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Rossi P, Cauti FM, Polselli M, Magnocavallo M, Niscola M, Fanti V, Limite LR, Evangelista A, Bellisario A, De Paolis R, Facchetti S, Quaglione R, Piccirillo G, Bianchi S. Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study. J Interv Card Electrophysiol 2024; 67:1365-1376. [PMID: 38206451 PMCID: PMC11379763 DOI: 10.1007/s10840-023-01721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. METHODS Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. RESULTS Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71-2.38mV) vs 1.54mV (IQR: 0.79-2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). CONCLUSIONS All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy.
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marta Niscola
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Veronica Fanti
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | | | - Antonietta Evangelista
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | | | | | | | - Raffaele Quaglione
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
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Li K, Wu S, Wang X, Han B, Qin M, Hou X, Liu X. A multicenter, cohort study of catheter ablation for persistent atrial fibrillation with/without atrial fibrillation termination (the termination-atrial fibrillation study). Europace 2024; 26:euae085. [PMID: 38573506 PMCID: PMC11022747 DOI: 10.1093/europace/euae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Kaige Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xinhua Wang
- Department of Cardiology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xumin Hou
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 West Huaihai Road, Xuhui District, Shanghai 200030, China
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Andronache M, Pastorcici A, Amet D, Blendea D, Boudias A, Mazieres G, Rosu R, Cismaru G, Puiu M, Mot S, Serban A, Mottref P, Dauphin C, Moini C, Lellouche N, Massoulié G. Acute mitral isthmus block during catheter ablation with vein of Marshall ethanol infusion: Angiographic considerations. Arch Cardiovasc Dis 2024; 117:119-127. [PMID: 38040560 DOI: 10.1016/j.acvd.2023.11.001] [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: 07/17/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Achieving bidirectional mitral isthmus block is still challenging. Conventional ablation methods involve radiofrequency applications on the endocardial aspect of the lateral mitral isthmus, and often epicardial applications inside the coronary sinus. AIM To evaluate the impact of the systematic use of ethanol infusion in the vein of Marshall on the achievement of acute mitral isthmus block of additional epicardial component lesion. METHODS We evaluated patients referred to two centres for long-standing persistent atrial fibrillation ablation or recurrent peri-mitral flutter. All patients had pulmonary vein isolation and mitral isthmus line using ethanol infusion in the vein of Marshall for the first procedure and additional radiofrequency ablation lesion if necessary. For redo procedures, additional ablations (atrial lines and complex fractionated atrial electrogram ablations, if needed) were also performed. RESULTS We included 149 patients, and ethanol infusion in the vein of Marshall was not performed in 27 patients (18%). Among 122 patients, 115 had long-standing persistent atrial fibrillation (94.2%) and seven had peri-mitral flutter (5.8%). The mean duration of continuous atrial fibrillation was 53 months before ablation. Acute bidirectional mitral isthmus block was obtained in 115 (94.2%) of the 122 patients who received ethanol infusion in the vein of Marshall (77% when considering the total population). The mean radiofrequency delivery time to obtain mitral isthmus block was 2.6minutes for the endocardial mitral isthmus radiofrequency ablation and 2.6minutes for the epicardial mitral isthmus radiofrequency ablation. Failure to obtain mitral isthmus block was associated with increased mitral isthmus length and left atrial dilation. No major complications related to ethanol infusion in the vein of Marshall were observed. CONCLUSION Ethanol infusion in the vein of Marshall, when feasible (82%), was a safe approach to obtaining a high success rate (94%) of acute bidirectional endocardial and epicardial mitral isthmus block.
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Affiliation(s)
- Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France; Alleray-Labrouste Cardiology Clinics, 75015 Paris, France
| | - Anda Pastorcici
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Denis Amet
- Alleray-Labrouste Cardiology Clinics, 75015 Paris, France; Cardiology Department, Georges Pompidou European Hospital, 75015 Paris, France
| | - Dan Blendea
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Antoine Boudias
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Guillaume Mazieres
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Radu Rosu
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Mihai Puiu
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Stefan Mot
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Adela Serban
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Pascal Mottref
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Claire Dauphin
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Cyrus Moini
- Department of Cardiology, GHSIF-Melun, 77000 Melun, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France.
| | - Grégoire Massoulié
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
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Xu J, Yu F, Li J, Wang K, Zhuge L, Dong X, Tang M. Electrophysiological responses of the left atrial appendage during pulsed-field electrical isolation utilizing a novel device in a canine model. J Cardiovasc Electrophysiol 2023. [PMID: 37300886 DOI: 10.1111/jce.15962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/12/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The electrophysiological responses of the left atrial appendage (LAA) during pulsed-field electrical isolation have not been established. OBJECTIVE This study aims to investigate the electrical responses of the LAA during pulsed-field electrical isolation using a novel device and their relations to acute isolation success. METHODS Six canines were enrolled. The E-SeaLA™ device, which is able to perform LAA occlusion and ablation simultaneously, was deployed into the LAA ostium. LAA potentials (LAAp) were mapped via a mapping catheter, and the LAAp recovery time (LAAp RT, the time between the last pulsed spike and the first recovered LAAp) was measured after pulsed-train delivery. The initial pulse index (PI, corelated to pulsed-field intensity) was adjusted during the ablation procedure until LAAEI was achieved. Acute LAA electrical isolation (LAAEI) success was defined as LAAp disappearance or exit and entrance conduction block, confirmed through a drug test and a 60-minute waiting period. RESULT All canines achieved successful LAA occlusion without peri-device leaks. Acute LAA electrical isolation (LAAEI) was achieved in five out of six canines (5/6, 83.3%). Very late LAAp recurrence (LAAp RT > 600 s) was observed during PFA. Early recurrence (LAAp RT < 30 s) was observed in two canines (2/6, 33.3%) post-PFA. Intermediate recurrence (LAAp RT ~ 120 s) was observed in three canines (3/6, 50%) post-PFA. The two canines with intermediate recurrence achieved LAAEI with higher PI ablations. The one canine with early LAAp recurrence had a peri-device leak and achieved LAAEI by the same PI after replacing with a larger size device and eliminating the peri-device leak. Another canine with early recurrence (1/6, 16.7%) failed to achieve LAAEI due to epicardial connection with persistent left superior vena cava. No coronary spasm, stenosis or other complications were observed. CONCLUSION These results suggest that with proper device-tissue contact and pulse intensity, LAAEI can be achieved using this novel device without serious complications. The LAAp RT patterns observed in this study could inform and guide the adjustment of the ablation strategy.
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Affiliation(s)
- Jiangang Xu
- Hangzhou Dinova Electrophysiology Medical Technology Co., Ltd, Hangzhou, China
| | - Fengyuan Yu
- Department of Arrhythmia, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianmin Li
- Hangzhou Dinova Electrophysiology Medical Technology Co., Ltd, Hangzhou, China
| | - Kun Wang
- Hangzhou Dinova Electrophysiology Medical Technology Co., Ltd, Hangzhou, China
| | - Lun Zhuge
- Hangzhou Dinova Electrophysiology Medical Technology Co., Ltd, Hangzhou, China
| | - Xiaonan Dong
- Department of Arrhythmia, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Arrhythmia, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sousonis V, Combes S, Pinon P, Combes N, Cardin C, Zeriouh S, Menè R, Jacob S, Boveda S, Albenque JP. A novel stepwise approach incorporating ethanol infusion in the vein of Marshall for the ablation of persistent atrial fibrillation. Front Cardiovasc Med 2023; 10:1194687. [PMID: 37304968 PMCID: PMC10251404 DOI: 10.3389/fcvm.2023.1194687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Apart from pulmonary vein isolation (PVI), several step-by-step procedures that aim to modify left atrial substrate have been proposed for the ablation of persistent atrial fibrillation (AF), yet the optimal strategy remains elusive. There are cumulative data suggesting an incremental benefit of adding vein of Marshall (VOM) ethanol infusion to PVI in patients with persistent AF. We sought to evaluate the feasibility and efficacy of a novel stepwise ablation approach, incorporating a VOM alcoholization step, for persistent AF. Methods In this single-center study, we prospectively enrolled 66 consecutive patients with symptomatic persistent AF and failure of at least one antiarrhythmic drug (ADD). The ablation procedure consisted of (i) PVI, (ii) left atrial segmentation with VOM ethanol infusion and the deployment of linear radiofrequency lesions across the roof and the mitral isthmus and (iii) electrogram-based ablation of dispersion zones. The first two steps were performed in all patients, whereas the third step was carried out only in those still in AF at the end of the second step. Atrial tachycardias during the procedure were mapped and ablated. At the end of the procedure, cavotricuspid isthmus ablation was additionally performed in all patients. The primary endpoint was 12-month freedom from AF and atrial tachycardia after a single procedure and an initial three-month blanking period. Results Total procedure time was 153 ± 38.5 min. Fluoroscopy time was 16 ± 6.5 min and the radiofrequency ablation time was 26.14 ± 0.26 min. The primary endpoint occurred in 54 patients (82%). At 12 months, 65% of patients were off any AAD. In the univariate Cox regression analysis, left ventricular ejection fraction < 40% was the only predictor of arrhythmia recurrence (HR 3.56; 95% CI, 1.04-12.19; p = 0.04). One patient developed a pericardial tamponade and another a minor groin hematoma. Conclusion A novel stepwise approach, including a step of ethanol infusion in the VOM, is feasible, safe and provides a high rate of sinus rhythm maintenance at 12 months in patients with persistent AF.
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Affiliation(s)
| | - Stéphane Combes
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Pauline Pinon
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Nicolas Combes
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Christelle Cardin
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Sarah Zeriouh
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Roberto Menè
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
| | - Sophie Jacob
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Serge Boveda
- Heart Rhythm Management Department, CliniquePasteur, Toulouse, France
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Zhang F, Liu J, Fang P, Wang X, Wang J, Wei Y, Yang H. Assessing the impact of blocking distal coronary sinus-left atrial muscular connection on inducible rate of atrial fibrillation and follow-up recurrence in persistent atrial fibrillation patients with different fibrotic degrees of left atrial: A retrospective study. Front Cardiovasc Med 2022; 9:987590. [PMID: 36312226 PMCID: PMC9606224 DOI: 10.3389/fcvm.2022.987590] [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] [Received: 07/06/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background The musculature of the coronary sinus (CS), especially its distal connection with the post wall of the left atrial (LA), has been associated with the genesis and maintenance of atrial flutter (AFL) and atrial fibrillation (AF). However, the relative contributions of the distal coronary sinus (CSD)-LA connection to PersAF with various degrees of atrial fibrosis remain unknown. Objective This study aimed to explore the different roles of blocking the CSD-LA connection in the induction of acute AF and middle-term follow-up of recurrence among PersAF patients with various degrees of LA fibrosis. Methods and results A retrospective cohort of 71 patients with drug-refractory and symptomatic PersAF underwent ablation for the first time were studied. The population was divided into two groups according to disconnection of the CSD-LA or not. All patients enrolled accepted the unified ablation procedure (circumferential pulmonary vein isolation, non-pulmonary vein trigger ablation and ablation of the CSD-LA connection). Group A (n = 47) successfully blocked the CSD-LA electrical connection and Group B (n = 24) failed. Twenty-five patients could be induced into sustained AF in the Group A compared to 20 in the Group B (53.2 vs. 83.3%, p = 0.013). After a mean follow-up of 185 ± 8 days, 24 (33.8%) patients experienced atrial arrhythmia recurrences. The Group A had significantly fewer recurrences (25.5%) compared to Group B (50%). Meanwhile, in Group A, the ROC curve analysis suggested that in the case of blocking CSD-LA, low voltage area (LVA) of LA can act as a predictive factor for acute AF induction (AUC = 0.943, Cut-off = 0.190, P < 0.001) with sensitivity and specificity of 92.3 and 90.5%, and middle-term recurrence (AUC = 0.889, Cut-off = 0.196, P < 0.001) with sensitivity and specificity of 100 and 65.7%. Conclusion Disconnection of CSD-LA could reduce the inducible rate of acute AF and the recurrences of atrial arrhythmia during middle-term follow-up. The PersAF patients with CSD-LA muscular connection blocked, experienced a higher acute AF inducible rate with larger proportion of LVA of LA (≥19%) and a higher recurrent rate of atrial arrhythmias with a larger proportion of LA fibrosis (≥19.6%).
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Deisenhofer I. Electrogram-based AF ablation -finally, reproducibility! J Cardiovasc Electrophysiol 2022; 33:2261-2262. [PMID: 35989539 DOI: 10.1111/jce.15660] [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: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
After several years with sobering experiences with electrogram-based AF ablation approaches, Seitz et al present with the VX1 software a reliable tool to map and ablate spatio-temporal dispersion. The presented multicenter study in persistent AF patients was conducted in 1 expert and 7 satellite centers with a total of 17 operators, using the VX1 software to detect and subsequently ablate spatiotemporal dispersion. While the AF termination rate (88%) and the freedom from AF in 12 months FU (82%) was very encouraging, the VX1 software, using AI enhanced electrogram adjudication, achieved very similar results in all centers, regardless of the centre`s or the operator`s experience. Thus, the biggest criticism of electrogram-based ablation strategies, i.e. the lack of reproducibility in "non-expert" centers, seems to be finally addressed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
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Squara F, Scarlatti D, Bun SS, Moceri P, Ferrari E, Meste O, Zarzoso V. Fibrillatory Wave Amplitude Evolution during Persistent Atrial Fibrillation Ablation: Implications for Atrial Substrate and Fibrillation Complexity Assessment. J Clin Med 2022; 11:jcm11154519. [PMID: 35956135 PMCID: PMC9369560 DOI: 10.3390/jcm11154519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Fibrillatory Wave Amplitude (FWA) has been described as a non-invasive marker of atrial fibrillation (AF) complexity, and it predicts catheter ablation outcome. However, the actual determinants of FWA remain incompletely understood. Objective. To assess the respective implications of anatomical atrial substrate and AF spectral characteristics for FWA. Methods. Persistent AF patients undergoing radiofrequency catheter ablation were included. FWA was measured on 1-min ECG by TQ concatenation in Lead I, V1, V2, and V5 at baseline and immediately before AF termination. FWA evolution during ablation was compared to that of AF dominant frequency (DF) measured by Independent Component Analysis on 12-lead ECG. FWA was compared to the extent of endocardial low-voltage areas (LVA I < 10%; II 10–20%; III 20–30%; IV > 30%), to the surface of healthy left atrial tissue, and to P-wave amplitude in sinus rhythm. The predictive value of FWA for AF recurrence during follow-up was assessed. Results. We included 29 patients. FWA remained stable along ablation procedure with comparable values at baseline and before AF termination (Lead I p = 0.54; V1 p = 0.858; V2 p = 0.215; V5 p = 0.14), whereas DF significantly decreased (5.67 ± 0.68 vs. 4.95 ± 0.58 Hz, p < 0.001). FWA was higher in LVA-I than in LVA-II, -III, and -IV in Lead I and V5 (p = 0.02 and p = 0.01). FWA in V5 was strongly correlated with the surface of healthy left atrial tissue (R = 0.786; p < 0.001). FWA showed moderate to strong correlation to P-wave amplitude in all leads. Finally, FWA did not predict AF recurrence after a follow-up of 23.3 ± 9.8 months. Conclusions. These findings suggest that FWA is unrelated to AF complexity but is mainly determined by the amount of viable atrial myocytes. Therefore, FWA should only be referred as a marker of atrial tissue pathology.
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Affiliation(s)
- Fabien Squara
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
- Correspondence: ; Tel.: +33-6-2016-5829
| | - Didier Scarlatti
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Sok-Sithikun Bun
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Pamela Moceri
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Emile Ferrari
- Cardiology Department, Université Côte d’Azur, Pasteur Hospital, 30 Avenue de la Voie Romaine, 06000 Nice, France; (D.S.); (S.-S.B.); (P.M.); (E.F.)
| | - Olivier Meste
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
| | - Vicente Zarzoso
- I3S Laboratory, Université Côte d’Azur, CNRS, 06900 Sophia Antipolis, France; (O.M.); (V.Z.)
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Gillis K, O'Neill L, Wielandts JY, Hilfiker G, Almorad A, Lycke M, El Haddad M, le Polain de Waroux JB, Tavernier R, Duytschaever M, Knecht S. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation. JACC Clin Electrophysiol 2022; 8:367-376. [PMID: 35331432 DOI: 10.1016/j.jacep.2021.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block. BACKGROUND Achieving MI block with the use of RF ablation is challenging. METHODS Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMFIRST group) vs RF ablation as a first step preceding VOMEt (RFFIRST group). The study end point was incidence of MI block after RF ablation and after the 2 steps. RESULTS In VOMFIRST, VOMEt was successful in 30/35 patients (86%) resulting in a low-voltage area of 12 ± 7.4 cm2 and MI block in 2/35 patients (6%). VOMFIRST, compared with RFFIRST, was associated with higher incidence of MI block after endocardial (46% vs 11%; P < 0.001) and epicardial ablation (94% vs 43%; P < 0.001), with fewer endocardial applications (4 vs 11 vs 4; P < 0.001) and similar epicardial applications (7 vs 8; P = 0.68). Incidence of MI block after the 2 steps was 94% vs 63% (P = 0.001) in VOMFIRST vs RFFIRST, respectively. Additional touch-up RF ablation in both groups resulted in final MI block in all but 1 patient (99%). CONCLUSIONS VOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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Affiliation(s)
- Kris Gillis
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
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10
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De Roy L, Dechaux D, Deceuninck O. Atrial fibrillation ablation and anterior isthmus line: a simple and precise method for validation of bidirectional block. Acta Cardiol 2022; 78:364-366. [PMID: 35188086 DOI: 10.1080/00015385.2022.2040824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Luc De Roy
- Service de cardiologie CHR de Namur, Namur, Belgium
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11
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Charitakis E, OKarlsson L, Carlhäll CJ, Liuba I, Jönsson AH, Walfridsson H, Alehagen U. Endocrine and Mechanical Cardiacfunction Four Months after Radiofrequency Ablation of Atrialfibrillation. J Atr Fibrillation 2021; 14:20200454. [PMID: 34950357 DOI: 10.4022/jafib.20200454] [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: 01/03/2021] [Revised: 02/17/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded.We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP)were measured. The maximum LAvolume (LAVmax),the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured usingtransthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results 87 patients had a recurrence during a mean follow-up of 143±36 days.NT-proBNPand MR-proANPdecreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA.The LAVmax decreased significantly, whereasthe PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions Despite extensiveablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars OKarlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Division of Cardiovascular Medicine and CMIV, Linköping University, Linköping, Sweden
| | - Ioan Liuba
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Walfridsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
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12
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Yamashita S, Tokuda M, Mahida S, Sato H, Ikewaki H, Oseto H, Yokoyama M, Isogai R, Tokutake K, Yokoyama K, Narui R, Kato M, Tanigawa SI, Sugimoto KI, Yoshimura M, Yamane T. Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation. Sci Rep 2021; 11:23591. [PMID: 34880293 PMCID: PMC8654861 DOI: 10.1038/s41598-021-02935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p = 0.76). During 100 ± 28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8 ± 0.9 procedures) compared with EGM-group (Logrank test: p = 0.0001 and p = 0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of atrial arrhythmia recurrence. Linear ablation might be a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.
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Affiliation(s)
- Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan.
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Hidenori Sato
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Hirotsugu Ikewaki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Hirotsuna Oseto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Masaaki Yokoyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ryota Isogai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Kenichi Tokutake
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Kenichi Yokoyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ryohsuke Narui
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Mika Kato
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Shin-Ichi Tanigawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ken-Ichi Sugimoto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
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13
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O’Neill L, Wielandts JY, Gillis K, Hilfiker G, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy. J Clin Med 2021; 10:jcm10184060. [PMID: 34575173 PMCID: PMC8467025 DOI: 10.3390/jcm10184060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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14
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Spittler R, Bahlke F, Hoffmann BA, Marx A, Mollnau H, Quesada-Ocete B, Konrad T, Rostock T. Durable pulmonary vein isolation but not complex substrate ablation determines the type of arrhythmia recurrence after persistent atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:417-426. [PMID: 34373981 DOI: 10.1007/s10840-021-01048-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complex ablation for persistent atrial fibrillation (AF) aims to modify the arrhythmogenic substrates to become incapable to perpetuate the arrhythmia. Ablation-associated determinants of atrial tachycardia (AT) rather than AF recurrences are unknown. The aim of the study was to evaluate the association between the type of arrhythmia recurrence and electrophysiological findings during redo procedures. METHODS A total number of 384 consecutive patients with persistent AF underwent complex ablation consisting of PV isolation (PVI), biatrial electrogram-guided ablation, and linear ablation with the desired procedural endpoint of AF termination. Electrophysiological findings during redo procedures and its relation to AR type are the subject of this study. RESULTS Overall, 177 (46%) patients underwent a second procedure. Patients with AT recurrences had significantly more often persistent PVI (47 vs. 25%; P = 0.002). Moreover, a higher number of recovered PVs were associated with AF recurrence (3 PVs recovered, AF = 16.1% vs. AT = 5.2%; P = 0.02; 4 PVs recovered, AF = 18.5% vs. AT = 6.3%; P = 0.01), regardless of the extent of substrate ablation during the first procedure. CONCLUSIONS Durable PV isolation but not the extent of atrial substrate ablation determines the type of arrhythmia recurrence. Thus, the PVs may represent dominant perpetuators (and not only triggers) of persistent AF even in the presence of a significantly modified atrial substrate.
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Affiliation(s)
- Raphael Spittler
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany.
| | - Fabian Bahlke
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | | | - Alexandra Marx
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Hanke Mollnau
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Blanca Quesada-Ocete
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Torsten Konrad
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
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15
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Gheini A, Pourya A, Pooria A. Atrial Fibrillation and Ventricular Tachyarrhythmias: Advancements for Better Outcomes. Cardiovasc Hematol Disord Drug Targets 2021; 20:249-259. [PMID: 33001020 DOI: 10.2174/1871529x20666201001143907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/01/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
Cardiac arrhythmias are associated with several cardiac diseases and are prevalent in people with or without structural and valvular abnormalities. Ventricular arrhythmias (VA) can be life threating and their onset require immediate medical attention. Similarly, atrial fibrillation and flutter lead to stroke, heart failure and even death. Optimal treatment of VA is variable and depends on the medical condition associated with the rhythm disorder (which includes reversible causes such as myocardial ischemia or pro-arrhythmic drugs). While an implanted cardioverter defibrillator is often indicated in secondary prevention of VA. This review highlights the newest advancements in these techniques and management of ventricular and atrial tachyarrhythmias, along with pharmacological therapy.
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Affiliation(s)
- Alireza Gheini
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Ali Pooria
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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16
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Ioannidis P, Christoforatou E, Zografos T, Charalambopoulos P, Kouvelas K, Christoulas G, Syros P, Tsitsinakis G, Kappou T, Tsoumeleas A, Floros S, Tagoulis D, Ntarladimas I, Tagoulis I, Avzotis D, Manolis AS, Vassilopoulos C. Incidence, electrophysiological characteristics, and long-term follow-up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block. J Arrhythm 2021; 37:584-596. [PMID: 34141011 PMCID: PMC8207388 DOI: 10.1002/joa3.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo-block). We aimed to study the incidence, the electrophysiological characteristics, and the long-term outcome of these patients. METHODS Seventy-two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high-density mapping. RESULTS Mitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high-density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF. CONCLUSION Perimitral atrial flutter with MI pseudo-block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonis S. Manolis
- First Department of CardiologyAthens University School of MedicineAthensGreece
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17
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Nelson JA, Gue YX, Christensen JM, Lip GYH, Ramakrishna H. Analysis of the ESC/EACTS 2020 Atrial Fibrillation Guidelines With Perioperative Implications. J Cardiothorac Vasc Anesth 2021; 36:2177-2195. [PMID: 34130901 DOI: 10.1053/j.jvca.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, with an individual lifetime risk of approximately 37% in the United States. Broadly defined as a supraventricular tachyarrhythmia with disorganized atrial activation, AF results in an increased risk of stroke, heart failure, valvular heart disease, and impaired quality of life, and confers a significant burden on the health of individuals and society. AF in the perioperative setting is common and a significant source of perioperative morbidity and mortality worldwide. The latest iteration of the European Society of Cardiology AF guidelines published in 2020 provide the clinician a valuable road map for the management of this arrythmia. This expert review will comprehensively analyze the 2020 European Society of Cardiology guidelines and provide perioperative management tools for the clinician.
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Affiliation(s)
- James A Nelson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ying X Gue
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jon M Christensen
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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18
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Hsieh YC, Lin YJ, Lo MT, Chen YY, Lin CY, Lin C, Chung FP, Lo LW, Chang SL, Chao TF, Hu YF, Tuan TC, Liao JN, Wu CI, Liu CM, Vicera JJB, Chen CC, Chin CG, Lugtu IC, Chen SA. Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3-year follow-up outcomes. J Cardiovasc Electrophysiol 2021; 32:1561-1571. [PMID: 33825268 PMCID: PMC8252615 DOI: 10.1111/jce.15033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
Objectives This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3‐year follow‐up in patients with persistent AF. Background The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear. Methods Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model. Results Baseline characteristics were similar across the four groups. At a follow‐up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p = .002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p = .006). Independent predictors of recurrence of AF were the ablation strategy (p = .002) and left atrial diameter (LAD) (p = .01). Conclusion In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3‐year outcomes of freedom from AT/AF
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Affiliation(s)
- Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yenn-Jiang Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Chungli, Taiwan.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Yun-Yu Chen
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Chungli, Taiwan.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Fa-Po Chung
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-I Wu
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer-Jeanne B Vicera
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chao Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chye-Gen Chin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Isaiah C Lugtu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
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19
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Tan C, Zeng LJ, Shi HF, Tian Y, Ma N, Liu H, Li SC, Hu XH, Mei J, Liu XP. Intraprocedural arrhythmia termination as an end point for hybrid ablation in patients with long-standing persistent atrial fibrillation: a 2-year follow-up study. Interact Cardiovasc Thorac Surg 2021; 33:43-50. [PMID: 33890060 DOI: 10.1093/icvts/ivab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Hybrid catheter and surgical ablation has emerged as an effective therapy for patients with persistent atrial fibrillation (AF). The aims of this study were to evaluate the relationship between intraprocedural arrhythmia termination and the long-term outcomes of hybrid ablation in patients with long-standing persistent AF. METHODS From May 2015 through April 2019, 50 patients with persistent AF with a mean duration of 73.3 ± 62.1 (median 54) months underwent single-step hybrid ablation. Pulmonary vein isolation, left atrial posterior wall isolation and left atrial appendage excision or closure were performed through a left-sided thoracoscopic approach. Subsequently, all patients underwent high-density endocardial mapping and electrogram-based ablation with the end point of AF termination. RESULTS We achieved intraprocedural AF termination in 84% (42/50) patients; this end point was reached in 16 patients during surgical ablation and in 26 patients during catheter ablation. Seven patients underwent repeat catheter ablation. After a mean follow-up period of 29 ± 13 months, the freedom from atrial tachyarrhythmia of a single procedure without the use of antiarrhythmic drugs was 70% (35/50). In the Cox regression model, intraprocedural termination of AF (hazard ratio 0.205, 95% confidence interval 0.058-0.730; P = 0.014) was the sole predictor of success. CONCLUSIONS The 2-year outcomes of a one-stop hybrid ablation with an end point of AF termination are promising in patients with long-standing persistent AF.
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Affiliation(s)
- Chen Tan
- Department of Cardiology, Hebei Yanda Hospital, Hebei, Hebei Province, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hai-Feng Shi
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Nan Ma
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Sheng-Chao Li
- Department of Cardiology, Hebei Yanda Hospital, Hebei, Hebei Province, China
| | - Xue-Hong Hu
- Department of Cardiology, Hebei Yanda Hospital, Hebei, Hebei Province, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xing-Peng Liu
- Department of Cardiology, Hebei Yanda Hospital, Hebei, Hebei Province, China.,Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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21
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Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
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McCann A, Vesin JM, Pruvot E, Roten L, Sticherling C, Luca A. ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation. Front Physiol 2021; 12:654053. [PMID: 33859573 PMCID: PMC8042333 DOI: 10.3389/fphys.2021.654053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Consistently successful patient outcomes following catheter ablation (CA) for treatment of persistent atrial fibrillation (pers-AF) remain elusive. We propose an electrocardiogram (ECG) analysis designed to (1) refine selection of patients most likely to benefit from ablation, and (2) examine the temporal evolution of AF organization indices that could act as clinical indicators of ongoing ablation effectiveness and completeness. Method: Twelve-lead ECG was continuously recorded in 40 patients (61 ± 8 years) during stepwise CA (step-CA) procedures for treatment of pers-AF (sustained duration 19 ± 11 months). Following standard pre-processing, ECG signals were divided into 10-s epochs and labeled according to their temporal placement: pre-PVI (baseline), dur-PVI (during pulmonary vein isolation), and post-PVI (during complex-fractionated atrial electrograms and linear ablation). Instantaneous frequency (IF), adaptive organization index (AOI), sample entropy (SampEn) and f-wave amplitude (FWA) measures were calculated and analyzed during each of the three temporal steps. Temporal evolution of these measures was assessed using a statistical test for mean value transitions, as an indicator of changes in AF organization. Results were then compared between: (i) patients grouped according to step-CA outcome; (ii) patients grouped according to type of arrhythmia recurrence following the procedure, if applicable; (iii) within the same patient group during the three different temporal steps. Results: Stepwise CA patient outcomes were as follows: (1) left-atrium (LA) terminated, not recurring (LTN, n = 8), (2) LA terminated, recurring (LTR, n = 20), and (3) not LA terminated, all recurring at follow-up (NLT, n = 12). Among the LTR and NLT patients, recurrence occurred as AF in seven patients and atrial tachycardia or atrial flutter (AT/AFL) in the remaining 25 patients. The ECG measures indicated the lowest level of organization in the NLT group for all ablation steps. The highest organization was observed in the LTN group, while the LTR group displayed an intermediate level of organization. Regarding time evolution of ECG measures in dur-PVI and post-PVI recordings, stepwise ablation led to increases in AF organization in most patients, with no significant differences between the LTN, LTR, and NLT groups. The median decrease in IF and increase in AOI were significantly greater in AT/AFL recurring patients than in AF recurring patients; however, changes in the SampEn and FWA parameters were not significantly different between types of recurrence. Conclusion: Noninvasive ECG measures, though unable to predict arrhythmia recurrence following ablation, show the lowest levels of AF organization in patients that do not respond well to step-CA. Increasing AF organization in post-PVI may be associated with organized arrhythmia recurrence after a single ablation procedure.
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Affiliation(s)
- Anna McCann
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Etienne Pruvot
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Adrian Luca
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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23
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Masuda T, Funama Y, Nakaura T, Sato T, Muraoka Y, Okimoto T, Yamashita Y, Oku T, Matsumoto Y, Masuda S, Kiguchi M, Awai K. The combined application of the contrast-to-noise index and 80 kVp for cardiac CTA scanning before atrial fibrillation ablation reduces radiation dose exposure. Radiography (Lond) 2021; 27:840-846. [PMID: 33549491 DOI: 10.1016/j.radi.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/26/2020] [Accepted: 01/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To compare the radiation dose, diagnostic accuracy, and the resultant ablation procedures using 80 and 120-kVp cardiac computed tomography angiography (CCTA) protocols with the same contrast-to-noise ratio in patients scheduled for atrial fibrillation (AF) ablation. METHODS This retrospective study was performed following institutional review board approval. We divided 140 consecutive patients who had undergone CCTA using a 64-MDCT scanner into two equal groups. Standard deviation (SD) of the CT number was set at 25 Hounsfield units (HU) for the 120-kVp protocol. To facilitate a reduction in radiation dose it was set at 40 HU for the 80 kVp protocol. We compared the two protocols with respect to the radiation dose, the diagnostic accuracy for detecting left atrial appendage (LAA) thrombi, matching for surface registration, and the resultant ablation procedures. RESULTS At 120 kVp, the dose length product (DLP) was 2.2 times that at 80 kVp (1269.0 vs 559.0 mGy cm, p < 0.01). The diagnostic accuracy for thrombus detection was 100% using both protocols. There was no difference between the two protocols with respect to matching for surface registration. The protocols did not differ with respect to the subsequent time required for the ablation procedures and the ablation fluoroscopy time, and the radiation dose (p = 0.54, 0.33, and 0.32, respectively). CONCLUSION For the same CNR, the DLP at 80 kVp (559.0 mGy cm) was 56% of that delivered at 120 kVp (1269.0 mGy cm). There was no reduction in diagnostic accuracy. IMPLICATIONS FOR PRACTICE Maintaining CNR allows for a reduction in the radiation dose without reducing the image quality.
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Affiliation(s)
- T Masuda
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan; Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
| | - Y Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - T Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Y Muraoka
- Department of Cardiovascular Internal Medicine, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - T Okimoto
- Department of Cardiovascular Internal Medicine, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Y Yamashita
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan
| | - T Oku
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan
| | - Y Matsumoto
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima, 730-8655, Japan
| | - S Masuda
- Department of Radiological Technology, Kawamura Clinic, Otemachi, Naka-ku, Hiroshima, 730-0051, Japan
| | - M Kiguchi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - K Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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24
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5324] [Impact Index Per Article: 1774.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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25
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Sakamoto Y, Lockwood D, Yamaguchi R, Yoshimoto D, Suzuki T, Ho SY, Nakagawa H. Systematic Evaluation of High-Resolution Activation Mapping to Identify Residual Endocardial and Epicardial Conduction Across the Mitral Isthmus. JACC Clin Electrophysiol 2021; 7:292-304. [PMID: 33516706 DOI: 10.1016/j.jacep.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to systematically evaluate the ability of a high-resolution mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) to rapidly and accurately localize residual endocardial and epicardial conduction after mitral isthmus (MI) ablation, facilitating MI block. BACKGROUND Achieving conduction block across the mitral isthmus (MI) is challenging. METHODS Fifty consecutive patients undergoing MI ablation after pulmonary vein isolation were enrolled. After initial endocardial radiofrequency (RF) ablation across the lateral MI, high-resolution activation mapping of the MI with simultaneous coronary sinus (CS) mapping was performed to verify block or localize residual conduction across the MI during left atrial (LA) appendage and CS pacing. Propagation maps were used to identify residual conduction across the MI as endocardial, via the CS or Marshall tract. RESULTS In all 50 patients, after the initial endocardial ablation across the MI, repeat high-resolution mapping of the LA and CS was obtained (median: 3,329 mapped points; 4.0 min of mapping time). The initial endocardial MI ablation resulted in block in 9 of 50 patients (18%). In the remaining 41 patients, the propagation map identified residual conduction in 4 patterns: 1) only endocardial gap in 12 patients (29%); 2) only CS connection in 10 patients (24%); 3) both endocardial and CS connections in 14 patients (34%); and 4) Marshall tract connection in 5 patients (12%). In 8 patients, the propagation map revealed residual conduction, despite differential atrial pacing suggesting bidirectional block. Focal ablation at the identified residual conduction site (median: 0.7 min of RF) resulted in block in 49 of 50 (98%) patients. CONCLUSIONS High-resolution propagation maps of the LA/CS rapidly and accurately localize residual endocardial and epicardial conduction across the MI. Focal ablation with short RF time at the identified gap(s) achieved complete block across MI in 98% of cases.
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Affiliation(s)
| | - Deborah Lockwood
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ryo Yamaguchi
- Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | | | - Takahiko Suzuki
- Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Siew Yen Ho
- Royal Brompton and Imperial College London, United Kingdom
| | - Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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26
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The shape of the left lateral ridge as a predictor of long-term outcome of catheter ablation for atrial fibrillation based on clinical and experimental data. Int J Cardiol 2020; 329:91-98. [PMID: 33370558 DOI: 10.1016/j.ijcard.2020.12.055] [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: 08/16/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The left lateral ridge (LLR) is an important structure for ablation of atrial fibrillation (AF). This study assessed how the LLR shape is associated with the long-term outcomes of AF ablation and investigated the relationship with radiofrequency (RF) lesion formation. METHODS AND RESULTS Clinical study - we assessed multi-detector computed tomography (MDCT) images in 247 patients who underwent AF ablation. Patients were classified into two groups according to the shape of the LLR: Narrow LLR group (n = 116; 47%) and Wide LLR group (n = 131; 53%). After a follow-up period 475 ± 245 days, the AF-free rate was significantly higher in the wide LLR than Narrow LLR group (83.2% vs. 62.9%, p = 0.0004). A multivariate analysis showed that the shape of the LLR was an independent predictor of AF recurrence after ablation (hazard ratio 2.58; 95% confidential interval = 1.48-4.51, p = 0.001). Experimental study - Two types of the ridge models were made with porcine atrial tissues: "Narrow ridge(4.2 ± 0.9 mm)" and "Wide ridge(9.7 ± 1.8 mm)" RF ablation was performed on each ridge model using a contact force (CF)-sensing catheter. The mean CF and the RF lesion volume of the narrow ridge were significantly less than those of the wide ridge model (5.42 ± 3.13 g vs. 10.37 ± 3.98 g, p = 0.001; 19.8 ± 9.9 mm3 vs. 44.2 ± 13.6 mm3, p < 0.001, respectively). CONCLUSIONS AF recurrence after ablation was more frequent in patients with a narrow LLR. LLR shape as assessed using MDCT is associated with long-term outcomes after AF ablation. CF and lesion formation data using the porcine atrial tissue model support our clinical results.
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27
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Hong KL, Borges J, Glover B. Catheter ablation for the management of atrial fibrillation: current technical perspectives. Open Heart 2020; 7:openhrt-2019-001207. [PMID: 32393656 PMCID: PMC7223467 DOI: 10.1136/openhrt-2019-001207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 01/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
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Affiliation(s)
- Kathryn Lauren Hong
- Cardiology, University of Toronto, Toronto, Canada.,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jazlyn Borges
- Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benedict Glover
- Cardiology, University of Toronto, Toronto, Canada .,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
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Paola AAVD. Translational Approach for Percutaneous Interventions for the Treatment of Cardiac Arrhythmias. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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Key factors behind autofluorescence changes caused by ablation of cardiac tissue. Sci Rep 2020; 10:15369. [PMID: 32958843 PMCID: PMC7506017 DOI: 10.1038/s41598-020-72351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
Radiofrequency ablation is a commonly used clinical procedure that destroys arrhythmogenic sources in patients suffering from atrial fibrillation and other types of cardiac arrhythmias. To improve the success of this procedure, new approaches for real-time visualization of ablation sites are being developed. One of these promising methods is hyperspectral imaging, an approach that detects lesions based on changes in the endogenous tissue autofluorescence profile. To facilitate the clinical implementation of this approach, we examined the key variables that can influence ablation-induced spectral changes, including the drop in myocardial NADH levels, the release of lipofuscin-like pigments, and the increase in diffuse reflectance of the cardiac muscle beneath the endocardial layer. Insights from these experiments suggested simpler algorithms that can be used to acquire and post-process the spectral information required to reveal the lesion sites. Our study is relevant to a growing number of multilayered clinical targets to which spectral approaches are being applied.
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Razeghian-Jahromi I, Natale A, Nikoo MH. Coronary sinus diverticulum: Importance, function, and treatment. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1582-1587. [PMID: 32815147 DOI: 10.1111/pace.14026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023]
Abstract
The importance of venous structure in the heart is usually overshadowed by that of the arterial system. Coronary sinus (CS) is a part of cardiac venous apparatus and connects left atria to the right atria. Other than having role in physiological contractions of both atria, it contributes substantially to cardiac electrical conduction system. Due to unique placement and connections of the CS, it has become growing interest in clinical cardiology. It is used in cardiac resynchronization therapy with biventricular pacing, left-sided catheter ablation of arrhythmias, and administration of retrograde cardioplegia in cardiac surgery. In some individuals, CS is presented with anatomical variants. CS diverticulum is a congenital outpouching that provides muscular connection between atria and ventricle. This connection provides a suitable substrate for occurrence of arrhythmias, which even results in life-threatening events such as sudden cardiac death. Early diagnosis leads to treatment with ablation techniques, which ultimately eliminates origins of arrhythmias.
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Affiliation(s)
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,MetroHealth Medical Center, CaseWestern Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California.,Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California
| | - Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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31
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Derval N, Takigawa M, Frontera A, Mahida S, Konstantinos V, Denis A, Duchateau J, Pillois X, Yamashita S, Berte B, Thompson N, Hooks D, Pambrun T, Sacher F, Hocini M, Bordachar P, Jaïs P, Haïssaguerre M. Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping. JACC Clin Electrophysiol 2020; 6:815-826. [DOI: 10.1016/j.jacep.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
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32
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Liao H, Zeng Y, Liao S, Chu Y, Zhou Y, Wang Y. Three Birds with One Stone: Injectable CaC 2 Nanobombs with Triple Effects for Minimally Invasive Tumor Chemical Ablation. ACS APPLIED BIO MATERIALS 2020; 3:3809-3816. [PMID: 35025251 DOI: 10.1021/acsabm.0c00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Percutaneous chemical ablation (PCA) is the oldest and most established technique for treating small solid tumors in organs. It has been widely used in clinics even on an outpatient basis. However, compared with the emerging microwave or magnetic hyperthermal ablation, PCA is faced with relatively poor necrosis results and needs to repeat multiple sessions. Inspired by the three effects in the bomb's explosive process, we herein expect to combine calcium carbide (CaC2) nanoparticles into the PCA technique to generate local explosion within tumor tissues, leading to three killing effects against tumors to further improve the ablation efficacy of PCA. Through an efficient wet milling procedure with poly(ethylene glycol), three kinds of nanobombs including CaC2, calcium oxide (CaO), and calcium hydroxide (Ca(OH)2) were fabricated, and they all exhibited desirable suspension stability. Among these nanobombs, in particular CaC2 nanobombs showed a synergistic effect that the generation of ethyne gas bubbles could facilitate the most rapid diffusion of hyperthermia. Also, CaC2 nanobombs offered the powerful ability to cause the sudden rise of local high temperature and pH value. According to the in vivo mice tumor excision trial, the tumors of 75% of cases that received CaC2 treatment were destroyed and eradicated, exhibiting the excellent ablation ability of CaC2 nanobombs against small solid tumors planted in mice.
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Affiliation(s)
- Hongguang Liao
- Department of Chemistry, Renmin University of China, Beijing 100872, China
| | - Yuting Zeng
- Department of Chemistry, Renmin University of China, Beijing 100872, China
| | - Shenglong Liao
- Department of Chemistry, Renmin University of China, Beijing 100872, China
| | - Yanji Chu
- Department of Chemistry, Renmin University of China, Beijing 100872, China
| | - You Zhou
- Department of Chemistry, Renmin University of China, Beijing 100872, China
| | - Yapei Wang
- Department of Chemistry, Renmin University of China, Beijing 100872, China
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Intrinsically stretchable electrode array enabled in vivo electrophysiological mapping of atrial fibrillation at cellular resolution. Proc Natl Acad Sci U S A 2020; 117:14769-14778. [PMID: 32541030 DOI: 10.1073/pnas.2000207117] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Electrophysiological mapping of chronic atrial fibrillation (AF) at high throughput and high resolution is critical for understanding its underlying mechanism and guiding definitive treatment such as cardiac ablation, but current electrophysiological tools are limited by either low spatial resolution or electromechanical uncoupling of the beating heart. To overcome this limitation, we herein introduce a scalable method for fabricating a tissue-like, high-density, fully elastic electrode (elastrode) array capable of achieving real-time, stable, cellular level-resolution electrophysiological mapping in vivo. Testing with acute rabbit and porcine models, the device is proven to have robust and intimate tissue coupling while maintaining its chemical, mechanical, and electrical properties during the cardiac cycle. The elastrode array records epicardial atrial signals with comparable efficacy to currently available endocardial-mapping techniques but with 2 times higher atrial-to-ventricular signal ratio and >100 times higher spatial resolution and can reliably identify electrical local heterogeneity within an area of simultaneously identified rotor-like electrical patterns in a porcine model of chronic AF.
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Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
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Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
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Kitamura T, Takigawa M, Derval N, Denis A, Martin R, Vlachos K, Nakatani Y, Frontera A, Cheniti G, Martin CA, Bourier F, Lam A, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Atrial tachycardia circuits include low voltage area from index atrial fibrillation ablation relationship between RF ablation lesion and AT. J Cardiovasc Electrophysiol 2020; 31:1640-1648. [PMID: 32437007 DOI: 10.1111/jce.14576] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND No study to date has used high-density mapping to investigate the relationship between prior radiofrequency (RF) lesions for persistent atrial fibrillation (PsAF) ablation and subsequent atrial tachycardias (ATs). METHODS From 41 consecutive patients who underwent AT ablation at a second procedure using an ultrahigh-density mapping system, 22 patients (38 ATs) were included as they also had complete maps with a multipolar catheter and three-dimensional (3D) mapping system at the time of the first PsAF ablation procedure. We, therefore, compared voltage maps from the first AF ablation procedure to those from the subsequent AT ablation procedure, as well as the lesion sets used for AF ablation vs the activation patterns in AT during the second procedure. RESULTS In the 38 ATs, 211 of 285 analyzed atrial areas displayed low voltage area (LVA) (74%). Eighteen percent (38/211) existed before the index ablation for AF while 82% (173/211) were newly identified as LVA during the second procedure. Ninety-nine percent (172/173) of the newly developed LVA colocalized with RF lesions delivered for PsAF. Of the 38 ATs, 89.5% (34/38) AT circuits were associated with newly developed LVA due to RF lesions whilst 10.5% (4/38) AT circuits were associated with pre-existing LVA observed at the index procedure. No AT circuit was completely independent from index RF lesions in this series. CONCLUSIONS Analysis of detailed 3D electroanatomical mapping demonstrates that most ATs after PsAF ablation are involving LVAs due to index RF lesions.
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Affiliation(s)
- Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ruairidh Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Anna Lam
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Meleze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
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36
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Maj R, Borio G, Osório TG, Iacopino S, Ströker E, Sieira J, Terasawa M, Rizzo A, Scala O, Galli A, Varnavas V, Paparella G, Capulzini L, Brugada P, De Asmundis C, Chierchia GB. Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second-generation cryoballoon pulmonary vein isolation. J Arrhythm 2020; 36:319-327. [PMID: 32256881 PMCID: PMC7132212 DOI: 10.1002/joa3.12301] [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] [Received: 08/14/2019] [Revised: 11/05/2019] [Accepted: 12/26/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The prevalence and the clinical impact of conversion of atrial fibrillation (AF) to sinus rhythm (SR) during cryoballoon ablation (CB-A) are unknown. OBJECTIVE The purpose of this study was to evaluate the prevalence of restoration of SR during CB-A and the clinical impact of this phenomenon. METHODS Between January 2012 and September 2018, all patients who experienced conversion of AF to SR during CB-A were included. This group was subsequently matched for gender, age, type of AF, diagnosis-to-ablation time, and left atrial size with patients who underwent CB-A and did not experienced conversion of AF to SR. After discharge, patients were scheduled for follow-up visits at 1, 3, 6, and 12 months and 24 hours Holter recordings were obtained at each follow-up visit. All documented AF episodes of >30 seconds were considered as recurrence. A 3 month post-procedural blanking period (BP) was applied. RESULTS A total of 1559 patients underwent pulmonary veins isolation by CB-A between January 2012 and September 2018; among them, 58 patients (3.7%) experienced restoration of SR during CB-A. In total, 53 patients (41 males [77.3%], mean age 61.4 ± 13.3 years) were included in the case group. During CB-A, restoration of SR occurred more frequently during right-side PVs applications (right inferior pulmonary vein 39.6%, right superior pulmonary vein 30.2%). If considering a BP, at 2 year follow-up, freedom from recurrences was 86.5% in the case group and 68.0% in the control group (P = .036). CONCLUSION Conversion of AF to SR is a favorable and relatively frequent phenomenon during cryoballoon pulmonary vein isolation ablation.
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Affiliation(s)
- Riccardo Maj
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | - Gianluca Borio
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | | | | | - Erwin Ströker
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | - Juan Sieira
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | - Muryo Terasawa
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | | | - Oriana Scala
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | - Alessio Galli
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
| | | | | | | | - Pedro Brugada
- Heart Rhythm Management CenterUZ Brussel‐VUBBrusselsBelgium
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37
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Tomii N, Asano K, Seno H, Ashihara T, Sakuma I, Yamazaki M. Validation of Intraoperative Catheter Phase Mapping Using a Simultaneous Optical Measurement System in Rabbit Ventricular Myocardium. Circ J 2020; 84:609-615. [DOI: 10.1253/circj.cj-19-1020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Tomii
- Faculty of Medicine, The University of Tokyo
| | | | | | - Takashi Ashihara
- Information Technology and Management Center, Shiga University of Medical Science
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38
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El Moheb M, Refaat MM. FIRM-guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection: Lessons learned. J Cardiovasc Electrophysiol 2020; 31:1038-1039. [PMID: 32115789 DOI: 10.1111/jce.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad El Moheb
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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39
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Pambrun T, Derval N, Duchateau J. Beyond pulmonary veins… The new horizon remains atrial anatomy. J Cardiovasc Electrophysiol 2019; 31:160-162. [DOI: 10.1111/jce.14297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique du Haut‐Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC)Université BordeauxBordeaux France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut‐Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC)Université BordeauxBordeaux France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut‐Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC)Université BordeauxBordeaux France
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40
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Takahashi Y, Akiyoshi K, Sekigawa M, Yagishita A, Yamamoto T, Maeda S, Kawabata M, Goya M, Hirao K, Sasano T. Endocardial contact mapping of the left atrial appendage in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:112-118. [PMID: 31724790 DOI: 10.1111/jce.14278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/19/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Isolation of the left atrial appendage (LAA) is often performed in persistent atrial fibrillation (AF). Propagation patterns in the LAA during AF remain to be elucidated. We sought to characterize propagation patterns in the LAA during AF in persistent AF. METHODS Persistent AF patients undergoing catheter ablation were studied. Pulmonary vein isolation (PVI) was performed during continuous AF. If AF was not terminated by PVI, bi-atrial mapping was performed using a multi-electrode catheter during AF. Maps were collected at each site for 30 seconds and analyzed offline with a novel software, CARTOFINDER. This software made automatic determinations of whether activation was focal or rotational. The left atrium (LA) was divided into five regions, of which the LAA was one, and the right atrium (RA) into three. RESULTS Eighty patients were studied (62 ± 10 years, 65 males). On average, 9.6 ± 2.2 and 4.1 ± 1.2 maps were created in the LA and RA, respectively. The LAA was mapped in 70 patients, resulting in 85 maps. In the LAA, activation was identified as focal more often than rotational (64 [91%] vs 10 [14%] patients, P < .001), seven patients displayed both. The number of focal activation events was greatest in the LAA (28.5 events/30 seconds [interquartile range, 15-54]) of the eight atrial regions. During focal activation, sites designated as earliest activation frequently covered a wide area, rather than being localized to a discrete site (5.4 ± 3.1 electrodes). CONCLUSIONS The results of this study suggest that focal activation is a major mechanism underlying the arrhythmogenicity of the LAA in persistent AF.
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Affiliation(s)
- Yoshihide Takahashi
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kikou Akiyoshi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Sekigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsuhiko Yagishita
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shingo Maeda
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mihoko Kawabata
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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41
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Lee JM, Shim J, Park J, Yu HT, Kim TH, Park JK, Uhm JS, Kim JB, Joung B, Lee MH, Kim YH, Pak HN. The Electrical Isolation of the Left Atrial Posterior Wall in Catheter Ablation of Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2019; 5:1253-1261. [PMID: 31753429 DOI: 10.1016/j.jacep.2019.08.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study explored whether complete electrical isolation of the left atrial (LA) posterior wall improves the rhythm outcome of catheter ablation of persistent atrial fibrillation (AF). BACKGROUND Although the STAR AF2 (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II) proved no additional benefit of empirical extra-pulmonary vein (PV) LA ablation, the long-term recurrence rate after circumferential PV isolation (CPVI) alone remains high. METHODS We randomly assigned 217 patients with persistent AF (83.1% men, age 58.7 ± 10.8 years, 73.3% long-standing persistent AF) to ablation with CPVI alone (CPVI group) or CPVI with a POsterior wall Box Isolation (POBI group). The endpoint of the POBI group was the elimination of the posterior atrial potentials by roof and posterior inferior lines and touch-up focal ablation. RESULTS After a mean follow-up of 16.2 ± 8.8 months, the clinical recurrence rate did not significantly differ between the 2 groups (23.8% vs. 26.5%; p = 0.779) in the CPVI and POBI groups. The recurrence rate for atrial tachycardias (16.0% vs. 11.1%; p = 0.913) and cardioversion rates (6.7% vs. 13.7%; p = 0.093) to control clinical recurrences also did not significantly differ between the 2 groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 50.5% and 55.9% in the CPVI and POBI groups, respectively (p = 0.522). No significant difference was found in the major complication rates between the 2 groups, but the total ablation time was significantly longer in the POBI group (4,289 ± 1,837 s vs. 5,365 ± 2,358 s; p < 0.001). CONCLUSIONS In patients with persistent AF, an empirical complete POBI did not improve the rhythm outcome of catheter ablation or influence the type of recurrent atrial arrhythmia. (Comparison of Circumferential Pulmonary Vein Isolation Alone Versus Linear Ablation in Addition to Circumferential Pulmonary Vein Isolation for Catheter Ablation in Persistent Atrial Fibrillation: Prospective Randomized Controlled Trial; NCT02721121).
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Affiliation(s)
- Jung Myung Lee
- Kyung Hee University Medical College, Seoul, Republic of Korea
| | - Jaemin Shim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Junbeom Park
- Ewha Womans University, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jin-Bae Kim
- Kyung Hee University Medical College, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Young-Hoon Kim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Melby DP, Gornick C, Abdelhadi R, Sengupta J, Pai M, Zakaib JS, Moore J, Benditt DG. Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map. J Cardiovasc Electrophysiol 2019; 30:1860-1867. [PMID: 31353679 PMCID: PMC6852153 DOI: 10.1111/jce.14092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Ablation of persistent atrial fibrillation (AF) remains challenging. Identification and ablation of localized AF drivers may offer the possibility for improved outcomes. Ripple map is a novel software algorithm that may allow improved localization of possible AF drivers through the whole chamber graphical display of continuously recorded bipolar electrograms. The objective of this study was to determine whether regions of high-frequency Ripple activation (HFRA) observed on Ripple map provide useful ablation targets in patients with persistent AF. METHODS AND RESULTS Consecutive patients underwent the first-time ablation of persistent AF (n = 162) using a standard stepwise (n = 105) or a Ripple map guided approach (n = 57). Ripple map guided patients underwent pulmonary vein antral isolation followed by ablation of HFRA sites. Acute termination of AF was observed in 91.2% of the Ripple-guided patients vs 52.4% in the stepwise approach, P < .0001. Following a single ablation procedure, after 18 months 98.2% of Ripple map guided patients were free of AF, compared with 81.4% of standard stepwise ablation (P = .005). Freedom from atrial tachycardia (54.4% Ripple map vs 52.4% standard, P = .9) or any atrial arrhythmia (52.6% Ripple map vs 39.0% standard, P = .10) did not differ between the two strategies. In a subset analysis (n = 30 of 56), Ripple map regions corresponded to sites with spatiotemporal dispersion in all atrial locations. No differences were observed in the rate of procedural complications. CONCLUSIONS Ablation of HFRA sites identified with Ripple map resulted in a higher rate of acute termination and improved freedom from AF compared to a standard stepwise approach.
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Affiliation(s)
- Daniel P. Melby
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - Charles Gornick
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - Raed Abdelhadi
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - Jay Sengupta
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - Manju Pai
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - John S. Zakaib
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - JoEllyn Moore
- Minneapolis Heart Institute and FoundationMinneapolisMinnesota
| | - David G. Benditt
- University of Minnesota Medical School, Cardiovascular DivisionMinneapolisMinnesota
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Yamashita S, Tokuda M, Matsuo S, Mahida S, Hachisuka EO, Sato H, Ikewaki H, Oseto H, Yokoyama M, Isogai R, Tokutake K, Yokoyama K, Narui R, Kato M, Tanigawa S, Sugimoto K, Yoshimura M, Yamane T. Comparison of atrial arrhythmia recurrence after persistent atrial fibrillation ablation between patients with or without tachycardia‐induced cardiomyopathy. J Cardiovasc Electrophysiol 2019; 30:2310-2318. [DOI: 10.1111/jce.14144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Seiichiro Matsuo
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Saagar Mahida
- Department of Cardiac Electrophysiology Liverpool Heart and Chest Hospital Liverpool UK
| | - Eri Okajima Hachisuka
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Hidenori Sato
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Hirotsugu Ikewaki
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Hirotsuna Oseto
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Masaaki Yokoyama
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Ryota Isogai
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Kenichi Tokutake
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Kenichi Yokoyama
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Ryohsuke Narui
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Mika Kato
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Shinichi Tanigawa
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Kenichi Sugimoto
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
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Ahmed N, Perveen S, Mehmood A, Rani G, Molon G. Coronary Sinus Ablation Is a Key Player Substrate in Recurrence of Persistent Atrial Fibrillation. Cardiology 2019; 143:107-113. [DOI: 10.1159/000501819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/18/2019] [Indexed: 11/19/2022]
Abstract
Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.
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Ciaccio EJ, Wan EY, Saluja DS, Acharya UR, Peters NS, Garan H. Addressing challenges of quantitative methodologies and event interpretation in the study of atrial fibrillation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:113-122. [PMID: 31416540 PMCID: PMC6748794 DOI: 10.1016/j.cmpb.2019.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/21/2019] [Accepted: 06/14/2019] [Indexed: 05/06/2023]
Abstract
Atrial fibrillation (AF) is the commonest arrhythmia, yet the mechanisms of its onset and persistence are incompletely known. Although techniques for quantitative assessment have been investigated, there have been few attempts to integrate this information to advance disease treatment protocols. In this review, key quantitative methods for AF analysis are described, and suggestions are provided for the coordination of the available information, and to develop foci and directions for future research efforts. Quantitative biologists may have an interest in this topic in order to develop machine learning and tools for arrhythmia characterization, but they may perhaps have a minimal background in the clinical methodology and in the types of observed events and mechanistic hypotheses that have thus far been developed. We attempt to address these issues via exploration of the published literature. Although no new data is presented in this review, examples are shown of current lines of investigation, and in particular, how electrogram analysis and whole-chamber quantitative modeling of the left atrium may be useful to characterize fibrillatory patterns of activity, so as to propose avenues for more efficacious acquisition and interpretation of AF data.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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Osório TG, Coutiño HE, Brugada P, Chierchia GB, De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices 2019; 16:799-808. [PMID: 31389263 DOI: 10.1080/17434440.2019.1653181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation. Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here. Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.
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Affiliation(s)
- Thiago Guimarães Osório
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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47
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Leef G, Shenasa F, Bhatia NK, Rogers AJ, Sauer W, Miller JM, Swerdlow M, Tamboli M, Alhusseini MI, Armenia E, Baykaner T, Brachmann J, Turakhia MP, Atienza F, Rappel WJ, Wang PJ, Narayan SM. Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 12:e006835. [PMID: 31352796 DOI: 10.1161/circep.118.006835] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation. METHODS We recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps. RESULTS Each patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium). CONCLUSIONS Wavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation.
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Affiliation(s)
- George Leef
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Fatemah Shenasa
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Neal K Bhatia
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Albert J Rogers
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - William Sauer
- Department of Medicine, University of Colorado, Denver (W.S., E.A.)
| | - John M Miller
- Department of Medicine, University of Indiana, Indianapolis (J.M.M.)
| | - Mark Swerdlow
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Mallika Tamboli
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Mahmood I Alhusseini
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Erin Armenia
- Department of Medicine, University of Colorado, Denver (W.S., E.A.)
| | - Tina Baykaner
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | | | - Mintu P Turakhia
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (M.P.T.)
| | - Felipe Atienza
- Departamento de Cardiologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain (F.A.)
| | | | - Paul J Wang
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University, California (G.L., F.S., N.K.B., A.J.R., M.S., M.T., M.I.A., T.B., P.J.W., S.M.N.)
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48
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Ghannam M, Oral H. Mapping and Imaging in Non-paroxysmal AF. Arrhythm Electrophysiol Rev 2019; 8:202-209. [PMID: 31463058 PMCID: PMC6702463 DOI: 10.15420/aer.2019.18.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Despite intense research efforts, maintenance of sinus rhythm in patients with non-paroxysmal AF remains challenging with suboptimal outcomes. A major limitation to the success of current ablation-based treatments is that our understanding of AF pathophysiology is incomplete. Advances in imaging and mapping tools have been reported to improve ablation outcomes. However, the role of these new approaches on the clinical care of patients with AF remains to be validated and better understood before wide adoption can occur. This article reviews the current techniques of imaging and mapping that can be applied in the management of patients with non-paroxysmal AF with a focus on their relevance to catheter ablation. Future applications and opportunities for new knowledge are also discussed.
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Affiliation(s)
- Michael Ghannam
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
| | - Hakan Oral
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
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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, Wyn Davies D, Day JD, d'Avila A, de Groot NMSN, 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: executive summary. J Interv Card Electrophysiol 2019; 50:1-55. [PMID: 28914401 PMCID: PMC5633646 DOI: 10.1007/s10840-017-0277-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | - Joseph G Akar
- Yale University School of Medicine, New Haven, CT, USA
| | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, UK
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, UK
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY, USA
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA, USA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, USA
- The National Center for Cardiovascular Research Carlos III (CNIC), Madrid, Spain
- 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, USA
| | - 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, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Stanley Nattel
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- 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, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
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50
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Isogai R, Matsuo S, Narui R, Seki S, Yoshimura M, Yamane T. Perimitral atrial flutter with partial conduction block between left atrium and coronary sinus. HeartRhythm Case Rep 2019; 5:179-182. [PMID: 30997329 PMCID: PMC6453559 DOI: 10.1016/j.hrcr.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ryota Isogai
- Department of Cardiovascular Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiichiro Matsuo
- Department of Cardiovascular Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryohsuke Narui
- Department of Cardiovascular Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Shingo Seki
- Department of Cardiovascular Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
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