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Markman TM, Khoshknab M, Nazarian S. Catheter ablation of atrial fibrillation: cardiac imaging guidance as an adjunct to the electrophysiological guided approach. Europace 2021; 23:520-528. [PMID: 33555014 DOI: 10.1093/europace/euaa249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/07/2020] [Accepted: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Catheter ablation is increasingly utilized to treat patients with atrial fibrillation (AF). Despite progress in technology and procedural strategy, there remain significant limitations with suboptimal outcomes. The role of imaging has continued to evolve, and multimodality imaging now presents an important opportunity to make substantial progress in the safety and efficacy of ablation. In this review, we discuss the history of imaging in the ablation of AF with a specific focus on the ability of cardiac computed tomography and magnetic resonance imaging to characterize anatomy, arrhythmogenic substrate, and guide ablation strategy. We will review the progress that has been made and highlight many of the limitations as well as future directions for the field.
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Affiliation(s)
- Timothy M Markman
- Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9118, Philadelphia, PA, USA
| | - Mirmilad Khoshknab
- Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9118, Philadelphia, PA, USA
| | - Saman Nazarian
- Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9118, Philadelphia, PA, USA
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Kanmanthareddy A, Vallakati A, Reddy Yeruva M, Dixit S, DI Biase L, Mansour M, Boolani H, Gunda S, Bunch TJ, Day JD, Ruskin JN, Buddam A, Koripalli S, Bommana S, Natale A, Lakkireddy D. Pulmonary vein isolation for atrial fibrillation in the postpneumonectomy population: a feasibility, safety, and outcomes study. J Cardiovasc Electrophysiol 2015; 26:385-389. [PMID: 25588757 DOI: 10.1111/jce.12619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) of the remnant pulmonary vein (PV) stumps in pneumonectomy patients has not been well characterized. METHODS This is a multicenter observational study of patients with a remnant PV stump after pneumonectomy. Consecutive patients with a history of pneumonectomy and who had undergone RF ablation for drug refractory AF were identified from the AF database at the participating institutions. RESULTS There were 15 patients in whom pneumonectomy was performed, for resection of tumors in 10, infection in 4, and bullae in 1 patient and who underwent RF ablation for AF. The mean age was 63 ± 7 years. The stumps were from the right lower PV in 5, left upper PV in 5, left lower PV in 3, and right upper PV in 2 patients. All the PV stumps were electrically active with PV potentials and 9 (60%) of them had triggered activity. PVI was performed in 14 and focal isolation in 1 patient. At 1-year follow-up, 80% were free of AF, off of antiarrhythmic medications. CONCLUSION PV stumps in AF patients with previous pneumonectomy are electrically active and are frequently the sites of active firing. Isolation of these PV stumps can be accomplished safely and effectively using catheter ablation with no practical concern for PV stenosis or compromising PV stump integrity.
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Affiliation(s)
| | - Ajay Vallakati
- Division of Cardiology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Madhu Reddy Yeruva
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - Sanjay Dixit
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Luigi DI Biase
- Division of Cardiology, Albert Einstein Montefiore Medical Center, Bronx, New York, USA
| | - Moussa Mansour
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hemant Boolani
- Division of Cardiology, Howard University Hospital, Washington, District of Columbia, USA
| | - Sampath Gunda
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - T Jared Bunch
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - John D Day
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Jeremy N Ruskin
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avanija Buddam
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - Sandeep Koripalli
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - Sudharani Bommana
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
| | - Andrea Natale
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Dhanunjaya Lakkireddy
- KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA
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