a promising candidate for this purpose, and basic research and translational research have been accumulated in recent years. AREAS COVERED This paper reviews the current state of gene therapy for arrhythmias, including susceptible arrhythmias, the route of administration to the heart, and the type of vector to use. We also discuss the latest progress in the technology of gene delivery and genome editing. EXPERT OPINION Gene therapy is one of the most promising technologies for arrhythmia treatment. However, additional technological innovation to achieve safe, localized, homogeneous, and long-lasting gene transfer is required for its clinical application.
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Affiliation(s)
- Kohei Kawajiri
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8519, Japan
| | - Kensuke Ihara
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8519, Japan
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21
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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Rizas KD, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Tsartsalis D, Sideris S, Dragioti E, Fragakis N, Chaimani A. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Med 2022; 20:193. [PMID: 35637488 PMCID: PMC9153169 DOI: 10.1186/s12916-022-02385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA). METHODS A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months. RESULTS In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38-0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41-0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68-0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11-0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed. CONCLUSIONS This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registry number: CRD42020169494 .
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Antonios P Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Konstantinos D Rizas
- Medizinische Klinik Und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ioan Liuba
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Almroth
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Skevos Sideris
- Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
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22
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Frontera A, Pagani S, Limite LR, Peirone A, Fioravanti F, Enache B, Cuellar Silva J, Vlachos K, Meyer C, Montesano G, Manzoni A, Dedé L, Quarteroni A, Lațcu DG, Rossi P, Della Bella P. Slow Conduction Corridors and Pivot Sites Characterize the Electrical Remodeling in Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:561-577. [PMID: 35589168 DOI: 10.1016/j.jacep.2022.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF). BACKGROUND Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression. METHODS High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: slow conductions corridors, defined as discrete areas of conduction velocity <50 cm/s, and pivot points, defined as sites showing high wave-front curvature documented by a curl module >2.5 1/s. RESULTS A progressive decrease of mean conduction velocity was recorded across the groups (111.6 ± 55.5 cm/s control subjects, 97.1 ± 56.3 cm/s PAF, and 84.7 ± 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 ± 2.2 control subjects, 13.3 ± 3.2 PAF, and 20.5 ± 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 ± 0.71 1/s PsAF vs 0.74 ± 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 ± 13.8 PsAF vs 9.5 ± 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra. CONCLUSIONS The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF.
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Affiliation(s)
- Antonio Frontera
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy.
| | - Stefano Pagani
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | | | - Andrea Peirone
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | | | | | - Jose Cuellar Silva
- University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | | | - Christian Meyer
- Division of Cardiology, Angiology, and Intensive Care, EVK Düsseldorf, University of Düsseldorf, Düsseldorf, Germany
| | - Giovanni Montesano
- Optometry and Vision Science - City, University of London, London, United Kingdom
| | - Andrea Manzoni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Luca Dedé
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy; Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Pietro Rossi
- San Giovanni Calibita Hospital, Fatebenefratelli, Rome, Italy
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23
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Gillis K, O'Neill L, Wielandts JY, Hilfiker G, Almorad A, Lycke M, El Haddad M, le Polain de Waroux JB, Tavernier R, Duytschaever M, Knecht S. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation. JACC Clin Electrophysiol 2022; 8:367-376. [PMID: 35331432 DOI: 10.1016/j.jacep.2021.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block. BACKGROUND Achieving MI block with the use of RF ablation is challenging. METHODS Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMFIRST group) vs RF ablation as a first step preceding VOMEt (RFFIRST group). The study end point was incidence of MI block after RF ablation and after the 2 steps. RESULTS In VOMFIRST, VOMEt was successful in 30/35 patients (86%) resulting in a low-voltage area of 12 ± 7.4 cm2 and MI block in 2/35 patients (6%). VOMFIRST, compared with RFFIRST, was associated with higher incidence of MI block after endocardial (46% vs 11%; P < 0.001) and epicardial ablation (94% vs 43%; P < 0.001), with fewer endocardial applications (4 vs 11 vs 4; P < 0.001) and similar epicardial applications (7 vs 8; P = 0.68). Incidence of MI block after the 2 steps was 94% vs 63% (P = 0.001) in VOMFIRST vs RFFIRST, respectively. Additional touch-up RF ablation in both groups resulted in final MI block in all but 1 patient (99%). CONCLUSIONS VOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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Affiliation(s)
- Kris Gillis
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
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24
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Muizniece L, Bertagnoli A, Qureshi A, Zeidan A, Roy A, Muffoletto M, Aslanidi O. Reinforcement Learning to Improve Image-Guidance of Ablation Therapy for Atrial Fibrillation. Front Physiol 2021; 12:733139. [PMID: 34512401 PMCID: PMC8424004 DOI: 10.3389/fphys.2021.733139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and currently affects more than 650,000 people in the United Kingdom alone. Catheter ablation (CA) is the only AF treatment with a long-term curative effect as it involves destroying arrhythmogenic tissue in the atria. However, its success rate is suboptimal, approximately 50% after a 2-year follow-up, and this high AF recurrence rate warrants significant improvements. Image-guidance of CA procedures have shown clinical promise, enabling the identification of key patient anatomical and pathological (such as fibrosis) features of atrial tissue, which require ablation. However, the latter approach still suffers from a lack of functional information and the need to interpret structures in the images by a clinician. Deep learning plays an increasingly important role in biomedicine, facilitating efficient diagnosis and treatment of clinical problems. This study applies deep reinforcement learning in combination with patient imaging (to provide structural information of the atria) and image-based modelling (to provide functional information) to design patient-specific CA strategies to guide clinicians and improve treatment success rates. To achieve this, patient-specific 2D left atrial (LA) models were derived from late-gadolinium enhancement (LGE) MRI scans of AF patients and were used to simulate patient-specific AF scenarios. Then a reinforcement Q-learning algorithm was created, where an ablating agent moved around the 2D LA, applying CA lesions to terminate AF and learning through feedback imposed by a reward policy. The agent achieved 84% success rate in terminating AF during training and 72% success rate in testing. Finally, AF recurrence rate was measured by attempting to re-initiate AF in the 2D atrial models after CA with 11% recurrence showing a great improvement on the existing therapies. Thus, reinforcement Q-learning algorithms can predict successful CA strategies from patient MRI data and help to improve the patient-specific guidance of CA therapy.
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Affiliation(s)
- Laila Muizniece
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Adrian Bertagnoli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Biomedical Engineering, ETH Zürich, Zürich, Switzerland
| | - Ahmed Qureshi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Aya Zeidan
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Aditi Roy
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Marica Muffoletto
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Oleg Aslanidi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
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25
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Seewöster T, Kosich F, Sommer P, Bertagnolli L, Hindricks G, Kornej J. Prediction of low-voltage areas using modified APPLE score. Europace 2021; 23:575-580. [PMID: 33279992 DOI: 10.1093/europace/euaa311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs. METHODS AND RESULTS In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233). CONCLUSION The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Falco Kosich
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Jelena Kornej
- School of Medicine-Cardiovascular Medicine, Boston University, 72 E Concord Street, Boston, MA 02118, USA
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26
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De Martino G, Compagnucci P, Mancusi C, Vassallo E, Calvanese C, Della Ratta G, Librera M, Franciulli M, Marino L, Russo AD, Casella M. Stepwise endo-/epicardial catheter ablation for atrial fibrillation: The Mediterranea approach. J Cardiovasc Electrophysiol 2021; 32:2107-2115. [PMID: 34216076 PMCID: PMC8457187 DOI: 10.1111/jce.15151] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Background Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. Objective We sought to evaluate the feasibility, effectiveness, and safety of a single‐stage stepwise endo‐/epicardial approach in patients with persistent/longstanding‐persistent AF. Methods We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding‐persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo‐/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3‐month blanking period. The secondary outcome was patients' symptom status during follow‐up. Results The stepwise endo‐/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow‐up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9‐month follow‐up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. Conclusion A single‐stage endo‐/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding‐persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
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Affiliation(s)
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
| | - Carmine Mancusi
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | - Enrico Vassallo
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | - Claudia Calvanese
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | | | | | | | - Luigi Marino
- Cardiac Surgery Unit, Mediterranea Hospital, Naples, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
| | - Michela Casella
- Department of Clinical, Special, and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
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27
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He SN, Tian Y, Shi L, Wang YJ, Xie BQ, Li XX, Zeng LJ, Yang XC, Liu XP. Identification of circumferential pulmonary vein isolation responders among patients with persistent atrial fibrillation: clinical value of the sequential low-dose ibutilide test. Europace 2021; 22:1197-1205. [PMID: 32514560 DOI: 10.1093/europace/euaa095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/24/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Circumferential pulmonary vein isolation can be effective as sole treatment for persistent atrial fibrillation. However, identifying those patients who will respond to this therapy remains a challenge. We investigated the clinical value of the sequential low-dose ibutilide test for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation is effective as sole therapy. METHODS AND RESULTS In a prospective cohort of 180 consecutive patients with persistent atrial fibrillation, intravenous low-dose (0.004 mg/kg) ibutilide was administered 3 days before ablation and after the completion of circumferential pulmonary vein isolation. In patients in whom ibutilide did not terminate atrial fibrillation pre-procedurally, but successfully terminated it intraprocedurally, no further atrial substrate modification was performed. Pre-procedural low-dose ibutilide failed to terminate the arrhythmia in all patients with persistent atrial fibrillation, while pulmonary vein isolation ± low-dose ibutilide terminated persistent atrial fibrillation in 55 (30.6%) of them (PsAF group 1). The remaining 125 (69.4%) patients underwent electrogram-based ablation (PsAF Group 2). The control group comprised 379 consecutive patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation over the same period. At 24 months follow-up, 39 (70.9%) patients in PsAF Group 1 and 276 (72.8%) patients in the control group were free from atrial tachyarrhythmias (P = NS); the arrhythmia-free rates in both groups were higher than that in PsAF group 2 (58.4%, P = 0.005). CONCLUSION The sequential low-dose ibutilide test is a simple method for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation alone is an appropriate treatment strategy.
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Affiliation(s)
- Shu-Nan He
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China.,Heart Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Liang Shi
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Yan-Jiang Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Bo-Qia Xie
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xue-Xun Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gong Ti Nan Road, Chaoyang District, Beijing 100020, China
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Murtaza G, Yarlagadda B, Akella K, Della Rocca DG, Gopinathannair R, Natale A, Lakkireddy D. Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond. Card Electrophysiol Clin 2021; 12:21-28. [PMID: 32067644 DOI: 10.1016/j.ccep.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The left atrial appendage (LAA) affects body homeostasis via atrial natriuretic peptide and the renin-angiotensin-aldosterone system and plays an important role in atrial compliance. Approximately 90% of clots in nonvalvular atrial fibrillation (AF) are formed in the LAA. AF is the most common sustained cardiac arrhythmia and is frequently associated with stroke. Because anticoagulation for stroke prophylaxis carries a higher bleeding risk, LAA closure via epicardial and endocardial approaches has gained popularity and is being increasingly pursued for arrhythmogenic, homeostatic, and stroke-reduction benefits. This review discusses the homeostatic role of the LAA and its involvement in arrhythmogenesis and thrombus formation.
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Affiliation(s)
- Ghulam Murtaza
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Bharath Yarlagadda
- Division of Cardiology, Department of Internal Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Krishna Akella
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Rakesh Gopinathannair
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA.
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29
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Gopinathannair R, Chen LY, Chung MK, Cornwell WK, Furie KL, Lakkireddy DR, Marrouche NF, Natale A, Olshansky B, Joglar JA. Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association. Circ Arrhythm Electrophysiol 2021; 14:HAE0000000000000078. [PMID: 34129347 DOI: 10.1161/hae.0000000000000078] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee's consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
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30
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Chen ZS, Tan HW, Song HM, Xu WJ, Liu XB. Impact of corrected sinus node recovery time in predicting recurrence in patients with paroxysmal atrial fibrillation. J Int Med Res 2021; 49:3000605211010103. [PMID: 33942630 PMCID: PMC8113929 DOI: 10.1177/03000605211010103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Atrial fibrillation (AF) and sinus node dysfunction (SND) have common
underlying pathophysiological mechanisms. As an index of SND, corrected
sinus node recovery time (CSNRT) may also reflect atrial function. The aim
of the present study was to determine whether CSNRT predicts AF recurrence
in patients undergoing AF ablation. Methods Consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent
radiofrequency catheter ablation between January 2017 and December 2018 were
enrolled. Clinical data, CSNRT, and other electrophysiology indices were
collected and analysed between patients with or without AF recurrence. Results A total of 159 patients with PAF who underwent the same radiofrequency
catheter ablation procedure were enrolled, including 25 patients with SND.
During the one-year follow-up period, 22 patients experienced AF recurrence.
Patients with recurrence had a significantly longer CSNRT and a larger left
atrial volume index (LAVI) than patients without AF recurrence. SND
(CSNRT > 550 ms) and a larger LAVI were independently associated with AF
recurrence after ablation. A statistically significant CSNRT cut-off value
of 550 ms predicted AF recurrence with 73% sensitivity and 85%
specificity. Conclusion CSNRT and LAVI are independent predictors of PAF recurrence following
ablation.
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Affiliation(s)
- Zhi-Song Chen
- Department of Cardiology, Tongji Hospital Affiliated to 12476Tongji University, Shanghai, China
| | - Hong-Wei Tan
- Department of Cardiology, Tongji Hospital Affiliated to 12476Tongji University, Shanghai, China
| | - Hao-Ming Song
- Department of Cardiology, Tongji Hospital Affiliated to 12476Tongji University, Shanghai, China
| | - Wen-Jun Xu
- Department of Cardiology, Tongji Hospital Affiliated to 12476Tongji University, Shanghai, China
| | - Xue-Bo Liu
- Department of Cardiology, Tongji Hospital Affiliated to 12476Tongji University, Shanghai, China
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31
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Salinet J, Molero R, Schlindwein FS, Karel J, Rodrigo M, Rojo-Álvarez JL, Berenfeld O, Climent AM, Zenger B, Vanheusden F, Paredes JGS, MacLeod R, Atienza F, Guillem MS, Cluitmans M, Bonizzi P. Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value. Front Physiol 2021; 12:653013. [PMID: 33995122 PMCID: PMC8120164 DOI: 10.3389/fphys.2021.653013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023] Open
Abstract
Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
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Affiliation(s)
- João Salinet
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rubén Molero
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, United Kingdom and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Joël Karel
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Miguel Rodrigo
- Electronic Engineering Department, Universitat de València, València, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematic Systems and Computation, University Rey Juan Carlos, Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI, United States
| | - Andreu M. Climent
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Brian Zenger
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Frederique Vanheusden
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Jimena Gabriela Siles Paredes
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rob MacLeod
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María S. Guillem
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
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32
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Kotalczyk A, Ding WY, Gupta D, Wright DJ, Lip GYH. Clinical outcomes following rhythm control for atrial fibrillation: is early better? Expert Rev Cardiovasc Ther 2021; 19:277-287. [PMID: 33715565 DOI: 10.1080/14779072.2021.1902307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF.Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy.Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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33
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D'Angelo RN, Rahman M, Khanna R, Yeh RW, Goldstein L, Yadalam S, Kalsekar I, Tung P, Zimetbaum PJ. Limited duration of antiarrhythmic drug use for newly diagnosed atrial fibrillation in a nationwide population under age 65. J Cardiovasc Electrophysiol 2021; 32:1529-1537. [PMID: 33760297 DOI: 10.1111/jce.15012] [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: 11/25/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Antiarrhythmic drugs (AADs) are commonly used for the treatment of newly diagnosed symptomatic atrial fibrillation (AF), however initial AAD choice, duration of therapy, rates of discontinuation, and factors associated with a durable response to therapy are poorly understood. This study assesses the initial choice and duration of antiarrhythmic drug therapy in the first 2 years after diagnosis of AF in a younger, commercially insured population. METHODS A large nationally representative sample of patients age 20-64 was studied using the IBM MarketScan Database. Patients who started an AAD within 90 days of AF diagnosis with continuous enrollment for 1-year pre-index diagnosis and 2 years post-index were included. A Cox proportional hazards model was used to determine factors associated with AAD discontinuation. RESULTS Flecainide was used most frequently (26.8%), followed by amiodarone (22.5%), dronedarone (18.3%), sotalol (15.8%), and propafenone (14.0%), with other AADs used less frequently. Twenty-two percent of patients who started on an AAD underwent ablation within 2 years, with 79% discontinuing the AAD after ablation. Ablation was the strongest predictor of AAD discontinuation (hazard ratio [HR], 1.70; 95% confidence interval [CI]: 1.61-1.80), followed by the male gender (HR, 1.10; CI: 1.02-1.19). Older patients (HR, 0.76; CI: 0.72-0.80; reference age 18-49) and those with comorbidities, including cardiomyopathy (HR, 075; CI: 0.61-0.91), diabetes (HR, 0.83; CI: 0.75-0.91), and hypertension (HR, 0.87; CI: 0.81-0.94) were less likely to discontinue AADs. CONCLUSION Only 31% of patients remained on the initial AAD at 2 years, with a mean duration of initial therapy 7.6 months before discontinuation.
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Affiliation(s)
- Robert N D'Angelo
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Motiur Rahman
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Rahul Khanna
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Goldstein
- Franchise Health Economics and Market Access, Johnson and Johnson, Irvine, California, USA
| | - Sashi Yadalam
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Iftekhar Kalsekar
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA.,Medical Safety, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Patricia Tung
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Marrouche NF, Greene T, Dean JM, Kholmovski EG, Boer LMD, Mansour M, Calkins H, Marchlinski F, Wilber D, Hindricks G, Mahnkopf C, Jais P, Sanders P, Brachmann J, Bax J, Dagher L, Wazni O, Akoum N. Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design. J Cardiovasc Electrophysiol 2021; 32:916-924. [PMID: 33600025 DOI: 10.1111/jce.14957] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Success rates of catheter ablation in persistent atrial fibrillation (AF) remain suboptimal. A better and more targeted ablation strategy is urgently needed to optimize outcomes of AF treatment. We sought to assess the safety and efficacy of targeting atrial fibrosis during ablation of persistent AF patients in improving procedural outcomes. METHODS The DECAAF II trial (ClinicalTrials. gov identifier number NCT02529319) is a prospective, randomized, multicenter trial of patients with persistent AF. Patients with persistent AF undergoing a first-time ablation procedure were randomized in a 1:1 fashion to receive conventional pulmonary vein isolation (PVI) ablation (Group 1) or PVI + fibrosis-guided ablation (Group 2). Left atrial fibrosis and ablation induced scarring were defined by late gadolinium enhancement magnetic resonance imaging at baseline and at 3-12 months postablation, respectively. The primary endpoint is the recurrence of atrial arrhythmia postablation, including atrial fibrillation, atrial flutter, or atrial tachycardia after the 90-day postablation blanking period. Patients were followed for a period of 12-18 months with a smartphone ECG Device (ECG Check Device, Cardiac Designs Inc.). With an anticipated enrollment of 900 patients, this study has an 80% power to detect a 26% reduction in the hazard ratio of the primary endpoint. RESULTS AND CONCLUSION The DECAAF II trial is the first prospective, randomized, multicenter trial of patients with persistent AF using imaging defined atrial fibrosis as a treatment target. The trial will help define an optimal approach to catheter ablation of persistent AF, further our understanding of influencers of ablation lesion formation, and refine selection criteria for ablation based on atrial myopathy burden.
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Affiliation(s)
- Nassir F Marrouche
- Department of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tom Greene
- University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Moussa Mansour
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hugh Calkins
- Department of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Francis Marchlinski
- Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Wilber
- Department of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | | | | | - Pierre Jais
- Department of Cardiology, Segalen University, Bordeaux, France
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | | | - Jereon Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lilas Dagher
- Department of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Oussama Wazni
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nazem Akoum
- Department of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Matteucci F, Maesen B, De Asmundis C, Parise G, Micali LR, Tuijthof G, Gerits P, Vernooy K, Maessen JG, La Meir M, Gelsomino S. New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:181-187. [PMID: 33410714 PMCID: PMC8108111 DOI: 10.1177/1556984520981025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To evaluate the size and depth of linear lesions by in vitro testing with a custom-made radio frequency biparietal bipolar ablation catheter in a single-stage setting. Methods A custom-made catheter was created to generate linear lesions around the left atrium and pulmonary veins of an ex vivo pig. Two frames were made, 1 epicardial and 1 endocardial. A continuous copper braid electrode and an alignment system consisting of 2 parallel rows of neodymium magnets were embedded in a flexible plastic support. After 24 hours of formalin conservation, samples of the left atrium of a freshly slaughtered pig were sliced in a cryotome, thus obtaining a sequence of 100-µm thick layers extending from the endocardial to the epicardial side. After being digitized through a scanner, these layers were evaluated using morphometric computer software. For each slice, we evaluated the maximum length of the lesions, the maximum epicardial length, the maximum endocardial length, the total area of the lesion, and the total volume. Results Forty transmural lesions from 40 specimens were obtained. The results were the following (the number in parenthesis is the interquartile range in mm): lesion maximum length (LMAX) was 7.297 mm (0.006), epicardial maximum length (LEPI) was 7.291 mm (0.014), and endocardial maximum length was 7.291 mm (0.018). The total area and total volume were 1018.50 ± 36.51 mm2 and 101.85 ± 3.65 mm3, respectively. Conclusions Our prototype showed very promising results. The next step will be to enhance the design for clinical application.
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Affiliation(s)
- Francesco Matteucci
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart Maesen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Carlo De Asmundis
- 60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Gianmarco Parise
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Renata Micali
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabrielle Tuijthof
- 5211 IDEE Engineering, Maastricht University, Maastricht, The Netherlands
| | - Peter Gerits
- 118066 Maastricht Instruments BV, Maastricht, The Netherlands
| | - Kevin Vernooy
- 5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Jos G Maessen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Mark La Meir
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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36
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Ha ACT, Wijeysundera HC, Qiu F, Henning K, Ahmad K, Angaran P, Birnie DH, Crystal E, Ha AH, Healey JS, Leong-Sit P, Makanjee B, Nery PB, Redfearn DP, Skanes AC, Verma A. Differences in Healthcare Use Between Patients With Persistent and Paroxysmal Atrial Fibrillation Undergoing Catheter-Based Atrial Fibrillation Ablation: A Population-Based Cohort Study From Ontario, Canada. J Am Heart Assoc 2020; 10:e016071. [PMID: 33381975 PMCID: PMC7955473 DOI: 10.1161/jaha.120.016071] [Citation(s) in RCA: 2] [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] [Indexed: 12/27/2022]
Abstract
Background Patients with persistent atrial fibrillation (AF) undergoing catheter-based AF ablation have lower success rates than those with paroxysmal AF. We compared healthcare use and clinical outcomes between patients according to their AF subtypes. Methods and Results Consecutive patients undergoing AF ablation were prospectively identified from a population-based registry in Ontario, Canada. Via linkage with administrative databases, we performed a retrospective analysis comparing the following outcomes between patients with persistent and paroxysmal AF: healthcare use (defined as AF-related hospitalizations/emergency room visits), periprocedural complications, and mortality. Multivariable Poisson modeling was performed to compare the rates of AF-related and all-cause hospitalizations/emergency room visits in the year before versus after ablation. Between April 2012 and March 2016, there were 3768 consecutive patients who underwent first-time AF ablation, of whom 1040 (27.6%) had persistent AF. The mean follow-up was 1329 days. Patients with persistent AF had higher risk of AF-related hospitalization/emergency room visits (hazard ratio [HR], 1.21; 95% CI, 1.09-1.34), mortality (HR, 1.74; 95% CI, 1.15-2.63), and periprocedural complications (odds ratio, 1.36; 95% CI, 1.02-1.75) than those with paroxysmal AF. In the overall cohort, there was a 48% reduction in the rate of AF-related hospitalization/emergency room visits in the year after versus before ablation (rate ratio [RR], 0.52; 95% CI, 0.48-0.56). This reduction was observed for patients with paroxysmal (RR, 0.45; 95% CI, 0.41-0.50) and persistent (RR, 0.74; 95% CI, 0.63-0.87) AF. Conclusions Although patients with persistent AF had higher risk of adverse outcomes than those with paroxysmal AF, ablation was associated with a favorable reduction in downstream AF-related healthcare use, irrespective of AF type.
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Affiliation(s)
- Andrew C T Ha
- Department of Medicine University of Toronto Ontario Canada.,Peter Munk Cardiac CentreToronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Department of Medicine University of Toronto Ontario Canada.,Sunnybrook Health Sciences Centre Toronto Ontario Canada.,ICES Toronto Ontario Canada
| | | | | | - Kamran Ahmad
- Department of Medicine University of Toronto Ontario Canada.,St. Michael's HospitalUnity Health Toronto Toronto Ontario Canada
| | - Paul Angaran
- Department of Medicine University of Toronto Ontario Canada.,St. Michael's HospitalUnity Health Toronto Toronto Ontario Canada
| | - David H Birnie
- University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Eugene Crystal
- Department of Medicine University of Toronto Ontario Canada.,Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Andrew H Ha
- Trillium Health Partners Mississauga Ontario Canada
| | - Jeff S Healey
- Department of Medicine Hamilton Health Sciences Population Health Research Institute McMaster University Hamilton Ontario Canada
| | - Peter Leong-Sit
- Division of Cardiology Western UniversityLondon Health Sciences Centre London Ontario Canada
| | | | - Pablo B Nery
- University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Damian P Redfearn
- Division of Cardiology Kingston General HospitalQueen's University Kingston Ontario Canada
| | - Allan C Skanes
- Division of Cardiology Western UniversityLondon Health Sciences Centre London Ontario Canada
| | - Atul Verma
- Department of Medicine University of Toronto Ontario Canada.,Southlake Regional Health Centre Newmarket Ontario Canada
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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38
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Natale A, Calkins H, Osorio J, Pollak SJ, Melby D, Marchlinski FE, Athill CA, Delaughter C, Patel AM, Gentlesk PJ, DeVille B, Macle L, Ellenbogen KA, Dukkipati SR, Reddy VY, Mansour M. Positive Clinical Benefit on Patient Care, Quality of Life, and Symptoms After Contact Force-Guided Radiofrequency Ablation in Persistent Atrial Fibrillation: Analyses From the PRECEPT Prospective Multicenter Study. Circ Arrhythm Electrophysiol 2020; 14:e008867. [PMID: 33290093 DOI: 10.1161/circep.120.008867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited evidence on the long-term clinical benefits of catheter ablation in patients with persistent atrial fibrillation. METHODS PRECEPT was a prospective, multicenter, single-arm Food and Drug Administration-regulated investigational device exemption clinical study. Patients were followed up to 15 months after ablation. Outcomes included use of antiarrhythmic drugs, rate of cardioversions and cardiovascular hospitalization, Atrial Fibrillation Effect on Quality-of-Life score, and Canadian Cardiovascular Society Severity of Atrial Fibrillation score. RESULTS A total of 333 enrolled persistent atrial fibrillation patients underwent ablation. The cardioversion rate decreased by 83% at the 9- to 15-month follow-up. Antiarrhythmic drug utilization decreased by 69% at 12 to 15 months post-ablation. The Kaplan-Meier estimate of freedom from cardiovascular hospitalization was 84.2% (95% CI, 80.2%-88.2%) at 15 months. Consistent improvements in mean Atrial Fibrillation Effect on Quality-of-Life composite (+50.0) were seen at 6 months, sustained at 15 months, and exceeded the minimum clinically important difference. Improvements in Atrial Fibrillation Effect on Quality-of-Life scores were significantly better among participants without documented atrial arrhythmia recurrences. By Canadian Cardiovascular Society Severity of Atrial Fibrillation symptom classification, >80% of patients were asymptomatic (class 0) at 15 months post-ablation compared with only 0.7% at baseline. CONCLUSIONS Contact force-guided radiofrequency ablation of persistent atrial fibrillation was associated with a significant decrease in antiarrhythmic drug use, cardioversion rate, and hospitalization. Clinically meaningful improvements in quality of life were observed in all patients. The majority of the patients (>80%) were asymptomatic at 15 months post-ablation. The positive clinical impact of improved quality of life and reduced health care utilization may help with shared decision-making in persistent atrial fibrillation treatment. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02817776.
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Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Research Foundation, Austin (A.N.)
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, AL (J.O.)
| | - Scott J Pollak
- Florida Hospital Cardiovascular Institute, Orlando (S.J.P.)
| | | | | | | | - Craig Delaughter
- Baylor Scott & White Heart and Vascular Hospital, Fort Worth, TX (C.D.)
| | | | | | | | | | | | | | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY (S.R.D., V.Y.R.)
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Ciconte G, Vicedomini G, Li W, Mangual JO, McSpadden L, Ryu K, Saviano M, Vitale R, Conti M, Ćalović Ž, Santinelli V, Pappone C. Non-paroxysmal atrial fibrillation mapping: characterization of the electrophysiological substrate using a novel integrated mapping technique. Europace 2020; 21:1193-1202. [PMID: 31056645 DOI: 10.1093/europace/euz123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/12/2019] [Indexed: 01/05/2023] Open
Abstract
AIMS Clinical outcomes after radiofrequency catheter ablation (RFCA) remain suboptimal in the treatment of non-paroxysmal atrial fibrillation (AF). Electrophysiological mapping may improve understanding of the underlying mechanisms. To describe the arrhythmia substrate in patients with persistent (Pers) and long-standing persistent (LSPers) AF, undergoing RFCA, using an integrated mechanism mapping technique. METHODS AND RESULTS Patients underwent high-density electroanatomical mapping before and after catheter ablation. Integrated maps characterized electrogram (EGM) cycle length (CL) in regions with repetitive-regular (RR) activations, stable wavefront propagation, fragmentation, and peak-to-peak bipolar voltage. Among 83 patients (72% male, 60 ± 11 years old), RR activations were identified in 376 regions (mean CL 180 ± 31 ms). PersAF patients (n = 43) showed more RR sites per patient (5.3 ± 2.4 vs. 3.7 ± 2.1, P = 0.002) with faster CL (166 ± 29 vs. 190 ± 29 ms; P < 0.001) and smaller surface area of fragmented EGMs (15 ± 14% vs. 27 ± 17%, P < 0.001) compared with LSPersAF. The post-ablation map in 50 patients remaining in AF, documented reduction of the RR activities per patient (1.5 ± 0.7 vs. 3.7 ± 1.4, P < 0.001) and area of fragmentation (22 ± 17% vs. 8 ± 9%, P < 0.001). Atrial fibrillation termination during ablation occurred at RR sites (0.48 ± 0.24 mV; 170.5 ± 20.2 ms CL) in 31/33 patients (94%). At the latest follow-up, arrhythmia freedom was higher among patients receiving ablation >75% of RR sites (Q4 82.6%, Q3 63.1%, Q2 35.1%, and Q1 0%; P < 0.001). CONCLUSION The integrated mapping technique allowed characterization of multiple arrhythmic substrates in non-paroxysmal AF patients. This technique might serve as tool for a substrate-targeted ablation approach.
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Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Wenwen Li
- Applied Research, Abbott, Sylmar, CA, USA
| | | | | | | | - Massimo Saviano
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Raffaele Vitale
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Manuel Conti
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
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Charitakis E, Karlsson LO, Rizas K, Almroth H, Hassel Jönsson A, Schweiler J, Sideris S, Tsartsalis D, Dragioti E, Chaimani A. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: protocol of a network meta-analysis of randomised controlled trials. BMJ Open 2020; 10:e041819. [PMID: 33234655 PMCID: PMC7684831 DOI: 10.1136/bmjopen-2020-041819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter ablation (CA) of AF is an increasingly offered therapeutic approach, primary to relieve AF-related symptoms. Despite the development of new ablation approaches, there is no consensus regarding the most efficient ablation strategy. The objective of this network meta-analysis (NMA) is to compare the efficacy and safety of all different CA approaches for the treatment of patients with paroxysmal (PAF) and non-PAF (non-PAF). METHODS AND ANALYSIS We will perform a systematic search to identify randomised controlled trials of different CA approaches for the treatment of PAF and non-PAF, through the final search date of 1 March 2020. Information sources will include major bibliographic databases (MEDLINE, Web of Science and CENTRAL) and clinical trial registries. Our primary outcomes will be the efficacy (recurrence-free survival) and safety of different CA approaches for the treatment of AF. Secondary outcomes will be all-cause mortality and procedural time. An NMA will be performed to determine the relative effects of different catheter ablation approaches (such as pulmonary vein isolation alone or in combination with ablation lines, ablation of complex fractionated atrial electrograms, etc). In PAF, a separate analysis will be performed including different energy sources (such as radiofrequency, cryogenic and laser energy). Risk of bias assessment and sensitivity analyses will be conducted to assess the robustness of the findings to potential bias. ETHICS AND DISSEMINATION No ethical approval will be needed because data are collected from previous studies. The results will be presented through peer-review journals and conference presentation. PROSPERO REGISTRATION NUMBER CRD42020169494.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
| | | | - Henrik Almroth
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
| | - Jonas Schweiler
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Dimitrios Tsartsalis
- Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Center and Department of Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), Univeristé de Paris, Paris, Île-de-France, France
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Boersma L, Rienstra M, de Groot JR. Therapeutic options for patients with advanced atrial fibrillation: from lifestyle and medication to catheter and surgical ablation. Neth Heart J 2020; 28:13-18. [PMID: 32780326 PMCID: PMC7419415 DOI: 10.1007/s12471-020-01447-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Atrial fibrillation (AF) is part of a vicious cycle that includes multiple cardiovascular risk factors and comorbidity which can promote atrial remodelling and AF progression. Most AF-related risk factors—hypertension, diabetes, sleep apnoea, obesity and sedentary lifestyle—are in essence modifiable which may prevent AF development. Treatment of associated cardiovascular conditions may prevent both symptoms and future cardiovascular events. For advanced forms of symptomatic AF refractory to lifestyle management and optimal medication, invasive ablation therapies have become a cornerstone. Although electrical trigger isolation from the pulmonary veins is reasonably effective and safe, more potent energy sources including high output-short duration radiofrequency, ultra-low cryo-energy, and electroporation, as well as more sophisticated arrays, balloons, and lattice-tipped catheter tools, are on their way to eliminate existing pitfalls and simplify the procedure. Electroanatomical navigation and mapping systems are becoming available to provide real-time information on ablation lesion quality and the critical pathways of AF in the individual patient to guide more extensive ablation strategies that may enhance long-term outcome for freedom of advanced AF. Surgical techniques, either stand-alone or concomitant to structural cardiac repair, hybrid, or convergent, with novel less invasive access options are developing and can be helpful in situations unsuitable for catheter ablation.
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Affiliation(s)
- L Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J R de Groot
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Impact of obesity on atrial fibrillation ablation. Arch Cardiovasc Dis 2020; 113:551-563. [PMID: 32753124 DOI: 10.1016/j.acvd.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
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Mansour M, Calkins H, Osorio J, Pollak SJ, Melby D, Marchlinski FE, Athill CA, Delaughter C, Patel AM, Gentlesk PJ, DeVille B, Macle L, Ellenbogen KA, Dukkipati SR, Reddy VY, Natale A. Persistent Atrial Fibrillation Ablation With Contact Force–Sensing Catheter. JACC Clin Electrophysiol 2020; 6:958-969. [DOI: 10.1016/j.jacep.2020.04.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
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Liu H, Yuan P, Zhu X, Fu L, Hong K, Hu J. Is Atrial Fibrillation Noninducibility by Burst Pacing After Catheter Ablation Associated With Reduced Clinical Recurrence?: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e015260. [PMID: 32654581 PMCID: PMC7660710 DOI: 10.1161/jaha.119.015260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background To date, there is no cumulative evidence supporting the association of atrial fibrillation (AF) noninducibility after ablation and freedom from AF. We performed a systematic review and meta‐analysis to determine whether AF noninducibility by burst pacing after catheter ablation is associated with reduced AF recurrence. Methods and Results We searched PubMed, Embase, Web of Science, and Cochrane Library databases through July 2019 to identify studies that evaluated AF noninducibility versus inducibility by burst pacing after catheter ablation for freedom from AF. A fixed effects model was used to estimate relative risk (RR) with 95% CIs. Twelve prospective cohort studies with AF noninducibility (n=1612) and inducibility (n=1160) were included. Compared with AF inducibility, AF noninducibility by burst pacing after ablation was associated with a reduced risk of AF recurrence (RR, 0.68; 95% CI, 0.60–0.77). Subgroup analysis showed that different AF types (paroxysmal AF and nonparoxysmal AF), different follow‐up times (≤6, 6–12, and >12 months), and different degrees of burst pacing (mild, moderate, severe) had no significant impact on the RRs. However, different cut‐off times for AF inducibility had a significant impact on the RR (Pinteraction=0.009), and only the cut‐off time of 1 minute showed a significant correlation (RR, 0.54; 95% CI, 0.45–0.66). Conclusions AF noninducibility by burst pacing after catheter ablation is associated with reduced clinical recurrence of AF. Induction protocols with a different cut‐off time for AF inducibility have a significant impact on the correlation, and the AF ≥1 minute for AF inducibility is recommended.
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Affiliation(s)
- Hualong Liu
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ping Yuan
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Xin Zhu
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Linghua Fu
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Kui Hong
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.,Jiangxi Key Laboratory of Molecular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jinzhu Hu
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
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Berlin S, Goette A, Summo L, Lossie J, Gebauer A, Al-Saady N, Calo L, Naccarelli G, Schunck WH, Fischer R, Camm AJ, Dobrev D. Assessment of OMT-28, a synthetic analog of omega-3 epoxyeicosanoids, in patients with persistent atrial fibrillation: Rationale and design of the PROMISE-AF phase II study. IJC HEART & VASCULATURE 2020; 29:100573. [PMID: 32685659 PMCID: PMC7356118 DOI: 10.1016/j.ijcha.2020.100573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
We designed a placebo controlled, double-blind, randomized, dose-finding phase II study on OMT-28 in the maintenance of sinus rhythm after electrical cardioversion (DCC) in patients with persistent atrial fibrillation (PROMISE-AF). OMT-28 is a first-in-class, synthetic analog of 17,18-epoxyeicosatetetraenoic acid, a bioactive lipid mediator generated by cytochrome P450 enzymes from the omega-3 fatty acid eicosapentaenoic acid. OMT-28 improves Ca2+-handling and mitochondrial function in cardiomyocytes and reduces pro-inflammatory signaling. This unique mode of action may provide a novel approach to target key mechanism contributing to AF pathophysiology. In a recent phase I study, OMT-28 was safe and well tolerated and showed favorable pharmacokinetics. The PROMISE-AF study (NCT03906799) is designed to assess the efficacy (primary objective), safety, and population pharmacokinetics (secondary objectives) of three different doses of OMT-28, administered once daily, versus placebo until the end of the follow-up period. Recruitment started in March 2019 and the study will include a total of 120 patients. The primary efficacy endpoint is the AF burden (% time with any AF), evaluated over a 13-week treatment period after DCC. AF burden is calculated based on continuous ECG monitoring using an insertable cardiac monitor (ICM). The primary efficacy analysis will be conducted on the modified intention-to-treat (mITT) population, whereas the safety analysis will be done on the safety population. Although ICMs have been used in other interventional studies to assess arrhythmia, PROMISE-AF will be the first study to assess antiarrhythmic efficacy and safety of a novel rhythm-stabilizing drug after DCC by using ICMs.
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Affiliation(s)
| | - Andreas Goette
- Cardiology and Intensive Care Medicine, St. Vincenz-Hospital, Paderborn, Germany.,Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | | | | | | | - Leonardo Calo
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy
| | - Gerald Naccarelli
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | - A John Camm
- St. George's University of London, London, United Kingdom
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
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Lai D, Ding F, Xie C, Zhang Y. An Adaptive Respiratory Motion Compensation Algorithm with Singular Value Decomposition for Intracardiac Catheter Tracking . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5065-5068. [PMID: 33019125 DOI: 10.1109/embc44109.2020.9176152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During radiofrequency catheterization for atrial fibrillation, how to accurately obtain non-X-ray intracardiac catheter position is crucial to successful endocardial mapping and ablation treatment. The major limitation of the cost-effective intracardiac catheter tracking with transthoracic electrical-fields is that the distribution of electrical conductivity within the volume torso remains dynamics and nonlinear and changes with the patient's respiratory motion. Studies have shown respiratory motion-induced catheter localization error over 20 mm. In this study, we present a novel adaptive respiratory motion compensation algorithm with singular value decomposition for reducing the interference of respiration to ensure the accuracy of intracardiac catheter localization. Animal experiments in swine were carried out for assessing the performance of the propose method through a comparison with a traditional filtering method. The obtained results demonstrate that the proposed adaptive filter based on the SVD performed well to track the original information of catheter position by accurately and timely removing the respiratory interference in case of either a fast- or slow- moving catheter operation. Future applications of this algorithm would be potentially useful for intracardiac catheter localization and real-time tracking.
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Ang YS, Rajamani S, Haldar SM, Hüser J. A New Therapeutic Framework for Atrial Fibrillation Drug Development. Circ Res 2020; 127:184-201. [DOI: 10.1161/circresaha.120.316576] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia and cause of significant morbidity and mortality. Its increasing prevalence in aging societies constitutes a growing challenge to global healthcare systems. Despite substantial unmet needs in AF prevention and treatment, drug developments hitherto have been challenging, and the current pharmaceutical pipeline is nearly empty. In this review, we argue that current drugs for AF are inadequate because of an oversimplified system for patient classification and the development of drugs that do not interdict underlying disease mechanisms. We posit that an improved understanding of AF molecular pathophysiology related to the continuous identification of novel disease-modifying drug targets and an increased appreciation of patient heterogeneity provide a new framework to personalize AF drug development. Together with recent innovations in diagnostics, remote rhythm monitoring, and big data capabilities, we anticipate that adoption of a new framework for patient subsegmentation based on pathophysiological, genetic, and molecular subsets will improve success rates of clinical trials and advance drugs that reduce the individual patient and public health burden of AF.
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Affiliation(s)
- Yen-Sin Ang
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
| | - Sridharan Rajamani
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
| | - Saptarsi M. Haldar
- From Amgen Research, Cardiometabolic Disorders, South San Francisco, CA (Y.-S.A., S.R., S.M.H.)
- Gladstone Institutes, San Francisco, CA (S.M.H.)
- Department of Medicine, Cardiology Division, UCSF School of Medicine, San Francisco, CA (S.M.H.)
| | - Jörg Hüser
- Bayer AG, Pharma-RD-PCR TA Cardiovascular Disease, Wuppertal, Germany (J.H.)
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A novel framework for noninvasive analysis of short-term atrial activity dynamics during persistent atrial fibrillation. Med Biol Eng Comput 2020; 58:1933-1945. [PMID: 32535735 PMCID: PMC7417421 DOI: 10.1007/s11517-020-02190-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/14/2020] [Indexed: 10/25/2022]
Abstract
ECG-based representation of atrial fibrillation (AF) progression is currently limited. We propose a novel framework for a more sensitive noninvasive characterization of the AF substrate during persistent AF. An atrial activity (AA) recurrence signal is computed from body surface potential map (BSPM) recordings, and a set of characteristic indices is derived from it which captures the short- and long-term recurrent behaviour in the AA patterns. A novel measure of short- and long-term spatial variability of AA propagation is introduced, to provide an interpretation of the above indices, and to test the hypothesis that the variability in the oscillatory content of AA is due mainly to a spatially uncoordinated propagation of the AF waveforms. A simple model of atrial signal dynamics is proposed to confirm this hypothesis, and to investigate a possible influence of the AF substrate on the short-term recurrent behaviour of AA propagation. Results confirm the hypothesis, with the model also revealing the above influence. Once the characteristic indices are normalized to remove this influence, they show to be significantly associated with AF recurrence 4 to 6 weeks after electrical cardioversion. Therefore, the proposed framework improves noninvasive AF substrate characterization in patients with a very similar substrate. Graphical Abstract Schematic representation of the proposed framework for the noninvasive characterization of short-term atrial signal dynamics during persistent AF. The proposed framework shows that the faster the AA is propagating, the more stable its propagation paths are in the short-term (larger values of Speed in the bottom right plot should be interpreted as lower speed of propagation of the corresponding AA propagation patters).
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Wijesuriya N, Papageorgiou N, Maclean E, Saberwal B, Ahsan S. The Role of the Electrophysiologist in Convergent Ablation. Arrhythm Electrophysiol Rev 2020; 9:8-14. [PMID: 32637114 PMCID: PMC7330726 DOI: 10.15420/aer.2019.06] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.
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Affiliation(s)
| | | | - Edd Maclean
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Bunny Saberwal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Syed Ahsan
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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50
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Kashou AH, DeSimone CV, Asirvatham SJ, Kapa S. Left atrial dissection as a trigger for recurrent atrial fibrillation. HeartRhythm Case Rep 2020; 6:329-333. [PMID: 32577388 PMCID: PMC7300347 DOI: 10.1016/j.hrcr.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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