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Anwar AM. Morphological and functional assessment of the left atrial appendage in daily practice: a comprehensive approach using basic and advanced echocardiography with practical tips. J Cardiovasc Imaging 2024; 32:12. [PMID: 39069633 DOI: 10.1186/s44348-024-00017-2] [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: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 07/30/2024] Open
Abstract
Cardioembolic stroke is the most serious and life-threatening complication of atrial fibrillation (AF), with an associated mortality up to 30% at 12 months. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the left atrial appendage (LAA). Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and pathological background of the LAA, followed by an assessment of different echocardiographic modalities. Many practical points are included to improve the diagnostic accuracy and to minimize errors during image acquisition and interpretation. In each clinical scenario where LAA is the crucial target, specific and essential information and parameters are collected.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Li J, Chen K, He L, Luo F, Wang X, Hu Y, Zhao J, Zhu K, Chen X, Zhang Y, Tao H, Dong J. Data-driven classification of left atrial morphology and its predictive impact on atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 2024; 35:811-820. [PMID: 38424601 DOI: 10.1111/jce.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Various left atrial (LA) anatomical structures are correlated with postablative recurrence for atrial fibrillation (AF) patients. Comprehensively integrating anatomical structures, digitizing them, and implementing in-depth analysis, which may supply new insights, are needed. Thus, we aim to establish an interpretable model to identify AF patients' phenotypes according to LA anatomical morphology, using machine learning techniques. METHODS AND RESULTS Five hundred and nine AF patients underwent first ablation treatment in three centers were included and were followed-up for postablative recurrent atrial arrhythmias. Data from 369 patients were regarded as training set, while data from another 140 patients, collected from different centers, were used as validation set. We manually measured 57 morphological parameters on enhanced computed tomography with three-dimensional reconstruction technique and implemented unsupervised learning accordingly. Three morphological groups were identified, with distinct prognosis according to Kaplan-Meier estimator (p < .001). Multivariable Cox model revealed that morphological grouping were independent predictors of 1-year recurrence (Group 1: HR = 3.00, 95% CI: 1.51-5.95, p = .002; Group 2: HR = 4.68, 95% CI: 2.40-9.11, p < .001; Group 3 as reference). Furthermore, external validation consistently demonstrated our findings. CONCLUSIONS Our study illustrated the feasibility of employing unsupervised learning for the classification of LA morphology. By utilizing morphological grouping, we can effectively identify individuals at different risks of postablative recurrence and thereby assist in clinical decision-making.
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Affiliation(s)
- Jiaju Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Chen
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fangyuan Luo
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
- Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xianqing Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yucai Hu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiangtao Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kui Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaowei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuekun Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hailong Tao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Batko J, Jakiel R, Krawczyk-Ożóg A, Litwinowicz R, Hołda J, Bartuś S, Bartuś K, Hołda MK, Konieczyńska M. Definition and anatomical description of the left atrial appendage neck. Clin Anat 2024; 37:201-209. [PMID: 38031393 DOI: 10.1002/ca.24125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three-dimensional reconstructions of the heart chambers based on contrast-enhanced electrocardiography-gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone-shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2 . The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three-dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.
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Affiliation(s)
- Jakub Batko
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Jakiel
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Radosław Litwinowicz
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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Piccini JP, Dave AS, Holmes DS, Winterfield JR, Tranter JH, Pipenhagen C, Moon LB, Ambrosius NM, Overmann JA, Boudlali H, Thao R, Geurkink C, Thamavong Z, Jensen JA, Fish JM. Optimal conditions for high-power, short-duration radiofrequency ablation using a novel, flexible-tipped, force-sensing catheter. Heart Rhythm O2 2023; 4:440-447. [PMID: 37520016 PMCID: PMC10373153 DOI: 10.1016/j.hroo.2023.06.005] [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] [Indexed: 08/01/2023] Open
Abstract
Background High-power, short-duration (HPSD) radiofrequency ablation (RFA) reduces procedure time; however, safety and efficacy thresholds vary with catheter design. Objective The study sought to determine optimal HPSD ablation conditions with a novel flexible-tipped, contact force-sensing RFA catheter. Methods RFA lesions were created in thigh muscle (16 swine) over a range of conditions (51-82 W, 2-40 g, 8-40 mL/min irrigation). An intracardiac study was performed (12 swine) to characterize steam pop thresholds. Lesions were created in a second intracardiac study (14 swine, n = 290 pulmonary vein isolation [PVI] lesions) with combinations of radiofrequency power, duration, and contact force. PVI was tested, animals were sacrificed, and lesions were measured. Results The likelihood of coagulation formation in the thigh model was <20% when power was ≤79 W, when contact force was ≤40 g, when duration was ≤11 seconds, and when irrigation rates were 8 to 40 mL/min. The impact of contact force on lesion safety and efficacy was more pronounced using HPSD (60 W/8 seconds) compared with conventional ablation (30 W/45 seconds) (P = .038). During PVI, focal atrial lesions ranged in width from 4.2 to 12.5 mm and were transmural 80.8% of the time. PVI was achieved in 13 of 14 veins. Logistic regression identified that the optimal parameters for radiofrequency application were 60 to 70 W with a duration <8 seconds and <15 g contact force. Conclusions Optimal HPSD lesions with this this flexible-tipped, force-sensing RFA catheter were created at 60 to 70 W for <8 seconds with <15 g contact force. Chronic studies are ongoing to assess radiofrequency parameter refinements and long-term lesion durability using these conditions.
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Affiliation(s)
| | - Amish S. Dave
- Houston Methodist DeBakey Cardiology Associates, Houston, Texas
| | - Douglas S. Holmes
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Jeffrey R. Winterfield
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Miller J, Sewani A, Rezazada J, Alawneh Y, Kazemian P, Terricabras M, Wright G, Tavallaei MA. Quantification of Mechanical Characteristics of Conventional Steerable Ablation Catheters for Treatment of Atrial Fibrillation Using a Heart Phantom. Cardiovasc Eng Technol 2023; 14:419-427. [PMID: 36828976 DOI: 10.1007/s13239-023-00662-6] [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: 09/05/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Accurate and reliable catheter navigation is important in formation of adequate lesions during radiofrequency cardiac catheter ablation. To inform future device design efforts and to characterize the limitations of conventional devices, the focus of this study is to assess and quantify the mechanical performance of manual ablation catheters for pulmonary vein isolation procedures within a phantom heart model. METHODS We measured three important metrics: accuracy of catheter tip navigation to target anatomical landmarks at the pulmonary veins (PVs), orientation of the catheter relative to the tissue at the targets, and the delivered force values and their stability and variations at those targets. A stereovision system was used for navigational guidance and to measure the catheter's tip position and orientation relative to the targets. To measure force, piezoelectric sensors were used which were integrated at the targets, whereby operators were instructed to stabilize the catheter to achieve a chosen reference force value. RESULTS An overall positioning accuracy of 1.57 ± 1.71 mm was achieved for all targets. No statistical significance was observed in position accuracy between the right and left PVs (p = 0.5138). The orientation of the catheter relative to tissue surface was 41° ± 21° with no statistical significance between targets. The overall force stability was 41 ± 6 g with higher difficulty in force stabilization in the right compared to the left PV (40 ± 8 vs. 43 ± 2 g, p < 0.0001). CONCLUSION Based on our results, future improvements to manual catheter navigation for ablation should focus on improving device performance in orientation control and improved force stability.
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Affiliation(s)
- Jacob Miller
- Toronto Metropolitan University, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Alykhan Sewani
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jeffrey Rezazada
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Yara Alawneh
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - M Ali Tavallaei
- Toronto Metropolitan University, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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Verma A, Neal R, Evans J, Castellvi Q, Vachani A, Deneke T, Nakagawa H. Characteristics of pulsed electric field cardiac ablation porcine treatment zones with a focal catheter. J Cardiovasc Electrophysiol 2023; 34:99-107. [PMID: 36335638 PMCID: PMC10100505 DOI: 10.1111/jce.15734] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pulsed electric field (PEF) therapies employ punctuated energy delivery to kill cells in a volume of tissue through mechanisms that are not dependent on thermal processes. A key component to successful cardiac ablation procedures is ensuring the generation of transmural, contiguous ablation zones, which requires in-depth knowledge regarding treatment sizes for a given therapeutic application. METHODS In this study, a series of acute treatments were delivered to porcine ventricles, where triphenyl tetrazolium chloride (TTC) vitality stain was used to identify treatment effect sizes for the three focal monopolar CENTAURI PEF cardiac ablation energy settings. RESULTS Treatment depths were 5.7, 7.2, and 8.2 mm for the 19, 22, and 25 A energy settings, respectively. Gross pathology indicated umbral zones of hemorrhage surrounded by pale avital TTC-negative-negative tissue, which contrasted significantly from radiofrequency ablation (RF) controls. Histologically, treatment zones are identified by regions of contraction band necrosis and cardiomyocytolysis, which contrasted with RF control lesions composed primarily of coagulation necrosis. CONCLUSIONS Together, these data indicate the ability for focal monopolar PEF treatments to generate deep treatment zones in cardiac ablation without incurring the gross or histological coagulative characteristics of RF thermal lesions.
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Affiliation(s)
- Atul Verma
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, Canada
| | | | - John Evans
- Galaxy Medical, San Carlos, California, USA
| | | | | | - Thomas Deneke
- Division of Cardiology, Cardiovascular Clinic Bad Neustadt ad Saale, Bad Neustadt ad Saale, Germany
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Terasawa M, Chierchia GB, Housari MA, Bala G, Cosyns B, Droogmans S, Tanaka K, Belsack D, De Mey J, Sieira J, Brugada P, de Asmundis C, Ströker E. Predictors of late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation-per vein analysis including cardiac computed tomography-based anatomic factors. Eur Heart J Cardiovasc Imaging 2022:6958487. [PMID: 36562390 DOI: 10.1093/ehjci/jeac255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS To identify predictors of individual late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation. Anatomic indicators of late pulmonary vein reconnection (LPVR) post-CB2 ablation have not yet been studied on an individual PV level, nor weighed against clinical and procedural factors. METHODS AND RESULTS Clinical, procedural, and PV anatomic data from 125 patients with a repeat procedure for arrhythmia recurrence after index CB2 ablation were analyzed. Preprocedural computed tomography (CT) evaluated 486 PVs for measurement of size; shape (ovality index); carina width; and orientation angle in frontal (superior/inferior) and transversal (anterior/posterior) plane (with horizontal line 0° as reference and upper/lower half circle as positive/negative value, respectively). Durable isolation in all PVs was demonstrated in 50/125 (40%) patients. Late reconnection rates at the different PVs were as follows: 16% left superior (LS), 12% left inferior (LI), 17% right superior (RS), and 31% right inferior (RI) PV. Multivariable analysis performed per vein showed following independent determinants predicting LPVR: ovality index [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.07-2.41, P = 0.022] and carina width (OR 0.75, CI 0.59-0.96, P = 0.024) for LSPV; carina width (OR 0.71, CI 0.53-0.95, P = 0.020) for LIPV; frontal angle (OR 0.91, CI 0.87-0.95, P < 0.001) for RIPV; and transversal angle (OR 1.15, CI 1.03-1.31, P = 0.032) for RSPV. CONCLUSION Cardiac CT-based evaluation of anatomic PV characteristics presented higher predictive value compared to clinical and procedural variables for individual LPVR after CB2 ablation. Pre-procedural identification of unfavourable PV anatomy might be important to tailor the ablation approach.
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Affiliation(s)
- Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.,Department of Cardiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku City, Tokyo 160-0023, Japan
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
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Orbán G, Salló Z, Perge P, Ábrahám P, Piros K, Nagy KV, Osztheimer I, Merkely B, Gellér L, Szegedi N. Characteristics of Very High-Power, Short-Duration Radiofrequency Applications. Front Cardiovasc Med 2022; 9:941434. [PMID: 35911564 PMCID: PMC9326019 DOI: 10.3389/fcvm.2022.941434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Pulmonary vein isolation is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). The very high-power, short-duration (vHPSD) radiofrequency (RF) ablation is a novel technology that favors resistive heating while decreasing the role of conductive heating. Our study aimed to evaluate the correlations between contact force (CF), power, impedance drop (ID), and temperature; and to assess their role in lesion formation with the vHPSD technique. Methods Consecutive patients who underwent initial point-by-point RF catheter ablation for AF were enrolled in the study. The vHPSD ablation was performed applying 90 W for 4 s with an 8 ml/min irrigation rate. Results Data from 85 patients [median age 65 (59–71) years, 34% female] were collected. The median procedure time, left atrial dwelling time, and fluoroscopy time were 70 (60–90) min, 49 (42–58) min, and 7 (5–11) min, respectively. The median RF time was 312 (237-365) sec. No steam pop nor major complications occurred. A total of 6,551 vHPSD RF points were analyzed. The median of CF, maximum temperature, and ID were 14 (10–21) g, 47.6 (45.1–50.4) °C, and 8 (6–10) Ohms, respectively. CF correlated significantly with the maximum temperature (p < 0.0001). A CF of 5 g and above was associated with a significantly higher temperature compared to those lesions with a CF below 5 grams (p < 0.0001). Bilateral first-pass isolation rate was 84%. The 6-month AF-recurrence rate was 7%. Conclusion The maximum temperature and CF significantly correlate with each other during vHPSD applications. A CF ≥ 5 g leads to better tissue heating and thus might be more likely to result in good lesion formation, although this clinical study was unable to assess actual lesion sizes.
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Kuniewicz M, Karkowski G, Gosnell M, Goncerz G, Badacz R, Rajs T, Legutko J. Anatomical and electrophysiological localization of ganglionated plexi using high-density 3D CARTO mapping system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Szegedi N, Simon J, Szilveszter B, Salló Z, Herczeg S, Száraz L, Kolossváry M, Orbán G, Széplaki G, Nagy KV, Mahdiui ME, Smit JM, Delgado V, Bax JJ, Maurovich-Horvat P, Merkely B, Gellér L. Abutting Left Atrial Appendage and Left Superior Pulmonary Vein Predicts Recurrence of Atrial Fibrillation After Point-by-Point Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:708298. [PMID: 35242821 PMCID: PMC8885731 DOI: 10.3389/fcvm.2022.708298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe role of the spatial relationship between the left superior pulmonary vein (LSPV) and left atrial appendage (LAA) is unknown. We sought to evaluate whether an abutting LAA and LSPV play a role in AF recurrence after catheter ablation for paroxysmal AF.MethodsConsecutive patients, who underwent initial point-by-point radiofrequency catheter ablation for paroxysmal AF at the Heart and Vascular Center of Semmelweis University, Budapest, Hungary, between January of 2014 and December of 2017, were enrolled in the study. All patients underwent pre-procedural cardiac CT to assess left atrial (LA) and pulmonary vein (PV) anatomy. Abutting LAA-LSPV was defined as cases when the minimum distance between the LSPV and LAA was less than 2 mm.ResultsWe included 428 patients (60.7 ± 10.8 years, 35.5% female) in the analysis. AF recurrence rate was 33.4%, with a median recurrence-free time of 21.2 (8.8–43.0) months. In the univariable analysis, female sex (HR = 1.45; 95%CI = 1.04–2.01; p = 0.028), LAA flow velocity (HR = 1.01; 95%CI = 1.00–1.02; p = 0.022), LAA orifice area (HR = 1.00; 95%CI = 1.00–1.00; p = 0.028) and abutting LAA-LSPV (HR = 1.53; 95%CI = 1.09–2.14; p = 0.013) were associated with AF recurrence. In the multivariable analysis, abutting LAA-LSPV (adjusted HR = 1.55; 95%CI = 1.04–2.31; p = 0.030) was the only independent predictor of AF recurrence.ConclusionAbutting LAA-LSPV predisposes patients to have a higher chance for arrhythmia recurrence after catheter ablation for paroxysmal AF.
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Affiliation(s)
- Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: Nándor Szegedi
| | - Judit Simon
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lili Száraz
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Orbán
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Heart and Vascular Centre, Mater Private Hospital, Dublin, Ireland
| | | | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeff M. Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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11
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Verma A, Asivatham SJ, Deneke T, Castellvi Q, Neal RE. Primer on Pulsed Electrical Field Ablation: Understanding the Benefits and Limitations. Circ Arrhythm Electrophysiol 2021; 14:e010086. [PMID: 34538095 DOI: 10.1161/circep.121.010086] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pulsed electrical field (PEF) energy is a promising technique for catheter ablation of cardiac arrhythmias. In this article, the key aspects that need to be considered for safe and effective PEF delivery are reviewed, and their impact on clinical feasibility is discussed. The most important benefit of PEF appears to be the ability to kill cells through mechanisms that do not alter stromal proteins, sparing sensitive structures to improve safety, without sacrificing cardiomyocyte ablation efficacy. Many parameters affect PEF treatment outcomes, including pulse intensity, waveform shape, and number of pulses, as well as electrode configuration and geometry. These physical and electrical characteristics must be titrated carefully to balance target tissue effects with collateral implications (muscle contraction, temperature rise, risk of electrical arcing events). It is important to note that any combination of parameters affecting PEF needs to be tested for clinical efficacy and safety. Applying PEF clinically requires knowledge of the fundamentals of this technology to exploit its opportunities and generate viable, durable health improvements for patients.
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Affiliation(s)
- Atul Verma
- Division of Cardiology, Southlake Regional Health Center, University of Toronto, Newmarket, Canada (A.V.)
| | - Samuel J Asivatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.J.A.)
| | - Thomas Deneke
- Division of Cardiology, Rhon-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany (T.D.)
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12
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Słodowska K, Hołda J, Dudkiewicz D, Malinowska K, Bolechała F, Kopacz P, Koziej M, Hołda MK. Thickness of the left atrial wall surrounding the left atrial appendage orifice. J Cardiovasc Electrophysiol 2021; 32:2262-2268. [PMID: 34245483 DOI: 10.1111/jce.15157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the thickness of the left atrial wall surrounding the left atrial appendage (LAA) orifice. METHODS AND RESULTS The tissue thickness around the LAA orifice was measured at four points (superior, inferior, anterior, and posterior) in 200 randomly selected autopsied human hearts. The thickest tissue was observed at the anterior point (3.17 ± 1.41 mm), followed by the superior (2.47 ± 1.00 mm), inferior (2.22 ± 0.80 mm) and posterior (2.22 ± 0.83 mm). The chicken wing LAA type was associated with the lowest thickness at the superior point compared to the cauliflower and arrowhead shapes (p = .024). In hearts with an oval LAA orifice, the atrial wall was significantly thicker in all points than in specimens with a round LAA orifice (p > .05). Both the LAA orifice anteroposterior diameter and orifice surface area were negatively correlated with the tissue thickness in the anterior (r = -.22, p = .004 and r = -.23, p = .001) and posterior points (r = -.24, p = .001 and r = -.28, p = .005). Endocardial surface roughness was commonly in the inferior pole of the LAA orifice (75.5% of cases), while they are much less prevalent in other sectors around the orifice (anterior: 17.5%), superior: 4.0%, and posterior: 1.5%). CONCLUSIONS Although a significant heterogeneity in the atrial wall thickness around the LAA orifice was observed, the thickness in the respective points is quite conservative and depends only on LAA orifice size and shape, as well as LAA body shape. Thin atrial wall and endocardial surface roughness might challenge invasive procedures within this region.
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Affiliation(s)
- Katarzyna Słodowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Damian Dudkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Karolina Malinowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Filip Bolechała
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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13
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Dudkiewicz D, Słodowska K, Jasińska KA, Dobrzynski H, Hołda MK. The clinical anatomy of the left atrial structures used as landmarks in ablation of arrhythmogenic substrates and cardiac invasive procedures. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Słodowska K, Szczepanek E, Dudkiewicz D, Hołda J, Bolechała F, Strona M, Lis M, Batko J, Koziej M, Hołda MK. Morphology of the Left Atrial Appendage: Introduction of a New Simplified Shape-Based Classification System. Heart Lung Circ 2021; 30:1014-1022. [PMID: 33582020 DOI: 10.1016/j.hlc.2020.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The left atrial appendage (LAA) is a heart structure with known prothrombogenic and pro-arrhythmogenic properties. AIM The aim of this study was to evaluate the specific anatomy of the LAA and to create a simple classification system based on the shape of its body. METHOD AND RESULTS This study investigated 200 randomly selected autopsied human hearts (25.0% females, 46.6±19.1 years old). Three (3) types of LAAs were distinguished: the cauliflower type (no bend, limited overall length, compact structure [36.5%]); the chicken wing type (substantial bend in the dominant lobe [37.5%]), and the arrowhead type (no bend, one dominant lobe of substantial length [26.0%]). Additional accessory lobes were present in 55.5% of all LAAs. Significant variations between category types were noted in LAA length (chicken wing: 35.7±9.8 mm, arrowhead: 30.8±10.1 mm, cauliflower: 22.3±9.6 mm [p<0.001]) and in the thickness of pectinate muscles located within the LAA apex (arrowhead: 1.2±0.7 mm; cauliflower: 1.1±0.6 mm; chicken wing: 0.9±0.6 mm [p<0.001]). Left atrial appendage volume and orifice size were not affected by the type of LAA shape. The age of the donor was positively correlated with LAA volume (r=0.29, p=0.005), body length (r=0.26, p=0.012), and area of the orifice (r=0.36, p<0.001). Donors with an oval LAA orifice were significantly older than those with round orifices (50.2±16.6 vs 43.7±20.4 years [p=0.014]) and had significantly heavier hearts (458.2±104.8 vs 409.6±114.1g [p=0.002]). CONCLUSIONS This study delivered a new simple classification system of the LAA based on its body shape. An increase in age and heart weight was associated with LAA enlargement and a more oval-shaped orifice. Results of current study may help to estimate the different thrombogenic properties associated with each LAA type and be an assistance during planning and performing interventions on LAA.
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Affiliation(s)
- Katarzyna Słodowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Elżbieta Szczepanek
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Lis
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Batko
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland; Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
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15
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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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16
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Sang C, Lai Y, Long D, Li M, Bai R, Jiang C, Wang W, Li S, Tang R, Guo X, Liu N, Zhao X, Zuo S, Wen S, Ning M, Wu J, Du X, Dong J, Ma C. Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:773-781. [PMID: 32856303 DOI: 10.1111/pace.14052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Songnan Wen
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
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Ren Z, Jia P, Wang S, Li S, Li H, Guo R, Zhang J, Zhang J, Yang H, Meng W, Zheng Y, Xu Y, Zhao D. Acute left atrial ridge lesion after cryoballoon ablation: How does this affect left atrial appendage closure combined procedure? J Cardiovasc Electrophysiol 2020; 31:2865-2873. [PMID: 33405334 DOI: 10.1111/jce.14718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute left atrial ridge (LAR) lesions have been observed following atrial fibrillation (AF) ablation. However, LAR lesions had not yet been quantitatively evaluated and their influence on procedure combining cryoballoon (CB) ablation with left atrial appendage closure (LAAC) remained to be explored. METHODS The profile of LAR lesions was measured by transesophageal echocardiography (TEE) in 117 consecutive nonvalvular AF patients, who underwent the combined procedure of CB ablation and LAAC. We thoroughly investigated how LAR lesions correlated with baseline variables and clinical outcomes. RESULTS A total of 95 out of 96 available TEE images presented prominent acute LAR lesions. In terms of dimensions, there was a greater change in width (Δwidth = 3.6 ± 2.3 mm) than the thickness (Δthickness = 2.6 ± 3.5 mm), and the outer ostium was narrowed (Δouter ostium diameter = -3.4 ± 4.0 mm), while the inner ostium remained unchanged. A higher nadir temperature when freezing the left superior pulmonary vein (LSPV) led to an LAR lesion with a two times greater width (adjusted odds ratio = 1.16; 95% confidence interval, 1.02-1.31). In the evaluation of LAAC outcomes, four patients implanted with Watchman devices had minimal residual flow at the inferior border, while two implanted with LAmbre devices developed residual flow at the LAR side. Clinical outcomes were similar between groups divided by lesion size. CONCLUSION Acute LAR lesions frequently occurred following the CB ablation combined procedure, and lesion width positively correlates with LSPV nadir temperature. The presence of these lesions affects the measurement of pacifier devices but has little impact on that of occluder devices.
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Affiliation(s)
- Zhongyuan Ren
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Soochow University Medical College, Suzhou, China
| | - Peng Jia
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University School of Medicine, Wuhan, China
| | - Shuang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hailing Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Guo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingying Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haotian Yang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weilun Meng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixing Zheng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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