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Kuo MJ, Ton ANK, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang TY, Lin CY, Kuo L, Wu CI, Liu CM, Cheng WH, Liu SH, Chhay C, Kao PH, Chen WT, Hsu CY, Chen SA. Abnormal Conduction Zone Detected by Isochronal Late Activation Mapping Accurately Identifies the Potential Atrial Substrate and Predicts the Atrial Fibrillation Ablation Outcome After Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2023; 16:e011149. [PMID: 36688314 DOI: 10.1161/circep.122.011149] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The presence of abnormal substrate of left atrium is a predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation. We aimed to investigate the isochronal late activation mapping to access the abnormal conduction velocity for predicting AF ablation outcome. METHODS Forty-five paroxysmal AF patients (30 males, 57.8±8.7 years old) who underwent pulmonary vein isolation were enrolled. Isochronal late activation mapping was retrospectively constructed with 2 different windows of interest: from onset of P wave to onset of QRS wave on surface electrocardiography (W1) and 74 ms tracking back from the end of P wave (W2). Deceleration zone was defined as regions with 3 isochrones (DZa) or ≥4 isochrones (DZb) within a 1 cm radius on the isochronal late activation mapping, and the estimated conduction velocity (ECV) are 0.27 m/s and <0.20 m/s for DZa and DZb, respectively in W2. The distribution of deceleration zone was compared with the location of low-voltage zone (bipolar voltage ≤0.5 mV). Any recurrence of atrial arrhythmias was defined as the primary end point during follow ups after a 3-month blanking period. RESULTS Pulmonary vein isolation was performed in all patients, and there were 2 patients (4.4%) received additional extrapulmonary vein ablation. After a mean follow-up of 12.7±4.5 months, recurrence of AF occurred in 14 patients (31.1%). Patients with the presence of DZb in W2 had higher AF recurrence (Kaplan-Meier event rate estimates: HR, 9.41 [95% CI, 2.61-33.90]; log-rank P<0.0001). There were 52.6% of the DZb locations in W2 comparable to the distributions of low-voltage zone and 47.4% DZb were distributed in the area without low-voltage zone. CONCLUSIONS Deceleration zone detected by isochronal late activation mapping represents a critical AF substrate, it accurately predicts the AF recurrence following ablation in patients with paroxysmal AF.
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Affiliation(s)
- Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital (M.-J.K., S.-A.C.)
| | - An Nu-Khanh Ton
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Tam Duc Heart hospital, Vietnam (A.N.-K.T.)
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Cheng-I Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chih-Min Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Wen-Han Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chheng Chhay
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Pei-Heng Kao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Wei-Tso Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chu-Yu Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital (M.-J.K., S.-A.C.).,National Chung Hsing University, Taichung, Taiwan (S.-A.C.)
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Schnabel RB, Marinelli EA, Arbelo E, Boriani G, Boveda S, Buckley CM, Camm AJ, Casadei B, Chua W, Dagres N, de Melis M, Desteghe L, Diederichsen SZ, Duncker D, Eckardt L, Eisert C, Engler D, Fabritz L, Freedman B, Gillet L, Goette A, Guasch E, Svendsen JH, Hatem SN, Haeusler KG, Healey JS, Heidbuchel H, Hindricks G, Hobbs FDR, Hübner T, Kotecha D, Krekler M, Leclercq C, Lewalter T, Lin H, Linz D, Lip GYH, Løchen ML, Lucassen W, Malaczynska-Rajpold K, Massberg S, Merino JL, Meyer R, Mont L, Myers MC, Neubeck L, Niiranen T, Oeff M, Oldgren J, Potpara TS, Psaroudakis G, Pürerfellner H, Ravens U, Rienstra M, Rivard L, Scherr D, Schotten U, Shah D, Sinner MF, Smolnik R, Steinbeck G, Steven D, Svennberg E, Thomas D, True Hills M, van Gelder IC, Vardar B, Palà E, Wakili R, Wegscheider K, Wieloch M, Willems S, Witt H, Ziegler A, Daniel Zink M, Kirchhof P. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. Europace 2022; 25:6-27. [PMID: 35894842 PMCID: PMC9907557 DOI: 10.1093/europace/euac062] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.
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Affiliation(s)
- Renate B Schnabel
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Serge Boveda
- Cardiology—Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Barbara Casadei
- RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mirko de Melis
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Eckardt
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | | | - Daniel Engler
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,University Center of Cardiovascular Science Hamburg, Hamburg, Germany
| | - Ben Freedman
- Heart Research Institute, The University of Sydney, Sydney, Australia
| | | | - Andreas Goette
- Atrial Fibrillation Network (AFNET), Muenster, Germany,St Vincenz Hospital, Paderborn, Germany
| | - Eduard Guasch
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Karl Georg Haeusler
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jeff S Healey
- Population Health Research Institute, McMaster University Hamilton, ON, Canada
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Gerhard Hindricks
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Dipak Kotecha
- University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Thorsten Lewalter
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Hospital Munich South, Department of Cardiology, Munich, Germany,Department of Cardiology, University of Bonn, Bonn, Germany
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maja Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Wim Lucassen
- Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands
| | | | - Steffen Massberg
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Jose L Merino
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | | | - Lluıs Mont
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | | | - Lis Neubeck
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | - Teemu Niiranen
- Medtronic, Dublin, Ireland,Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK
| | - Michael Oeff
- Atrial Fibrillation Network (AFNET), Muenster, Germany
| | - Jonas Oldgren
- University of Turku and Turku University Hospital, Turku, Finland
| | | | - George Psaroudakis
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helmut Pürerfellner
- School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Bayer AG, Leverkusen, Germany
| | - Michiel Rienstra
- Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria
| | - Lena Rivard
- Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Daniel Scherr
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ulrich Schotten
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - Dipen Shah
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Moritz F Sinner
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands,Royal Brompton Hospital, London, UK
| | | | - Gerhard Steinbeck
- Atrial Fibrillation Network (AFNET), Muenster, Germany,MUMC+, Maastricht, The Netherlands
| | - Daniel Steven
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland
| | - Emma Svennberg
- Center for Cardiology at Clinic Starnberg, Starnberg, Germany
| | - Dierk Thomas
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany,Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden,Department of Cardiology, Medical University Hospital, Heidelberg, Germany
| | - Mellanie True Hills
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Isabelle C van Gelder
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Burcu Vardar
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elena Palà
- StopAfib.org, American Foundation for Women’s Health, Decatur, TX, USA
| | - Reza Wakili
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Karl Wegscheider
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Mattias Wieloch
- Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Willems
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden
| | | | | | - Matthias Daniel Zink
- Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Corresponding author. Tel: +49 40 7410 52438; Fax: +49 40 7410 55862. E-mail address:
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8
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Chen WT, Lo LW, Tsai WC, Lin YJ, Chang SL, Hu YF, Chung FP, Liao JN, Tuan TC, Chao TF, Lin CY, Chang TY, Kuo L, Liu CM, Liu SH, Cheng WH, Lin L, Ton ANK, Hsu CY, Chheng C, Elimam A, Wang HS, Kuo MR, Kao PH, Chen SA. Application of dynamic display technology to identify gaps after pulmonary vein isolation in catheter ablation of atrial fibrillation. J Cardiol 2022; 80:34-40. [PMID: 35337707 DOI: 10.1016/j.jjcc.2022.02.020] [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: 12/11/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The identification of post pulmonary vein isolation (PVI) gaps by activation and voltage maps is time-consuming. This study aimed to investigate the characteristics, efficiency and accuracy of LiveView dynamic display module (EnSite™ Dynamic Display; Abbott, Abbott Park, IL, USA) in unmasking post PVI gaps and conduction block line. METHOD Twenty four patients with paroxysmal atrial fibrillation (PAF) who failed to achieve first-pass PVI or with recurrent PAF were enrolled. Ninety-six pulmonary veins (PVs) were evaluated, and gaps were identified in 25 (26.0%) PVs. The gap location was confirmed by activation and propagation maps; 110 frames on gaps and 118 frames on block lines were analyzed by using LiveView module. We defined isochronal crowding in the local activation time (LAT) mode as three colors between two adjacent electrodes. Each frame was classified as with or without isochronal crowding in LAT mode and one/continuous color or isochronal discontinuity in reentrant mode. The gray color inside the PVs was considered to represent conduction block. RESULT The isochronal crowding could be found on both gap and block line in LAT mode, whereas isochronal discontinuity only presented on the block line in reentrant mode. The sensitivity and specificity of isochronal discontinuity or gray color in reentrant mode to identify block line were 61.0% and 100%, respectively. The sensitivity and specificity of isochronal crowding or gray color in LAT mode to identify block line were 71.2% and 71.8%, respectively. CONCLUSION Reentrant mode in LiveView module is very specific in identifying block lines. We proposed an efficient, practical algorithm to differentiate the block line from PV gaps.
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Affiliation(s)
- Wei-Tso Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Wen-Chin Tsai
- Division of Cardiology, Department of Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Linda Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An Nu-Khanh Ton
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Yu Hsu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chhay Chheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ahmed Elimam
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Sheng Wang
- Division of Cardiology, Department of Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ming-Ren Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Heng Kao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular center, Taichung Veterans General Hospital, Taichung, Taiwan.
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