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Kawamura I, Miyazaki S, Inamura Y, Nitta J, Kobori A, Nakamura K, Murakami M, Nakamura T, Inaba O, Sekiguchi Y, Asano S, Sasaki Y, Mizuno S, Naito S, Hirakawa A, Sasano T. A randomized controlled trial of the size-adjustable cryoballoon vs conventional cryoballoon for paroxysmal atrial fibrillation: The CONTRAST-CRYO II trial rationale and design. Heart Rhythm O2 2024; 5:301-306. [PMID: 38840770 PMCID: PMC11148497 DOI: 10.1016/j.hroo.2024.04.006] [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: 06/07/2024] Open
Abstract
Background Pulmonary vein isolation (PVI) with cryoballoon technology is a well-established therapy for treatment of atrial fibrillation (AF). Recently, a size-adjustable cryoballoon (POLARxTM FIT) that enables delivery in a standard 28-mm or an expanded 31-mm size was introduced. Objective The purpose of this study was to perform a randomized clinical trial to evaluate the safety and efficacy of this novel cryoballoon compared to the conventional cryoballoon. Methods The CONTRAST-CRYO II trial is a multicenter, prospective, open-label, randomized controlled trial in which 214 patients with paroxysmal AF will be randomized 1:1 to cryoballoon ablation with either a conventional cryoballoon (Arctic Front AdvanceTM Pro) or a size-adjustable cryoballoon (POLARx FIT). The study was approved by the Institutional Review Boards at all investigational sites and has been registered in the UMIN Clinical Trials Registry (UMIN000052500). Results The primary endpoint of this study will be the incidence of phrenic nerve injury. Secondary endpoints include procedural success, chronic success through 12 months, procedure-related adverse events, biophysiological parameters during applications for each pulmonary vein (PV), total procedural and fluoroscopy times, level of PVI and isolation area, and probability of non-PV foci initiating AF. Conclusion The CONTRAST-CRYO II trial is a multicenter, prospective, randomized controlled trial designed to assess the safety and efficacy of the POLARx FIT vs the Arctic Front Advance Pro. The findings from this trial will provide additional utility data on the efficacy of the size-adjustable cryoballoon for isolating PVs in patients with paroxysmal AF.
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Affiliation(s)
- Iwanari Kawamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Masato Murakami
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Sou Asano
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Hirokami J, Nagashima M, Fukunaga M, Korai K, Sadohara Y, Kaimi R, Takeo A, Niu H, Ando K, Hiroshima K. A novel ablation strategy for recurrent atrial fibrillation: Fractionated signal area in the atrial muscle ablation 1-year follow-up. J Cardiovasc Electrophysiol 2023; 34:2461-2471. [PMID: 37702156 DOI: 10.1111/jce.16047] [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: 04/04/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Treatment of recurrent atrial fibrillation (AF) is sometimes challenging due to non-pulmonary vein (PV) foci. Fractionated signal area in the atrial muscle (FAAM) is a valid predictor of the location of non-PV foci. FAAM ablation has the potential to decrease the recurrence rate of atrial tachyarrhythmia in patients with recurrent AF. We compared the clinical impact of FAAM ablation for recurrent AF, using 1 year follow up date. METHODS A total of 230 consecutive patients with symptomatic recurrent AF who underwent catheter ablation specifically targeting non-PV foci as FAAM-guided ablation (n = 113) and non-FAAM-guided ablation (n = 117) were retrospectively analyzed. FAAM was assigned a parameter (peaks slider, which indicates the number of components of fractionated signals), ranging from 1 to 15, indicating the location of the FAAM (1: largest, 15: smallest). FAAM-guided ablation was performed by ablating FAAM until none inducibility of non-PV foci. On the other hand, non-FAAM-guided ablation was performed via linear ablation, complex fractionated atrial electrogram ablation, superior vena cava isolation, and focal ablation according to the location of the non-PV foci. The RHYTHMIA system was used to perform all the procedures. The primary endpoints were AF recurrence, atrial flutter, and/or atrial tachycardia. RESULTS After a 1-year follow up, freedom from atrial tachyarrhythmia was achieved in 90.3% and 75.2% of patients in the FAAM and non-FAAM groups, respectively (hazard ratio = 0.438 [95% confidence interval: 0.243-0.788], p = .005). CONCLUSIONS FAAM ablation showed a promising decrease in the recurrence rate of atrial tachyarrhythmia in patients with recurrent AF during a 1-year follow-up.
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Affiliation(s)
- Jun Hirokami
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- Abteilung für Kardiologie, Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Michio Nagashima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kengo Korai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yohei Sadohara
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryogo Kaimi
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ayaka Takeo
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Harushi Niu
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Tsai WC, Lin YJ, Chang SL, Lo LW, Hu YF, Chao TF, Chung FP, Liao JN, Chang TY, Tuan TC, Kuo L, Wu CI, Liu CM, Liu SH, Kuo MR, Chen SA. High-density characterization of the sinus rhythm: a new functional substrate map of scar-related atrial tachycardia. J Interv Card Electrophysiol 2023; 66:1631-1639. [PMID: 36692685 DOI: 10.1007/s10840-023-01480-5] [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: 10/29/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Reentrant atrial tachycardias (ATs) utilize critical isthmus (CI) for the maintenance of the circuit. The electrophysiological characteristics and clinical implications of the targeted CI regions of reentrant ATs during sinus rhythm (SR) were not clear. Therefore, our research aims at studying the electrical properties of the CI sites for scar-related reentrant ATs and the functional substrate mapping identified during SR. METHODS Patients mapped with high-density catheters during SR and reentrant ATs were retrospectively analyzed. The CI regions of the reentrant ATs were confirmed by the combination of the activation map and the entrainment. The substrate mapping was analyzed for wavefront propagation, conduction velocity, and electrogram patterns. RESULTS Twenty patients with 22 reentrant ATs that underwent high-density maps were analyzed at 2 hospitals. Mapping performed during SR identified a scar region of 23.0 ± 13.6% of the left atrium. Regions of the CI in SR were characterized by low voltage (0.3 ± 0.2 mV), conduction slowing (0.4 ± 0.2 m/s), and fractionated electrogram (duration 62.5 ± 13.9 ms). Substrate mapping during SR showed that the regions of the CI located with the low-voltage zone in 16 out of 22 CI (72.7%), the deceleration zone in 15 out of 22 CI (68.2%), and late atrial activation in 12 out of 22 CI (54.5%). Targeting regions of CI achieve 94% of termination or change of the reentrant circuit. At 6.2 ± 7.1 months, there was 75% freedom from atrial arrhythmia. CONCLUSIONS Novel high-density mapping can identify the functional substrates during SR and guide ablation. Low-voltage areas with conduction slowing are putative predictors of the CI for the maintenance of the reentrant ATs.
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Affiliation(s)
- Wen-Chin Tsai
- Department of Cardiology, Cardiovascular Research Center, Buddhist Tzu Chi General Hospital and Tzu Chi University, No. 707, Section 3, Zhongyang Road, Hualien City, Taiwan.
| | - Yenn-Jiang Lin
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan.
| | - Shih-Lin Chang
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Li-Wei Lo
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Yu-Feng Hu
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Tze-Fan Chao
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Fa-Po Chung
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Jo-Nan Liao
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Ting-Yung Chang
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Ta-Chuan Tuan
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Ling Kuo
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Cheng-I Wu
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Chih-Min Liu
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Shin-Huei Liu
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Ming-Ren Kuo
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
| | - Shih-Ann Chen
- Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Takigawa M, Kamakura T, Martin C, Derval N, Cheniti G, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Negishi M, Yamamoto T, Ikenouchi T, Goto K, Shigeta T, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T, Haissaguierre M, Jais P. Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias. Europace 2023; 25:euad195. [PMID: 37428890 PMCID: PMC10403248 DOI: 10.1093/europace/euad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
AIMS Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. OBJECTIVE We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization. METHODS One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the RhythmiaTM system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253-348) ms, P = 0.0001; mCL = 283 (243-341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261-349) ms, P = 0.0016; mCL = 295 (248-340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421-555) ms, mCL = 427 (347-508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%). CONCLUSION Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Claire Martin
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- Cardiology Department, Royal Papworth Hospital, Cambridge CB2 0AY, UK
- Department of Medicine, Cambridge University, Cambridge CB2 0QQ, UK
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Masahiko Goya
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Michel Haissaguierre
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
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Nakamura K, Kimura K, Sasaki T, Minami K, Take Y, Naito S. Selective ethanol ablation targeting the distal vein of Marshall for a peri–left atrial appendage reentrant atrial tachycardia after completing anterior mitral isthmus conduction block. HeartRhythm Case Rep 2022; 8:627-631. [PMID: 36147719 PMCID: PMC9485659 DOI: 10.1016/j.hrcr.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ishimura M, Yamamoto K, Yamamoto M, Himi T, Kobayashi Y. Roof-dependent atrial flutter with epicardial conduction pathway masked by left atrium posterior wall debulking ablation. Ann Noninvasive Electrocardiol 2022; 28:e12997. [PMID: 35861693 PMCID: PMC9833369 DOI: 10.1111/anec.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 01/23/2023] Open
Abstract
Roof-dependent atrial flutter (AFL) is a major tachyarrhythmia rotating in the left atrium (LA). Here, we describe a case of roof-dependent AFL during atrial fibrillation ablation. LA posterior wall (LAPW) debulking ablation was performed before the induction. Atrial tachycardia (AT) was induced by burst pacing, and the 3D mappings showed a focal pattern from the LA inferior area. The post-pacing interval from the roof and bottom line corresponded to the AT cycle length. The LAPW debulking ablation masked roof-dependent AFL due to the lack of endocardium potentials in the LAPW. We report that roof-dependent AFL connected by epicardium fibers.
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Affiliation(s)
| | - Kayo Yamamoto
- Department of CardiologyKimitsu Central HospitalKisarazuJapan
| | | | - Toshiharu Himi
- Department of CardiologyKimitsu Central HospitalKisarazuJapan
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Wang YC, Shi LB, Chu SY, Solheim E, Schuster P, Chen J. The Roles of Fractionated Potentials in Non-Macroreentrant Atrial Tachycardias Following Atrial Fibrillation Ablation: Recognition Beyond Three-Dimensional Mapping. Front Cardiovasc Med 2022; 8:759563. [PMID: 35360369 PMCID: PMC8960301 DOI: 10.3389/fcvm.2021.759563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Non-macroreentrant atrial tachycardia (nAT) following atrial fibrillation (AF) ablation is being increasingly reported. Many issues remain to be elucidated. We aimed to characterize the fractionated potentials (FPs) in nAT and introduce a new method of cross-mapping for clarifying their roles. Methods and Results Forty-four nATs in 37 patients were enrolled and classified into focal AT (FAT, 12), microreentrant AT (MAT, 14), and small-loop-reentrant AT (SAT, 18) groups, according to activation pattern. FP was found on all targets except in nine FATs. The ratio of FP duration to AT cycle length (TCL) was different among groups (28 ± 7% in FAT, 53 ± 11% in MAT, and 42 ± 14% in SAT, p < 0.05), and ablation duration were longer in SATs (313 ± 298 vs. 111 ± 125 s, p < 0.05). The ratio of mappable cycle length to TCL was lower in the FAT group (63 ± 22% vs. 90 ± 9% and 89 ± 8%, p < 0.05). When cross-mapping was employed, trans-potential time differences in both longitudinal and transverse direction were longer around the culprit FP for MAT (p < 0.01). After Receiver Operating Characteristic curve analysis, it is best to adopt the sum of time difference ratios in both directions ≥60% as a cut-off value for discrimination of the FPs responsible for MAT with a sensitivity of 92% and specificity of 87%. Conclusions FP could be found on target in most nATs following a previous AF ablation. The ratio of FP duration to TCL may help for differentiation. A simple method of cross-mapping could be employed to clarify the roles of FPs.
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Affiliation(s)
- Yu-Chuan Wang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Li-Bin Shi
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Song-Yun Chu
- Department of Geriatrics, Peking University First Hospital, Beijing, China
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Peter Schuster
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- *Correspondence: Jian Chen
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CORRELATION BETWEEN SINUS RHYTHM DECELERATION ZONES AND CRITICAL SITES FOR LOCALIZED REENTRANT ATRIAL FLUTTER: A RETROSPECTIVE MULTICENTER ANALYSIS. Heart Rhythm O2 2022; 3:279-287. [PMID: 35734295 PMCID: PMC9207739 DOI: 10.1016/j.hroo.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Atypical left atrial flutter (AFL) may be macroreentrant or spatially localized. The relationship between the critical isthmus (CI) for localized reentry with sinus rhythm (SR) conduction slowing has not been systematically examined. Objective To examine the correlation between CI sites for localized AFL (L-AFL) and deceleration zones (DZ) identified by isochronal late activation mapping (ILAM) during baseline rhythm. Methods Patients with localized AFL who underwent high-density activation mapping of both SR and AFL were retrospectively analyzed. L-AFL was defined as reentry restricted to 2 wall segments of the left atrium. CI was defined by activation mapping and sites of successful termination during ablation. DZ, defined as >3 isochrones within 1 cm radius during baseline rhythm, were correlated to the locations of the CI. Results Thirty-one consecutive patients that underwent detailed sinus rhythm and AFL high-density activation maps were analyzed at 3 centers. A mean 4060 ± 3275 and 6209 ± 8656 points were collected in ILAM and AFL activation maps, respectively. At least 1 DZ (1.7 ± 0.77) was identified in all patients. ILAM showed 3.27 ± 0.52 isochrones per DZ (168 ± 32 ms), and co-localized to CI sites at a distance of 6.7 ± 3 mm. A total of 34% ± 14% of the AFL cycle length was contained within 0.5 cm of the DZ. Conclusions In patients with L-AFL, CI co-localized with DZ during baseline rhythm, suggesting that DZ mapping during SR may yield candidate targets for ablation as an adjunct to pulmonary vein isolation to prevent a subtype of AFL.
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Sasaki W, Nakamura K, Minami K, Sasaki T, Take Y, Naito S. Left atrial roof-dependent atrial tachycardia via the Marshall bundle. HeartRhythm Case Rep 2021; 7:566-570. [PMID: 34434710 PMCID: PMC8377269 DOI: 10.1016/j.hrcr.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Kohki Nakamura
- Address reprint requests and correspondence: Dr Kohki Nakamura, Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan.
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Atrial flutter with alternating tachycardia cycle length after atrial fibrillation ablation. HeartRhythm Case Rep 2021; 7:34-38. [PMID: 33505852 PMCID: PMC7813786 DOI: 10.1016/j.hrcr.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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