1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024; 21:e31-e149. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [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: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Alderete J, Fernández-Armenta J, Zucchelli G, Sommer P, Nazarian S, Falasconi G, Soto-Iglesias D, Silva E, Mazzocchetti L, Bergau L, Khoshknab M, Penela D, Berruezo A. The Ablate-by-LAWT multicentre prospective study: Personalized paroxysmal atrial fibrillation ablation with ablation index adapted to local left atrial wall thickness. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01871-2. [PMID: 39009785 DOI: 10.1007/s10840-024-01871-2] [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: 05/17/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Personalized radiofrequency (RF) ablation for paroxysmal atrial fibrillation (PAF), adapting the ablation index (AI) to local left atrial wall thickness (LAWT), proved to be highly efficient maintaining high arrhythmia-free survival rates. However, multicentre data are lacking. This multicentre, prospective, non-randomized study was conducted at 5 tertiary hospitals and sought to assess the safety, efficacy, and reproducibility of the LAWT-guided ablation for PAF. METHODS Consecutive patients referred for first-time PAF were prospectively enrolled. The LAWT maps were obtained from preprocedural multidetector computed tomography and integrated into the navigation system. AI was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the pulmonary veins (PVs). RESULTS A total 109 patients (60.1 ± 9.4 years, 64.2% male) were enrolled. Median procedure time was 61.7 min (48.4-83.8), fluoroscopy time was 1.0 min (0.4-3.3), and RF time was 13.9 min (12.3-16.8). Median AI tailored to the local LAWT was 393 (374-412) for the anterior wall and 340 (315-378) for the posterior wall. Right and left PVs first-pass isolation was achieved in 89% and 91.7% of the patients, respectively. At 12-month follow-up, freedom from any atrial arrhythmia was 93.4% (95% CI 88.7-98.1), without differences across centres (P = 0.169). One patient experienced femoral artery pseudoaneurysm, with no other serious procedural-related complication. CONCLUSION The Ablate-by-LAWT study proved that LAWT-guided PV isolation for PAF is safe, effective, and efficient in a multicentre setting. Twelve-month recurrence-free survival exceeded 90% (NCT04218604).
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Affiliation(s)
- José Alderete
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain
- Campus Clinic, University of Barcelona, C/Villarroel 170, 08024, Barcelona, Spain
| | - Juan Fernández-Armenta
- Department of Cardiology, Puerta del Mar University Hospital, Av. Ana de Viya, 21, 11009, Cadiz, Spain
| | - Giulio Zucchelli
- Second Division of Cardiology, Azienda Ospedaliero Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- Und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, 32545, Bad Oeynhausen, Germany
| | - Saman Nazarian
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Giulio Falasconi
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain
- Campus Clinic, University of Barcelona, C/Villarroel 170, 08024, Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain
| | - Etel Silva
- Department of Cardiology, Puerta del Mar University Hospital, Av. Ana de Viya, 21, 11009, Cadiz, Spain
| | - Lorenzo Mazzocchetti
- Second Division of Cardiology, Azienda Ospedaliero Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- Und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, 32545, Bad Oeynhausen, Germany
| | - Mirmilad Khoshknab
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Diego Penela
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain.
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4
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Compagnucci P, Casella M. Atrial tachyarrhythmia recurrence after cryobaloon ablation: does thickness imply failure? J Interv Card Electrophysiol 2024; 67:681-683. [PMID: 38261099 DOI: 10.1007/s10840-024-01747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Via Conca 71, 60126, Ancona, Italy.
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Via Conca 71, 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
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5
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Bai Y, Jia R, Wang X, Chan J, Cui K. Association of left atrial wall thickness with recurrence after cryoballoon ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:657-667. [PMID: 37966658 DOI: 10.1007/s10840-023-01691-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Transmural injury plays a role in successful atrial fibrillation ablation. The effect of left atrial wall thickness (LAWT) on the efficacy of radiofrequency ablation has been identified, but data on the relationship between LAWT and cryoballoon for paroxysmal atrial fibrillation (PAF) are lacking. We aim to explore the relationship between LAWT and recurrence after cryoballoon ablation (CBA). METHODS We studied 364 patients (mean age 62 years) with PAF who underwent a second-generation CBA and pre-procedure cardiac CTA. LAWT and left atrial volume index (LAVI) were obtained based on pre-procedure cardiac CTA measurements. Follow-up was at least 12 months and predictors of atrial tachyarrhythmia recurrence during follow-up were assessed. RESULTS Patients were followed up for a median of 19 (12-28) months, with an atrial tachyarrhythmia-free rate of 77.5% after cryoablation. Greater LAVI (50.0 ± 19.6 mL/m2 vs. 44.3 ± 15.4 mL/m2, P = 0.018) and greater LAWT (1.67 ± 0.24 vs. 1.46 ± 0.25 mm, P < 0.001) were associated with atrial tachyarrhythmia recurrence. The mean LAWT of PV antrum correlated with TTI (R = 0.252, P < 0.001). Adding LAWT to the established risk model improved both the discrimination and reclassification effects (IDI: 0.099, 95% CI: 0.065-0.134, P < 0.001; NRI: 0.685, 95% CI: 0.455-0.915, P < 0.001). In a multivariable Cox proportional hazard model, the mean LAWT of PV antrum (hazard ratio [HR]:3.657, 95%CI: 2.319-5.765, P < 0.001) was an independent predictor of atrial tachyarrhythmia recurrence after cryoablation. CONCLUSIONS The mean LAWT of PV antrum, obtained from preoperative measurements on CT, was associated with atrial tachyarrhythmia recurrence after cryoablation.
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Affiliation(s)
- Yixuan Bai
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ruikun Jia
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Xinmeng Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Juan Chan
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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6
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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7
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Younis A, Buck E, Santangeli P, Tabaja C, Garrott K, Lehn L, Hussein AA, Nakhla S, Nakagawa H, Yavin HD, Kanj M, Sroubek J, Saliba WI, Wazni OM. Efficacy of Pulsed Field vs Radiofrequency for the Reablation of Chronic Radiofrequency Ablation Substrate: Redo Pulsed Field Ablation. JACC Clin Electrophysiol 2024; 10:222-234. [PMID: 37978965 DOI: 10.1016/j.jacep.2023.09.015] [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: 03/20/2023] [Revised: 08/25/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The efficacy of pulsed field ablation (PFA) for redo procedures is unknown. OBJECTIVES In this study, the authors aimed to evaluate the effectiveness of PFA when performing PFA over chronic RFA (redo environment). METHODS This was a 3-step in vivo study. In step 1 (creation of redo environment), 6 swine underwent radiofrequency ablation (RFA) with a local impedance measuring catheter and a contact force-enabled catheter in 3 different sites: the right atrium (RA) (intercaval line with intentional gaps), the left atrium (LA) (pulmonary vein isolation [PVI] with intentional gaps and superficial posterior wall ablations), and the left ventricle (LV) (short RFA applications [chronic RFA]). In step 2 (re-ablation), following a survival period of ≈5 weeks, animals were retreated as follows: in the RA, a focal PFA catheter over the prior intercaval line; in the LA, PVI using a pentaspline PFA catheter; and in the LV, animals were randomized to focal PFA or RFA. In each arm, 2 types of lesions were performed: acute or acute over chronic. In step 3 (remapping and euthanization), following an additional 3 to 5 days, all animals were remapped and sacrificed. RESULTS In the RA, re-ablation with PFA resulted in a complete intercaval block in all animals, expanding and homogenizing the disparate chronic RFA lesions from a width of 4 to 7 mm (chronic RFA) to a width of 16 to 28 mm (PFA over chronic RFA). In the LA, re-ablation with PFA resulted in complete PVI and transmural ablation of the PW. In the LV, the mean depth for acute RFA (post 2-5 days survival) was 7.6 ± 1.3 mm vs 3.9 ± 1.6 mm in the acute over chronic RFA lesions (P < 0.01). In contrast, the mean depth for acute PFA was 7.0 ± 1.6 mm, similar to when ablating with PFA over RFA (7.1 ± 1.3 mm; P = 0.94). CONCLUSIONS PFA is highly efficient for ablation following prior RFA, which may be beneficial in patients presenting for redo procedures. In the ventricle, PFA resulted in lesions that are deeper than RFA when ablating over chronic superficial RFA lesions.
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Affiliation(s)
- Arwa Younis
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Eric Buck
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kara Garrott
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lauren Lehn
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hagai D Yavin
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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8
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Lee SR, Park HS, Kwon S, Choi EK, Oh S. Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1811-1819. [PMID: 37595097 DOI: 10.1111/jce.16026] [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: 05/01/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Although left atrial wall thickness (LAWT) is known to be varied, a fixed target Ablation Index (AI) based pulmonary vein isolation (PVI) has been suggested in catheter ablation for atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of PVI applying tailored AI based on LAWT assessed by cardiac computed tomography (CT). METHODS The thick segment was defined as the segment including ≥LAWT grade 3 (≥1.5 mm). The fixed AI strategy was defined as AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments regardless of LAWT. The tailored AI strategy consisted of AI increasing the targets to 500 on the anterior/roof segments and to 400 on the posterior/inferior/carina segments when ablating the thick segment. After PVI, acute pulmonary vein (PV) reconnection, defined by the composite of residual potential and early reconnection, was evaluated. RESULTS A total of 156 patients (paroxysmal AF 72%) were consecutively included (86 for the fixed AI group and 70 for the tailored AI group). The tailored AI group showed a significantly lower rate of segments with acute PV reconnection than the fixed AI group (8% vs. 5%, p = .007). The tailored AI group showed a trend for shorter ablation time for PVI. One-year AF/atrial tachycardia free survival rate was similar in two groups (87.2% in the fixed AI group and 90.0% in the tailored AI group, p = .606). CONCLUSION Applying tailored AI based on the LAWT was a feasible and effective strategy to reduce acute PV reconnection after PVI.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Division of Cardiology, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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9
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Saglietto A, Jauregui B, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Gaspardone C, San Antonio R, Huguet M, Cámara Ó, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation. Europace 2023; 25:euad118. [PMID: 37125968 PMCID: PMC10228614 DOI: 10.1093/europace/euad118] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
AIMS Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. METHODS AND RESULTS Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50-67), fluoroscopy time was 43 s (IQR 20-71), and radiofrequency (RF) time was 16.5 min (IQR 14.3-18.4). The median AI tailored to the local LAWT was 387 (IQR 360-410) for the anterior wall and 335 (IQR 300-375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. CONCLUSION In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).
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Affiliation(s)
- Giulio Falasconi
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Diego Penela
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Cheryl Teres
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Beatriz Jauregui
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Daniel Viveros
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Aldo Bellido
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Julia Meca-Santamaria
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Paula Franco
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Carlo Gaspardone
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Óscar Cámara
- Department of Information and Communication Technologies, Pompeu Fabra University, C/Tànger 122-140, 08018 Barcelona, Spain
| | - José-Tomás Ortiz-Pérez
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
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10
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Takahara H, Kiuchi K, Fukuzawa K, Takami M, Izawa Y, Nakamura T, Nakasone K, Sonoda Y, Yamamoto K, Suzuki Y, Tani KI, Iwai H, Nakanishi Y, Shoda M, Murakami A, Yonehara S, Negi N, Somiya Y, Hirata KI. The impact of the procedural parameters on the lesion characteristics associated with AF recurrence: Late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) analysis. J Cardiovasc Electrophysiol 2023; 34:527-535. [PMID: 36598438 DOI: 10.1111/jce.15805] [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: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lesion gaps assessed by late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) are associated with the atrial fibrillation (AF) recurrence after pulmonary vein isolation. Animal studies have demonstrated that the catheter-contact force (CF), stability, and orientation are strongly associated with lesion formation. However, the impact of those procedural factors on the lesion characteristics associated with AF recurrence has not been well discussed. METHODS A total of 30 patients with paroxysmal AF who underwent catheter ablation were retrospectively enrolled. Radiofrequency (RF) applications were performed with 35 W for 30 s in a point-by-point fashion under esophageal temperature monitoring. The inter-lesion distance was 4 mm. The lesions were visualized by LGE-MRI 3 months postprocedure and assessed by the LGE volume (ml), gap number (GN), and average gap length (AGL [mm]). The gaps were defined as nonenhancement sites of >4 mm. The procedural factors including the catheter-CF, stability, and orientation were calculated on the NavX system. RESULTS Six (20%) of 30 patients had AF recurrences 12 months postablation. A univariate analysis demonstrated that the AGL was associated with AF recurrence (hazard ratio [HR]: 1.20, confidence interval [CI]: 1.03-1.42, p = .02). All AF recurrence were found in patients with an AGL of >7 mm. The catheter-CF and stability were associated with an AGL of >7 mm, but not the orientation (CF-HR: 0.62, CI: 0.39-0.97, p = .038; stability-HR: 0.8, CI: 0.66-0.98, p = .027). CONCLUSIONS RF ablation with a low CF and poor catheter stability has a potential risk of creating large lesion gaps associated with AF recurrence.
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Affiliation(s)
- Hiroyuki Takahara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazutaka Nakasone
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Sonoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Yamamoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuya Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Tani
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidehiro Iwai
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuhiko Shoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Murakami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shogo Yonehara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe, Japan
| | - Yuichiro Somiya
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Canpolat U. Reconduction (reconnection or gap) after pulmonary vein isolation for paroxysmal atrial fibrillation ablation is a multifactorial process rather than a battle of fire and ice alone! J Cardiovasc Electrophysiol 2023; 34:1326-1328. [PMID: 36786512 DOI: 10.1111/jce.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Ugur Canpolat
- Department of Cardiology, Arrhythmia and Electrophysiology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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12
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Teres C, Soto-Iglesias D, Penela D, Falasconi G, Viveros D, Meca-Santamaria J, Bellido A, Alderete J, Chauca A, Ordoñez A, Martí-Almor J, Scherer C, Panaro A, Carballo J, Cámara Ó, Ortiz-Pérez JT, Berruezo A. Relationship between the posterior atrial wall and the esophagus: esophageal position and temperature measurement during atrial fibrillation ablation (AWESOME-AF). A randomized controlled trial. J Interv Card Electrophysiol 2022; 65:651-661. [PMID: 35861901 DOI: 10.1007/s10840-022-01302-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) implies unavoidable ablation lesions to the left atrial posterior wall, which is closely related to the esophagus, leading to several potential complications. This study evaluates the usefulness of the esophageal fingerprint in avoiding temperature rises during paroxysmal atrial fibrillation (PAF) ablation. METHODS Isodistance maps of the atrio-esophageal relationship (esophageal fingerprint) were derived from the preprocedural computerized tomography. Patients were randomized (1:1) into two groups: (1) PRINT group, the PVI line was modified according to the esophageal fingerprint; (2) CONTROL group, standard PVI with operator blinded to the fingerprint. The primary endpoint was temperature rise detected by intraluminal esophageal temperature probe monitoring. Ablation settings were as specified on the Ablate BY-LAW study protocol. RESULTS Sixty consecutive patients referred for paroxysmal AF ablation were randomized (42 (70%) men, mean age 60 ± 11 years). Temperature rise (> 39.1 °C) occurred in 5 (16%) patients in the PRINT group vs. 17 (56%) in the CONTROL group (p < 0.01). Three AF recurrences were documented at a mean follow-up of 12 ± 3 months (one (3%) in the PRINT group and 2 (6.6%) in the CONTROL group, p = 0.4). CONCLUSION The esophageal fingerprint allows for a reliable identification of the esophageal position and its use for PVI line deployment results in less frequent esophageal temperature rises when compared to the standard approach. Further studies are needed to evaluate the impact of PVI line modification to avoid esophageal heating on long-term outcomes. The development of new imaging-derived tools could ultimately improve patient safety (NCT04394923).
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain.,Lausanne University Hospital, Lausanne, Switzerland
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | | | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Alejandro Panaro
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Julio Carballo
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Óscar Cámara
- Department of Information and Communication Technologies, BCN-MedTech, Universitat Pompeu Fabra, PhySense group, Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain.
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13
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Falasconi G, Penela D, Soto-Iglesias D, Terés C, Jáuregui B, Martí-Almor J, Meca-Santamaria J, Franco P, Ordoñez A, Scherer C, Viveros D, Bellido A, Berruezo A. Multidetector Computed Tomography identification of previous ablation lines: insights for left atrial flutter ablation. Heart Rhythm 2022; 19:1753-1754. [PMID: 35577317 DOI: 10.1016/j.hrthm.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | - Cheryl Terés
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | | | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
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14
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Optimal Ablation Settings Predicting Durable Scar Detected Using LGE-MRI after Modified Left Atrial Anterior Line Ablation. J Clin Med 2022; 11:jcm11030830. [PMID: 35160281 PMCID: PMC8837068 DOI: 10.3390/jcm11030830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The modified anterior line (MAL) has been described as an alternative to the mitral isthmus line. Despite better ablation results, achieving a bidirectional line block can be challenging. We aimed to investigate the ablation parameters that determine a persistent scar on late-gadolinium enhancement magnet resonance imaging (LGE-MRI) as a surrogate parameter for successful ablation 3 months after MAL ablation. (2) Methods: Twenty-four consecutive patients who underwent a MAL ablation have been included. The indication for MAL was perimitral flutter (n = 5) or substrate ablation in the diffuse anterior left atrial (LA) low-voltage area in persistent atrial fibrillation (AF) (n = 19). The MAL was divided into three segments: segment 1 (S1) from mitral annulus to height of lower region of left atrial appendage (LAA) antrum; segment 2 (S2) height of lower region of LAA antrum to end of upper LAA antrum; segment 3 (S3) from end of upper LAA antrum to left superior pulmonary vein. Ablation was performed using a contact force irrigated catheter with a power of 40 Watt and guided by automated lesion tagging and the Ablation Index (AI). The AI target was left to the operator’s choice. An inter-lesion distance of ≤6 mm was recommended. The bidirectional block was systematically evaluated using stimulation maneuvers at the end of procedure. All patients underwent LGE-MRI imaging at 3 months, regardless of symptoms, to identify myocardial lesions (scars). (3) Results: Bidirectional MAL block was achieved in all patients. LGE-MRI imaging revealed scarring in 45 of 72 (63%) segments. In all three segments of MAL, ablation time and AI were significantly higher in scarred areas compared with non-scar areas. The mean AI value to detect a durable scar was 514.2 in S1, 486.7 in S2 and 485.9 in S3. The mean ablation time to detect a scar was 20.4 s in S1, 22.1 s in S2 and 20.2 s in S3. Mean contact force and impedance drop were not significantly different between scar and non-scar areas. (4) Conclusions: Targeting optimal AI values is crucial to determine persistent left atrial scars on an LGE-MRI scan 3 months after ablation. AI guided linear left atrial ablation seems to be effective in producing durable lesions.
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15
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Teres C, Soto-Iglesias D, Penela D, Jáuregui B, Ordoñez A, Chauca A, Carreño JM, Scherer C, Huguet M, Ramírez C, Mandujano JT, Maldonado G, Panaro A, Carballo J, Cámara Ó, Ortiz-Pérez JT, Berruezo A. Relationship between the posterior atrial wall and the esophagus: esophageal position during atrial fibrillation ablation. Heart Rhythm O2 2022; 3:252-260. [PMID: 35734293 PMCID: PMC9207737 DOI: 10.1016/j.hroo.2022.02.007] [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: 12/02/2022] Open
Abstract
Background Atrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent. Objectives The purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure. Methods Esophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of first pulmonary vein isolation and redo intervention (redo group) was segmented with ADAS 3D™ to compare the stability of the atrioesophageal isodistance prints. Second, 3 imaging modalities were compared for the same procedure (multimodality group): (1) preprocedural MDCT; (2) intraprocedural fluoroscopy obtained with the transesophageal echocardiographic probe in place with CARTOUNIVU™; and (3) esophageal fast anatomic map (FAM) at the end of the procedure. Esophageal position correlation between different imaging techniques was computed in MATLAB using semiautomatic segmentation analysis. Results Thirty-five redo patients were analyzed and showed a mean atrioesophageal distance of 1.2 ± 0.6 mm and a correlation between first and redo procedure esophageal fingerprint of 91% ± 5%. Only 3 patients (8%) had a clearly different position. The multi-imaging group was composed of 100 patients. Esophageal position correlation between MDCT and CARTOUNIVU was 82% ± 10%; between MDCT and esophageal FAM was 80% ± 12%; and between esophageal FAM and CARTOUNIVU was 83% ± 15%. Conclusion There is high stability of esophageal position between procedures and from the beginning to the end of a procedure. Further research is undergoing to test the clinical utility of the esophageal fingerprinted isodistance map to the posterior atrial wall.
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, Barcelona, Spain
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | - Marina Huguet
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Carlos Ramírez
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | - Julio Carballo
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Óscar Cámara
- PhySense group, BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, Barcelona, Spain
- Address reprint requests and correspondence: Dr Antonio Berruezo, Heart Institute, Teknon Medical Center, C/ Vilana, 12, 08022 Barcelona, Spain.
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A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:629-639. [PMID: 34757547 DOI: 10.1007/s10840-021-01086-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)-guided zero-fluoroscopy approach (ZFA) for RFA. METHODS Consecutive patients (n = 111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure. RESULTS ZFA success was achieved in 80 (72%) procedures. BMI > 35 kg/m2 resulted in the only independent predictor of ZFA failure (OR = 6.10, 95% CI 1.15-46.49, p = 0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63 s, p < 0.001), total emitted fluoroscopy dose (0.2 vs. 6.0 mGy, p < 0.001), dose area product (0.04 vs. 1.4 Gy*cm2, p < 0.001), and effective dose (0.8 vs. 27.2 mSv*100, p < 0.001). Complete pulmonary vein isolation was achieved in all procedures. No difference was observed between the groups in in-hospital complication rate (0.9% vs. 1.8%, p = 0.99). CONCLUSIONS This is the largest study proving procedural feasibility, safety, and efficacy of TEE-guided AF-ablation with a complete or near-complete avoidance of radiological exposure, without using intracardiac echocardiography.
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Sequential versus optimized pulmonary vein isolation for paroxysmal atrial fibrillation: a pilot study. J Interv Card Electrophysiol 2021; 64:59-66. [PMID: 34716525 DOI: 10.1007/s10840-021-01082-z] [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: 04/29/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to investigate whether the sequence of wide circumferential pulmonary vein isolation (PVI) ablation had an effect on the acute reconnection or long-term effectiveness in patients with paroxysmal atrial fibrillation (AF). METHODS One hundred consecutive paroxysmal AF patients, who were scheduled to accept PVI, were enrolled and randomized into two groups: (1) optimized group. Lesions were first applied to the anterior/posterior carina and the ridge between the left atrial (LA) appendage and the left pulmonary vein (PV). Then both circles were closed with continuous lesions. (2) Sequential group-continuous circular lesions were created counter-clockwise and started from the site of 6 o'clock. The primary endpoint was the freedom from non-blanking period recurrence of any atrial tachyarrhythmias lasting for 30 s or longer during the 1-year follow-up period after a single procedure. The secondary endpoint included safety endpoints, LA dwelling time, and fluoroscopy time/dose. RESULTS Forty-nine patients in the optimized group and 48 patients in the sequential group were available for analysis. There was no difference between the AF-free rate of the optimized group and the sequential group (75.5% vs. 72.9%, p = 0.7715). Cox regression analysis found that acute reconnection had the potential to predict long-term recurrence at 1 year (Risk ratio 2.175, p = 0.0818). Both groups had similar safety endpoints, LA dwelling time, and fluoroscopy time/dose. CONCLUSIONS Adjusting the ablation sequence of PVI by ablating the anterior/posterior carina and the ridge between the left PV and the LA appendage first did not improve 1-year AF-free rate for paroxysmal AF.
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Left atrial wall thickness; at the forefront of atrial fibrillation ablation strategies. Int J Cardiovasc Imaging 2021; 37:3537-3538. [PMID: 34635966 DOI: 10.1007/s10554-021-02434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
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Teres C, Soto-Iglesias D, Penela D, Jáuregui B, Ordoñez A, Chauca A, Carreño JM, Scherer C, San Antonio R, Huguet M, Roque A, Ramírez C, Oller G, Jornet A, Palet J, Santana D, Panaro A, Maldonado G, de Leon G, Jiménez G, Evangelista A, Carballo J, Ortíz-Pérez JT, Berruezo A. Personalized paroxysmal atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: the 'Ablate by-LAW' single-centre study-a pilot study. Europace 2021; 24:390-399. [PMID: 34480548 DOI: 10.1093/europace/euab216] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine if adapting the ablation index (AI) to the left atrial wall thickness (LAWT), which is a determinant of lesion transmurality, is feasible, effective, and safe during paroxysmal atrial fibrillation (PAF) ablation. METHODS AND RESULTS Consecutive patients referred for PAF first ablation. Left atrial wall thickness three-dimensional maps were obtained from multidetector computed tomography and integrated into the CARTO navigation system. Left atrial wall thickness was categorized into 1 mm layers and AI was titrated to the LAWT. The ablation line was personalized to avoid thicker regions. Primary endpoints were acute efficacy and safety, and freedom from atrial fibrillation (AF) recurrences. Follow-up (FU) was scheduled at 1, 3, 6, and every 6 months thereafter. Ninety patients [60 (67%) male, age 58 ± 13 years] were included. Mean LAWT was 1.25 ± 0.62 mm. Mean AI was 366 ± 26 on the right pulmonary veins with a first-pass isolation in 84 (93%) patients and 380 ± 42 on the left pulmonary veins with first-pass in 87 (97%). Procedure time was 59 min (49-66); radiofrequency (RF) time 14 min (12.5-16); and fluoroscopy time 0.7 min (0.5-1.4). No major complication occurred. Eighty-four out of 90 (93.3%) patients were free of recurrence after a mean FU of 16 ± 4 months. CONCLUSION Personalized AF ablation, adapting the AI to LAWT allowed pulmonary vein isolation with low RF delivery, fluoroscopy, and procedure time while obtaining a high rate of first-pass isolation, in this patient population. Freedom from AF recurrences was as high as in more demanding ablation protocols. A multicentre trial is ongoing to evaluate reproducibility of these results.
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Albert Roque
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Carlos Ramírez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Guillermo Oller
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Agustí Jornet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jordi Palet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Santana
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alejandro Panaro
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Giuliana Maldonado
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo de Leon
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo Jiménez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Arturo Evangelista
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Julio Carballo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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Imaging Techniques for the Study of Fibrosis in Atrial Fibrillation Ablation: From Molecular Mechanisms to Therapeutical Perspectives. J Clin Med 2021; 10:jcm10112277. [PMID: 34073969 PMCID: PMC8197293 DOI: 10.3390/jcm10112277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) is the most prevalent form of cardiac arrhythmia. It is often related to diverse pathological conditions affecting the atria and leading to remodeling processes including collagen accumulation, fatty infiltration, and amyloid deposition. All these events generate atrial fibrosis, which contribute to beget AF. In this scenario, cardiac imaging appears as a promising noninvasive tool for monitoring the presence and degree of LA fibrosis and remodeling. The aim of this review is to comprehensively examine the bench mechanisms of atrial fibrosis moving, then to describe the principal imaging techniques that characterize it, such as cardiac magnetic resonance (CMR) and multidetector cardiac computed tomography (MDCT), in order to tailor atrial fibrillation ablation to each individual.
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