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Gkalapis C, Vlachos K, Papadakis M, Pavleros N, Hippe HJ, Benali K, Bazoukis G, Letsas KP, Frontera A, Jais P, Gotzmann M. Analysis of the effectiveness of the latest 4th-generation cryoballoon catheters in pulmonary vein isolation using high-resolution mapping. Hellenic J Cardiol 2024:S1109-9666(24)00081-2. [PMID: 38663567 DOI: 10.1016/j.hjc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/23/2024] [Accepted: 04/13/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Long-term data showed that up to 27% of pulmonary veins are reconnected using cryoballoon ablation. This study aimed to evaluate the efficacy of the latest 4th-generation cryoballoon catheters using ultra high-resolution mapping. METHODS In patients with atrial fibrillation, a standard pulmonary vein isolation (PVI) with the latest 4th-generation cryoballoon catheter (Arctic Front Advance PRO, Medtronic Minneapolis, USA) and the spiral mapping catheter (Achieve Advance, Medtronic, Minneapolis, MN, USA) was performed. Subsequently, high-resolution mapping was achieved using the novel multipolar grid mapping catheter (Advisor HD Grid SE, Abbott Laboratories, USA). Follow-up was obtained after 6 months by means of a 7-day Holter electrocardiogram. RESULTS In our study, acute PVI was successfully achieved in all 31 patients. The latest 4th-generation cryoballoon catheter is safe in the acute phase of PVI. Additional high-resolution mapping (mean points per map 21,001 ± 4911) using the multipolar grid mapping catheter enabled us to identify residual gaps only in the carina pulmonary vein region; therefore, no additional ablation was performed. Three of 31 patients (10%) presented with atrial arrhythmia recurrence always related with pulmonary vein reconnection; using high-resolution mapping had no additional benefit in identifying pulmonary veins in which reconnection will occur. CONCLUSION The utility of additional high-density mapping, facilitated by the HD Grid catheter after PVI with the 4th-generation cryoballoon catheter do not substantiate a discernible advantage over conventional mapping methodologies, particularly, the spiral mapping catheter. Residual carinal conduction was observed in a substantial cohort of patients (48%), highlighting a persistent challenge in achieving complete electrical isolation.
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Affiliation(s)
- Charis Gkalapis
- Department of Cardiology, Marien-Hospital Witten, Ruhr University Bochum, Germany; Department of Cardiology, Klinikum Vest, Recklinghausen, Germany.
| | - Konstantinos Vlachos
- Department of Cardiology, Klinikum Vest, Recklinghausen, Germany; Cardiac Pacing and Electrophysiology Department, Hopital Cardiologique du Haut Léveque, Pessac, France; INSERM U1045, IHU-L'institut de Rythmologie et Modélisation Cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Marios Papadakis
- Department of Surgery II, University of Witten/Herdecke, Wuppertal, Germany
| | - Nikonas Pavleros
- Department of Cardiology, Marien-Hospital Witten, Ruhr University Bochum, Germany; Department of Cardiology, Klinikum Vest, Recklinghausen, Germany
| | - Hans-Jörg Hippe
- Department of Cardiology, Marien-Hospital Witten, Ruhr University Bochum, Germany
| | - Karim Benali
- INSERM U1045, IHU-L'institut de Rythmologie et Modélisation Cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus; European University Cyprus, Medical School, Nicosia, Cyprus
| | | | | | - Pierre Jais
- Cardiac Pacing and Electrophysiology Department, Hopital Cardiologique du Haut Léveque, Pessac, France; INSERM U1045, IHU-L'institut de Rythmologie et Modélisation Cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
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Zhao Z, Jiang B, Zhang F, Ma R, Han X, Li C, Zhang C, Wang Z, Yang Y. Association between the systemic immune-inflammation index and outcomes among atrial fibrillation patients with diabetes undergoing radiofrequency catheter ablation. Clin Cardiol 2023; 46:1426-1433. [PMID: 37503809 PMCID: PMC10642337 DOI: 10.1002/clc.24116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To investigate the relationship between the incidence of atrial fibrillation (AF) recurrence and the levels of the systemic immune-inflammatory index (SII, platelet × neutrophil/lymphocyte ratio) in patients with AF and diabetes mellitus (DM) undergoing after radiofrequency catheter ablation (RFCA). PATIENTS AND METHODS Preoperative SII levels were determined in AF patients with DM undergoing RFCA. Restricted cubic splines were used to determine the correlation between SII and the risk of AF recurrence. Multivariate-adjusted logistic regression models were constructed to determine the relationship between SII levels and AF recurrence. The predictive value of the clinical model and combined with the SII index was estimated by the area under the receiver-operating characteristic curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS A total of 204 patients with AF and DM who underwent RFCA in our hospital were included. Seventy-seven patients had AF recurred during a mean follow-up of 20 months. Restricted cubic spline analysis showed that when SII ≥ 444.77 × 109 /L, there was a positive correlation with the incidence of AF recurrence. In addition, adding the SII to the predictive model for AF recurrence after RFCA in patients with DM and AF could contribute to an increase in C-statistics (0.798 vs. 0.749, p = .034). After SII was incorporated into the clinical model, the comprehensive discrimination and net reclassification tended to improve (IDI and NRI > 0, p < .05). CONCLUSION SII was independently and positively associated with recurrence after the first catheter ablation in patients with DM and AF.
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Affiliation(s)
- Zhihao Zhao
- Department of Cardiology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou, China
| | - Baoping Jiang
- Department of Cardiology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou, China
| | - Fengyun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ruicong Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiao Han
- Department of Clinical Nutrition, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yu Yang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Ma GJ, Guo FQ, Hu J, Liu XW, Chen C, Gao B, Li CY. Association of pericoronary adipose tissue with atrial fibrillation recurrence after ablation based on computed tomographic angiography. Jpn J Radiol 2023; 41:955-964. [PMID: 37040024 DOI: 10.1007/s11604-023-01426-x] [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: 02/06/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Quantitative measurement of pericoronary adipose tissue volume (PCATV) and fat attenuation index (FAI) has mostly been used in the study of coronary artery related diseases but rarely in the relationship with atrial fibrillation (AF). This study was conducted to investigate the correlation of PCATV and FAI with the AF recurrence after ablation and the clinical significance. MATERIALS AND METHODS Patients with continuous AF who underwent radiofrequency ablation and computed tomographic angiography (CTA) were retrospectively enrolled. The PCATV, FAI, epicardial adipose tissue volume (EATV) and EAT density (EATD) arround the three main branches of the coronary arteries (LAD, LCX, and RCA) were measured quantitatively with cardiac function software and analyzed. RESULTS 189 patients with continuous AF who underwent radiofrequency ablation for the first time were enrolled. After 12-month follow-up with a mean follow-up time of 10.93 ± 0.16 months, 47 (24.9%) patients were confirmed to have AF recurrence. The 3 V-FAI (- 81.17 ± 4.27 vs. - 83.31 ± 4.59 HU, P = 0.005), LCX-FAI (median - 77 vs. median - 81HU, P < 0.001), EATV (median 141.14vs. median 125.39 ml, P = 0.010), and EATVI (median 70.77 vs. 66.73 ml/m2, P = 0.008) were significantly increased in the recurrence group. EATVI (OR 1.043, 95% CI 1.020-1.066) and LCX-FAI (OR 1.254, 95% CI 1.145-1.374) were two significant independent risk factors for AF recurrence. In the comparison of ROC, the predictive value of LCX-FAI (cut-off value of >- 81.5 HU, area under the curve (AUC) of 0.722) was higher than that of EATVI (cut-off value > 81.07 ml/m2, AUC of 0.630). CONCLUSION EATVI and LCX-FAI were related to recurrence of AF after ablation and have important clinical value in predicting the AF recurrence.
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Affiliation(s)
- Guo-Jing Ma
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei Province, China
- Hebei General Hospital, Shijiazhuang, China
| | - Fu-Qian Guo
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei Province, China
| | - Jie Hu
- The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Xiao-Wei Liu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei Province, China
| | - Chen Chen
- Hebei General Hospital, Shijiazhuang, China
| | - Bulang Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei Province, China
| | - Cai-Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei Province, China.
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Jing M, Li D, Xi H, Zhang Y, Zhou J. Value of Imaging in the Non-Invasive Prediction of Recurrence after Catheter Ablation in Patients with Atrial Fibrillation: An Up-to-Date Review. Rev Cardiovasc Med 2023; 24:241. [PMID: 39076720 PMCID: PMC11266785 DOI: 10.31083/j.rcm2408241] [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: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 07/31/2024] Open
Abstract
Catheter ablation (CA) is the first-line treatment for atrial fibrillation (AF) patients. However, the risk of recurrence associated with CA treatment should not be ignored. Therefore, the preoperative identification of patients at risk of recurrence is essential for identifying patients who will benefit from non-invasive surgery. Echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) are essential for the preoperative non-invasive prediction of AF recurrence after CA. Compared to laboratory examinations and other examination methods, these modalities can identify structural changes in the heart and assess functional variations. Accordingly, in past studies, morphological features, quantitative parameters, and imaging information of the heart, as assessed by echocardiography, CT, and MRI, have been used to predict AF recurrence after CA noninvasively. This review summarizes and discusses the current research on echocardiography, CT, MRI, and machine learning for predicting AF recurrence following CA. Recommendations for future research are also presented.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Dong Li
- Department of Cardiovascular Medicine, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
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Aryana A. Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation. J Innov Card Rhythm Manag 2021; 12:4633-4646. [PMID: 34476116 PMCID: PMC8384303 DOI: 10.19102/icrm.2021.120801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
There is strong evidence in support of pulmonary vein isolation (PVI) with concomitant left atrial (LA) posterior wall (PW) isolation (PWI) for the treatment of patients with persistent atrial fibrillation (persAF). While this may be achieved using surgical and catheter-based strategies, there is growing interest in performing this approach using the cryoballoon. There are several potential advantages to this strategy. First, lesions created using the current-generation cryoballoons are typically large and durable. Second, cryoballoon ablation offers a simple technique to directly ablate and debulk the LAPW. Moreover, some consider cryoenergy a safer modality specifically with regard to collateral structures (ie, the esophagus). Based on the available data, cryoballoon PVI + PWI is associated with greater intraprocedural AF terminations and reductions in long-term AF recurrence (typically by ~20%), as compared to PVI alone in patients with persAF, but with similar rates of adverse events. As such, PVI + PWI has emerged as a significant predictor of freedom from recurrent AF (odds ratio: 3.67, 95% confidence interval: 1.44-9.34; p = 0.006) as well as all atrial arrhythmias (hazard ratio: 2.04, 95% confidence interval: 1.15-3.61; p = 0.015). Adjunct radiofrequency ablation to complete PWI is required in at least one-third of the patients, and this need is highly predicted by the LA size (significantly increased with an LA diameter > 48 mm). LAPW reconnection also seems to be associated with LA dimension, particularly an LA diameter greater than 48 mm (negative predictive value: 89.7%). Nevertheless, based on the analysis of patients who underwent repeat electrophysiology study for arrhythmia recurrences, cryoballoon PVI + PWI yields acceptable long-term durability (> 80%).
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Affiliation(s)
- Arash Aryana
- Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
- Cardiac Catheterization Laboratory, Mercy General Hospital, Sacramento, CA, USA
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Aryana A, Su W, Kuniss M, Okishige K, de Asmundis C, Tondo C, Chierchia GB. Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III. Heart Rhythm 2021; 18:1435-1444. [PMID: 33905811 DOI: 10.1016/j.hrthm.2021.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | - Wilber Su
- Banner University Medical Center, Phoenix, Arizona
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | | | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS; Department of Biochemical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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