1
|
Zhou D, Zhang B, Zeng C, Yin X, Guo X. A novel approach to terminate roof-dependent atrial flutter with epicardial conduction through septopulmonary bundle. BMC Cardiovasc Disord 2024; 24:340. [PMID: 38970012 PMCID: PMC11225292 DOI: 10.1186/s12872-024-03941-9] [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: 01/22/2024] [Accepted: 05/14/2024] [Indexed: 07/07/2024] Open
Abstract
Atrial flutter, a prevalent cardiac arrhythmia, is primarily characterized by reentrant circuits in the right atrium. However, atypical forms of atrial flutter present distinct challenges in terms of diagnosis and treatment. In this study, we examine three noteworthy clinical cases of atypical atrial flutter, which offer compelling evidence indicating the implication of the lesser-known Septopulmonary Bundle (SPB). This inference is based on the identification of distinct electrocardiographic patterns observed in these patients and their favorable response to catheter ablation, which is a standard treatment for atrial flutter. Remarkably, in each case, targeted ablation at the anterior portion of the left atrial roof effectively terminated the arrhythmia, thus providing further support for the hypothesis of SPB involvement. These insightful observations shed light on the potential significance of the SPB in the etiology of atypical atrial flutter and introduce a promising therapeutic target. We anticipate that this paper will stimulate further exploration into the role of the SPB in atrial flutter and pave the way for the development of targeted ablation strategies.
Collapse
Affiliation(s)
- Dongchen Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310002, China
| | - Biqi Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310002, China
| | - Cong Zeng
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310002, China
| | - Xiang Yin
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310002, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310002, China.
| |
Collapse
|
2
|
Lin C, Nguyen A, Ling I, Partow-Navid R, Leung S, Zadeh A, Ho I, Zaman JA. SuperMap algorithm: an efficient, safe and accurate modality for mapping and eliminating challenging cardiac arrhythmias. Future Cardiol 2024; 20:45-53. [PMID: 38530866 DOI: 10.2217/fca-2023-0123] [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: 10/17/2023] [Accepted: 01/31/2024] [Indexed: 03/28/2024] Open
Abstract
Even with the development of advanced catheter-based mapping systems, there remain several challenges in the electrophysiological evaluation and elimination of atrial arrhythmias. For instance, atrial tachycardias with irregular rates cannot be reliably mapped by systems that require stability in order to sequentially gather data points to be organized thereafter. Separately, these arrhythmias often arise following initial ablation for atrial fibrillation, posing logistic challenges. Here, we present the available literature summarizing the use of a non-contact mapping catheter, the AcQMap catheter, in conjunction with SuperMap, an algorithm that compiles a large number of non-contact data points from multiple catheter positions within the atria. These studies demonstrate the efficiency, safety and accuracy of this technology.
Collapse
Affiliation(s)
- Charlie Lin
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Nguyen
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ian Ling
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Rod Partow-Navid
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Steven Leung
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Zadeh
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ivan Ho
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Junaid Ab Zaman
- Keck School of Medicine, University of Southern California, CA 90033, USA
| |
Collapse
|
3
|
Raymond-Paquin A, Pillai A, Myadam R, Mankad P, Lovejoy S, Koneru JN, Ellenbogen KA. Atypical atrial flutter catheter ablation in the era of high-density mapping. J Interv Card Electrophysiol 2023; 66:1807-1815. [PMID: 36645578 DOI: 10.1007/s10840-023-01475-2] [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: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mapping and ablating atypical atrial flutters (AAFLs) have evolved greatly with advances in high-density 3D mapping systems over the last years. METHODS The objectives are to evaluate the feasibility of AAFL catheter ablation based on high-density mapping and minimizing entrainment and to better characterize AAFL circuits. Consecutive patients who underwent AAFL ablation using the EnSite Precision™ system and HD Grid™ mapping catheter (Abbott, Chicago, IL) between 06/2018 and 1/2022 were included. Mitral isthmus-dependent and roof-dependent AAFLs were classified as conventional circuits. All other AAFL circuits were classified as non-conventional circuits and were defined based on the location of the critical isthmus. RESULTS Sixty-two patients underwent AAFL ablation (mean age 68±11 years). A total of 95 AAFLs were mapped and 92 (97%) were successfully ablated. Fifty-three (85%) patients had a previous AF/AFL ablation. Forty-four (46%) AAFL circuits were classified as conventional and 51 (54%) as non-conventional. Conventional AAFL circuits had longer critical isthmuses (19.0±9.0 vs 10.8±6.3mm, p<0.001), a lower prevalence of slow conduction at the critical isthmus (59% vs 86%, p=0.005), and a longer radiofrequency time to AAFL termination (117±119 vs 51±66 s, p=0.002). Entrainment was attempted in 19 (20%) flutters and its use declined significantly over the study period. Procedural success rates remained high whether entrainment was used or not. Freedom of any atrial tachycardia was 65% over a follow-up of 13.8±9.0 months. CONCLUSIONS AAFL catheter ablation can be achieved with high procedural success rate using a contemporary strategy based on high-density mapping alone. Non-conventional circuits are frequent and present unique electrophysiological characteristics.
Collapse
Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Bélanger Street, Montreal, Quebec, H1T 1C8, Canada.
| | - Ajay Pillai
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rahul Myadam
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Pranav Mankad
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
4
|
Hernández-Romero I, Molero R, Fambuena-Santos C, Herrero-Martín C, Climent AM, Guillem MS. Electrocardiographic imaging in the atria. Med Biol Eng Comput 2023; 61:879-896. [PMID: 36370321 PMCID: PMC9988819 DOI: 10.1007/s11517-022-02709-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
The inverse problem of electrocardiography or electrocardiographic imaging (ECGI) is a technique for reconstructing electrical information about cardiac surfaces from noninvasive or non-contact recordings. ECGI has been used to characterize atrial and ventricular arrhythmias. Although it is a technology with years of progress, its development to characterize atrial arrhythmias is challenging. Complications can arise when trying to describe the atrial mechanisms that lead to abnormal propagation patterns, premature or tachycardic beats, and reentrant arrhythmias. This review addresses the various ECGI methodologies, regularization methods, and post-processing techniques used in the atria, as well as the context in which they are used. The current advantages and limitations of ECGI in the fields of research and clinical diagnosis of atrial arrhythmias are outlined. In addition, areas where ECGI efforts should be concentrated to address the associated unsatisfied needs from the atrial perspective are discussed.
Collapse
Affiliation(s)
| | - Rubén Molero
- ITACA, Universitat Politècnica de València, Valencia, Spain
| | | | | | | | | |
Collapse
|
5
|
Gunawardene MA, Hartmann J, Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Willems S. [Focal atrial tachycardias: diagnostics and therapy]. Herzschrittmacherther Elektrophysiol 2022; 33:467-475. [PMID: 36342506 DOI: 10.1007/s00399-022-00907-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
In this article, typical characteristics of focal atrial tachycardias are described and a systematic approach regarding diagnostics and treatment options in the field of invasive cardiac electrophysiology (EP) is presented. Subjects of this article include the definition of focal atrial tachycardias, knowledge about localizing the origin of such, and guidance on how to approach an invasive EP study (e.g., administration of medication during the EP study to provoke tachycardias). Further, descriptions will be found on how to localize the origin of focal atrial tachycardias with the help of the 12-lead ECG and invasive three-dimensional mapping to successfully treat focal atrial tachycardias with catheter ablation.
Collapse
Affiliation(s)
- Melanie A Gunawardene
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Jens Hartmann
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CL.NIC-University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Klinik für Elektrophysiologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Stephan Willems
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| |
Collapse
|
6
|
Gagyi RB, Noten AME, Lesina K, Mahmoodi BK, Yap SC, Hoogendijk MG, Wijchers S, Bhagwandien RE, Szili-Torok T. Single-beat global atrial mapping facilitates the treatment of short-lived atrial tachycardias and infrequent premature atrial contractions. J Interv Card Electrophysiol 2022; 66:951-959. [PMID: 36282368 PMCID: PMC10172249 DOI: 10.1007/s10840-022-01405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Short runs of atrial tachycardias (ATs) and infrequent premature atrial contractions (PACs) are difficult to map and ablate using sequential electrophysiology mapping techniques. The AcQMap mapping system allows for highly accurate mapping of a single atrial activation.
Objectives
We aimed to test the value of a novel dipole charge density-based high-resolution mapping technique (AcQMap) in the treatment of brief episodes of ATs and PACs.
Methods
Data of all patients undergoing catheter ablation (CA) using the AcQMap mapping system were reviewed.
Results
Thirty-one out of 219 patients (male n = 8; female n = 23) had short runs of ATs (n = 23) and PACs (n = 8). The mean procedural time was 155.3 ± 46.6 min, with a mean radiation dose of 92.0 (IQR 37.0–121.0) mGy. Total radiofrequency application duration 504.0 (271.0–906.0) s. Left atrial localization of ATs and PACs was identified in 45.1% of the cases, right atrium localization in 45.1%, and septal origins in 9.8% of the cases. Acute success was achieved in 30/31 (96.8%), and recurrence during the follow-up developed in six patients (19.4%), including four patients with PACs and two patients with short-lived ATs. One patient presented procedure-related groin hematoma as minor complication.
Conclusion
Brief episodes of highly symptomatic ATs and infrequent PACs can be mapped using charge density mapping and successfully ablated with high acute and long-term success rates.
Collapse
Affiliation(s)
- Rita B Gagyi
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Anna M E Noten
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Krista Lesina
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Bakhtawar K Mahmoodi
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Sip Wijchers
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Electrophysiology, Erasmus MC, University Medical Center Rotterdam, 2040, 3000, Rotterdam, Netherlands.
| |
Collapse
|
7
|
Atypisches Vorhofflattern. Herzschrittmacherther Elektrophysiol 2022; 33:341-350. [PMID: 35986095 PMCID: PMC9411094 DOI: 10.1007/s00399-022-00887-3] [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: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
ZusammenfassungIm Gegensatz zum typischen Vorhofflattern handelt es sich beim atypischen Vorhofflattern um eine heterogene Gruppe von rechts- und linksatrialen Makro- bzw. Localized-Reentry-Tachykardien, deren kritischer Bestandteil zur Aufrechterhaltung der Tachykardie nicht der cavotrikuspidale Isthmus ist. Atypisches Vorhofflattern tritt gehäuft nach vorangegangener Katheterablation sowie nach herzchirurgischen Eingriffen auf. Die intraprozedurale Erfolgsrate während der Ablation ist hoch, wobei die Rezidivrate von strukturellen Veränderungen der Vorhöfe sowie des zugrundeliegenden Mechanismus abhängig ist. Dieser Artikel bietet einen Überblick über die Mechanismen sowie über Mapping- und Ablationsstrategien der häufigsten Formen von rechts- und linksatrialem atypischem Vorhofflattern. Dieser Beitrag ist Teil der Serie „EP-Basics“ zur gezielten Fortbildung im Bereich Invasive Elektrophysiologie. Grundlagen, Klinik und Therapie des atypischen Vorhofflatterns werden mit Fokus auf klinisch relevante Aspekte dargelegt. Vorgehensweise und Befunde der invasiven elektrophysiologischen Diagnostik und die Ablationsbehandlung bilden den Schwerpunkt dieses Artikels.
Collapse
|
8
|
Sekihara T, Eguchi T, Aoyama D, Uzui H, Tada H. Focal
post‐Maze
atrial tachycardia mimicking macroreentrant tachycardia around the Maze lesion diagnosed using ultra‐high‐resolution mapping. J Arrhythm 2022; 38:650-652. [PMID: 35936031 PMCID: PMC9347202 DOI: 10.1002/joa3.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Takayuki Sekihara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Tomoya Eguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| |
Collapse
|
9
|
Comparison of the Anterior Septal Line and Mitral Isthmus Line for Perimitral Atrial Flutter Ablation Using Robotic Magnetic Navigation. J Interv Cardiol 2022; 2022:1793590. [PMID: 35185396 PMCID: PMC8826208 DOI: 10.1155/2022/1793590] [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: 07/27/2021] [Revised: 11/13/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Perimitral atrial flutter (PMAFL) is one of the most common macro-reentrant left atrial tachycardias. Mitral isthmus (MI) linear ablation is a common strategy for the treatment of PMAFLs, and anterior septum (AS) linear ablation has emerged as a novel ablation approach. We aimed at assessing the effectiveness of AS linear ablation using robotic magnetic navigation for PMAFL ablation. Methods In this retrospective study, a total of 36 consecutive patients presented with AFL as the unique arrhythmia or accompanied with atrial fibrillation (AF) who underwent catheter ablation were enrolled. Patients were classified into two groups according to the different ablation strategies, the MI line group (10 patients) and the AS line group (26 patients). Results The clinical baseline characteristics of patients in the two groups were nearly identical. There were no significant differences in procedure time (148.7 ± 46.1 vs. 123.2 ± 30.1 min, P=0.058) or radiofrequency ablation time (25.9 ± 11.4 vs. 23.5 ± 12.6 min) between the two groups. Fluoroscopy time was longer in the MI line group (8.0 ± 4.4 vs. 5.1 ± 2.7 min, P=0.024), and the acute success rate was higher in the AS line group versus the MI line group (96.2% vs. 70%, P=0.025). The long-term freedom from arrhythmia survival rate was higher in the AS line group (73%) than in the MI line group (40%) after a mean follow-up time of 37.4 months with a 3-month blanking period (P=0.049). Conclusions AS linear ablation is an effective and safe strategy for PMAFL ablation using robotic magnetic navigation.
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Atrial flutter (AFL) is the second most prevalent arrhythmia after atrial fibrillation (AF). It is a macro-reentrant tachycardia that is either cavotricuspid isthmus dependent (typical) or independent (atypical). This review aims at highlighting mechanism, diagnosis and treatment of atypical AFL and the recent developments in electroanatomic mapping. RECENT FINDINGS Incidence of left AFL is at an exponential rise presently with increase in AF ablation rates. The mechanism of left AFL is most often peri-mitral, roof-dependent or within pulmonary veins in preablated, in contrast to posterior or anterior wall low voltage areas in ablation naïve patients. Linear lesions, compared to pulmonary vein isolation alone, have higher incidence of atypical right or left AFL. Catheter ablation for atypical AFL is associated with lower rates of thromboembolic events, transfusions, and length of stay compared to typical AFL. SUMMARY Advances in mapping have allowed rapid simultaneous acquisition of automatically annotated points in the atria and identification of details of macro-reentrant circuits, including zones of conduction block, scar, and slow conduction.
Collapse
|
11
|
Influence of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract83495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The treatment of left atrial flutter is a problem that requires a deep understanding of the underlying complex mechanism of arrhythmia. Although a considerable experience exists already in understanding the mechanisms underlying atrial flutter after ablation or surgery, little is known about atypical forms of atrial flutter in patients who have not previously undergone ablation or other cardiac surgery.
Clinical case description: We present a clinical case of interventional treatment of a patient with atypical atrial flutter who had not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter.
Conclusion: When performing a surgical intervention, high-density mapping will help to visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help to minimize the RF exposure during the treatment.
Collapse
|
12
|
Saliani A, Irakoze É, Jacquemet V. Simulation of diffuse and stringy fibrosis in a bilayer interconnected cable model of the left atrium. Europace 2021; 23:i169-i177. [PMID: 33751082 DOI: 10.1093/europace/euab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to design a computer model of the left atrium for investigating fibre-orientation-dependent microstructure such as stringy fibrosis. METHODS AND RESULTS We developed an approach for automatic construction of bilayer interconnected cable models from left atrial geometry and epi- and endocardial fibre orientation. The model consisted of two layers (epi- and endocardium) of longitudinal and transverse cables intertwined-like fabric threads, with a spatial discretization of 100 µm. Model validation was performed by comparison with cubic volumetric models in normal conditions. Then, diffuse (n = 2904), stringy (n = 3600), and mixed fibrosis patterns (n = 6840) were randomly generated by uncoupling longitudinal and transverse connections in the interconnected cable model. Fibrosis density was varied from 0% to 40% and mean stringy obstacle length from 0.1 to 2 mm. Total activation time, apparent anisotropy ratio, and local activation time jitter were computed during normal rhythm in each pattern. Non-linear regression formulas were identified for expressing measured propagation parameters as a function of fibrosis density and obstacle length (stringy and mixed patterns). Longer obstacles (even below tissue space constant) were independently associated with prolonged activation times, increased anisotropy, and local fluctuations in activation times. This effect was increased by endo-epicardial dissociation and mitigated when fibrosis was limited to the epicardium. CONCLUSION Interconnected cable models enable the study of microstructure in organ-size models despite limitations in the description of transmural structures.
Collapse
Affiliation(s)
- Ariane Saliani
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
| | - Éric Irakoze
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, Université de Montréal, Montréal, QC H3T 1J4, Canada.,Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, Montréal, QC H4J 1C5, Canada
| |
Collapse
|
13
|
Costache MF, Arhirii RE, Mogos SJ, Lupascu-Ursulescu C, Litcanu CI, Ciumanghel AI, Cucu C, Ghiciuc CM, Petris AO, Danila N. Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature. World J Clin Cases 2021; 9:5575-5587. [PMID: 34307612 PMCID: PMC8281402 DOI: 10.12998/wjcc.v9.i20.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC), the second most aggressive malignant tumor, lacks epidemiological data worldwide; therefore, every new case can improve the understanding of the pathology and treatment of this malignancy.
CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgen-producing ACC (21 cm × 17 cm × 12 cm; 2100 g), without metastases, which unusually presented with an acute onset of atrial flutter and congestive heart failure. The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor. Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy, therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC. The atrial flutter was remitted after initiation of drug treatment during admission. The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.
CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the first-line treatment to cure the excess of androgen, which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.
Collapse
Affiliation(s)
- Mircea-Florin Costache
- Surgery Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Raluca-Elena Arhirii
- Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Simona-Juliette Mogos
- Department of Endocrinology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Endocrinology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Corina Lupascu-Ursulescu
- Department of Radiology and Imaging Sciences, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Radiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | | | - Adi-Ionut Ciumanghel
- Anesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Anesthesia and Intensive Care Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Catalina Cucu
- Histopatology Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Cristina-Mihaela Ghiciuc
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Antoniu-Octavian Petris
- Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
- Department of Cardiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Nicolae Danila
- Surgery Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
- Surgery Clinic, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| |
Collapse
|
14
|
Ramak R, Chierchia GB, Paparella G, Monaco C, Miraglia V, Cecchini F, Bisignani A, Mojica J, Al Housari M, Sofianos D, Kazawa S, Overeinder I, Bala G, Ströker E, Sieira J, Osorio TG, Brugada P, de Asmundis C. Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm. J Interv Card Electrophysiol 2021; 61:187-195. [PMID: 32643104 PMCID: PMC8195776 DOI: 10.1007/s10840-020-00808-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. METHODS Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. RESULTS Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. CONCLUSION The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.
Collapse
Affiliation(s)
- Robbert Ramak
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Federico Cecchini
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thiago Guimaraes Osorio
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| |
Collapse
|
15
|
The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.943128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Luongo G, Schuler S, Luik A, Almeida TP, Soriano DC, Dossel O, Loewe A. Non-Invasive Characterization of Atrial Flutter Mechanisms Using Recurrence Quantification Analysis on the ECG: A Computational Study. IEEE Trans Biomed Eng 2021; 68:914-925. [PMID: 32746003 DOI: 10.1109/tbme.2020.2990655] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Atrial flutter (AFl) is a common arrhythmia that can be categorized according to different self-sustained electrophysiological mechanisms. The non-invasive discrimination of such mechanisms would greatly benefit ablative methods for AFl therapy as the driving mechanisms would be described prior to the invasive procedure, helping to guide ablation. In the present work, we sought to implement recurrence quantification analysis (RQA) on 12-lead ECG signals from a computational framework to discriminate different electrophysiological mechanisms sustaining AFl. METHODS 20 different AFl mechanisms were generated in 8 atrial models and were propagated into 8 torso models via forward solution, resulting in 1,256 sets of 12-lead ECG signals. Principal component analysis was applied on the 12-lead ECGs, and six RQA-based features were extracted from the most significant principal component scores in two different approaches: individual component RQA and spatial reduced RQA. RESULTS In both approaches, RQA-based features were significantly sensitive to the dynamic structures underlying different AFl mechanisms. Hit rate as high as 67.7% was achieved when discriminating the 20 AFl mechanisms. RQA-based features estimated for a clinical sample suggested high agreement with the results found in the computational framework. CONCLUSION RQA has been shown an effective method to distinguish different AFl electrophysiological mechanisms in a non-invasive computational framework. A clinical 12-lead ECG used as proof of concept showed the value of both the simulations and the methods. SIGNIFICANCE The non-invasive discrimination of AFl mechanisms helps to delineate the ablation strategy, reducing time and resources required to conduct invasive cardiac mapping and ablation procedures.
Collapse
|
17
|
Suzuki K, Miyamoto K, Ueda N, Nakajima K, Kamakura T, Wada M, Yamagata K, Ishibashi K, Inoue Y, Noda T, Nagase S, Aiba T, Yambe T, Kakuta T, Tadokoro N, Fukushima S, Fujita T, Kusano K. Relationship between electrical gaps after Maze procedure and atrial tachyarrhythmias and ablation outcomes after cardiac surgery and concomitant Maze procedure. Heart Vessels 2021; 36:675-685. [PMID: 33580804 DOI: 10.1007/s00380-020-01737-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Atrial tachycardia (AT) and atrial fibrillation (AF) commonly occur after cardiac surgeries (CSs). This study investigated the mechanisms and long-term outcomes of AT and AF ablation after various Maze procedures, particularly whether atrial tachyarrhythmias after the Maze procedure occur due to gaps in the Maze lines. We analyzed 37 consecutive cases with atrial tachyarrhythmias after the Maze procedures and concomitant CSs between 2007 and 2019. Fifty-nine atrial tachyarrhythmias were induced in 37 consecutive cases, and 49 of those atrial tachyarrhythmias were mappable ATs. Forty ATs were related to the Maze procedures in the 49 mappable ATs (81.6%). All 37 consecutive cases had residual electrical conductions (gaps) in the Maze lines (88 gaps; 2.4 ± 1.2 gaps/patient). Forty of 88 gaps (45.5%) were associated with gap-related ATs. The common ATs in this study were 1. peri-mitral atrial flutter due to gaps at pulmonary vein isolation (PVI) line to mitral valve annulus (MVA) (20 cases), and 2. peri-tricuspid atrial flutter due to gaps at right atrial incision to the tricuspid valve annulus (TVA) (10 cases). Forty-seven of 49 ATs (95.9%) were successfully ablated at the first session, and there were no complications. The mean follow-up period after ablation was 3.6 ± 3.2 (median, 2.1; interquartile range, 0.89-6.84) years. The Kaplan-Meier analysis of freedom from recurrent atrial tachyarrhythmias after Maze procedure was 82.7% at 1-year follow-up and 75.5% at 4-year follow-up after a single procedure. Reentry was the main mechanism of ATs after Maze procedures and concomitant CSs, and ATs were largely related to the gaps on the Maze lines between the PVI line and the MVA or those on the lines between right atrial incision to the TVA. Long-term follow-up data suggest that catheter ablation of atrial tachyarrhythmias after various Maze procedures is effective and safe.
Collapse
Affiliation(s)
- Keisuke Suzuki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Institute of Development Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Yambe
- Institute of Development Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| |
Collapse
|
18
|
Atrial fibrillation in the athlete: Case report and a contemporary appraisal. J Electrocardiol 2021; 66:6-11. [PMID: 33676172 DOI: 10.1016/j.jelectrocard.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most prevalent sustained arrhythmia affecting up to 1% of the world's population. The overwhelming majority of patients with AF have concomitant structural heart disease and comorbidities, including hypertension and diabetes mellitus. One out of ten AF patients has no substantial comorbidities and has been traditionally termed "lone AF". Paradoxically, there exists an association of highintensity endurance exercises and AF. CASE 43-year-old competitive cyclist and cross-country skier with no known cardiac comorbidities who presented with multiple episodes of dyspnea and palpitations. He was found to have exercise-induced AF without structural heart abnormalities. DISCUSSION This case highlights the clinical diversity of AF in athletes. In this review, we delve into the specifics of the pathophysiology and clinical features of AF in athletes. We then review the key points in managing AF in athletes, including medical therapy and catheter ablation. CONCLUSION AF in the athletes is incompletely understood due to a lack of prospective study volume. There exist some crucial pathophysiological differences between AF in athletes and AF in older patients with structural heart disease. Treating physicians must be aware of the nuances of management of AF in athletes, including the concepts of detraining, medical therapy options, and ablation.
Collapse
|
19
|
Abstract
While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.
Collapse
Affiliation(s)
- Harold Rivner
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - Raul D Mitrani
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| |
Collapse
|
20
|
Hung Y, Chang SL, Lin WS, Lin WY, Chen SA. Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage? Arrhythm Electrophysiol Rev 2020; 9:54-60. [PMID: 32983525 PMCID: PMC7491065 DOI: 10.15420/aer.2020.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
With catheter ablation becoming effective for non-pharmacological management of AF, many cases of atrial tachycardia (AT) after AF ablation have been reported in the past decade. These arrhythmias are often symptomatic and respond poorly to medical therapy. Post-AF-ablation ATs can be classified into the following three categories: focal, macroreentrant and microreentrant ATs. Mapping these ATs is challenging because of atrial remodelling and its complex mechanisms, such as double ATs and multiple-loop ATs. High-density mapping can achieve precise identification of the circuits and critical isthmuses of ATs and improve the efficacy of catheter ablation. The purpose of this article is to review the mechanisms, mapping and ablation strategy, and outcome of ATs after AF ablation.
Collapse
Affiliation(s)
- Yuan Hung
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yu Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
21
|
Decloedt A, Van Steenkiste G, Vera L, Buhl R, van Loon G. Atrial fibrillation in horses part 1: Pathophysiology. Vet J 2020; 263:105521. [PMID: 32928494 DOI: 10.1016/j.tvjl.2020.105521] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/05/2020] [Accepted: 07/21/2020] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia in horses, with a reported prevalence up to 2.5%. The pathophysiology has mainly been investigated in experimental animal models and human medicine, with limited studies in horses. Atrial fibrillation results from the interplay between electrical triggers and a susceptible substrate. Triggers consist of atrial premature depolarizations due to altered automaticity or triggered activity, or local (micro)reentry. The arrhythmia is promoted by atrial myocardial ion channel alterations, Ca2+ handling alterations, structural abnormalities, and autonomic nervous system imbalance. Predisposing factors include structural heart disease such as valvular regurgitation resulting in chronic atrial stretch, although many horses show so-called 'lone AF' or idiopathic AF in which no underlying cardiac abnormalities can be detected using routine diagnostic techniques. These horses may have underlying ion channel dysfunction or undiagnosed myocardial (micro)structural alterations. Atrial fibrillation itself results in electrical, contractile and structural remodelling, fostering AF maintenance. Electrical remodelling leads to shortening of the atrial effective refractory period, promoting reentry. Contractile remodelling consists of decreased myocardial contractility, while structural remodelling includes the development of interstitial fibrosis and atrial enlargement. Reverse remodelling occurs after cardioversion to sinus rhythm, but full recovery may take weeks to months depending on duration of AF. The clinical signs of AF depend on the aerobic demands during exercise, ventricular rhythm response and presence of underlying cardiac disease. In horses with so-called 'lone AF', clinical signs are usually absent at rest but during exercise poor performance, exercise-induced pulmonary hemorrhage, respiratory distress, weakness or rarely collapse may develop.
Collapse
Affiliation(s)
- Annelies Decloedt
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium.
| | - Glenn Van Steenkiste
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Lisse Vera
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gunther van Loon
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| |
Collapse
|
22
|
Mantovan R, Corò L, Allocca G, Sitta N, Rivetti L, Marinigh R. How small could a detectable reentrant circuit be in a localized microreentrant tachycardia? HeartRhythm Case Rep 2020; 6:222-225. [PMID: 32322502 PMCID: PMC7157758 DOI: 10.1016/j.hrcr.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Roberto Mantovan
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Leonardo Corò
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Giuseppe Allocca
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Nadir Sitta
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Luigi Rivetti
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| | - Ricarda Marinigh
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, Conegliano, Italy
| |
Collapse
|