1
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
Collapse
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
2
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
Collapse
Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
3
|
Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
Collapse
Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
4
|
Chen S, Wang Z, Xuan F, Liang M, Jin Z, Ding J, Sun M, Zhang P, Han Y. One-year outcomes of wide antral cryoballoon ablation guided by high-density mapping vs. conventional cryoballoon ablation for atrial fibrillation: a propensity score-matched study. Front Cardiovasc Med 2024; 11:1327639. [PMID: 38361587 PMCID: PMC10867262 DOI: 10.3389/fcvm.2024.1327639] [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: 10/25/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Background Pulmonary vein isolation with wide antral ablation leads to better clinical outcomes for the treatment of atrial fibrillation, but the isolation lesion is invisible in conventional cryoballoon ablation. In this study, we aim to investigate the efficacy of the wide pulmonary vein isolation technique that includes the intervenous carina region, guided by high-density mapping, compared with pulmonary vein isolation alone without the mapping system. Methods We conducted a propensity score-matched comparison of 74 patients who underwent a wide cryoballoon ablation guided by high-density mapping (mapping group) and 74 controls who underwent conventional cryoballoon ablation in the same period (no-mapping group). The primary outcome was a clinical recurrence of documented atrial arrhythmias for >30 s during the 1-year follow-up. Results Of 74 patients in the mapping group, residual local potential in the pulmonary vein antrum was found in 30 (40.5%) patients, and additional cryothermal applications were performed to achieve a wide pulmonary vein isolation. Compared with the no-mapping group, the use of the mapping system in the mapping group was associated with a longer fluoroscopic time (26.97 ± 8.07 min vs. 23.76 ± 8.36 min, P = 0.023) and greater fluoroscopic exposure [339 (IQR181-586) mGy vs. 224 (IQR133-409) mGy, P = 0.012]. However, no significant differences between the two groups were found in terms of procedural duration and left atrial dwell time (104.10 ± 18.76 min vs. 102.45 ± 21.01 min, P = 0.619; 83.52 ± 17.01 min vs. 79.59 ± 17.96 min, P = 0.177). The rate of 12-month freedom from clinical atrial arrhythmia recurrence was 85.1% in the mapping group and 70.3% in the no-mapping group (log-rank P = 0.029). Conclusion Voltage and pulmonary vein potential mapping after cryoballoon pulmonary vein isolation can identify residual potential in the pulmonary vein antrum, and additional cryoablation guided by mapping leads to improved freedom from atrial arrhythmias compared with conventional pulmonary vein isolation without the mapping system. Clinical Trial Registration Number ChiCTR2200064383.
Collapse
Affiliation(s)
- Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Fengqi Xuan
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Ming Liang
- 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
| | - Jian Ding
- 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
| | - Ping Zhang
- 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
| |
Collapse
|
5
|
Rottner L, Metzner A. Atrial Fibrillation Ablation: Current Practice and Future Perspectives. J Clin Med 2023; 12:7556. [PMID: 38137626 PMCID: PMC10743921 DOI: 10.3390/jcm12247556] [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: 11/14/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Catheter ablation to perform pulmonary vein isolation (PVI) is established as a mainstay in rhythm control of atrial fibrillation (AF). The aim of this review is to provide an overview of current practice and future perspectives in AF ablation. The main clinical benefit of AF ablation is the reduction of arrhythmia-related symptoms and improvement of quality of life. Catheter ablation of AF is recommended, in general, as a second-line therapy for patients with symptomatic paroxysmal or persistent AF, who have failed or are intolerant to pharmacological therapy. In selected patients with heart failure and reduced left-ventricular fraction, catheter ablation was proven to reduce all-cause mortality. Also, optimal management of comorbidities can reduce AF recurrence after AF ablation; therefore, multimodal risk assessment and therapy are mandatory. To date, the primary ablation tool in widespread use is still single-tip catheter radiofrequency (RF) based ablation. Additionally, balloon-based pulmonary vein isolation (PVI) has gained prominence, especially due to its user-friendly nature and established safety and efficacy profile. So far, the cryoballoon (CB) is the most studied single-shot device. CB-based PVI is characterized by high efficiency, convincing success rates, and a beneficial safety profile. Recently, CB-PVI as a first-line therapy for AF was shown to be superior to pharmacological treatment in terms of efficacy and was shown to reduce progression from paroxysmal to persistent AF. In this context, CB-based PVI gains more and more importance as a first-line treatment choice. Non-thermal energy sources, namely pulsed-field ablation (PFA), have garnered attention due to their cardioselectivity. Although initially applied via a basket-like ablation tool, recent developments allow for point-by-point ablation, particularly with the advent of a novel lattice tip catheter.
Collapse
Affiliation(s)
- Laura Rottner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| |
Collapse
|
6
|
Zormpas C, Hillmann HAK, Hohmann S, Müller-Leisse J, Eiringhaus J, Veltmann C, Potter TD, Garcia R, Kosiuk J, Duncker D. Utilization of 3D mapping systems in interventional electrophysiology and its impact on procedure time and fluoroscopy-Insights from the "Go for Zero Fluoroscopy" project. Pacing Clin Electrophysiol 2023; 46:875-881. [PMID: 37483154 DOI: 10.1111/pace.14788] [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: 03/20/2023] [Revised: 06/11/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Abstract
AIM The implementation of 3D mapping systems plays an important role in interventional electrophysiology (EP) in recent years. The aim of the present study was to evaluate use of 3D mapping systems regarding fluoroscopy and procedure duration. METHOD In the "Go for Zero Fluoroscopy" project 25 European centers provided data of consecutive EP procedures. Data on use of 3D mapping systems as well as utilization of contact force catheters and multipolar mapping catheters were associated with fluoroscopy time, dose area product (DAP), and procedure duration. RESULT A 3D mapping system was used in 966 (54%) cases. Use of 3D mapping for atrioventricular nodal reentry tachycardia (AVNRT) was associated with reduced fluoroscopy time (p < 0.001), DAP (p = 0.04) but increased procedure time (p = 0.029). Moreover, fluoroscopy time (p < 0.001) and DAP (p = 0.005) were significantly lower in the 3D mapping group in ablation of typical atrial flutter. However, the procedure time (p < 0.001) increased. Use of 3D mapping in the ablation of accessory pathway (AP) was associated with reduced fluoroscopy time (p < 0.001) and DAP (p < 0.001) with no significant increase in procedure time (p = 0.066). In the case of atrial fibrillation, a 3D mapping system was used in 485 patients (75.8%). Additional use of a contact force catheter was associated with lower fluoroscopy time (p < 0.001) and DAP (p < 0.001). Use of a multipolar mapping catheter was associated with lower fluoroscopy time (p = 0.002). The implementation of 3D mapping systems in the ablation of ventricular tachycardias resulted in a significant increase in the procedure time (p = 0.001) without significant differences regarding the DAP (p = 0.773) and fluoroscopy time (p = 0.249). CONCLUSION Use of 3D mapping systems in ablation of supraventricular tachycardias is associated with lower radiation exposure. Nevertheless, the procedure time often increases, except in the case of ablation for AP. Use of contact force catheters and multipolar mapping catheters is associated with yet lower radiation exposure values. Prospective randomized studies are needed to further elucidate potential benefit of these technological tools.
Collapse
Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johanna Müller-Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Jedrzej Kosiuk
- Rhythmology Department, Helios Klinikum Köthen, Köthen, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
Galappaththige S, Pathmanathan P, Gray RA. A computational modeling framework for pre-clinical evaluation of cardiac mapping systems. Front Physiol 2023; 14:1074527. [PMID: 37485068 PMCID: PMC10358980 DOI: 10.3389/fphys.2023.1074527] [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: 10/19/2022] [Accepted: 05/31/2023] [Indexed: 07/25/2023] Open
Abstract
There are a variety of difficulties in evaluating clinical cardiac mapping systems, most notably the inability to record the transmembrane potential throughout the entire heart during patient procedures which prevents the comparison to a relevant "gold standard". Cardiac mapping systems are comprised of hardware and software elements including sophisticated mathematical algorithms, both of which continue to undergo rapid innovation. The purpose of this study is to develop a computational modeling framework to evaluate the performance of cardiac mapping systems. The framework enables rigorous evaluation of a mapping system's ability to localize and characterize (i.e., focal or reentrant) arrhythmogenic sources in the heart. The main component of our tool is a library of computer simulations of various dynamic patterns throughout the entire heart in which the type and location of the arrhythmogenic sources are known. Our framework allows for performance evaluation for various electrode configurations, heart geometries, arrhythmias, and electrogram noise levels and involves blind comparison of mapping systems against a "silver standard" comprised of computer simulations in which the precise transmembrane potential patterns throughout the heart are known. A feasibility study was performed using simulations of patterns in the human left atria and three hypothetical virtual catheter electrode arrays. Activation times (AcT) and patterns (AcP) were computed for three virtual electrode arrays: two basket arrays with good and poor contact and one high-resolution grid with uniform spacing. The average root mean squared difference of AcTs of electrograms and those of the nearest endocardial action potential was less than 1 ms and therefore appears to be a poor performance metric. In an effort to standardize performance evaluation of mapping systems a novel performance metric is introduced based on the number of AcPs identified correctly and those considered spurious as well as misclassifications of arrhythmia type; spatial and temporal localization accuracy of correctly identified patterns was also quantified. This approach provides a rigorous quantitative analysis of cardiac mapping system performance. Proof of concept of this computational evaluation framework suggests that it could help safeguard that mapping systems perform as expected as well as provide estimates of system accuracy.
Collapse
|
8
|
Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
Collapse
Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| |
Collapse
|
9
|
A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121700. [PMID: 36556902 PMCID: PMC9781762 DOI: 10.3390/medicina58121700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p < 0.0001; LA angiography: 297.9 ± 4.62 vs. PV-Angiography: 348.9 ± 11.03; p < 0.001, respectively) per vein were slightly but significantly higher in the PV angiography group. We observed no difference in late AF recurrence (24.7% LA angiography vs. 21.3% PV angiography; p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups.
Collapse
|
10
|
Garibaldi S, Chianca M, Fabiani I, Emdin M, Piacenti M, Passino C, Aimo A, Fedele A, Cipolla CM, Cardinale DM. Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation. J Clin Med 2022; 11:jcm11154452. [PMID: 35956068 PMCID: PMC9369260 DOI: 10.3390/jcm11154452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Longer life expectancy along with advancements in cancer and atrial fibrillation (AF) therapies and treatment strategies have led to an increase in the number of individuals with both diseases. As a result, the complicated management of these patients has become crucial, necessitating individualised treatment that considers the bi-directional relationship between these two diseases. On the one hand, giving appropriate pharmaceutical therapy is exceptionally difficult, considering the recognised thromboembolic risk posed by AF and malignancy, as well as the haemorrhagic risk posed by cancer. The alternative pulmonary vein isolation (PVI) ablation, on the other hand, has been inadequately explored in the cancer patient population; there is yet inadequate data to allow the clinician to unambiguously select patients that can undertake this therapeutic intervention. The goal of this review is to compile the most valuable data and supporting evidence about the characteristics, care, and therapy of cancer patients with AF. Specifically, we will evaluate the pharmaceutical options for a proper anticoagulant therapy, as well as the feasibility and safety of PVI in this population.
Collapse
Affiliation(s)
- Silvia Garibaldi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Michela Chianca
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Correspondence:
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Marcello Piacenti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Claudio Passino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Alberto Aimo
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Antonella Fedele
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Carlo Maria Cipolla
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Daniela Maria Cardinale
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| |
Collapse
|
11
|
Tahin T, Riba A, Nemeth B, Arvai F, Lupkovics G, Szeplaki G, Geller L. Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures. BMC Cardiovasc Disord 2021; 21:407. [PMID: 34433424 PMCID: PMC8390247 DOI: 10.1186/s12872-021-02219-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Objective Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice.
Methods We developed a simplified ICE guided technique to perform ablation procedures for AF, with the aid of a 3D electroanatomical mapping system. The workflow was implemented in two phases: (1) the Introductory phase, where the first 16 ZF PVIs were compared with 16 cases performed with fluoroscopy and (2) the Extension phase, where 71 consecutive patients (including repeat procedures) with ZF approach were included. Standard PVI (and redoPVI) procedures were performed, data on feasibility of the ZF approach, complications, acute and 1-year success rates were collected. Results In the Introductory phase, 94% of the procedures could be performed with complete ZF with a median procedure time of 77.5 (73.5–83) minutes. In one case fluoroscopy was used to guide the ICE catheter to the atrium. There was no difference in the complication, acute and 1-year success rates, compared with fluoroscopy guided procedures. In the Extension phase, 97% of the procedures could be completed with complete ZF. In one case fluoroscopy was used to guide the transseptal puncture and in another to position the ICE catheter. Acute success of PVI was achieved in all cases, 64.4% patients were arrhythmia free at 1-year. Acute major complications were observed in 4 cases, all of these occurred in the redo PVI group and consisted of 2 tamponades, 1 transient ischemic attack and 1 pseudoaneurysm at the puncture site. The procedures were carried out by all members of the electrophysiology unit in the Extension phase, including less experienced operators and electrophysiology fellows (3 physicians) under the supervision of the senior electrophysiologist. Consequently, procedure times became longer [90 (75–105) vs 77.5 (73.5–85) min, p = 0.014]. Conclusions According to our results, a ZF workflow of AF ablations can be successfully implemented into the routine practice of an electrophysiology laboratory, without compromising safety and effectivity.
Collapse
Affiliation(s)
- Tamas Tahin
- Department of Cardiology, Zala County St. Rafael Hospital, Zrinyi str. 1, Zalaegerszeg, 8900, Hungary.,Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Adam Riba
- Department of Cardiology, Zala County St. Rafael Hospital, Zrinyi str. 1, Zalaegerszeg, 8900, Hungary.
| | - Barnabas Nemeth
- Department of Cardiology, Zala County St. Rafael Hospital, Zrinyi str. 1, Zalaegerszeg, 8900, Hungary
| | - Ferenc Arvai
- Department of Cardiology, Zala County St. Rafael Hospital, Zrinyi str. 1, Zalaegerszeg, 8900, Hungary
| | - Geza Lupkovics
- Department of Cardiology, Zala County St. Rafael Hospital, Zrinyi str. 1, Zalaegerszeg, 8900, Hungary
| | - Gabor Szeplaki
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Laszlo Geller
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| |
Collapse
|
12
|
Does merged three-dimensional mapping improve contact force and long-term procedure outcome in atrial fibrillation ablation? (MICRO-AF study): a prospective randomized controlled study. Int J Cardiovasc Imaging 2021; 37:3431-3438. [PMID: 34255269 DOI: 10.1007/s10554-021-02335-8] [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] [Received: 04/30/2021] [Accepted: 06/29/2021] [Indexed: 01/01/2023]
Abstract
Integration of electroanatomical map (EAM) with preacquired three-dimensional (3D) cardiac images provides detailed appreciation of the complex anatomy of the left atrium (LA) and pulmonary vein (PV). High-density (HD) multi-electrode mapping catheters have enabled creating more accurate EAM reflecting real-time volume-rendered LA-PV geometry during atrial fibrillation (AF) ablation. However, no study has compared the outcomes of AF ablation using HD-EAM versus 3D-merged map. We aimed to investigate the procedural and clinical outcomes of AF ablation with HD-EAM (HD-EAM group) versus 3D-merged map (Merge group). One hundred patients (59.5 ± 11.5 years, 53% with paroxysmal AF [PAF]) were randomly assigned (1:1) to HD-EAM or Merged group. HD multi-electrode mapping and contact force (CF)-sensing catheters were used to create virtual LA-PV chamber and to perform wide antral circumferential ablation (WACA), respectively. The two groups showed no significant differences in baseline characteristics and procedural data including ablation time, fluoroscopy time, LA voltage, and CF. PV isolation with a single WACA line was achieved in 21 (42%) and 27 (54%) patients in the Merge and HD-EAM groups, respectively (P = NS). CF was significantly lower in lesions with gap than lesions without gap after a single WACA (7.3 ± 7.3 g vs. 16.0 ± 8.3, respectively, P < 0.001). During the 12-month follow-up, no significant difference in AF recurrence was observed between two groups, irrespective of AF type. In multivariate analysis, non-PAF was an independent risk factor for AF recurrence. Integration of 3D cardiac imaging did not improve procedural and clinical outcomes. HD-EAM provides an accurate real-time LA geometry.
Collapse
|
13
|
Chin CG, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Wu CI, Liu CM, Vicera JJB, Chen CC, Chuang CM, Chen YJ, Hsieh MH, Chen SA. The application of novel segmentation software to create left atrial geometry for atrial fibrillation ablation: The implication of spatial resolution. J Chin Med Assoc 2020; 83:830-837. [PMID: 32649420 PMCID: PMC7478205 DOI: 10.1097/jcma.0000000000000390] [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: 12/05/2022] Open
Abstract
BACKGROUND The application of new imaging software for the reconstruction of left atrium (LA) geometry during atrial fibrillation (AF) ablation has not been well investigated. METHODS A total of 27 patients undergoing AF ablation using a CARTO Segmentation Module system were studied (phase I). High-density LA mapping using PentaRay was merged with computed tomography-based geometry from the auto-segmentation module. The spatial distortion between the two LA geometries was analyzed and compared using Registration Match View. The associated contact force on the two LA shells was prospectively validated in 16 AF patients (phase II). RESULTS Of the five LA regions, the roof area had the highest quality score between the two LA shells (1.7 ± 0.6). In addition, among the pulmonary veins (PVs), higher quality scores were observed in bilateral PV carinas (both 1.8 ± 0.1, p < 0.05) than in the anterior or posterior PV regions. Furthermore, surrounding the PV ostium, the on-surface points had a significantly higher contact force when targeting the high-density fast anatomical mapping shell than for the auto-segmentation module (right superior pulmonary vein, 20.7 ± 5.8 g vs 12.5 ± 4.4 g; right inferior pulmonary vein, 19.3 ± 6.8 g vs 11.8 ± 4.8 g; left superior pulmonary vein, 22.5 ± 7.3 g vs 11.2 ± 4.5 g; left inferior pulmonary vein, 15.7 ± 6.9 g vs 9.7 ± 4.4 g, p < 0.05 for each group). CONCLUSION The CARTO Segmentation Module and Registration Match View provide better anatomic accuracy and less regional distortion of the LA geometry, and this can prevent excessive contact and potential procedural complications.
Collapse
Affiliation(s)
- Chye-Gen Chin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shih-Lin Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Li-Wei Lo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ta-Chuan Tuan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Tze-Fan Chao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jo-Nan Liao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chin-Yu Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ting-Yung Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Cheng-I Wu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chih-Min Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jennifer Jeanne B. Vicera
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- University of Santo Tomas Hospital, Manila, Philippines
| | - Chun-Chao Chen
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chieh-Mao Chuang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Pediatric Cardiology, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ming-Hsiung Hsieh
- Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Author correspondence. Dr. Ming-Hsiung Hsieh, Division of Cardiology, Wan-Fang Hospital, Taipei Medical University, 111, Section 3, Hsin-Lung Road, Taipei 116, Taiwan, ROC. E-mail address: (M.-H. Hsieh)
| | - Shih-Ann Chen
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| |
Collapse
|
14
|
Obeng-Gyimah E, Nazarian S. Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes? J Innov Card Rhythm Manag 2020; 11:4172-4178. [PMID: 32724708 PMCID: PMC7377648 DOI: 10.19102/icrm.2020.110701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Since the introduction of atrial fibrillation (AF) ablation in the 1990s, the procedure has continuously evolved, with gradual improvements in outcomes and safety. Recent technological advancements include the introduction of contact force catheters and high-resolution electroanatomical mapping systems, while imaging modalities including transesophageal echocardiography and fluoroscopy have become integral parts of AF ablation procedures. Further, intraprocedural intracardiac echocardiography and the integration of cardiac magnetic resonance and computed tomography images with electroanatomical mapping have shown promise to improve procedural outcomes by reducing radiation exposure and procedural times. However, available data on procedural utility and the reduction in AF recurrence rates associated with these modalities are mixed. This review therefore aims to discuss the current common imaging modalities used in AF ablation and their potential impact on outcomes. In particular, imaging is discussed with respect to the important information it offers before, during, and after the procedure. Perspectives on the future of imaging in AF ablation are also shared.
Collapse
Affiliation(s)
- Edmond Obeng-Gyimah
- Perelman Clinical Electrophysiology Section, Cardiovascular Division, Department of Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Saman Nazarian
- Perelman Clinical Electrophysiology Section, Cardiovascular Division, Department of Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
15
|
Role of pre-procedural CT imaging on catheter ablation in patients with atrial fibrillation: procedural outcomes and radiological exposure. J Interv Card Electrophysiol 2020; 60:477-484. [PMID: 32405889 DOI: 10.1007/s10840-020-00764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. The aim of the study was to determine the impact of pre-procedural cardiac CT with 3D reconstruction on procedural outcomes and radiological exposure in patients who underwent radiofrequency catheter ablation (RFA) of AF. METHODS In this registry, 493 consecutive patients (age 62 ± 8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent first procedure of RFA were included. A pre-procedural CT scan was obtained in 324 patients (CT group). Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3D electroanatomical navigation system. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT group) and without (no CT group) pre-procedural cardiac CT. RESULTS Acute PV isolation was obtained in all patients, with a comparable overall complication rate between CT and no CT group (4.3% vs 3%, p = 0.7). No differences were observed about mean duration of the procedure (231 ± 60 vs 233 ± 58 min, p = 0.7) and fluoroscopy time (13 ± 10 vs 13 ± 8 min, p = 0.6) among groups. Cumulative radiation dose resulted significantly higher in the CT group compared with no CT group (8.9 ± 24 vs 4.8 ± 15 mSv, P = 0.02). At 1 year, freedom from AF/atrial tachycardia were comparable among groups (CT group, 227/324 (70%), vs no CT group,119/169 (70%), p = ns). CONCLUSIONS Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure.
Collapse
|
16
|
Huang HD, Abid QUA, Ravi V, Sharma P, Larsen T, Krishnan K, Trohman RG. Meta-analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low- and zero-fluoroscopy approaches. J Cardiovasc Electrophysiol 2020; 31:1403-1412. [PMID: 32202003 DOI: 10.1111/jce.14450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Radiation exposure during catheter ablation procedures is a significant hazard for both patients and operators. Atrial fibrillation (AF) ablation procedures have been historically associated with higher fluoroscopy usage than other electrophysiology procedures. Recent efforts have been made to reduce dependence on fluoroscopy during pulmonary vein isolation (PVI) ablation procedures using alternative techniques. METHODS We performed a meta-analysis of studies comparing zero or low fluoroscopy (LF) vs conventional fluoroscopy (CF) approaches for AF ablation. Outcomes of interest included acute and 12-month procedural efficacy, safety, procedure duration, fluoroscopy time, and dose area product. Aggregated data were analyzed with random-effects models, using a Bayesian hierarchical approach. RESULTS A total of 2228 participants (LF, n = 1190 vs CF, n = 1038) from 15 studies were included in the meta-analysis. Risk of AF recurrence in 12 months (odds ratio [OR], 95% confidence interval [95% CI] = 1.343 [0.771-2.340]; P = .297), redo-ablation procedures (OR [95% CI] = 0.521 [0.198-1.323]; P = .186), and procedural complications (OR [95% CI] = 0.99 [0.485-2.204]; P = .979) were similar between LF- and CF-ablation groups. In comparison to CF ablation, LF ablation led to shorter procedure duration (weighted mean differences [WMDs] [95% CI] = -14.6 minutes [-22.5 to -6.8]; P < .001), fluoroscopy time (WMD [95% CI] = -8.8 minutes [-11.9 to -5.9]; P < .001), and dose area product (WMD [95% CI] = -1946 mGy/cm2 [-2685 to 1207]; P < .001). CONCLUSION LF approaches have similar clinical efficacy and safety as CF approaches for PVI. LF approaches are associated with shorter procedure time, fluoroscopy usage, and dose area product during PVI.
Collapse
Affiliation(s)
- Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Qurrat-Ul-Ain Abid
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Venkatesh Ravi
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Parikshit Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Timothy Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
17
|
Maalouf J, Whiteside HL, Pillai A, Omar A, Berman A, Saba S, Hreibe H. Reduction of radiation and contrast agent exposure in a cryoballoon ablation procedure with integration of electromagnetic mapping and intracardiac echocardiography: a single center experience. J Interv Card Electrophysiol 2019; 59:545-550. [DOI: 10.1007/s10840-019-00667-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
|
18
|
Schreiber T, Kähler N, Tscholl V, Nagel P, Landmesser U, Huemer M, Attanasio P. [Update on radiation exposure in catheter ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2019; 31:84-90. [PMID: 31758249 DOI: 10.1007/s00399-019-00660-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 02/03/2023]
Abstract
The rising number of catheter ablations of atrial fibrillation increases radiation exposure for both patients and surgeons. Fortunately, this trend is counteracted by the development of measures to reduce total fluoroscopy time using non-fluoroscopic catheter visualization. Since even low-dose radiation can cause serious injury, all options to reduce radiation burden must be utilized (ALARA, "as low as reasonably achievable"). Dose reduction protocols with low-dose settings, which include reduced framerates, pulse duration, detector entrance dose and increased beam hardening, play a decisive role in this regard. This review provides a state-of-the-art summary of non-fluoroscopic catheter visualization and dose reduction protocols for catheter ablation of atrial fibrillation.
Collapse
Affiliation(s)
- Tobias Schreiber
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Nora Kähler
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Verena Tscholl
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Patrick Nagel
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Ulf Landmesser
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Martin Huemer
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Philipp Attanasio
- Medizinische Klinik für Kardiologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| |
Collapse
|
19
|
Bourier F, Vlachos K, Lam A, Martin CA, Takigawa M, Kitamura T, Massoullié G, Cheniti G, Frontera A, Duchateau J, Pambrun T, Klotz N, Derval N, Denis A, Hocini M, Haïssaguerre M, Cochet H, Jaïs P, Sacher F. Three-dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures. J Cardiovasc Electrophysiol 2019; 30:2790-2796. [PMID: 31646698 DOI: 10.1111/jce.14249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D-mapping system image integration module and computed tomographic (CT)-derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. METHODS AND RESULTS CT left atrium-angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D-overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). CONCLUSION 3D-overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.
Collapse
Affiliation(s)
- Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Grégoire Massoullié
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| |
Collapse
|
20
|
Shun-Shin MJ, Leong KMW, Ng FS, Linton NWF, Whinnett ZI, Koa-Wing M, Qureshi N, Lefroy DC, Harding SE, Lim PB, Peters NS, Francis DP, Varnava AM, Kanagaratnam P. Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress. Europace 2019; 21:1422-1431. [PMID: 30820561 DOI: 10.1093/europace/euz015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/02/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise. METHODS AND RESULTS Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50). CONCLUSION We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.
Collapse
Affiliation(s)
- Matthew J Shun-Shin
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Kevin M W Leong
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Nicholas W F Linton
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Zachary I Whinnett
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Michael Koa-Wing
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Norman Qureshi
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - David C Lefroy
- Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Sian E Harding
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Phang Boon Lim
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Nicholas S Peters
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Darrel P Francis
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Amanda M Varnava
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Prapa Kanagaratnam
- National Heart & Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| |
Collapse
|
21
|
Siebermair J, Neumann B, Risch F, Riesinger L, Vonderlin N, Koehler M, Lackermaier K, Fichtner S, Rizas K, Sattler SM, Sinner MF, Kääb S, Estner HL, Wakili R. High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation - Two-year clinical outcome of a single center experience. Sci Rep 2019; 9:8830. [PMID: 31222008 PMCID: PMC6586935 DOI: 10.1038/s41598-019-45115-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation dose (866.0 ± 1003.3 vs. 1731.2 ± 1978.4 cGy; p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials.
Collapse
Affiliation(s)
- J Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - B Neumann
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - F Risch
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - L Riesinger
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - N Vonderlin
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - M Koehler
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - K Lackermaier
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - S Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - K Rizas
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S M Sattler
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - H L Estner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany. .,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany. .,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
| |
Collapse
|
22
|
Abstract
Ablation of AF through electrical isolation of the pulmonary veins is a well-established technique and a cornerstone in the ablation of AF, although there are a variety of techniques and ablation strategies now available. However, high numbers of patients are returning to hospital after ablation procedures such as pulmonary vein isolation (PVI). Scar tissue (as identified by contact voltage mapping) is found to be present in many of these patients, especially those with persistent AF and even those with paroxysmal AF. This scarring is associated with poor outcomes after PVI. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimised. Multipolar mapping catheters offer more information regarding the status of the tissue than standard ablation catheters. A patient-tailored catheter ablation approach, targeting the patient-specific low voltage/fibrotic substrate can lead to improved outcomes.
Collapse
|
23
|
Extensive Use of 3D Nonfluoroscopic Mapping Systems for Reducing Radiation Exposure during Catheter Ablation Procedures: An Analysis of 10 Years of Activity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4217076. [PMID: 30984780 PMCID: PMC6431475 DOI: 10.1155/2019/4217076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2019] [Indexed: 01/16/2023]
Abstract
Purpose 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposure. At the end of the follow-up period, the estimated probability of disease-free survival was 67.7% at 12 months for AF CA procedures and 97.2% at 3 months for SVT CA, without any statistically significant difference between years. Conclusions Our study shows the feasibility of using NMSs as the main imaging modality to guide CA. The extended, routine use of NMSs dramatically reduces radiation exposure, with only slight fluctuations due to the process of acquiring experience on the part of untrained operators, without affecting disease-free survival.
Collapse
|
24
|
Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Shariat MH, Redfearn DP. Cardiac Conduction Velocity Estimation During Wavefront Collision. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4840-4843. [PMID: 30441428 DOI: 10.1109/embc.2018.8513172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Catheter ablation therapy is an effective approach to treat different arrhythmias. Cardiac conduction velocity (Cv), extracted from intracardiac electrograms, shows the speed and direction of the wavefront propagation at different sites and is an insightful feature to guide ablation therapy. To create a propagation map, a small mapping catheter with a high density of electrodes is usually used to sequentially collect electrograms from different sites in a desired chamber of the heart. The CV and isochrone surface estimations are very challenging during complex arrhythmias such as atrial fibrillation, where multiple wavefronts simultaneously excite different cardiac sites. Specifically, the performances of CV estimators significantly degrade at catheter sites where wave- fronts collide. This is mainly because during collision, different wavefronts pass the areas under different electrodes of the catheter. Consequently, the activation times of the electrodes are the results of different wavefronts, and there are sharp changes in isochrone line patterns in the vicinity of the collision's border. In this paper, we propose a method that is able to identify the collision sites and improve the estimation of CV and isochrone maps. The proposed method finds the electrodes of the catheter that are excited by a similar wavefront and then estimates the corresponding isochrone lines for that wavefront. Our simulation results confirmed the efficiency of the proposed method during collision.
Collapse
|
26
|
Yamada S, Lo LW, Lin YJ, Chang SL, Chung FP, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chen SA. The Accuracy and Clinical Applicability of a Sensor Based Electromagnetic Non-fluoroscopic Catheter Tracking System. Korean Circ J 2018; 49:84-96. [PMID: 30468028 PMCID: PMC6331321 DOI: 10.4070/kcj.2018.0195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives The differences between electromagnetic-based mapping (EM) and impedance-based mapping (IM) in 3D anatomical reconstruction have not been fully clarified. We aimed to investigate the anatomical accuracy between EM (MediGuide™) and IM (EnSite Velocity™) systems. Methods We investigated 15 consecutive patients (10 males, mean age 58±9 years) who underwent pulmonary veins (PVs) isolation for paroxysmal atrial fibrillation (PAF). Contrast-enhanced computed tomography (CT) image of the left atrium (LA) was acquired before ablation and the 3D geometry of the LA was constructed using EM during ablation procedure. We measured the 4 PV angles between the main trunk of each PV and the posterior LA after field scaling. Additionally, the posterior LA surface area was measured. The variables were compared to those of CT-based geometry. A control group of 40 patients who underwent conventional PVs isolation using IM were also evaluated. Results The actual and relative changes of EM and CT-based geometry in all PV angles and posterior LA were significantly smaller compared to those of IM and CT-based geometry. Intraclass correlation coefficient (ICC) between EM and CT-based geometry were 0.871 (right superior pulmonary vein [RSPV]), 0.887 (right inferior pulmonary vein [RIPV]), 0.853 (left superior pulmonary vein [LSPV]), 0.911 (left inferior pulmonary vein [LIPV]), and 0.833 (posterior LA). On the other hand, ICC between IM and CT-based geometry were 0.548 (RSPV), 0.639 (RIPV), 0.691 (LSPV), 0.706 (LIPV), and 0.568 (posterior LA). Conclusions Image integration with EM enables high accurate visualization of cardiac anatomy compared to IM in PAF ablation.
Collapse
Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Li Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fa Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chin Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| |
Collapse
|
27
|
Long-term outcomes after “Zero X-ray” arrhythmia ablation. J Interv Card Electrophysiol 2018; 54:43-48. [DOI: 10.1007/s10840-018-0390-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
|
28
|
Lehrmann H, Jadidi AS, Minners J, Keyl C, Hochholzer W, Carrapatoso F, Trenk D, Weber R, Arentz T. Important reduction of the radiation dose for pulmonary vein isolation using a multimodal approach. Europace 2018; 20:279-287. [PMID: 28011800 DOI: 10.1093/europace/euw334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The number of pulmonary vein isolation (PVI) ablation procedures is steadily increasing worldwide resulting in a substantial radiation exposure to patients and operators. The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety. Methods and results First, we assessed radiation exposure for primary PVI procedures over time (2005-2015) at the University Heart Center Freiburg-Bad Krozingen. Second, we prospectively evaluated in 52 patients, the efficacy and safety of a novel radiation reduction program (particularly applying an enhanced fluoroscopy pulse dose-reduction and optimized 3D-mapping system use). In 2035 primary PVI procedures, radiation exposure, assessed as estimated effective dose (eED in mSv, dose area product * 0.002 * conversion factor for females), fluoroscopy-time, and procedure-time decreased significantly from 2005 to 2015 (e.g. eED decreased from 9.3 (interquartile range (IQR) 6.4-13.4) mSv to 0.9 (IQR 0.5-1.6) mSv, p for trend <0.001). Importantly, application of the enhanced radiation reduction program further reduced eED to 0.4 mSv (IQR 0.3-0.6, P < 0.001 vs. control), a value not significantly different from slow-pathway ablation procedures (P = 0.41). Multiple linear regression analysis identified the radiation reduction program as the only independent variable associated with a decrease in radiation exposure. Conclusion Radiation exposure during PVI decreased over the last decade and can further be reduced significantly by the implementation of an enhanced radiation reduction program.
Collapse
Affiliation(s)
- Heiko Lehrmann
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Amir S Jadidi
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Cornelius Keyl
- Department of Anesthesiology, University Heart Center Freiburg/Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Filipe Carrapatoso
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Reinhold Weber
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| |
Collapse
|
29
|
Guhl EN, Adelstein E, Voigt A, Wang NC, Saba S, Jain SK. Impact of 3D mapping on procedural characteristics and outcomes in cryoballoon pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2018; 51:71-75. [DOI: 10.1007/s10840-017-0304-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
|
30
|
Demystifying the EP Laboratory: Anesthetic Considerations for Electrophysiology Procedures. Int Anesthesiol Clin 2018; 56:98-119. [DOI: 10.1097/aia.0000000000000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 708] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
32
|
Abstract
Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm-rhythm control therapy-can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF.
Collapse
Affiliation(s)
- Richard Bond
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paulus Kirchhof
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| |
Collapse
|
33
|
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1370] [Impact Index Per Article: 195.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
34
|
WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
35
|
Usefulness of multidetector computed tomography before and after pulmonary vein isolation. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
36
|
Lee JH, Kim J, Kim M, Hwang J, Hwang YM, Kang JW, Nam GB, Choi KJ, Kim YH. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation: A comparison of 2 versus 4 frame rate. Medicine (Baltimore) 2017; 96:e7200. [PMID: 28614264 PMCID: PMC5478349 DOI: 10.1097/md.0000000000007200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups.The 4-FPS group showed higher median DAP (599.9 cGy cm; interquartile range [IR], 371.4-1337.5 cGy cm vs. 392.0 cGy cm; IR, 289.7-591.4 cGy cm; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5-34.9 min vs. 15.1 min; IR, 10.7-20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7-2.5 mSv vs. 0.7 mSv; IR, 0.6-1.1 mSv; P < .01) compared with the 2-FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan-Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25).In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional fluoroscopy setting.
Collapse
Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Revilla Orodea A, Sánchez Lite I, Gallego Beuth JC, Sevilla Ruiz T, Sandín Fuentes MG, Amat Santos IJ, San Román Calvar JA. Usefulness of multidetector computed tomography before and after pulmonary vein isolation. RADIOLOGIA 2017; 59:321-328. [PMID: 28457532 DOI: 10.1016/j.rx.2017.03.002] [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: 04/16/2016] [Revised: 02/20/2017] [Accepted: 03/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of pulmonary veins and the impact of the MDCT findings on the approach to treatment. METHOD We retrospectively analyzed 92 consecutive MDCT studies done in 80 patients between January 2011 and June 2013; 70 (76%) studies were done before a first ablation procedure and 22 (24%) were done in patients who had undergone an ablation procedure. RESULTS Findings were useful in 34% of the patients who underwent MDCT before the first ablation procedure and in 68% of the studies done after a procedure. The incidence of stroke associated with the ablation procedure was 3%, similar to the incidence recorded in our center before we started to use MDCT to evaluate the anatomy of the left atrium. All symptomatic patients had some pulmonary vein stenosis, and 80% had significant stenosis. Furthermore, the stenoses progressed very rapidly; treatment with balloon angioplasty was associated with early restenosis. Stenting was an alternative in cases of failed angioplasty. CONCLUSION In the preprocedural evaluation and postprocedural follow-up of patients undergoing pulmonary vein isolation, MDCT is useful for guiding treatment and detecting complications.
Collapse
Affiliation(s)
- Ana Revilla Orodea
- Unidad de Imagen Cardiaca, Servicio de Cardiología Hospital Clínico Universitario, Valladolid, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), España.
| | | | | | - Teresa Sevilla Ruiz
- Unidad de Imagen Cardiaca, Servicio de Cardiología Hospital Clínico Universitario, Valladolid, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), España
| | | | - Ignacio Jesús Amat Santos
- CIBER de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, España
| | - José Alberto San Román Calvar
- CIBER de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, España
| |
Collapse
|
38
|
RAZMINIA MANSOUR, WILLOUGHBY MICHAELCAMERON, DEMO HANY, KESHMIRI HESAM, WANG THEODORE, D'SILVA OLIVERJ, ZHEUTLIN TERRYA, JIBAWI HAKEEM, OKHUMALE PAUL, KEHOE RICHARDF. Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:425-433. [DOI: 10.1111/pace.13038] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
- MANSOUR RAZMINIA
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - MICHAEL CAMERON WILLOUGHBY
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HANY DEMO
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HESAM KESHMIRI
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - THEODORE WANG
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - OLIVER J. D'SILVA
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - TERRY A. ZHEUTLIN
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HAKEEM JIBAWI
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - PAUL OKHUMALE
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - RICHARD F. KEHOE
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| |
Collapse
|
39
|
Kocyigit D, Canpolat U, Aytemir K. Who Needs Catheter Ablation And Which Approach? J Atr Fibrillation 2016; 8:1335. [PMID: 27957233 DOI: 10.4022/jafib.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
Abstract
Catheter ablation therapy for atrial fibrillation (AF) has gained a significant role during maintenance of sinus rhythm compared to anti-arrhythmic medication. Catheter ablation techniques are also improved and progressed over years in parallel to better understanding of disease mechanisms and technological advancements. However, due to invasive nature of the therapy with its pertinent procedural risks, both appropriate patient selection and use of relevant approach should be considered by all electrophysiologists before decide to perform catheter ablation.
Collapse
Affiliation(s)
- Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
40
|
Casella M, Dello Russo A, Pelargonio G, Del Greco M, Zingarini G, Piacenti M, Di Cori A, Casula V, Marini M, Pizzamiglio F, Zucchetti M, Riva S, Russo E, Narducci ML, Soldati E, Panchetti L, Startari U, Bencardino G, Perna F, Santangeli P, Di Biase L, Cichocki F, Fattore G, Bongiorni M, Picano E, Natale A, Tondo C. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace 2016; 18:1565-1572. [PMID: 26559916 PMCID: PMC5072134 DOI: 10.1093/europace/euv344] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIMS Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure. METHODS AND RESULTS We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. CONCLUSION This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01132274.
Collapse
Affiliation(s)
- Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | | | - Gianluca Zingarini
- Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Marcello Piacenti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | | | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| | | | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Luca Panchetti
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | - Umberto Startari
- CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy
| | | | | | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | | | - Giovanni Fattore
- Department of Policy Analysis and Public Management and CERGAS, Università Bocconi, Milan, Italy
| | - Mariagrazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy
| |
Collapse
|
41
|
Shariat MH, Gazor S, Redfearn D. Cardiac conduction velocity estimation from sequential mapping assuming known Gaussian distribution for activation time estimation error. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:505-508. [PMID: 28268381 DOI: 10.1109/embc.2016.7590750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this paper, we study the problem of the cardiac conduction velocity (CCV) estimation for the sequential intracardiac mapping. We assume that the intracardiac electrograms of several cardiac sites are sequentially recorded, their activation times (ATs) are extracted, and the corresponding wavefronts are specified. The locations of the mapping catheter's electrodes and the ATs of the wavefronts are used here for the CCV estimation. We assume that the extracted ATs include some estimation errors, which we model with zero-mean white Gaussian noise values with known variances. Assuming stable planar wavefront propagation, we derive the maximum likelihood CCV estimator, when the synchronization times between various recording sites are unknown. We analytically evaluate the performance of the CCV estimator and provide its mean square estimation error. Our simulation results confirm the accuracy of the proposed method and the error analysis of the proposed CCV estimator.
Collapse
|
42
|
Zaman S, Pouliopoulos J, Al Raisi S, Sullivan J, Thiagalingam A, Swinnen J, Kovoor P. Novel use of NavX three-dimensional mapping to guide renal artery denervation. EUROINTERVENTION 2016; 9:687-93. [PMID: 24169130 DOI: 10.4244/eijv9i6a112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Renal artery denervation (RAD) is an effective treatment for resistant hypertension. The Navigation and Visualisation Technology (NavX) system creates three-dimensional (3-D) anatomical maps to guide catheter position and identify ablation sites. This first-in-human study assessed the utility of NavX 3-D mapping for RAD. METHODS AND RESULTS Consecutive patients who underwent RAD using fluoroscopy alone (control group, n=8) were compared to NavX-guided RAD (NavX group, n=10). Where NavX was utilised, orthogonally located skin patches were applied to the torso for acquisition of 3-D geometry of each renal artery. Baseline clinical characteristics and renal artery anatomy were similar between groups. Median contrast dose was significantly higher in the control versus NavX group (123 ml versus 78 ml, p=0.016). Median radiation dose was significantly higher in the control versus NavX group (166 Gy cm² versus 43 Gy cm², p=0.034). Mean changes in systolic and diastolic BP at three-month follow-up were -22/-9 mmHg and -23/-11 mmHg in the control and NavX group, respectively (p=0.99). CONCLUSIONS Use of NavX mapping as compared to standard renal artery denervation was found to correlate with a significant reduction in contrast load and radiation exposure. This study demonstrates both the feasibility and potential benefits of NavX 3-D mapping to guide renal artery denervation.
Collapse
|
43
|
Nedios S, Sommer P, Bollmann A, Hindricks G. Advanced Mapping Systems To Guide Atrial Fibrillation Ablation: Electrical Information That Matters. J Atr Fibrillation 2016; 8:1337. [PMID: 27909489 PMCID: PMC5089464 DOI: 10.4022/jafib.1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
Catheter ablation is an established and widespread treatment for atrial fibrillation (AF). Contemporary electroanatomical mapping systems (EAMs) have been developed to facilitate mapping processes but remain limited by spatiotemporal and processing restrictions. Advanced mapping systems emerged from the need to better understand and ablate complex AF substrate, by improving the acquisition and illustration of electrophysiological information. In this review, we present you the recently advanced mapping systems for AF ablation in comparison to the established contemporary EAMs.
Collapse
Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| |
Collapse
|
44
|
Capítulo 7. Utilidad del mapeo tridimensional en la ablación de la fibrilación auricular persistente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
45
|
See J, Amora JL, Lee S, Lim P, Teo WS, Tan BY, Ho KL, Lee CW, Ching CK. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure. Singapore Med J 2016; 57:390-5. [PMID: 26805664 DOI: 10.11622/smedj.2016017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. METHODS We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. RESULTS A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. CONCLUSION The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time.
Collapse
Affiliation(s)
- Jason See
- Department of Cardiology, Changi General Hospital, Singapore
| | - Jonah L Amora
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Sheldon Lee
- Department of Cardiology, Changi General Hospital, Singapore
| | - Paul Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Boon Yew Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chee Wan Lee
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Chi-Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| |
Collapse
|
46
|
BOURIER FELIX, REENTS TILKO, AMMAR-BUSCH SONIA, SEMMLER VERENA, TELISHEVSKA MARTA, KOTTMAIER MARC, LENNERZ CARSTEN, GREBMER CHRISTIAN, KOLB CHRISTOF, DEISENHOFER ISABEL, HESSLING GABRIELE. Transseptal Puncture Guided by CT-Derived 3D-Augmented Fluoroscopy. J Cardiovasc Electrophysiol 2016; 27:369-72. [DOI: 10.1111/jce.12885] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/04/2015] [Accepted: 11/14/2015] [Indexed: 11/29/2022]
Affiliation(s)
- FELIX BOURIER
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - TILKO REENTS
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - SONIA AMMAR-BUSCH
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - VERENA SEMMLER
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - MARTA TELISHEVSKA
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - MARC KOTTMAIER
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - CARSTEN LENNERZ
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - CHRISTIAN GREBMER
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - CHRISTOF KOLB
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - ISABEL DEISENHOFER
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| | - GABRIELE HESSLING
- Department of Electrophysiology, German Heart Center Munich; Technische, Universitaet Munich; Germany
| |
Collapse
|
47
|
|
48
|
Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletes. Rev Port Cardiol 2015; 34:753-70. [PMID: 26643438 DOI: 10.1016/j.repc.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/01/2015] [Accepted: 07/25/2015] [Indexed: 01/02/2023] Open
Abstract
Sudden cardiac death is the leading cause of death in athletes during sport. It is a tragic event that generates significant media attention and discussion throughout society as to whether everything possible had been done to prevent it. Regular physical exercise causes cardiac remodeling at both the mechanical and electrical level, known as athlete's heart, resulting in an electrocardiogram (ECG) considered abnormal compared with the ECGs of the general population. Some of these electrocardiographic changes are considered normal or physiological in athletes, while others suggest underlying cardiac disease with the potential to cause sudden cardiac death. There is thus an urgent need to define the electrocardiographic patterns that allow or prohibit participation in sports, and to differentiate them in terms of gender, ethnicity and age. The purpose of this review is to present the latest data on the electrocardiographic changes considered benign or pathological that are typically found in athletes and to critically analyze the most recent criteria for classifying ECGs in this population (the Seattle criteria), comparing them with previous guidelines and with the latest studies on the subject. This article also examines the question of including ECGs in pre-participation screening programs, the US and European approaches to the subject, and the most up-to-date data on the sensitivity, specificity and cost-effectiveness of the ECG in athletes.
Collapse
Affiliation(s)
- Marino Machado
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Vaz Silva
- Serviço de Cardiologia/Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| |
Collapse
|
49
|
Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletesBenign and pathological electrocardiographic changes in athletes. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
50
|
Bourier F, Reents T, Ammar-Busch S, Buiatti A, Kottmaier M, Semmler V, Telishevska M, Brkic A, Grebmer C, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures. Europace 2015; 18:1406-10. [PMID: 26589627 PMCID: PMC5400031 DOI: 10.1093/europace/euv364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022] Open
Abstract
Aims This study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels. Methods and results From October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0). Conclusion The new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
Collapse
Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Sonia Ammar-Busch
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Alessandra Buiatti
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christof Kolb
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| |
Collapse
|