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Mujović N, Marinković M, Marković N, Stanković G, Lip GYH, Blomstrom-Lundqvist C, Bunch TJ, Potpara TS. Persistency of left atrial linear lesions after radiofrequency catheter ablation for atrial fibrillation: Data from an invasive follow-up electrophysiology study. J Cardiovasc Electrophysiol 2017; 28:1403-1414. [PMID: 28836709 DOI: 10.1111/jce.13322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/27/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on the roof line (RL) and mitral isthmus line (MIL) reconnections after atrial fibrillation (AF) catheter ablation (CA) are scarce. OBJECTIVE We studied the RL and MIL completeness and localization of reconnection sites in consecutive patients after their first-ever AF-CA. METHODS We prospectively included 41 consecutive AF patients who underwent predefined lesion sets of two circumferential lines (CLs) for ipsilateral pulmonary vein isolation (PVI) combined with a RL and lateral MIL. Three months after CA, all patients underwent invasive follow-up procedure for line persistency evaluation, irrespective of clinical outcome. RESULTS At the time of index ablation, PVI-CLs, RL, and MIL was completed in 41 (100%), 39 (95%), and 34 (83%) of patients, respectively. At the 3-month follow-up procedure, reconnections of PVI-CLs, RL, and MIL were found in 61% (25/41), 28% (11/39), and 24% (8/34) of patients, respectively. The 3-month reconnections were located commonly in the anterior and posterior PVI-CL segments, and rarely in the right third of RL and in the posterior part of MIL. The 3-month reconnections were rarely seen at the sites of acute reconnections during index procedure (6%, 20%, and 25% of the PVI-CL segments, RL segments, and MIL segments, respectively). CONCLUSIONS To our knowledge, this is the first study systematically investigating the reconnection of standardized left atrium linear lesions such as RL and MIL after RF-CA for AF in consecutive patients. The RL and MIL 3-month reconnection rates were relatively low (28% and 24%), with poor anatomical concordance between the sites with acute and 3-month reconnections.
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Affiliation(s)
- Nebojša Mujović
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Goran Stanković
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gregory Y H Lip
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA.,Department of Internal Medicine, Stanford University, Palo Alto, CA, USA
| | - Tatjana S Potpara
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Miyazaki S, Shah AJ, Liu X, Jadidi AS, Nault I, Wright M, Forclaz A, Linton N, Xhaët O, Rivard L, Derval N, Knecht S, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Preprocedural Clinical Parameters Determining Perimitral Conduction Time During Mitral Isthmus Line Ablation. Circ Arrhythm Electrophysiol 2011; 4:287-94. [DOI: 10.1161/circep.110.958983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Achievement of complete conduction block across left mitral isthmus (MI) is challenging. Anticipation of perimitral conduction time (PMCT) associated with MI block may expedite this procedure. We evaluated the relationship between the preprocedural variables and the quantum of PMCT in patients with bidirectionally blocked MI.
Methods and Results—
We reviewed clinical and echocardiographic parameters in 290 consecutive patients with confirmed bidirectional MI block during atrial fibrillation (AF) ablation. PMCT was defined as the temporal delay to the latest of the double potentials on the line of block while pacing posteroseptal to it in the left atrium (LA). LA size and type of AF significantly influenced PMCT in multivariate analysis. A cumulative score based on LA size (0≦45 mm; 1>45 mm) and type of AF (0: paroxysmal; 1=nonparoxysmal) ranged from 0 to 2. PMCT was directly correlated to the cumulative score (0: 169 ms; n=78; 95% confidential interval, 156 to 181); 1: 187 ms; n=103; 95% confidential interval, 178 to 196; 2: 209 ms; n=109; 95% confidential interval, 200 to 217). In 61 patients who underwent AF ablation twice, the difference between 2 PMCT values was <30 ms in 75% patients. Another consecutive 143 patients with and without MI block after at least 15 minutes of radiofrequency application were analyzed. Perimitral conduction delay <130 ms ruled out bidirectional MI block. Perimitral conduction delay >173 ms predicted bidirectional block with an accuracy of 86%.
Conclusions—
LA size and AF type significantly influence PMCT in patients undergoing successful MI ablation. These parameters can be used to predict the time value associated with MI block, preprocedurally.
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Affiliation(s)
- Shinsuke Miyazaki
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Ashok J. Shah
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Xingpeng Liu
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Amir S. Jadidi
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Isabelle Nault
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Matthew Wright
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Andrei Forclaz
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Nick Linton
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Olivier Xhaët
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Lena Rivard
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Sébastien Knecht
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Frédéric Sacher
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Mélèze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Pierre Jaïs
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
| | - Michel Haïssaguerre
- From the Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France (S.M., A.J.S., X.L., A.S.J., I.N., M.W., A.F., N.L., O.X., L.R., N.D., S.K., F.S., M.H., P.J., M.H.); and Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (M.W.)
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