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Berruezo A, Penela D, Jáuregui B, de Asmundis C, Peretto G, Marrouche N, Trayanova N, de Chillou C. Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias. Europace 2023; 25:euad183. [PMID: 37622578 PMCID: PMC10450789 DOI: 10.1093/europace/euad183] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 08/26/2023] Open
Abstract
Catheter ablation is nowadays considered the treatment of choice for numerous cardiac arrhythmias in different clinical scenarios. Fluoroscopy has traditionally been the primary imaging modality for catheter ablation, providing real-time visualization of catheter navigation. However, its limitations, such as inadequate soft tissue visualization and exposure to ionizing radiation, have prompted the integration of alternative imaging modalities. Over the years, advancements in imaging techniques have played a pivotal role in enhancing the safety, efficacy, and efficiency of catheter ablation procedures. This manuscript aims to explore the utility of imaging, including electroanatomical mapping, cardiac computed tomography, echocardiography, cardiac magnetic resonance, and nuclear cardiology exams, in helping electrophysiology procedures. These techniques enable accurate anatomical guidance, identification of critical structures and substrates, and real-time monitoring of complications, ultimately enhancing procedural safety and success rates. Incorporating advanced imaging technologies into routine clinical practice has the potential to further improve clinical outcomes of catheter ablation procedures and pave the way for more personalized and precise ablation therapies in the future.
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Affiliation(s)
- Antonio Berruezo
- Arrhythmia Unit, Teknon Medical Centre, Carrer de Vilana, 12, 08022 Barcelona, Spain
| | - Diego Penela
- Arrhythmia Unit, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano Milan, Italy
| | - Beatriz Jáuregui
- Arrhythmia Unit - Miguel Servet University Hospital, P.º de Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Blvd Géneral Jacques 137, 1050 Ixelles, Brussels, Belgium
| | - Giovanni Peretto
- Arrhythmia Unit, Ospedale San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Nassir Marrouche
- Department of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Applied Math and Statistics, Johns Hopkins University, Baltimore, MD 21218, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Christian de Chillou
- INSERM IADI U1254, University Hospital Nancy, University of Lorraine, 29 Av. du Maréchal de Lattre de Tassigny, 54000 Nancy, France
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Isa SO, Khan MR, Changezi HU, Hassan M. Coronary artery occlusion following low-power catheter ablation. J Community Hosp Intern Med Perspect 2020; 10:358-360. [PMID: 32850098 PMCID: PMC7427452 DOI: 10.1080/20009666.2020.1780677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablation procedures. This case describes the occurrence of acute myocardial infarction following low-power ablation in a young patient and highlights the importance of maintaining high index of suspicion following catheter ablation irrespective of the ablation power used. A 22-year-old patient had low-power ablation of the right posteroseptal accessory pathway in the ostium of the coronary sinus on account of persistently symptomatic WPW syndrome with orthodromic re-entrant tachycardia. Two hours after the procedure, she developed moderately severe chest pain. Electrocardiogram showed ST elevation in the inferior leads. Coronary angiography showed 100% stenosis of the right coronary artery just beyond the posterior descending artery. She failed balloon angioplasty and a drug eluting stent was placed in the posterolateral branch of the right coronary artery. The symptoms resolved and follow up echocardiogram showed normal left ventricular systolic and diastolic functions with no regional wall motion abnormality. This case demonstrates the occurrence of MI following low-power catheter ablation. Patients should be monitored for this complication irrespective of the ablation power used.
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Affiliation(s)
- Sakiru O. Isa
- Department of Medicine, Mclaren Regional Medical Center, 401 S. Ballenger Highway, Flint, MI, USA
| | - Mahin R. Khan
- Department of Medicine, Mclaren Regional Medical Center, 401 S. Ballenger Highway, Flint, MI, USA
| | - Hameem U. Changezi
- Department of Medicine, Mclaren Regional Medical Center, 401 S. Ballenger Highway, Flint, MI, USA
| | - Mustafa Hassan
- Department of Medicine, Mclaren Regional Medical Center, 401 S. Ballenger Highway, Flint, MI, USA
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Pothineni NV, Kancharla K, Katoor AJ, Shanta G, Paydak H, Kapa S, Deshmukh A. Coronary artery injury related to catheter ablation of cardiac arrhythmias: A systematic review. J Cardiovasc Electrophysiol 2018; 30:92-101. [PMID: 30288838 DOI: 10.1111/jce.13764] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Catheter ablation (CA) has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of CA-related coronary injury has not been well studied. We sought to systematically evaluate all cases of CA-related coronary injuries. METHODS AND RESULTS A PubMed search was conducted from inception until May 1, 2017 using the keywords "coronary artery" and "ablation." We identified 2817 published articles of which 43 articles met our inclusion criteria representing 61 cases of coronary artery injury attributed to CA procedures from 1992 to 2017. Posteroseptal accessory pathway ablation was associated with the highest incidence of coronary injury (35.6% of cases), followed by cavotricuspid isthmus-dependent flutter (19.3%). The right coronary artery was the site of injury in over two-thirds of all reported cases. Coronary injury was detected intraprocedurally in about half of the cases (43.1%), whereas it was a delayed presentation in the other half. Coronary intervention was performed in a third of all cases (32.7%). There were a total of three deaths attributed to coronary artery injury. CONCLUSIONS Most (91.8%) coronary injuries are a result of anatomic proximity to the site of ablation. Awareness of the relation between coronary artery course and anatomical site of ablation could prevent myocardial damage and improve procedural safety.
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Affiliation(s)
- Naga Venkata Pothineni
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Krishna Kancharla
- Division of Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajoe J Katoor
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Hakan Paydak
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Suraj Kapa
- Division of Electrophysiology, Mayo Clinic, Rochester, Minnesota
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Aung TT, Roberto ES, Kravitz KD. Cardiogenic Shock, Acute Severe Mitral Regurgitation and Complete Heart Block After Cavo-Tricuspid Isthmus Atrial Flutter Ablation. Cardiol Res 2017; 8:63-67. [PMID: 28515824 PMCID: PMC5421488 DOI: 10.14740/cr534w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
Radiofrequency (RF) ablation is the first-line management of cavo-tricuspid isthmus dependent atrial flutter. It has been performed with 95% success rate. Adverse events are very rare. We report the first case of acute severe mitral regurgitation (MR) and complete heart block developed after successful atrial flutter ablation. A 62-year-old female with mild MR presented with palpitations. Surface electrocardiogram was suggestive of isthmus dependent atrial flutter. A duodecapolar mapping catheter showed an atrial flutter with cycle length of 280 ms. An 8 mm tipped Thermistor RF ablation catheter was placed at the cavo-tricuspid isthmus. RF energy was delivered as the catheter was dragged to the inferior vena cava. Temperature limit was 60 °C; the power output limit was 60 W. The patient converted to sinus rhythm with the first ablation line. Bi-directional block was recorded. Two additional ablation lines lasting 60 - 120 s were delivered. The patient started having chest pain and developed complete heart block with no escape rhythm. She became hypotensive and was immediately paced from the right ventricle. There were no signs of pericardial tamponade. Emergent bedside echo demonstrated severe MR with a retracted posteromedial mitral valve leaflet. She was 100% paced and EKG changes could not be assessed. Based on the sudden onset chest pain, hypotension, complete heart block and acute severe MR after ablation, the right coronary artery occlusion was suspected. She was immediately transferred to the catheterization laboratory. Coronary angiography revealed a total occlusion of the posterolateral branch from the right coronary artery. Balloon angioplasty and coronary artery stenting was performed. Complete heart block subsequently resolved. Subsequent bedside echocardiogram showed marked improvement of the MR. Patients with smaller body size have smaller hearts and more likely to have injury from RF current. Higher energy penetrates deeper and causes more tissue damage. The use of lower temperature limits (55 °C) and lower energy (60 W) for small, elderly, and female patients is encouraged.
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Affiliation(s)
- Thein Tun Aung
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Good Samaritan Hospital, Dayton, OH, USA
| | - Edward Samuel Roberto
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Good Samaritan Hospital, Dayton, OH, USA
| | - Kevin D Kravitz
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Good Samaritan Hospital, Dayton, OH, USA.,Dayton Heart and Vascular Hospital, Dayton, OH, USA
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Lewalter T, Weiss C, Mewis C, Jung W, Haverkamp W, Proff J, Bauer W. An optimized approach for right atrial flutter ablation: a post hoc analysis of the AURUM 8 study. J Interv Card Electrophysiol 2016; 48:159-166. [DOI: 10.1007/s10840-016-0202-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
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Dallaglio PD, Anguera I, Jiménez-Candil J, Peinado R, García-Seara J, Arcocha MF, Macías R, Herreros B, Quesada A, Hernández-Madrid A, Alvarez M, Di Marco A, Filgueiras D, Matía R, Cequier A, Sabaté X. Impact of previous cardiac surgery on long-term outcome of cavotricuspid isthmus-dependent atrial flutter ablation. Europace 2015; 18:873-80. [PMID: 26506836 DOI: 10.1093/europace/euv237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/10/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) in adults with and without previous cardiac surgery (PCS), and predictors of these outcomes. Structural alterations of the anatomical substrate of the CTI-AFL are observed in post-operative patients, and these may have an impact on the acute success of the ablation and in the long-term. METHODS AND RESULTS Clinical records of consecutive adults undergoing RFCA of CTI-AFL were analysed. Two main groups were considered: No PCS and PCS patients, who were further subdivided into acquired heart disease (AHD: ischaemic heart disease and valvular/mixed heart disease) and congenital heart disease [CHD: ostium secundum atrial septal defect (OS-ASD) and complex CHD]. Multivariate analysis identified clinical and procedural factors that predicted acute and long-term outcomes. A total of 666 patients (73% men, age 65 ± 12 years) were included: 307 of them with PCS. Ablation was successful in 647 patients (97%), 96% in the PCS group and 98% in the No PCS group (P = 0.13). Regression analysis showed that surgically corrected complex CHD was related to failure of the procedure [odds ratio 5.6; 95% confidence interval (CI) 1.6-18, P = 0.008]. After a follow-up of 45 ± 15 months, recurrences were observed in 90 patients (14%), more frequently in the PCS group: absolute risk of recurrence 18 vs. 10.5%, relative risk 1.71, 95% CI: 1.2-2.5, P = 0.006. Multivariate analysis indicated that the types of PCS [OS-ASD vs. No PCS: hazard ratio (HR) 2.57; 95% CI: 1.1-6.2, P = 0.03 and complex CHD vs. No PCS: HR 2.75; 95% CI: 1.41-5.48, P = 0.004], female gender (HR 1.55; 95% CI: 1.04-2.4, P = 0.048), and severe LV dysfunction (HR 1.36; 95% CI: 1.06-1.67, P = 0.04) were independent predictors of long-term recurrence. CONCLUSION Radiofrequency catheter ablation of CTI-AFL after surgical correction of AHD and CHD is associated with high acute success rates. The severity of the structural alterations of the underlying heart disease and consequently the type of surgical correction correlates with higher risk for recurrence.
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Affiliation(s)
- Paolo D Dallaglio
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Ignasi Anguera
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Javier Jiménez-Candil
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Javier García-Seara
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Rosa Macías
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Benito Herreros
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | | | | | - Miguel Alvarez
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Andrea Di Marco
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | | | - Roberto Matía
- Hospital Universitario 'Ramón y Cajal' de Madrid, Madrid, Spain
| | - Angel Cequier
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Xavier Sabaté
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
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Asirvatham SJ, Swale MJ. Imaging and cardiac ablation: improving on success. JACC Cardiovasc Imaging 2011; 4:727-9. [PMID: 21757162 DOI: 10.1016/j.jcmg.2010.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 12/20/2010] [Indexed: 11/29/2022]
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Cosio FG, Perea J. The continuing challenge of typical atrial flutter ablation: it is the anatomy! (Again). Europace 2010; 12:1518-9. [DOI: 10.1093/europace/euq375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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