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Chen G, Wang Y, Proietti R, Wang X, Ouyang F, Ma CS, Yu RH, Zhao C, Ma K, Qiu J, Liu Q, Wang DW. Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience. BMC Cardiovasc Disord 2020; 20:48. [PMID: 32013865 PMCID: PMC6996189 DOI: 10.1186/s12872-020-01344-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. METHODS A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. RESULTS Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zero-fluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. CONCLUSION The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03042078; first registered February 3, 2017; retrospectively registered.
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Affiliation(s)
- Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, via Giustiniani 2, 35121, Padua, Italy
| | - Xunzhang Wang
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Chang Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Rong Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Kezhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Xiangyang, 441021, People's Republic of China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qigong Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Lee HG, Shim J, Choi JI, Kim YH, Oh YW, Hwang SH. Use of Cardiac Computed Tomography and Magnetic Resonance Imaging in Case Management of Atrial Fibrillation with Catheter Ablation. Korean J Radiol 2020; 20:695-708. [PMID: 30993921 PMCID: PMC6470091 DOI: 10.3348/kjr.2018.0774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia associated with the risk of morbidity and mortality in clinical patients. AF is considered as an arrhythmia type that develops and progresses through close connection with cardiac structural arrhythmogenic substrates. Since the introduction of catheter ablation-mediated electrical isolation of arrhythmogenic substrates, cardiac imaging indicates improved treatment outcome and prognosis with appropriate candidate selection, ablation catheter guidance, and post-ablation follow-up. Currently, cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging are essential in the case management of AF at both pre-and post-procedural stages of catheter ablation. In this review, we discuss the roles and technical considerations of CCT and CMR imaging in the management of patients with AF undergoing catheter ablation.
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Affiliation(s)
- Hee Gone Lee
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jong Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Young Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yu Whan Oh
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea.
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Linte CA, Camp JJ, Rettmann ME, Haemmerich D, Aktas MK, Huang DT, Packer DL, Holmes DR. Lesion modeling, characterization, and visualization for image-guided cardiac ablation therapy monitoring. J Med Imaging (Bellingham) 2018; 5:021218. [PMID: 29531966 PMCID: PMC5831757 DOI: 10.1117/1.jmi.5.2.021218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
In spite of significant efforts to improve image-guided ablation therapy, a large number of patients undergoing ablation therapy to treat cardiac arrhythmic conditions require repeat procedures. The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation, in turn leading to the arrhythmia recurrence. Ongoing research efforts aim to better characterize and visualize RF delivery to monitor the induced tissue damage during therapy. Here, we propose a method that entails modeling and visualization of the lesions in real-time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression are quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples undergoing ex vivo clinically relevant ablation protocols. The studies demonstrated less than 5°C difference between the model-predicted and experimentally measured end-ablation temperatures. The model predicted lesion patterns were within 0.5 to 1 mm from the observed lesion patterns, suggesting sufficiently accurate modeling of the ablation lesions. Lastly, our proposed method enables therapy delivery feedback with no significant workflow latency. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.
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Affiliation(s)
- Cristian A. Linte
- Rochester Institute of Technology, Biomedical Engineering and Chester F. Carlson Center for Imaging Science, Rochester, New York, United States
| | - Jon J. Camp
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
| | - Maryam E. Rettmann
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - Dieter Haemmerich
- Medical University of South Carolina, Department of Pediatrics, Charleston, South Carolina, United States
| | - Mehmet K. Aktas
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - David T. Huang
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - Douglas L. Packer
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - David R. Holmes
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
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Linte CA, Camp JJ, Rettmann ME, Haemmerich D, Aktas MK, Huang DT, Packer DL, Holmes DR. Technical Note: On Cardiac Ablation Lesion Visualization for Image-guided Therapy Monitoring. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10576:105760N. [PMID: 31213732 PMCID: PMC6581517 DOI: 10.1117/12.2322523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation and leads to arrhythmia recurrence and a large number of patients requiring repeat procedures. In concert with ongoing research efforts aimed at better characterizing the RF energy delivery, here we propose a method that entails modeling and visualization of the lesions in real time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression is quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.
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Affiliation(s)
- Cristian A. Linte
- Biomedical Engineering and Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester NY USA
- Biomedical Imaging Resource, Mayo Clinic, Rochester MN USA
| | - Jon J. Camp
- Biomedical Imaging Resource, Mayo Clinic, Rochester MN USA
| | | | - Dieter Haemmerich
- Department of Pediatrics, Medical University of South Carolina, Charleston SC USA
| | - Mehmet K. Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester NY USA
| | - David T. Huang
- Division of Cardiology, University of Rochester Medical Center, Rochester NY USA
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Laughner J, Shome S, Child N, Shuros A, Neuzil P, Gill J, Wright M. Practical Considerations of Mapping Persistent Atrial Fibrillation With Whole-Chamber Basket Catheters. JACC Clin Electrophysiol 2015; 2:55-65. [PMID: 29766854 DOI: 10.1016/j.jacep.2015.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/12/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to evaluate basket catheter deployment, catheter-tissue contact, and time-space stability of unipolar atrial electrograms (aEGMs) recorded in persistent atrial fibrillation (AF) patients. BACKGROUND Panoramic mapping of human AF using multiple-electrode basket catheters may identify AF sources. Although clinical results using this technique are provocative, questions remain about its effectiveness. METHODS Data were collected from patients (N = 25) undergoing catheter ablation for AF during the multicenter STARLIGHT (Signal Transfer of Atrial Fibrillation Data to Guide Human Treatment) trial (NCT01765075). Left and right aEGM signals were recorded using basket catheters during baseline AF, following ablation and during sinus rhythm. Data were analyzed for basket deployment, peak-to-peak voltage, and electrogram stability and organization. Electrogram stability and organization were evaluated via time-frequency analysis (TFA). RESULTS Basket catheters displayed equatorial bunching when deployed in atria. Interspline spacing ranged from 1.7 to 64.0 mm in the right atrial and from 1.5 to 85.08 mm in the left atrial basket. Approximately one-third of mapping electrodes failed to demonstrate a median peak-to-peak voltage >2× the low-voltage threshold. Time-space stability and organization was observed in 13 of 22 (59.09%) right atrial and 10 of 22 (45.45%) left atrial baskets. CONCLUSIONS Despite poor deployment and a large number of low-voltage electrodes, stability and organization was observed in about one-half of the mapped patients. Although this study suggests that basket catheters have limitations for patient-specific AF mapping, concordant activation occurs in some persistent AF patients, which may be amenable to high-density mapping techniques.
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Affiliation(s)
| | | | - Nicholas Child
- Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jaswinder Gill
- Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Matthew Wright
- Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Yagishita A, Hachiya H, Higuchi K, Nakamura T, Sugiyama K, Tanaka Y, Sasano T, Kawabata M, Isobe M, Hirao K. Differentiation of atrial tachycardia from other long RP tachycardias by electrocardiographic characteristics. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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