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Sano M, Yamaji H, Higashiya S, Kubo M, Murakami T, Kawamura H, Murakami M, Kamikawa S, Hirohata S, Kusachi S. Efficacy and safety of a novel temperature-controlled catheter for cavotricuspid isthmus ablation. J Cardiovasc Electrophysiol 2024. [PMID: 39049491 DOI: 10.1111/jce.16378] [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: 05/07/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Maintaining an adequate temperature at the target site is essential for effective ablation. We hypothesized that a tissue temperature-controlled (T-Con) catheter for cavotricuspid isthmus (CTI) ablation could improve the procedural ablation parameters. PURPOSE To evaluate the efficacy and safety of the T-Con (DiamondTemp™) catheter for CTI ablation compared with non-irrigation (Non-Irri) and irrigation (Irri) catheters. METHODS We analyzed 150 patients who underwent prophylactic CTI ablation combined with pulmonary vein isolation. The Non-Irri, Irri, and T-Con catheter groups comprised 50 patients each, and the ablation procedural parameters and complications were compared between these groups. RESULTS There were no significant differences in clinical background characteristics among the three groups. The Kruskal-Wallis and post hoc tests demonstrated that the T-Con group showed the lowest total radiofrequency energy delivery time among the three groups (median [25 and 75 percentiles]: 340 [209, 357], 147 [100, 199], and 83 [61, 109] s, respectively in the Non-Irri, Irri, and T-Con groups; T-Con versus Non-Irri, p < .01; T-Con versus Irri, p < .01). The total procedural time and acute reconnection rate in the T-Con group (264 s and 4%, respectively) were lower than those in the Non-Irri group (438 s and 24%) but were similar to those in the Irri group (268 s and 6%). No significant complications were observed in any group. CONCLUSIONS The T-Con catheter achieved a short energy delivery time and a low acute reconnection rate, indicating its potential as an alternative catheter for CTI ablation.
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Affiliation(s)
- Masaya Sano
- Heart Rhythm Center, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | | | - Motoki Kubo
- Heart Rhythm Center, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Takashi Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Hiroshi Kawamura
- Department of Cardiology, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Masaaki Murakami
- Department of Cardiology, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Shigeshi Kamikawa
- Department of Cardiology, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
| | - Satoshi Hirohata
- Department of Medical Technology, Okayama University Graduate School of Health Okayama, Japan Sciences, Kita-ku, Okayama, Japan
| | - Shozo Kusachi
- Heart Rhythm Center, Okayama Heart Clinic, Naka-Ku, Okayama, Japan
- Department of Medical Technology, Okayama University Graduate School of Health Okayama, Japan Sciences, Kita-ku, Okayama, Japan
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Abdala-Lizarraga J, Quesada-Ocete J, Quesada-Ocete B, Jiménez-Bello J, Quesada A. Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation. Rev Cardiovasc Med 2024; 25:11. [PMID: 39077671 PMCID: PMC11262378 DOI: 10.31083/j.rcm2501011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 07/31/2024] Open
Abstract
The demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment. However, certain aspects regarding its deeper physiopathology, ablation targets, and methods for verifying the results remain to be clarified. While current research efforts have primarily been focused on the advancement of effective ablation techniques, it is crucial to continue exploring the intricate electrophysiological, ultrastructural, and pharmacological pathways that underlie the development of atrial flutter. This ongoing investigation is essential for the development of targeted preventive strategies that can act upon the specific mechanisms responsible for the initiation and maintenance of this arrhythmia. In this work, we will discuss less ascertained aspects alongside the most widely recognized general data, as well as the most recent or less commonly used contributions regarding the electrophysiological evaluation and ablation of typical atrial flutter. Regarding electrophysiological characteristics, one of the most intriguing findings is the presence of low voltage zones in some of these patients together with the presence of a functional, unidirectional line of block between the two vena cava. It is theorized that episodes of paroxysmal atrial fibrillation can trigger this line of block, which may then allow the onset of stable atrial flutter. Without this, the patient will either remain in atrial fibrillation or return to sinus rhythm. Another of the most important pending tasks is identifying patients at risk of developing post-ablation atrial fibrillation. Discriminating between individuals who will experience a complete arrhythmia cure and those who will develop atrial fibrillation after flutter ablation, remains essential given the important prognostic and therapeutic implications. From the initial X-ray guided linear cavotricuspid ablation, several alternatives have arisen in the last decade: electrophysiological criteria-directed point applications based on entrainment mapping, applications directed by maximum voltage criteria or by wavefront speed and maximum voltage criteria (omnipolar mapping). Electro-anatomical navigation systems offer substantial support in all three strategies. Finally, the electrophysiological techniques to confirm the success of the procedure are reviewed.
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Affiliation(s)
- Julian Abdala-Lizarraga
- School of Doctorate, Catholic University of Valencia San Vicente
Mártir, 46001 Valencia, Spain
- Arrhythmia Unit, Cardiology Service, General University Hospital
Consortium of Valencia, 46014 Valencia, Spain
| | - Javier Quesada-Ocete
- School of Doctorate, Catholic University of Valencia San Vicente
Mártir, 46001 Valencia, Spain
- Arrhythmia Unit, Cardiology Service, General University Hospital
Consortium of Valencia, 46014 Valencia, Spain
| | - Blanca Quesada-Ocete
- Arrhythmia Unit, Cardiology Service, General University Hospital
Consortium of Valencia, 46014 Valencia, Spain
| | - Javier Jiménez-Bello
- Arrhythmia Unit, Cardiology Service, General University Hospital
Consortium of Valencia, 46014 Valencia, Spain
| | - Aurelio Quesada
- School of Doctorate, Catholic University of Valencia San Vicente
Mártir, 46001 Valencia, Spain
- Arrhythmia Unit, Cardiology Service, General University Hospital
Consortium of Valencia, 46014 Valencia, Spain
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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Ducceschi V, Zingarini G, Nigro G, Brasca FMA, Malacrida M, Carbone A, Lavalle C, Maglia G, Infusino T, Aloia A, Nicolis D, Auricchio C, Uccello A, Notaristefano F, Rago A, Botto GL, Esposito L. Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter. Pacing Clin Electrophysiol 2022; 45:612-618. [PMID: 35383979 DOI: 10.1111/pace.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. METHODS RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. RESULTS 392 point-by-point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4±12Ω prior to ablation and 92.0±11Ω after ablation (p<0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8±6Ω vs 8.7±4Ω; RedV: 17.2±6Ω vs 7.8±5Ω; UPC: 19.6±6Ω vs 10.1±5Ω, all p<0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure-related adverse events were reported. CONCLUSIONS A LI-guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | - Antonio Aloia
- Division of Cardiology, Presidio Ospedaliero di Vallo della Lucania, Italy
| | | | | | | | | | - Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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5
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Arnold R, Hofer E, Haas J, Sanchez-Quintana D, Plank G. Diversity and complexity of the cavotricuspid isthmus in rabbits: A novel scheme for classification and geometrical transformation of anatomical structures. PLoS One 2022; 17:e0264625. [PMID: 35231058 PMCID: PMC8887761 DOI: 10.1371/journal.pone.0264625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to describe the morphology of the cavotricuspid isthmus (CTI) in detail and introduce a comprehensive scheme to describe the topology of this region based on functional considerations. This may lead to a better understanding of isthmus-dependent flutter and fibrillation and to improved intervention strategies. We used images of the cavotricuspid isthmus from 52 rabbits of both sexes with a median weight of 3.40 ± 0.93 kg. The area of the CTI was 124.25 ± 42.14 mm2 with 53.28 ± 21.13 mm2 covered by pectinate muscles connecting the terminal crest and the vestibule. Isthmus length decreased from inferolateral (13.09 ±2.14 mm) to central (9.85 ± 2.14 mm) to paraseptal (4.88 ± 1.96 mm) resembling the overall human geometry. Ramification sites of pectinate muscles were identified and six levels dividing the CTI from posterior to anterior were introduced. This allowed the classification of pectinate muscle segments based on the connected ramification level. To account for the high inter-individual variations in size and shape, the CTI was projected onto a normalized reference frame using bilinear transformation. Furthermore, two measures of complexity were introduced: (i) the ramification index, which reflects the total number of muscle segments connected to a ramification site and (ii) the complexity index, which reflects the type of ramification (branching or merging site). Topological analysis showed that the complexity of the pectinate muscle network decreases from inferolateral to paraseptal and that the number of electrically uncoupled parallel pathways increases in the central section between the terminal crest and the vestibule which introduces potential reentry pathways.
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Affiliation(s)
- Robert Arnold
- Division of Biophysics, Gottfried-Schatz-Research-Center, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Ernst Hofer
- Division of Biophysics, Gottfried-Schatz-Research-Center, Medical University of Graz, Graz, Austria
| | - Josef Haas
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Gernot Plank
- Division of Biophysics, Gottfried-Schatz-Research-Center, Medical University of Graz, Graz, Austria
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Hołda J, Słodowska K, Malinowska K, Strona M, Mazur M, Jasińska KA, Matuszyk A, Koziej M, Walocha JA, Hołda MK. Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures. Diagnostics (Basel) 2021; 11:960. [PMID: 34073631 PMCID: PMC8227200 DOI: 10.3390/diagnostics11060960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.
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Affiliation(s)
- Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna Słodowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Karolina Malinowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, 31-007 Cracow, Poland;
| | - Małgorzata Mazur
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Aleksandra Matuszyk
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
- Department of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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7
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Maclean E, Simon R, Ang R, Dhillon G, Ahsan S, Khan F, Earley M, Lambiase PD, Rosengarten J, Chow AW, Dhinoja M, Providencia R, Markides V, Wong T, Hunter RJ, Behar JM. A multi-center experience of ablation index for evaluating lesion delivery in typical atrial flutter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1039-1046. [PMID: 33782987 DOI: 10.1111/pace.14228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. METHODS Thirty-eight patients underwent CTI ablation at two tertiary centers. Operators delivered 682 lesions with a target ablation index (AI) of 600 Wgs. Ablation parameters were recorded every 10-20 ms. Post hoc, Visitags were trisected according to CTI position: inferior vena cava (IVC), middle (Mid), or ventricular (V) lesions. RESULTS There were no complications. 92.1% of patients (n = 35) remained in sinus rhythm after 14.6 ± 3.4 months. For the whole CTI, peak AI correlated with mean impedance drop (ID) (R2 = 0.89, p < .0001). However, analysis by anatomical site demonstrated a non-linear relationship Mid CTI (R2 = 0.15, p = .21). Accordingly, while mean AI was highest Mid CTI (IVC: 473.1 ± 122.1 Wgs, Mid: 539.6 ± 103.5 Wgs, V: 486.2 ± 111.8 Wgs, ANOVA p < .0001), mean ID was lower (IVC: 10.7 ± 7.5Ω, Mid: 9.0 ± 6.5Ω, V: 10.9 ± 7.3Ω, p = .011), and rate of ID was slower (IVC: 0.37 ± 0.05 Ω/s, Mid: 0.18 ± 0.08 Ω/s, V: 0.29 ± 0.06 Ω/s, p < .0001). Mean contact force was similar at all sites; however, temporal fluctuations in contact force (IVC: 19.3 ± 12.0 mg/s, Mid: 188.8 ± 92.1 mg/s, V: 102.8 ± 32.3 mg/s, p < .0001) and catheter angle (IVC: 0.42°/s, Mid: 3.4°/s, V: 0.28°/s, p < .0001) were greatest Mid CTI. Use of a long sheath attenuated these fluctuations and improved energy delivery. CONCLUSIONS Ablation characteristics vary across the CTI. At the Mid CTI, higher AI values do not necessarily deliver more effective ablation; this may reflect localized fluctuations in catheter angle and contact force.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ron Simon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Richard Ang
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Gurpreet Dhillon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Syed Ahsan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Fakhar Khan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mark Earley
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - James Rosengarten
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mehul Dhinoja
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Rui Providencia
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Vias Markides
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Tom Wong
- Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan M Behar
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
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8
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Jiménez Restrepo A, Mesa JE, Sánchez-Quintana D, Cabrera JÁ. Da Vinci Anatomy Card #1: The Eustachian Valve and its Implications in Invasive Cardiology and Cardiac Surgery. JACC Case Rep 2021; 3:87-90. [PMID: 34317475 PMCID: PMC8305677 DOI: 10.1016/j.jaccas.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Juan E. Mesa
- Division of Cardiovascular Medicine, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
| | | | - José Ángel Cabrera
- Division of Cardiology, Hospital Universitario Quirón Salud, European University of Madrid, Madrid, Spain
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9
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Hołda J, Słodowska K, Tyrak K, Bolechała F, Jasińska KA, Koziej M, Hołda MK, Walocha JA. Topographical anatomy of the right atrial appendage vestibule and its isthmuses. J Cardiovasc Electrophysiol 2020; 31:3199-3206. [PMID: 33010077 DOI: 10.1111/jce.14767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. METHODS AND RESULTS We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). CONCLUSIONS This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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Affiliation(s)
- Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Słodowska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Kamil Tyrak
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna A Jasińska
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Suzuki M, Ogata M, Murata Y, Suzuki S. Presence of the annular ridge and location of the coronary sinus ostium as morphological features ofthe right atrium and interatrial septum in healthy common marmosets (Callithrix jacchus). Exp Anim 2020; 69:295-305. [PMID: 32074546 PMCID: PMC7445055 DOI: 10.1538/expanim.19-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
To effectively use a common marmoset (Callithrix jacchus) as an experimental animal species, it is critical to establish a normal characteristics and morphology of the organs of the common marmoset. Although gross morphology of the common marmoset heart is reportedly the same as that of humans, little information is available regarding detailed morphology of the right atrium and the interatrial septum. Heart specimens were collected from three male and 10 female marmosets aged 9 to 65 months to determine the morphological features of the right atrium and the interatrial septum. Ten specimens were evaluated morphologically with a stereoscopic microscope in accordance with preparation and investigation methods designed to facilitate evaluation. Three specimens were histologically evaluated after being stained with hematoxylin-eosin, Elastica van Gieson and periodic acid Schiff. An annular ridge that is not present in the human heart was present in the right atrium and the interatrial septum of the common marmoset hearts. Tissue structure of the annular ridge was similar to atrial myocardial fibers. Furthermore, location of the coronary sinus ostium was different to that in humans. Present findings were used to create a schematic view of the annular ridge in the common marmoset heart. In the common marmoset heart, the annular ridge may function as a valve of the superior vena cava ostium, inferior vena cava ostium, and coronary sinus ostium. Present study provides morphological evidence that common marmosets have a valve-like structure in the right atrium.
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Affiliation(s)
- Motoaki Suzuki
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan.,Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaki Ogata
- Department of Anatomy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Yuzo Murata
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.,Department of Medical Technology and Science, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka 831-8501, Japan
| | - Satsuki Suzuki
- Research Center for Odontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
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Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures. JACC Cardiovasc Interv 2019; 12:169-178. [PMID: 30678795 DOI: 10.1016/j.jcin.2018.09.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies. BACKGROUND The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve. METHODS The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts. RESULTS The right atrioventricular valves have "3-leaflet" configurations in 57.5% and "4-leaflet" configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area. CONCLUSIONS The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
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Affiliation(s)
- Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland.
| | - Jorge D Zhingre Sanchez
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael G Bateman
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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A comprehensive review of the anatomical variations in the right atrium and their clinical significance. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Baccillieri MS, Rizzo S, De Gaspari M, Paradiso B, Thiene G, Verlato R, Basso C. Anatomy of the cavotricuspid isthmus for radiofrequency ablation in typical atrial flutter. Heart Rhythm 2019; 16:1611-1618. [DOI: 10.1016/j.hrthm.2019.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 11/25/2022]
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Garweg C, De Buck S, Vandenberk B, Willems R, Ector J. High-Detailed evaluation of the right atrial anatomy by three-dimensional rotational angiography during ablation procedures for atrioventricular nodal reentrant tachycardia and atrial flutter. SCAND CARDIOVASC J 2018; 52:268-274. [PMID: 30445881 DOI: 10.1080/14017431.2018.1546893] [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] [Indexed: 10/27/2022]
Abstract
AIM 3D Rotational angiography (3DRA) allows for detailed reconstruction of atrial anatomy and is often used to facilitate pulmonary vein isolation. This study aimed to reappraise the anatomy of the right atrium (RA) using 3DRA, specifically looking at Koch's triangle and the cavotricuspid isthmus (CTI) in atrio-ventricular reentrant tachycardia (AVNRT) and atrial flutter (AFl) ablation. METHODS AND RESULTS 3DRA was performed in 97 patients: AVNRT = 51 and AFl = 46. Dimensions of Koch's triangle and CTI were highly variable between individuals but were not different in both ablation groups. RA volume was significantly larger in AFl patients (p = .004) while indexed RA volume to the body surface area (RAVI) was lightly different (p = .024). In univariate Cox analysis, age (p = .003), RAVI (p < .001) and previous ablation of AFl (p = .003) were predictors of AF occurrence . In multivariate Cox analysis, RAVI was the only independent predictor of AF occurrence. RAVI >80 ml/m2 was a strong predictor for AF during follow-up. CONCLUSION 3DRA allows for detailed per-procedural evaluation of RA anatomy and revealed a great variability in Koch's triangle and CTI dimensions and morphology. RA enlargement as measured by RAVI was an independent predictor for AF occurrence during follow-up.
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Affiliation(s)
- Christophe Garweg
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Stijn De Buck
- b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Bert Vandenberk
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Rik Willems
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Joris Ector
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
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Hołda MK, Hołda J, Strona M, Koziej M, Klimek-Piotrowska W. Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line. Clin Anat 2018; 31:1024-1030. [DOI: 10.1002/ca.23242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/13/2018] [Accepted: 06/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Mateusz K. Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Marcin Strona
- Department of Forensic Medicine; Jagiellonian University Medical College; Cracow Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
| | - Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy; Jagiellonian University Medical College; Cracow Poland
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Further Evidence of Tricuspid Isthmus "Muscle Bundles" Using Rhythmia Mapping Technology. JACC Clin Electrophysiol 2018; 4:1119-1120. [PMID: 30139496 DOI: 10.1016/j.jacep.2018.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 11/23/2022]
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Hamaya R, Miyazaki S, Kajiyama T, Watanabe T, Kusa S, Nakamura H, Hachiya H, Iesaka Y. Efficacy and safety comparison between different types of novel design enhanced open-irrigated ablation catheters in creating cavo-tricuspid isthmus block. J Cardiol 2018; 71:513-516. [DOI: 10.1016/j.jjcc.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/11/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
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Leiria TLL, Medeiros AK, Almeida ED, Ley ALG, Santos CBLD, Sant'Anna RT, Kruse ML, Pires LM, Lima GGD. Uninterrupted Use of Oral Anticoagulants for the Ablation of Atrial Flutter: A Single Center Cohort of 154 Patients. Arq Bras Cardiol 2018; 110:151-156. [PMID: 29466488 PMCID: PMC5855908 DOI: 10.5935/abc.20180001] [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: 04/25/2017] [Accepted: 08/09/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The uninterrupted use of oral anticoagulation (OAC) with vitamin K antagonists (VKAs) for electrophysiology procedures has been more and more recommended. The clinical practice in our service recommends the continuous use of these drugs for atrial flutter ablation. There is little evidence as to the uninterrupted use of non-vitamin K antagonist oral anticoagulants (NOACs) in this scenario. OBJECTIVE To compare the rates of complications related with the uninterrupted use of different types of oral anticoagulants in patients referred to atrial flutter (AFL) ablation. METHODS Historical, single-center cohort of ablation procedures by AFL conducted from November 2012 to April 2016. The primary outcome was the occurrence of hemorrhagic or embolic complication during the procedure. The secondary outcome was the occurrence of stroke or transient ischemic attack (TIA) in follow-up. The statistical significance level was 5%. RESULTS There were 288 ablations per AFL; 154 were carried out with the uninterrupted use of OAC (57.8% with VKA and 42.2% with NOAC). Mean age was 57 ± 13 years. The rate of hemorrhagic complication during the procedure was 3% in each group (p = NS). The rate of stroke/TIA was, respectively, of 56/1,000 people-year in the VKA group against zero/1,000 people-year in the NOAC group (p = 0.02). CONCLUSION In our population there were no hemorrhagic complications regarding the procedure of OAC use uninterruptedly, including NOACs. There was higher occurrence of stroke/TIA in the follow-up of the group of patients undergoing VKAs; however, this difference may not only be a result of the type of OAC used.
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Affiliation(s)
- Tiago Luiz Luz Leiria
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | | | - Eduardo Dytz Almeida
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Antonio Lessa Gaudie Ley
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | | | - Roberto Toffani Sant'Anna
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Marcelo Lapa Kruse
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Leonardo Martins Pires
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Gustavo Glotz de Lima
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
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Holda JP. Radiationless transseptal puncture. Anatol J Cardiol 2017; 17:473-474. [PMID: 28529296 PMCID: PMC5477079 DOI: 10.14744/anatoljcardiol.2017.24711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jakub P Holda
- Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College; Cracow-Poland.
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A practical guide for building a highway between atria during transseptal puncture without radiation. Anatol J Cardiol 2017; 17:470-472. [PMID: 28315567 PMCID: PMC5477078 DOI: 10.14744/anatoljcardiol.2017.7525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate whether switching the ablation catheter between the right and left atria through transseptal puncture site can be accurately performed without fluoroscopy. METHODS Forty patients with persistent atrial fibrillation (mean age, 60.2±7.4 years; 65% males) got "2C3L" approach were randomized in a 1:1 ratio to undergo either crossing interatrial septum guided by fluoroscopy (trackless group) or crossing septum guided by track image that was mapped by Carto3 system (track group). RESULTS The three-dimensional image of the track could be mapped smoothly and shown clearly. No significant differences were found in the success rates between the two groups (100% vs. 100%, p>0.05). However, the procedure of crossing septum was completed without any fluoroscopy use in track group, which showed a shorter procedure time than trackless group (4±3 s vs. 20±10 s, p<0.01). CONCLUSION Visualizing the track passing through the puncture site using Carto3 system can guide the ablation catheter in safely crossing the intra-atrial septum quickly with zero fluoroscopy.
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