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Kantharia BK, Tun ZW, Shah AN. Atrial Tachycardias After "Multiple" Previous Ablations for Tachyarrhythmias: Treatment by Anti-arrhythmic Drugs or Additional Ablation? J Innov Card Rhythm Manag 2024; 15:5795-5802. [PMID: 38584751 PMCID: PMC10994163 DOI: 10.19102/icrm.2024.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/15/2023] [Indexed: 04/09/2024] Open
Abstract
Pulmonary vein (PV) isolation (PVI) ablation as the first-line therapy for atrial fibrillation (AF) and repeat PVIs for patients who had symptomatic improvement with the index PVI but who develop AF recurrence are directed by practice guidelines. How many catheter ablation (CA) procedures constitute the definition of "multiple" ablations is not known. Whether atrial tachyarrhythmias (AF, atrial tachycardia [AT], atrial flutter [AFL]) that occur post-ablation are due entirely to the proarrhythmic effects of CA or a continuum of the arrhythmia spectrum from the underlying atriopathy is debatable. Herein, we describe a case of a 65-year-old man with a CHA2DS2-VASc score of 5 points who suffered from atrial tachyarrhythmias for which seven CA procedures were performed. Because of symptomatic and drug-refractory AT/AFL that failed cardioversions, he requested another ablation procedure. During the eighth procedure, high-density three-dimensional electroanatomic mapping, including Coherent and Ripple mapping (CARTO® 3; Biosense Webster, Diamond Bar, CA, USA), of AT/AFL was performed. Small discrete areas of relatively viable tissue within an extensively scarred left atrium and a macro-re-entrant circuit with early-meets-late activation between the left atrial anterior wall and the right superior PV were found. Radiofrequency ablation performed at this site resulted in the termination of the tachycardia, and bidirectional conduction block across the line was achieved. On clinical follow-ups and rhythm monitoring by an implantable loop recorder, the patient remained in sinus rhythm with significant clinical improvement. Our case suggests that, in patients with prior multiple CAs, additional clinically indicated ablation should be performed using high-density mapping to accurately identify arrhythmia mechanisms, elucidate the disease substrate, and restore the sinus rhythm successfully.
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Affiliation(s)
- Bharat K. Kantharia
- Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Hospital—Morningside, New York, NY, USA
| | - Zaw Win Tun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Hospital—Morningside, New York, NY, USA
| | - Arti N. Shah
- Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- NYC Health and Hospitals, Elmhurst, Queens, NY, USA
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Bahlke F, Englert F, Popa M, Bourier F, Reents T, Lennerz C, Kraft H, Martinez AT, Kottmaier M, Syväri J, Tydecks M, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Erhard N. First clinical data on artificial intelligence-guided catheter ablation in long-standing persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:406-414. [PMID: 38197476 DOI: 10.1111/jce.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Despite advanced ablation strategies and major technological improvements, treatment of persistent atrial fibrillation (AF) remains challenging and the underlying pathophysiology is not fully understood. This study analyzed the multiple procedure outcome and safety of catheter ablation of spatiotemporal dispersions (DISPERS) detected by artificial intelligence (AI)-guided software in patients with long-standing persistent AF. METHODS AND RESULTS The Volta VX1 software was used for 50 consecutive patients undergoing catheter ablation for persistent AF. First, high-density mapping (78% biatrial) with a multipolar mapping catheter was performed. In addition to pulmonary vein isolation (PVI), ablation of DISPERS was performed aiming at homogenizing, dissecting, isolating, or connecting DISPERS areas to nonconducting anatomical structures. Follow-up contained regular visits at our outpatient clinic at 1, 3, 6, and 12 months including 7-day Holter electrocardiograms. Patients were mainly suffering from long-standing persistent AF (mean AF duration 50.30 ± 54.28 months). Following PVI, ablation of left atrial and right atrial DISPERS areas led to AF cycle length prolongation (mean of 162.0 ± 16.6 to 202.2 ± 21.6 ms after) and AF termination to atrial tachycardia (AT) or sinus rhythm (SR) in 12 patients (24%). No stroke or pericardial effusion occurred; major groin complications (pseudoaneurysm n = 1, atrioventricular fistula n = 1) were detected in two patients. After a blanking period of 6 weeks, recurrence of any atrial arrhythmia was documented in 26 patients (52%). The majority of patients presented with organized AT (n = 15) while AF was present in n = 9 patients and AT/AF was observed in n = 2 patients. Twenty-two patients underwent reablation. During a mean follow-up of 363.14 ± 187.42 days and after an average of 1.46 ± 0.68 procedures, 82% of patients remained in stable SR. CONCLUSION DISPERS-guided ablation using machine learning software (the Volta VX1 software) in addition to PVI in long-standing persistent AF ablation resulted in high long-term success rates regarding AF and AT elimination. Most arrhythmia recurrences were reentrant AT. After a total of 1.46 ± 0.68 procedures, freedom from AF/AT was 82%. Despite prolonged procedure times complication rates were low. Randomized studies are necessary to evaluate long-term efficacy of dispersion-guided ablation using AI.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alex Tunsch Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Chen S, Wang Z, Xuan F, Liang M, Jin Z, Ding J, Sun M, Zhang P, Han Y. One-year outcomes of wide antral cryoballoon ablation guided by high-density mapping vs. conventional cryoballoon ablation for atrial fibrillation: a propensity score-matched study. Front Cardiovasc Med 2024; 11:1327639. [PMID: 38361587 PMCID: PMC10867262 DOI: 10.3389/fcvm.2024.1327639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Background Pulmonary vein isolation with wide antral ablation leads to better clinical outcomes for the treatment of atrial fibrillation, but the isolation lesion is invisible in conventional cryoballoon ablation. In this study, we aim to investigate the efficacy of the wide pulmonary vein isolation technique that includes the intervenous carina region, guided by high-density mapping, compared with pulmonary vein isolation alone without the mapping system. Methods We conducted a propensity score-matched comparison of 74 patients who underwent a wide cryoballoon ablation guided by high-density mapping (mapping group) and 74 controls who underwent conventional cryoballoon ablation in the same period (no-mapping group). The primary outcome was a clinical recurrence of documented atrial arrhythmias for >30 s during the 1-year follow-up. Results Of 74 patients in the mapping group, residual local potential in the pulmonary vein antrum was found in 30 (40.5%) patients, and additional cryothermal applications were performed to achieve a wide pulmonary vein isolation. Compared with the no-mapping group, the use of the mapping system in the mapping group was associated with a longer fluoroscopic time (26.97 ± 8.07 min vs. 23.76 ± 8.36 min, P = 0.023) and greater fluoroscopic exposure [339 (IQR181-586) mGy vs. 224 (IQR133-409) mGy, P = 0.012]. However, no significant differences between the two groups were found in terms of procedural duration and left atrial dwell time (104.10 ± 18.76 min vs. 102.45 ± 21.01 min, P = 0.619; 83.52 ± 17.01 min vs. 79.59 ± 17.96 min, P = 0.177). The rate of 12-month freedom from clinical atrial arrhythmia recurrence was 85.1% in the mapping group and 70.3% in the no-mapping group (log-rank P = 0.029). Conclusion Voltage and pulmonary vein potential mapping after cryoballoon pulmonary vein isolation can identify residual potential in the pulmonary vein antrum, and additional cryoablation guided by mapping leads to improved freedom from atrial arrhythmias compared with conventional pulmonary vein isolation without the mapping system. Clinical Trial Registration Number ChiCTR2200064383.
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Affiliation(s)
- Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Fengqi Xuan
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, Beifang Hospital of China Medical University, Shenyang, China
| | - Ming Liang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Ding
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ping Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
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Thakro V, Varshney N, Malik N, Daware A, Srivastava R, Mohanty JK, Basu U, Narnoliya L, Jha UC, Tripathi S, Tyagi AK, Parida SK. Functional allele of a MATE gene selected during domestication modulates seed color in chickpea. Plant J 2024; 117:53-71. [PMID: 37738381 DOI: 10.1111/tpj.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023]
Abstract
Seed color is one of the key target traits of domestication and artificial selection in chickpeas due to its implications on consumer preference and market value. The complex seed color trait has been well dissected in several crop species; however, the genetic mechanism underlying seed color variation in chickpea remains poorly understood. Here, we employed an integrated genomics strategy involving QTL mapping, high-density mapping, map-based cloning, association analysis, and molecular haplotyping in an inter-specific RIL mapping population, association panel, wild accessions, and introgression lines (ILs) of Cicer gene pool. This delineated a MATE gene, CaMATE23, encoding a Transparent Testa (TT) and its natural allele (8-bp insertion) and haplotype underlying a major QTL governing seed color on chickpea chromosome 4. Signatures of selective sweep and a strong purifying selection reflected that CaMATE23, especially its 8-bp insertion natural allelic variant, underwent selection during chickpea domestication. Functional investigations revealed that the 8-bp insertion containing the third cis-regulatory RY-motif element in the CaMATE23 promoter is critical for enhanced binding of CaFUSCA3 transcription factor, a key regulator of seed development and flavonoid biosynthesis, thereby affecting CaMATE23 expression and proanthocyanidin (PA) accumulation in the seed coat to impart varied seed color in chickpea. Consequently, overexpression of CaMATE23 in Arabidopsis tt12 mutant partially restored the seed color phenotype to brown pigmentation, ascertaining its functional role in PA accumulation in the seed coat. These findings shed new light on the seed color regulation and evolutionary history, and highlight the transcriptional regulation of CaMATE23 by CaFUSCA3 in modulating seed color in chickpea. The functionally relevant InDel variation, natural allele, and haplotype from CaMATE23 are vital for translational genomic research, including marker-assisted breeding, for developing chickpea cultivars with desirable seed color that appeal to consumers and meet global market demand.
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Affiliation(s)
- Virevol Thakro
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Nidhi Varshney
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Naveen Malik
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, 303002, India
| | - Anurag Daware
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Rishi Srivastava
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Jitendra K Mohanty
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Udita Basu
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Laxmi Narnoliya
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - Uday Chand Jha
- Indian Institute of Pulses Research (IIPR), Kanpur, 208024, India
| | - Shailesh Tripathi
- Indian Institute of Pulses Research (IIPR), Kanpur, 208024, India
- Division of Genetics, Indian Agricultural Research Institute (IARI), New Delhi, 110012, India
| | - Akhilesh K Tyagi
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
- Department of Plant Molecular Biology, University of Delhi, South Campus, New Delhi, 110021, India
| | - Swarup K Parida
- National Institute of Plant Genome Research (NIPGR), Aruna Asaf Ali Marg, New Delhi, 110067, India
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Dulai R, Bangash F, Sharma A, Cambridge A, Wong G, Lim W, Farwell D, Garcia J, Srinivansan NT. Open Window Mapping of Accessory Pathways: A Literature Review and Practical Guide. Arrhythm Electrophysiol Rev 2023; 12:e28. [PMID: 38213630 PMCID: PMC10782422 DOI: 10.15420/aer.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/17/2023] [Indexed: 01/13/2024] Open
Abstract
Catheter ablation is the treatment of choice for patients with symptomatic accessory pathways (APs) causing recurrent atrioventricular reciprocating tachycardia or in situations where APs conduct rapidly, posing a risk of sudden cardiac death. Conventional AP mapping relies on point-by-point assessment of local electrograms looking closely for pathway electrograms or early atrial or ventricular electrograms, which may be challenging and time consuming. Recently, open window mapping (OWM) using 3D navigational systems has emerged as a novel technique to help localise and ablate APs. OWM has significant advantages over conventional point-by-point mapping techniques. The purpose of this review is to summarise the currently available literature on the OWM technique and to highlight the technical aspects and mapping considerations for OWM, including specific cases demonstrating its utility.
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Affiliation(s)
- Rajdip Dulai
- Cardiology Research Department, Eastbourne District General Hospital, East Sussex Hospitals NHS Trust Eastbourne, UK
| | - Fatima Bangash
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University Chelmsford, Essex, UK
| | - Ajay Sharma
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
| | - Alex Cambridge
- Ashford and St Peter's NHS Foundation Trust Chertsey, Surrey, UK
| | - Geoff Wong
- Cardiac Sciences Clinical Institute, Epworth Richmond Hospital Melbourne, Australia
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich, UK
| | - David Farwell
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
| | - Jason Garcia
- Biosense Webster Melbourne, Australia & New Zealand
| | - Neil T Srinivansan
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University Chelmsford, Essex, UK
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Abeln BGS, Balt JC, Klaver MN, Maarse M, van Dijk VF, Wijffels MCEF, Boersma LVA. High-density mapping for ablation of atypical atrial flutters - procedural characteristics related to outcome. Pacing Clin Electrophysiol 2023; 46:1403-1411. [PMID: 37724739 DOI: 10.1111/pace.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND High-density (HD) mapping is increasingly used to characterize arrhythmic substrate for ablation of atypical atrial flutters (AAFl). However, results on clinical outcomes and factors that are associated with arrhythmia recurrence are scarce. METHODS Single-center, prospective, observational cohort study that enrolled patients with catheter ablation for AAFl using a HD mapping system and a grid-shaped mapping catheter. Procedural characteristics, rates of atrial flutter recurrence, and factors that were associated with atrial flutter recurrence were evaluated. RESULTS Sixty-one patients with a total of 94 AAFl were included in the cohort. HD mapping was used to successfully identify the flutter circuit of 80/94 AAFl. The circuit was not identified for 14/94 AAFl in 11 patients. Critical isthmuses were identified and ablated in 29 patients (48%). Acute procedural success was achieved in 52 patients (85%), and 37 patients (61%) remained free from atrial flutter recurrence during a follow up of 1.3 [1.0-2.1] years. Atrial flutter recurrence was univariably associated with presence of a non-identified flutter circuit (HR:2.6 95% CI [1.1-6.3], p = .04) and critical isthmus-targeted ablation (HR:0.4 [0.15-0.90], p = .03). In multivariable regression analyses, critical isthmus ablation remained significant (HR:0.4 [0.16-0.97], p = .04), whereas presence of a non-identified flutter did not (HR:2.4 [0.96-5.8], p = .06). CONCLUSION HD mapping was successfully used to identify the majority of AAFl circuits. Ablation resulted in freedom from atrial flutter recurrence in 61% of the cohort. Successful identification of all flutter circuits and critical isthmuses appears to be beneficial for long-term outcomes.
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Affiliation(s)
- Bob G S Abeln
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiology Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jippe C Balt
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martijn N Klaver
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiology Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Moniek Maarse
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiology Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vincent F van Dijk
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiology Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Fu L, Xue Y. High density mapping of complex atrial tachycardia in patients after cardiac surgery. Pacing Clin Electrophysiol 2023; 46:1341-1347. [PMID: 37846820 DOI: 10.1111/pace.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
To provide an overview of the current application of high-density mapping (HDM) in the mechanism of complex atrial tachycardias (ATs). Complex ATs are frequently scar-related, after history of previous cardiac surgery and large scars. These scar-related ATs are difficult to manage medically and frequently recur after electrical cardioversion. HDM technologies have enabled rigorous elucidation of AT mechanisms in patients post cardiac surgery. This article showed the application of HDM technology in complex ATs from the mechanisms of complex ATs, the development of HDM technology, and the identification of scars or critical isthmus from HDM. HDM-guided approach is highly effective for identifying the ATs mechanism and critical isthmus.
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Affiliation(s)
- Lu Fu
- Department of Cardiology, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Liu J, Guan W, Guo J, Li X, Xia Y, Niu G, Yao Y. Optimization of superior vena cava isolation with aid of ablation index guidance. J Cardiovasc Electrophysiol 2023; 34:1820-1827. [PMID: 37493500 DOI: 10.1111/jce.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION To investigate the optimal range of quantitative ablation index (AI) value during superior vena cava (SVC) electrical isolation by radiofrequency catheter ablation (RFCA). METHODS First, in a development cohort of patients with atrial fibrillation (AF), the RFCA with 40 W was performed to complete SVC isolation guided by the conduction breakthrough point from the right atrium to SVC. Then, the range of AI value was calculated by offline analysis on different segments of SVC. Lastly, for the validation of AF patients, the safety and effectiveness of SVC isolation with the optimized target range of AI value were evaluated with an additional adenosine test. RESULTS A total of 101 patients with AF were included in the study (44 patients in the development cohort/57 in the validation cohort). The segmental ablation strategy was applied in 70% of the patients. According to the offline analysis of the AI values in the development cohort, the target AI value range was set as 350-400. The success rate of SVC isolation in the validation cohort was significantly higher than that in the exploration cohort (100% vs. 90.9%, p = .02), and no complications occurred in the exploration cohort. During the adenosine test, the recovery rate of electrical conduction in SVC was significantly lower than that in the pulmonary vein (3.5% vs. 17.5%). CONCLUSION The target AI value with a range from 350 to 400 is safe and effective for high-power RFCA to complete SVC isolation.
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Affiliation(s)
- Jun Liu
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Wenchi Guan
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Jinrui Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Xiaofeng Li
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Yu Xia
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Guodong Niu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Yan Yao
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
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Umemoto S, Takemoto M, Koga T, Tsuchihashi T. Detection of a unidirectional epicardial connection between the right-sided pulmonary venous carina and the right atrium by pacing from a high-density mapping catheter. Pacing Clin Electrophysiol 2023; 46:928-933. [PMID: 36515076 DOI: 10.1111/pace.14645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
We report a case of recurring, persistent atrial fibrillation (AF) in a patient with a unidirectional epicardial connection (EC) between the right-sided pulmonary venous (PV) carina and the right atrium detected using a high-density mapping catheter with a steerable introducer support, but not a conventional circular mapping catheter. This unidirectional EC could be steadily abolished by a radiofrequency delivery. Finally, we were able to successfully achieve complete PV antrum isolation. Thereafter, he has remained well without any AF.
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Affiliation(s)
- Shintaro Umemoto
- Cardiovascular Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Masao Takemoto
- Cardiovascular Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Tokushi Koga
- Cardiovascular Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Takuya Tsuchihashi
- Cardiovascular Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
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Lai Y, Ge W, Sang C, Macle L, Tang R, Long D, Dong J, Ma C. Epicardial connections and bi-atrial tachycardias: From anatomy to clinical practice. Pacing Clin Electrophysiol 2023; 46:895-903. [PMID: 37433176 DOI: 10.1111/pace.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Bi-atrial tachycardia (BiAT) is not rare after extensive atrial ablation or cardiac surgery. The complexity of bi-atrial reentrant circuits poses a great challenge for clinical practice. With recent advances in mapping technologies, we are now able to characterize atrial activation in detail. However, given the involvement of both atria and multiple epicardial conductions, endocardial mapping for BiATs is not easy to understand. Knowledge of the atrial myocardial architecture is the foundation for the clinical management of BiATs; as it is required to understand the possible mechanism of the tachycardia and identify the optimal target of ablation. In this review we summarize current knowledge about the anatomy of interatrial connections as well as other epicardial fibers and discuss the interpretation of electrophysiological findings and ablation strategies for BiATs.
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Affiliation(s)
- Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Weili Ge
- Department of Cardiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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11
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Dubey A, Ahmed A, Patel H, Wrobel J, Donlon J, Lakshman H, Shah D. Epicardial Potential in the Left Atrium During Posterior Wall Isolation in Persistent Atrial Fibrillation. J Innov Card Rhythm Manag 2023; 14:5510-5513. [PMID: 37492692 PMCID: PMC10364663 DOI: 10.19102/icrm.2023.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/17/2023] [Indexed: 07/27/2023] Open
Abstract
Pulmonary vein isolation (PVI) is used for rhythm control in atrial fibrillation (AF). Posterior wall isolation (PWI) is often an adjunct to PVI. Successful PWI is limited by esophageal location, epicardial bridging signals, tissue thickness, and mapping catheter resolution. High-density grid mapping catheters can assist with PWI. Here, we report a case of a 71-year-old woman with persistent AF who underwent PVI and PWI with high-density grid mapping catheters, thus demonstrating the use of omnipolar technology in facilitating successful PWI.
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Affiliation(s)
- Ankita Dubey
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University/College of Human Medicine, Grand Rapids, MI, USA
| | - Ammar Ahmed
- Department of Cardiovascular Disease, Ascension Providence Hospital, Michigan State University/College of Human Medicine, Southfield, MI, USA
| | - Harshil Patel
- Department of Cardiovascular Disease, Ascension Providence Hospital, Michigan State University/College of Human Medicine, Southfield, MI, USA
| | | | | | - Harini Lakshman
- Department of Cardiovascular Disease, Ascension Providence Hospital, Michigan State University/College of Human Medicine, Southfield, MI, USA
| | - Dipak Shah
- Department of Cardiovascular Disease, Ascension Providence Hospital, Michigan State University/College of Human Medicine, Southfield, MI, USA
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12
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Balt JC, Abeln BGS, Mahmoodi BK, van Dijk VF, Wijffels MCEF, Boersma LVA. Long-term success of a multi-electrode substrate mapping and ablation strategy versus a classic single tip mapping and ablation strategy for ventricular tachycardia ablation in patients with ischemic cardiomyopathy. Pacing Clin Electrophysiol 2023. [PMID: 37254956 DOI: 10.1111/pace.14717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Over the past years, mapping and ablation techniques for the treatment of ventricular tachycardia (VT) have evolved rapidly. High Density (HD) substrate mapping is now routine and pre-procedural imaging is increasingly used. The additional value of these techniques for long-term VT-free survival is not clear. METHODS We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of ventricular tachycardia in patients with ischemic heart disease between two groups. (1) Low Density (LD) group: VT mapping and ablation with a 4 mm single tip catheter (2) HD group: HD substrate mapping with the Pentaray (Biosense Webster, USA) or HD Grid (Abbott, USA) catheter and ablation with a 4 mm single tip catheter. RESULTS VT ablation was performed in 133 patients (71 patients in LD group and 62 patients in HD group). The median follow-up was 5.0 years in LD group and 2.0 years in HD group. One-, two-, and five-year VT recurrence rates were 47%, 56%, and 65% in the LD group versus 39%, 50%, and 55% in the HD group (log-rank test for VT recurrence p = .70). One-, two-, and five-year ICD shock recurrence rates were 14%, 18%, and 24% in the LD group versus 8%, 15%, and 19% in the HD group (log-rank test for ICD-shock p = .79). All-cause mortality, cardiac (non-arrhythmic), and arrhythmic death, were similar in both groups. Severe procedural complications (tamponade, stroke, or procedural death) occurred in four patients (5%, 1 vascular, 3 tamponade) in the LD group versus two patients (3%, both tamponade) in the HD group (NS). In univariate and multivariable analysis, only a higher LVEF was significantly associated with VT-free survival. HD mapping was not significantly associated with VT-free survival. Anterior infarct location and age were significantly associated with ICD recurrent shock in both univariate and multivariable analyses. CONCLUSIONS In patients with ischemic cardiomyopathy, a HD substrate mapping, and ablation strategy did not lead to higher VT-free survival and shock-free survival compared to a single tip mapping and ablation strategy. In this study, only LVF is an independent predictor for VT recurrence. Anterior infarct location and age predict recurrent ICD shocks.
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Affiliation(s)
- Jippe C Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Bob G S Abeln
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Vincent F van Dijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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13
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Franco E, Lozano Granero C, Cortez-Dias N, Nakar E, Segev M, Matía R, Hernández-Madrid A, Zamorano JL, Moreno J. Automatic identification of areas with low-voltage fragmented electrograms for the detection of the critical isthmus of atypical atrial flutters. J Cardiovasc Electrophysiol 2023; 34:356-365. [PMID: 36434798 DOI: 10.1111/jce.15758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Critical isthmuses of atypical atrial flutters (AAFLs) are usually located at slow conduction areas that exhibit fractionated electrograms. We tested a novel software, intended for integration with a commercially available navigation system, that automatically detects fractionated electrograms, to identify the critical isthmus in patients with AAFL ablation. METHODS AND RESULTS All available patients were analyzed; 27 patients with 33 AAFLs were included. The PentaRay NAV catheter (Biosense Webster) was used for mapping. The novel software was retrospectively applied; fractionated points with duration ≥80 ms and bipolar voltage between 0.05 and 0.5 mV were highlighted on the surface of maps. In 10 randomly chosen AAFLs, an expert electrophysiologist evaluated the positive predictive value of the algorithm to detect true fractionation: 74.4%. We tested the capacity of the software to identify areas of fractionation (defined as clusters of ≥3 adjacent points with fractionation) at the critical isthmus of the AAFLs (defined using conventional mapping criteria). An area of fractionation was identified at the critical isthmus in 30 cases (91%). Globally, 144 areas of fractionation (median number per AAFL 4 [3-6]) were identified. Duration of the fractionation or the surface of the areas was not different between areas at critical isthmuses and the rest. Setting the fractionation score filter of the software in nine provided best performance. CONCLUSIONS The novel software detected areas of fractionation at the critical isthmus in most AAFLs, which may help identify the critical isthmus in clinical practice.
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Affiliation(s)
- Eduardo Franco
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Cristina Lozano Granero
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Center, Lisbon, Portugal
| | - Elad Nakar
- Research and Development Department, Biosense Webster, Johnson & Johnson, Yokneam, Israel
| | - Meytal Segev
- Research and Development Department, Biosense Webster, Johnson & Johnson, Yokneam, Israel
| | - Roberto Matía
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Hernández-Madrid
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Javier Moreno
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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14
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Akbulak RÖ, Hedenus K, Wahedi R, Anwar O, Gessler N, Hartmann J, Willems S. Pulsed field ablation in patients with complex consecutive atrial tachycardia in conjunction with ultra-high density mapping: Proof of concept. J Cardiovasc Electrophysiol 2022; 33:2431-2443. [PMID: 36259717 DOI: 10.1111/jce.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/19/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Catheter-ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel nonthermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT. This study sought to investigate PFA of consecutive LAT following prior CA of AF. METHODS Consecutive patients with LAT underwent ultrahigh-density (UHDx) mapping. Subsequent to identification of the AT mechanism, PFA was performed at the assumed critical sites for LAT maintenance. Continuous ablation lines were performed if required and evaluated with pre- and post-PFA HDx-mapping. RESULTS Fifteen patients (age 70 ± 10, male 73%) who underwent 3.6 ± 2 prior AF-CA procedures were included. The total mean procedure and fluoroscopy times were 141 ± 43 and 18 ± 10 min, respectively. All 19 of 19 (100%) LAT were successfully ablated with PFA. Two AT located at the right atria required RF-ablation. LAT were identified as localized reentry (n = 1) and macro-reentry LAT (n = 18) and targeted with PFA. All LAT terminated with PFA either to sinus rhythm (9/15) or a secondary AT (6/15 and subsequently to SR); 63% (12/19) terminated with the first PFA-application. All lines (13 roof, 11 anterior, 1 mitral) were blocked. LA-posterior-wall isolation (LAPWI) was successfully achieved when performed (10/10). AF/AT free survival was 80% (12/15) after 153 [88-207] days of follow-up. No procedure-related complications occurred. CONCLUSION PFA of consecutive LAT is feasible and safe. Successful creation of ablation lines and LAPWI can be achieved in a short time. PFA may offer the opportunity for effective ablation of atrial arrhythmias beyond AF.
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Affiliation(s)
- Melanie A Gunawardene
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Katja Hedenus
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Rahin Wahedi
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
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15
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Fink T, Sciacca V, Sommer P. CT-imaging vs. high-density mapping in ischemic cardiomyopathy VT ablation: in whom do we trust? J Cardiovasc Electrophysiol 2022; 33:2181-2182. [PMID: 35938389 DOI: 10.1111/jce.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022]
Abstract
Ablation of ventricular tachycardia (VT) has emerged an effective therapy in patients with ischemic heart disease. Electroanatomical mapping is currently considered the gold standard in terms of VT ablation This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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16
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van Munster KN, Dijkgraaf MGW, Oude Elferink RPJ, Beuers U, Ponsioen CY. Symptom patterns in the daily life of PSC patients. Liver Int 2022; 42:1562-1570. [PMID: 35396817 PMCID: PMC9325051 DOI: 10.1111/liv.15271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients with primary sclerosing cholangitis (PSC) may suffer from complaints such as pruritus, right upper abdominal quadrant pain (RUQ-A) and fatigue. However, the severity of these complaints, daily and/or seasonal patterns and other factors of influence in PSC are largely unknown. The aim of this study is to assess daily symptoms and patterns thereof in PSC patients in their natural setting. METHODS A mobile application was designed according to the experience sampling method. Push notifications with a response time of max 4 h were sent during tiers of 3 months. Questions comprised VAS scales on degree of pruritus, fatigue, RUQ-A, time of the day these symptoms were worst, as well as time of intake of medication. Linear mixed modelling was used to identify patient- and external factors associated with pruritus, fatigue and RUQ-A pain. RESULTS A total of 6713 questionnaires were completed by 137 patients. Fatigue was the most prevalent symptom among PSC patients being reported in a striking 71% of measurements, followed by pruritus (38%). Both increased during the day and were associated with longer disease duration. A highly significant correlation between pruritus and day temperature was observed (ρ = -0.14, p = .000), and itch was generally worse during winter (p = .000). Patient preference for the tool was high. CONCLUSION Pruritus and fatigue are prevalent symptoms in the daily life of PSC patients and show a distinct diurnal pattern. This may have implications for efficient dosing of anti-pruritic agents. The level of pruritus is highly correlated with day temperature, which may have several implications.
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Affiliation(s)
- Kim N. van Munster
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Ronald P. J. Oude Elferink
- Tytgat Laboratory for Liver and Intestinal DiseasesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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17
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Franco E, Lozano Granero C, Matía R, Hernández-Madrid A, Sánchez Pérez I, Zamorano JL, Moreno J. Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study). Cardiol J 2022; 30:799-809. [PMID: 35578756 PMCID: PMC10635713 DOI: 10.5603/cj.a2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unstable reentrant atrial tachycardias (ATs) (i.e., those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. We tested a strategy to achieve arrhythmia stabilization into mappable stable ATs based on the detection and ablation of rotors. METHODS All consecutive patients from May 2017 to December 2019 were included. Mapping was performed using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV, or Advisor HD Grid). Rotors were subjectively identified as fractionated continuous (or quasi-continuous) electrograms on 1-2 adjacent bipoles, without dedicated software. In patients without detectable rotors, sites with spatiotemporal dispersion (i.e., all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted. Ablation success was defined as conversion to a stable AT or sinus rhythm. RESULTS Ninety-seven patients with reentrant ATs were ablated. Of these, 18 (18.6%) presented unstable circuits. Thirteen (72%) patients had detectable rotors (median 2 [1-3] rotors per patient); focal ablation was successful in 12 (92%). In the other 5 patients, 17 sites with spatiotemporal dispersion were identified and targeted. Globally, and excluding 1 patient with spontaneous AT stabilization, ablation success was achieved in 16/17 patients (94.1%). One-year freedom from atrial arrhythmias was similar between patients with unstable and stable ATs (66.7% vs. 65.8%, p = 0.946). CONCLUSIONS Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm.
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Affiliation(s)
- Eduardo Franco
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.
| | | | - Roberto Matía
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | - José Luis Zamorano
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Javier Moreno
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
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18
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Kamp AN, Nair K, Fish FA, Khairy P. Catheter ablation of atrial arrhythmias in patients post-Fontan. Can J Cardiol 2022; 38:1036-1047. [PMID: 35240252 DOI: 10.1016/j.cjca.2022.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/25/2022] Open
Abstract
Atrial arrhythmias are highly prevalent in the aging Fontan population and contribute importantly to morbidity and mortality. Although the most common arrhythmia is scar-based intra-atrial re-entrant tachycardia, various other arrhythmias may occur including focal atrial tachycardia, atrioventricular node-dependent tachycardias, and atrial fibrillation. The type and prevalence of atrial arrhythmia is determined, in part, by the underlying congenital defect and variant of Fontan surgery. While the cumulative incidence of atrial tachyarrhythmias has decreased substantially from the atriopulmonary anastomosis to the more recent total cavopulmonary connection Fontan, the burden of atrial arrhythmias remains substantial. Management is often multi-faceted and can include anticoagulation, anti-arrhythmic drug therapy, pacing, and cardioversion. Catheter ablation plays a key role in arrhythmia control. Risks and benefits must be carefully weighed. Among the important considerations are the clinical burden of arrhythmia, ventricular function, hemodynamic stability in tachycardia, suspected arrhythmia mechanisms, risks associated with anaesthesia, venous access, approaches to reaching the pulmonary venous atrium, and accompanying co-morbidities. Careful review of surgical notes, electrocardiographic tracings, and advanced imaging is paramount, with particular attention to anatomic abnormalities such as venous obstructions and displaced conduction systems. Despite numerous challenges, ablation of atrial arrhythmias is effective in improving clinical status. Nevertheless, onset of new arrhythmias is common during long-term follow-up. Advanced technologies such as high-density mapping catheters and remote magnetic guided ablation carry the potential to further improve outcomes. Fontan patients with atrial arrhythmias should be referred to centers with dedicated expertise in congenital heart disease including catheter ablation, anaesthesia support, and advanced imaging.
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Affiliation(s)
- Anna N Kamp
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital, Toronto, Canada
| | - Frank A Fish
- Vanderbilt University Medical Center, Nashville, TN, USA; and
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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19
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Conte G, Piciacchia F, Medeiros-Domingo A, Grego S, Ripellino P, Auricchio A. Filamin C missense variant associated with severe right atrial disease and skeletal myopathy. J Cardiovasc Electrophysiol 2021; 32:2777-2780. [PMID: 34411373 DOI: 10.1111/jce.15218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Filamin C (FLNC) gene variants associated with atrial cardiomyopathies have not been reported so far. The aim of this study was to assess the genetics of two siblings presenting with recurrent right atrial arrhythmias, severe right atrial dilatation, and skeletal myopathy. METHODS A family with subjects affected by recurrent atrial arrhythmias and skeletal myopathy was extensively evaluated by the means of electrocardiographic recordings, magnetic resonance, intracardiac high-density mapping, and genetic testing. RESULTS Two siblings with right atrial arrhythmias and severe right atrial disease were found to be heterozygous carriers of the variant FLNC-c.925G>A p.(Glu309Lys), previously reported as a variant of uncertain significance. Despite the presence of a severe dilatation of the right atrium in both patients, one presented with skeletal muscle myopathy and an atrial arrhythmia refractory to pharmacological and invasive treatment, while the other one did not have any myopathy, and rhythm control was easily achieved by drugs. CONCLUSION Filamin C missense variant c.925G>A p.(Glu309Lys) is associated with the severe right atrial disease. Considering cosegregation with the disease (PP1 supporting), this variant should be classified as likely pathogenic.
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Affiliation(s)
- Giulio Conte
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Flavia Piciacchia
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Susanna Grego
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paolo Ripellino
- Neurocentro, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Angelo Auricchio
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
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20
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Ellermann C, Frommeyer G, Orwat S, Baumgartner H, Eckardt L. High-Density Mapping Revealing Figure-of-Eight Re-Entrant Atrial Tachycardia in Uhl's Anomaly. JACC Clin Electrophysiol 2021; 7:1074-1075. [PMID: 34332870 DOI: 10.1016/j.jacep.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Christian Ellermann
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Gerrit Frommeyer
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Münster, Germany
| | - Stefan Orwat
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Münster, Germany
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21
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Sun X, Niu G, Lin J, Suo N, Guo T, Lu J, Feng T, Zheng L, Yao Y, Zhang S. The incidence and location of epicardial connections in the era of contact force guided ablation for pulmonary vein isolation. J Cardiovasc Electrophysiol 2021; 32:2381-2390. [PMID: 34270147 DOI: 10.1111/jce.15174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effects of epicardial connections (ECs) involving pulmonary veins (PVs) in atrial fibrillation (AF) ablation have been revealed recently. However, no systematic approaches to identify and ablate the ECs were established. METHODS Patients with AF undergoing radiofrequency (RF) catheter ablation were retrospectively analyzed. ECs were identified when (1) PV isolation (PVI) cannot be achieved after first-pass isolation; (2) PVI was still absent although the conduction gap was detected and ablated; (3) the earliest activation area (EAA) was revealed located within the PV antrum distant from the initial ablation line using high-density mapping (HDM) technique; (4) focal ablation at the EAA was effective to achieve PVI. Relevant pacing maneuvers were performed to elucidate ECs' bidirectional conduction. RESULTS Overall, 36 ECs were identified and ablated in 35/597 (5.86%) patients. Among the 35 patients with ECs, at least one PV insertion of ECs was located at the carina region. The most common pattern was a single breakthrough in 31 (88.6%) patients, followed by multiple breakthroughs in 3 and wide breakthroughs in 1. The median distance from EAA to the initial ablation line was 10.0 mm. The average number of RF energy delivery was 1.75 ± 1.00, and single RF delivery was adequate in 16/36 (44.4%) patients. Continuous potentials were present at the EAA in 9/34 (26.5%) patients. CONCLUSION ECs were confirmed and ablated successfully in 5.86% (35/597) AF patients using HDM. PV insertions of ECs were mainly located at the carina region. Continuous potentials might assist in the prediction of ECs.
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Affiliation(s)
- Xuerong Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guodong Niu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinxuan Lin
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Suo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Guo
- Arrhythmia Center, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jiang Lu
- Arrhythmia Center, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Tianjie Feng
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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John LA, Mullis A, Payne J, Tung R, Aksu T, Winterfield JR. Cardioneuroablation for cardioinhibitory vasovagal syncope. J Cardiovasc Electrophysiol 2021; 32:1748-1753. [PMID: 33855779 DOI: 10.1111/jce.15044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardioneuroablation (CNA) is an emerging technique being used to treat patients with cardioinhibitory vasovagal syncope (VVS). We describe a case of CNA in targeting atrial ganglionated plexi (GP) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a patient with cardioinhibitory syncope. CASE PRESENTATION A 20-year-old healthy female presented with malignant VVS and symptomatic sinus pauses, with the longest detected at 10 s. She underwent acutely successful CNA with demonstration of vagal response (VR) noted after ablation of left sided GP, and tachycardia noted with right sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of Ensite Precision mapping system with high density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, there were no recurrent syncopal episodes or sinus pauses. Longer term follow-up with implantable loop recorder is planned. CONCLUSION We performed CNA in a patient with VVS by utilizing a novel approach of combined use of high density mapping and fractionation mapping software. With this approach, we were able to detect fractionation in all GP sites and demonstrate acute VR. This workflow may allow for a new, standardized technique suitable for widespread use.
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Affiliation(s)
- Leah A John
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andin Mullis
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua Payne
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roderick Tung
- Department of Medicine, The University of Chicago Medicine Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Jeffrey R Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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John LA, Mullis A, Payne J, Tung R, Aksu T, Winterfield JR. Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation. J Innov Card Rhythm Manag 2021; 12:4473-4476. [PMID: 33936863 PMCID: PMC8081457 DOI: 10.19102/icrm.2021.120405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Cardioneuroablation (CNA) is an emerging technique used to treat patients with vasovagal syncope (VVS). We herein describe a case of CNA targeting the atrial ganglionated plexi (GPs) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a 20-year-old healthy female who presented to our center with malignant VVS and symptomatic sinus pauses, the longest of which measured 10 seconds. She underwent acutely successful CNA with a demonstration of vagal response noted following ablation of the left-sided GPs, and tachycardia was noted with right-sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of the EnSite Precision™ cardiac mapping system (Abbott, Chicago, IL, USA) with high-density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, no recurrent syncopal episodes or sinus pauses had been recorded. Longer-term follow-up with an implantable loop recorder is planned. Broadly, we performed CNA in a patient with VVS by combining high-density mapping and fractionation mapping software in a novel approach, which allowed us to detect fractionation in all GP sites and demonstrate an acute vagal response. This workflow may facilitate the introduction of a standardized technique suitable for widespread use.
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Affiliation(s)
- Leah A. John
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Andin Mullis
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Payne
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Roderick Tung
- The University of Chicago Medicine Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA
| | - Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
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24
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Affiliation(s)
- Jose Osorio
- Grandview Medical Center, Birmingham, AL, USA
| | | | - Tolga Aksu
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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25
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Affiliation(s)
- Ahmadreza Karimianpour
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey R Winterfield
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua E Payne
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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26
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Gee LV, Osman F, Panikker S, Yusuf S, Dhanjal T. Decrementing Evoked-potential Propagation Map Defines the Ventricular Tachycardia Isthmus. J Innov Card Rhythm Manag 2021; 12:51-53. [PMID: 33604124 PMCID: PMC7885972 DOI: 10.19102/icrm.2021.120119s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lim Ven Gee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, England
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, England.,University of Warwick Medical School, Gibbet Hill, Coventry, England
| | - Sandeep Panikker
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, England
| | - Shamil Yusuf
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, England
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, England.,University of Warwick Medical School, Gibbet Hill, Coventry, England
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27
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China P, Quinto L, Vitale R, Corrado A, Marras E, Themistoclakis S. High-quality and Fast Mapping of a Focal Atrial Tachycardia Arising from Koch's Triangle. J Innov Card Rhythm Manag 2021; 12:14-15. [PMID: 33604107 PMCID: PMC7885945 DOI: 10.19102/icrm.2021.120114s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Paolo China
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | - Levio Quinto
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | - Raffaele Vitale
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | - Andrea Corrado
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | - Elena Marras
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | - Sakis Themistoclakis
- Unit of Electrophysiology and Cardiac Pacing, Department of Cardiothoracic & Vascular Medicine, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
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28
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Hrachian H, Rios J. Accurate Identification of Reentrant Circuit and Critical Isthmus of an Atrial Tachycardia Over the Posterior Wall of the Left Atrium Requiring a 1.4-second Single Radiofrequency Energy Application. J Innov Card Rhythm Manag 2021; 12:26-27. [PMID: 33604113 PMCID: PMC7885974 DOI: 10.19102/icrm.2021.120104s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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29
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Strohmer B, Danmayr F, Kraus J, Lassnig M, Hoppe UC. High-density Mapping Facilitates Successful Ablation of Postincisional Right Atrial Flutter After Previous Mechanical Mitral Valve Replacement. J Innov Card Rhythm Manag 2021; 12:9-10. [PMID: 33604105 PMCID: PMC7885963 DOI: 10.19102/icrm.2021.120101s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bernhard Strohmer
- Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Franz Danmayr
- Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Johannes Kraus
- Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Markus Lassnig
- Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Salzburg, Austria
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30
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Shah D, Racette A, Wrobel J. High-density Grid Catheter Localizes Eccentric Atrial Flutter to the Left Superior Pulmonary Vein Ridge Through Extreme Isochronal Compression. J Innov Card Rhythm Manag 2021; 12:24-25. [PMID: 33604112 PMCID: PMC7885953 DOI: 10.19102/icrm.2021.120115s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dipak Shah
- Ascension Providence Hospital, Mobile, AL, USA
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31
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Rillo M, Palamà Z, My G, Punzi R, Aurelio A, Aloisio A, Zonno F, Giannattasio C, My L. A Tailored Approach to the Ablation of Atrial Fibrillation in Rheumatic Valvular Disease with High-density Grid Technology. J Innov Card Rhythm Manag 2021; 12:37-38. [PMID: 33604117 PMCID: PMC7885950 DOI: 10.19102/icrm.2021.120120s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mariano Rillo
- Electrophysiology Service, Division of Cardiology - Casa di Cura Villa Verde, Taranto, Italy
| | - Zefferino Palamà
- Electrophysiology Service, Division of Cardiology - Casa di Cura Villa Verde, Taranto, Italy
| | - Giulia My
- Cardiology Unit - Casa di Cura "Villa Verde," Taranto, Italy
| | - Raffaele Punzi
- Electrophysiology Service, Division of Cardiology - Casa di Cura Villa Verde, Taranto, Italy
| | - Andrea Aurelio
- Cardiology Unit - Casa di Cura "Villa Verde," Taranto, Italy
| | - Angelo Aloisio
- Cardiology Unit - Casa di Cura "Villa Verde," Taranto, Italy
| | | | | | - Luigi My
- Cardiology Unit - Casa di Cura "Villa Verde," Taranto, Italy
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33
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Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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34
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Methachittiphan N, Akoum N, Gopinathannair R, Boyle PM, Sridhar AR. Dynamic voltage threshold adjusted substrate modification technique for complex atypical atrial flutters with varying circuits. Pacing Clin Electrophysiol 2020; 43:1273-1280. [PMID: 32914522 DOI: 10.1111/pace.14068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atypical atrial flutter (AFL) is common in patients with postsurgical atrial scar, with macro- or microscopic channels in the scar acting as substrate for reentry. Heterogeneous atrial scarring can cause varying flutter circuits, which makes mapping and ablation challenging, and recurrences common. AIM We hypothesize that dynamically adjusting voltage thresholds can identify heterogeneous atrial scarring, which can then be effectively homogenized to eliminate atypical AFLs. METHODS We studied consecutive patients who presented to Electrophysiology laboratory for atypical AFL ablation with history of atriotomy and included the patients with multiple, varying flutter circuits during mapping in our study. We excluded patients with stable flutter circuit that was sustained and could be localized using traditional entrainment and activation mapping strategy. In the included patients, we performed detailed high-density voltage map of the atrium of interest. We adjusted voltage thresholds as needed to identify heterogeneity and channels in the scarred regions. A thorough scar homogenization was performed with irrigated smart-touch ablation catheter. Re-inducibility of tachycardia, and immediate and long-term outcomes were studied. RESULTS Of five studied cases, one was female; age 66 ± 10 years. All five had prior surgical substrate. All the patients had multiple flutter morphologies, which varied as we mapped the AFL. After scar homogenization, tachycardia was not inducible in any patient. No recurrence of flutter was noted during a mean follow-up duration of 450 ± 27 days. CONCLUSION High-density voltage mapping and homogenization of the scar can be an effective strategy in eliminating complex scar-mediated atypical AFL with multiple circuits.
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Affiliation(s)
- Nilubon Methachittiphan
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.,Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nazem Akoum
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Patrick M Boyle
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Arun R Sridhar
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
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35
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Jungen C, Akbulak R, Kahle AK, Eickholt C, Schaeffer B, Scherschel K, Dinshaw L, Muenkler P, Schleberger R, Nies M, Gunawardene MA, Klatt N, Hartmann J, Merbold L, Jularic M, Willems S, Meyer C. Outcome after tailored catheter ablation of atrial tachycardia using ultra- high-density mapping. J Cardiovasc Electrophysiol 2020; 31:2645-2652. [PMID: 32748442 DOI: 10.1111/jce.14703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tailored catheter ablation of atrial tachycardias (ATs) is increasingly recommended as a potentially easy treatment strategy in the era of high-density mapping (HDM). As follow-up data are sparse, we here report outcomes after HDM-guided ablation of ATs in patients with prior catheter ablation or cardiac surgery. METHODS AND RESULTS In 250 consecutive patients (age 66.5 ± 0.7 years, 58% male) with ATs (98% prior catheter ablation, 13% prior cardiac surgery) an HDM-guided catheter ablation was performed with the support of a 64-electrode mini-basket catheter. A total of 354 ATs (1.4 ± 0.1 ATs per patient; mean cycle length 304 ± 4.3 ms; 64% macroreentry, 27% localized reentry, and 9% focal) with acute termination of 95% were targeted in the index procedure. A similar AT as in the index procedure recurred in five patients (2%) after a median follow-up time of 535 days (interquartile range (IQR) 25th-75th percentile: 217-841). Tailored ablation of reentry ATs with freedom from any arrhythmia was obtained in 53% after a single procedure and in 73% after 1.4 ± 0.4 ablation procedures (range: 1-4). A total of 228 patients (91%) were free from any arrhythmia recurrence after 210 days (IQR: 152-494) when including optimal usual care. CONCLUSIONS Tailored catheter ablation of ATs guided by HDM has a high acute success rate. The recurrence rate of the index AT is low. In patients with extensive atrial scaring further ablation procedures need to be considered to achieve freedom from any arrhythmia.
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Affiliation(s)
- Christiane Jungen
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ruken Akbulak
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Benjamin Schaeffer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Katharina Scherschel
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Leon Dinshaw
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Paula Muenkler
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Ruben Schleberger
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Moritz Nies
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | | | - Niklas Klatt
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Meyer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany.,Institute of Neuronal and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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36
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra- high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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Nakai K, Kashiwa A, Kunitomi A, Matsuoka S. Conduction gap mapping of linear ablation lesions with high-density mapping. J Cardiovasc Electrophysiol 2020; 31:1953-1963. [PMID: 32506717 DOI: 10.1111/jce.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/10/2020] [Accepted: 05/31/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION When performing linear ablation, creating contiguous and transmural lesions are technically challenging due to the difficulty in finding electrical conduction gaps. We hypothesized that high-density mapping could identify the gaps. METHODS AND RESULTS This study included consecutive patients who underwent conduction gap mapping of de novo lesions (41 patients, 55 lines) and previous lesions (25 patients, 34 lines). We analyzed the utility of bipolar and unipolar conduction gap mapping and retrospectively assessed the voltage and morphology of the bipolar electrograms at the gap sites. Bipolar and unipolar propagation maps were classified into three types: the propagation wavefront traveled through the linear ablation lesions (direct leak), the wavefront jumped to an opposite site across the line and returned to the line (jump and return leak), and others (indefinite leak). In the jump and return leak maps, the site where it returned suggested a conduction gap site. Bipolar propagation maps identified 30 (54.5%) conduction gaps and unipolar maps identified 40 (72.7%) gaps at de novo linear ablation lesions (P = .01), and 32 (94.1%) gaps and 33 (97.1%) gaps, respectively, at previous lesions (P = .56). Bipolar voltage mapping did not add any further efficacy in detecting conduction gaps, and the morphology of the electrograms recorded at the gap sites was not related to the types of propagation maps. CONCLUSION Conduction gaps of linear ablation lesions can be visualized by high-density mapping with a high probability. Unipolar propagation, when used with bipolar mapping, may help detect conduction gap sites.
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Affiliation(s)
- Kentaro Nakai
- Heart Center, Rhythm Management Division, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Asami Kashiwa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Kunitomi
- Department of Fundamental Cell Technology, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Shunzo Matsuoka
- Heart Center, Cardiovascular Division, Uji-Tokushukai Medical Center, Kyoto, Japan
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Kitamura T, Takigawa M, Derval N, Denis A, Martin R, Vlachos K, Nakatani Y, Frontera A, Cheniti G, Martin CA, Bourier F, Lam A, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Atrial tachycardia circuits include low voltage area from index atrial fibrillation ablation relationship between RF ablation lesion and AT. J Cardiovasc Electrophysiol 2020; 31:1640-1648. [PMID: 32437007 DOI: 10.1111/jce.14576] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND No study to date has used high-density mapping to investigate the relationship between prior radiofrequency (RF) lesions for persistent atrial fibrillation (PsAF) ablation and subsequent atrial tachycardias (ATs). METHODS From 41 consecutive patients who underwent AT ablation at a second procedure using an ultrahigh-density mapping system, 22 patients (38 ATs) were included as they also had complete maps with a multipolar catheter and three-dimensional (3D) mapping system at the time of the first PsAF ablation procedure. We, therefore, compared voltage maps from the first AF ablation procedure to those from the subsequent AT ablation procedure, as well as the lesion sets used for AF ablation vs the activation patterns in AT during the second procedure. RESULTS In the 38 ATs, 211 of 285 analyzed atrial areas displayed low voltage area (LVA) (74%). Eighteen percent (38/211) existed before the index ablation for AF while 82% (173/211) were newly identified as LVA during the second procedure. Ninety-nine percent (172/173) of the newly developed LVA colocalized with RF lesions delivered for PsAF. Of the 38 ATs, 89.5% (34/38) AT circuits were associated with newly developed LVA due to RF lesions whilst 10.5% (4/38) AT circuits were associated with pre-existing LVA observed at the index procedure. No AT circuit was completely independent from index RF lesions in this series. CONCLUSIONS Analysis of detailed 3D electroanatomical mapping demonstrates that most ATs after PsAF ablation are involving LVAs due to index RF lesions.
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Affiliation(s)
- Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ruairidh Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Anna Lam
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Meleze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
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Frisch DR. Identifying a Gap in a Cavotricuspid Isthmus Flutter Line Using the Advisor™ HD Grid High-Density Mapping Catheter. J Innov Card Rhythm Manag 2019; 10:3919-3922. [PMID: 32477713 PMCID: PMC7252717 DOI: 10.19102/icrm.2019.111202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/05/2019] [Indexed: 12/05/2022] Open
Abstract
This report discusses the mapping of an incomplete cavotricuspid isthmus flutter line with a high-density mapping catheter to visualize the arrhythmogenic substrate responsible for incomplete block. The relevant signals were unapparent when using a traditional ablation catheter but were evident with application of a high-density mapping catheter. High-density mapping holds promise for recording electrograms in gaps in other ablation lesion sets that may not be able to be easily identified using more traditional equipment alone.
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Münkler P, Gunawardene MA, Jungen C, Klatt N, Schwarzl JM, Akbulak RÖ, Dinshaw L, Hartmann J, Jularic M, Kahle AK, Riedel R, Merbold L, Eickholt C, Willems S, Meyer C. Local impedance guides catheter ablation in patients with ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 31:61-69. [PMID: 31701589 DOI: 10.1111/jce.14269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
AIMS Catheter contact and local tissue characteristics are relevant information for successful radiofrequency current (RFC)-ablation. Local impedance (LI) has been shown to reflect tissue characteristics and lesion formation during RFC-ablation. Using a novel ablation catheter incorporating three mini-electrodes, we investigated LI in relation to generator impedance (GI) in patients with ventricular tachycardia (VT) and its applicability as an indicator of effective RFC-ablation. METHODS AND RESULTS Baseline impedance, Δimpedance during ablation and drop rate (Δimpedance/time) were analyzed for 625 RFC-applications in 28 patients with recurrent VT undergoing RFC-ablation. LI was lower in scarred (87.0 Ω [79.0-95.0]) compared to healthy myocardium (97.5 Ω ([82.75-111.50]; P = .03) while GI did not differ between scarred and healthy myocardium. ΔLI was higher (18 Ω [9.4-26.0]) for VT-terminating as compared to non-terminating RFC-ablation (ΔLI 13 Ω [8.85-18.0]; P = .03), but did not differ for ΔGI between terminating vs nonterminating RFC-ablation. Correspondingly, LI drop rate was higher for RFC-ablation terminating the VT compared with RFC-ablation not terminating the VT (0.63 Ω/s [0.52-0.76] vs 0.32 Ω [0.20-0.58]; P = .008) while there was no difference for GI drop rate. ΔLI was higher in patients with nonischemic cardiomyopathy vs patients with ischemic cardiomyopathy (16 Ω [11.0-20.0] vs 11.0 Ω [7.85-17.00]; P = .003). CONCLUSION Our findings suggest that LI is a sensitive parameter to guide RFC-ablation in patients with VT. LI indicates differences in tissue characteristics and generally is higher in patients with nonischemic cardiomyopathy. Hence, the etiology of the underlying cardiomyopathy needs to be considered when adopting LI for monitoring catheter ablation of VT.
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Affiliation(s)
- Paula Münkler
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Melanie A Gunawardene
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Niklas Klatt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - René Riedel
- Max Planck Institute for Evolutionary Biology, Plön, Germany
| | | | - Christian Eickholt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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Solimene F, Maddaluno F, Schillaci V, García-Bolao I. Feasibility of transaortic approach to map an atrial re-entrant tachycardia within the pulmonary venous atrium in a patient with d-transposition of the great arteries after Mustard operation by using a high-density mini-basket catheter. J Cardiovasc Electrophysiol 2019; 30:2518-2519. [PMID: 31452285 DOI: 10.1111/jce.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Francesco Solimene
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Italy
| | | | - Vincenzo Schillaci
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Italy
| | - Ignacio García-Bolao
- Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Pamplona, Spain
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Rogers AJ, Bhatia NK, Brodt C, Narayan SM. Editorial: High density mapping of atrial fibrillation sources. J Cardiovasc Electrophysiol 2019; 30:964-965. [PMID: 31056801 PMCID: PMC6591061 DOI: 10.1111/jce.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Albert J Rogers
- Cardiovascular Division and Cardiovascular Institute, Stanford University, Stanford, CA
| | - Neal K Bhatia
- Cardiovascular Division and Cardiovascular Institute, Stanford University, Stanford, CA
| | - Chad Brodt
- Cardiovascular Division and Cardiovascular Institute, Stanford University, Stanford, CA
| | - Sanjiv M Narayan
- Cardiovascular Division and Cardiovascular Institute, Stanford University, Stanford, CA
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Takigawa M, Relan J, Martin R, Kim S, Kitamura T, Cheniti G, Vlachos K, Pillois X, Frontera A, Massoullié G, Thompson N, Martin CA, Bourier F, Lam A, Wolf M, Duchateau J, Klotz N, Pambrun T, Denis A, Derval N, Magat J, Naulin J, Merle M, Collot F, Quesson B, Cochet H, Hocini M, Haïssaguerre M, Sacher F, Jaïs P. Detailed Analysis of the Relation Between Bipolar Electrode Spacing and Far- and Near-Field Electrograms. JACC Clin Electrophysiol 2018; 5:66-77. [PMID: 30678788 DOI: 10.1016/j.jacep.2018.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study sought to evaluate the relation between bipolar electrode spacing and far- and near-field electrograms. BACKGROUND The detailed effects of bipolar spacing on electrograms (EGMs) is not well described. METHODS With a HD-Grid catheter, EGMs from different bipole pairs could be created in each acquisition. This study analyzed the effect of bipolar spacing on EGMs in 7 infarcted sheep. A segment was defined as a 2-mm center-to-center bipole. In total, 4,768 segments (2,020 healthy, 1,542 scar, and 1,206 in border areas, as defined by magnetic resonance imaging [MRI]) were covered with an electrode pair of spacing of 2 mm (Bi-2), 4 mm (Bi-4), and 8 mm (Bi-8). RESULTS A total of 3,591 segments in Bi-2 were free from local abnormal ventricular activities (LAVAs); 1,630 segments were within the MRI-defined scar and/or border area. Among them, 172 (10.6%) segments in Bi-4 and 219 (13.4%) segments in Bi-8 showed LAVAs. In contrast, LAVAs were identified in 1,177 segments in Bi-2; 1,118 segments were within the MRI-defined scar and/or border area. Among them, LAVAs were missed in 161 (14.4%) segments in Bi-4 and in 409 (36.6%) segments in Bi-8. In segments with LAVAs, median far-field voltage increased from 0.09 mV (25th to 75th percentile: 0.06 to 0.14 mV) in Bi-2, to 0.16 mV (25th to 75th percentile: 0.10 to 0.24 mV) in Bi-4, and to 0.28 mV (25th to 75th percentile: 0.20 to 0.42 mV) in Bi-8 (p < 0.0001). Median near-field voltage increased from 0.14 mV (25th to 75th percentile: 0.08 to 0.25 mV) in Bi-2, to 0.21 mV (25th to 75th percentile: 0.12 to 0.35 mV) in Bi-4, and to 0.32 mV (25th to 75th percentile: 0.17 to 0.48 mV) in Bi-8 (p < 0.0001). The median near-/far-field voltage ratio decreased from 1.67 in Bi-2, to 1.43 in Bi-4, and 1.23 in Bi-8 (p < 0.0001). CONCLUSIONS Closer spacing better discriminates surviving tissue from dead scar area. Although far-field voltage systematically increases with spacing, near-field voltages were more variable, depending on local surviving muscular bundles. Near-field EGMs are more easily observed with smaller spacing, largely due to the reduction of the far-field effect.
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Affiliation(s)
- Masateru Takigawa
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Jatin Relan
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France; Abbott, St. Paul, Minnesota
| | - Ruairidh Martin
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | - Takeshi Kitamura
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | | | - Xavier Pillois
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Antonio Frontera
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | | | | | - Claire A Martin
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Felix Bourier
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Anna Lam
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Michael Wolf
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | | | - Nicolas Klotz
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Arnaud Denis
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Julie Magat
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Jérôme Naulin
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Mathilde Merle
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Florent Collot
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Bruno Quesson
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | | | - Frédéric Sacher
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- CHU Bordeaux, IHU Lyric, Université de Bordeaux, Bordeaux, France
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Rodríguez-Mañero M, Valderrábano M, Baluja A, Kreidieh O, Martínez-Sande JL, García-Seara J, Saenen J, Iglesias-Álvarez D, Bories W, Villamayor-Blanco LM, Pereira-Vázquez M, Lage R, Álvarez-Escudero J, Heidbuchel H, González-Juanatey JR, Sarkozy A. Validating Left Atrial Low Voltage Areas During Atrial Fibrillation and Atrial Flutter Using Multielectrode Automated Electroanatomic Mapping. JACC Clin Electrophysiol 2018; 4:1541-1552. [PMID: 30573117 DOI: 10.1016/j.jacep.2018.08.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/17/2018] [Accepted: 08/16/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aimed: 1) to determine the voltage correlation between sinus rhythm (SR) and atrial fibrillation (AF)/atrial flutter (AFL) using multielectrode fast automated mapping; 2) to identify a bipolar voltage cutoff for scar and/or low voltage areas (LVAs); and 3) to examine the reproducibility of voltage mapping in AF. BACKGROUND It is unclear if bipolar voltage cutoffs should be adjusted depending on the rhythm and/or area being mapped. METHODS High-density mapping was performed first in SR and afterward in induced AF/AFL. In some patients, 2 maps were performed during AF. Maps were combined to create a new one. Points of <1 mm difference were analyzed. Correlation was explored with scatterplots and agreement analysis was assessed with Bland-Altman plots. The generalized additive model was also applied. RESULTS A total of 2,002 paired-points were obtained. A cutoff of 0.35 mV in AFL predicted a sinus voltage of 0.5 mV (95% confidence interval [CI]: 0.12 to 2.02) and of 0.24 mV in AF (95% CI: 0.11 to 2.18; specificity [SP]: 0.94 and 0.96; sensitivity [SE]: 0.85 and 0.75, respectively). When generalized additive models were used, a cutoff of 0.38 mV was used for AFL for predicting a minimum value of 0.5 mV in SR (95% CI: 0.5 to 1.6; SP: 0.94, SE: 0.88) and of 0.31 mV for AF (95% CI: 0.5 to 1.2; SP: 0.95, SE: 0.82). With regard to AF maps, there was no change in the classification of any left atrial region other than the roof. CONCLUSIONS It is possible to establish new cutoffs for AFL and/or AF with acceptable validity in predicting a sinus voltage of <0.5 mV. Multielectrode fast automated mapping in AFL and/or AF seems to be reliable and reproducible when classifying LVAs. These observations have clinical implications for left atrial voltage distribution and in procedures in which scar distribution is used to guide pulmonary vein isolation and/or re-isolation.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain.
| | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Department of Cardiology Houston Methodist Hospital, Houston, Texas
| | - Aurora Baluja
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Omar Kreidieh
- Cardiology Department, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Jose Luis Martínez-Sande
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain
| | - Javier García-Seara
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain
| | - Johan Saenen
- Cardiology Department, Cardiac Electrophysiology Section, University Hospital of Antwerp, Antwerp, Belgium
| | - Diego Iglesias-Álvarez
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain
| | - Wim Bories
- Cardiology Department, Cardiac Electrophysiology Section, University Hospital of Antwerp, Antwerp, Belgium
| | | | - María Pereira-Vázquez
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain
| | - Ricardo Lage
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain
| | - Julián Álvarez-Escudero
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Hein Heidbuchel
- Cardiology Department, Cardiac Electrophysiology Section, University Hospital of Antwerp, Antwerp, Belgium
| | - José Ramón González-Juanatey
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain
| | - Andrea Sarkozy
- Cardiology Department, Cardiac Electrophysiology Section, University Hospital of Antwerp, Antwerp, Belgium
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Zhou W, Wang L, Zhou B, Wu L. Catheter ablation of paroxysmal atrial fibrillation using high-density mapping-guided substrate modification. Pacing Clin Electrophysiol 2018; 41:1630-1634. [PMID: 30353561 DOI: 10.1111/pace.13524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/13/2018] [Accepted: 09/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the effect of substrate modification in paroxysmal atrial fibrillation (AF) patients prior to circumferential pulmonary vein isolation (CPVI). METHODS Patients without left atrial low-voltage and/or scar areas were defined as Group A. Patients with left atrial low-voltage and/or scar areas underwent regular CPVI (Group B) or substrate modification after CPVI (Group C). The procedural success rate and differences in the left atrial diameter (LAD) among groups were compared at 1 year postoperatively. RESULTS The procedural success rate in Group C was comparable to that in Group A (P > 0.05) and was significantly higher than that in Group B (P < 0.01). The LAD of patients in Groups A and C significantly decreased at 1 year postoperatively compared to that prior to the surgery (P < 0.05). However, no significant difference was noted in Group B. CONCLUSIONS Our study demonstrated that substrate modification could contribute to the single catheter ablation surgery success rate in patients with paroxysmal AF and narrow LAD.
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Affiliation(s)
- Wei Zhou
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Long Wang
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Bo Zhou
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Lirong Wu
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
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Koutbi L, Maille B, Peyrol M, Hourdain J, Salaun E, Deharo JC, Franceschi F. High-density mapping for catheter ablation of premature ventricular complexes originating from left ventricular papillary muscles: A case series. Pacing Clin Electrophysiol 2018; 41:1071-1077. [PMID: 29947109 DOI: 10.1111/pace.13417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Ablation of premature ventricular complexes (PVCs) originating from left-sided papillary muscles is challenging. We tested a new approach by performing high-density mapping of PVC. METHODS AND RESULTS We used a 20-pole deflectable spiral catheter during ablation procedures in four consecutive patients. Three presented with mitral valve prolapse, one with dilated cardiomyopathy. PVC burden was 24 ± 13%. The procedures lasted 182 ± 55.4 minutes, including 10 ± 3.2 minutes of radiofrequency. In all patients, mapping evidenced internal primary activation relative to the left ventricle shell (mean distance 21.3 ± 5.1 mm). Endocavitary prematurity was -38.3 ± 4.8 ms. Primary ablation success was achieved for all patients. CONCLUSIONS High-density mapping of the papillary muscles in the left ventricle using a spiral catheter may be feasible. We identified the PVC foci away from the left ventricular shell. This consolidates the assumption for the origin of these ectopic beats at the junction between the chordae tendineae and the papillary muscles.
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Affiliation(s)
- Linda Koutbi
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France
| | - Baptiste Maille
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France.,UMR MD2, Aix Marseille University (AMU), Marseille, France
| | - Michael Peyrol
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, North Hospital, France
| | - Jérôme Hourdain
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France
| | - Erwan Salaun
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France
| | - Jean-Claude Deharo
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France.,UMR MD2, Aix Marseille University (AMU), Marseille, France
| | - Frédéric Franceschi
- Department of Cardiology, Assistance Publique - Hôpitaux de Marseille (APHM), Aix-Marseille University, Timone Hospital, France.,UMR MD2, Aix Marseille University (AMU), Marseille, France
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Yamashita S, Hooks DA, Cheniti G, Jais P. High-density contact and noninvasive mapping of focal atrial tachycardia: Evidence of dual endocardial exits from an epicardial focus. Pacing Clin Electrophysiol 2018; 41:666-668. [PMID: 29318634 DOI: 10.1111/pace.13278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
We report a case of recurrent focal atrial tachycardia (AT) which mechanisms could be resolved by using noninvasive electrocardiographic imaging (ECGI) reconstructing epicardial potentials and rapid high-density endocardial contact mapping (Rhythmia™, Boston Scientific, Natick, MA, USA). ECGI demonstrated focal activity from the anterior of the left superior pulmonary vein antrum, although Rhythmia™ showed focal activity from the high anterior left atrium with the 2nd focus originating from the site where identical to the focus on the ECGI map with slightly delay (by 8 ms). Elimination of the AT by radiofrequency applications for both of the endocardial focuses indicated the dual endocardial exits from an epicardial focus.
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Affiliation(s)
- Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Avenue de Magellan, Bordeaux-Pessac, 33604, France
| | - Darren A Hooks
- Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Avenue de Magellan, Bordeaux-Pessac, 33604, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Avenue de Magellan, Bordeaux-Pessac, 33604, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Avenue de Magellan, Bordeaux-Pessac, 33604, France
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Vlachos K, Efremidis M, Letsas KP, Bazoukis G, Martin R, Kalafateli M, Lioni L, Georgopoulos S, Saplaouras A, Efremidis T, Liu T, Valkanas K, Karamichalakis N, Asvestas D, Sideris A. Low-voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1393-1402. [PMID: 28884923 DOI: 10.1111/jce.13321] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/30/2017] [Accepted: 08/14/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the extent of atrial fibrosis in paroxysmal atrial fibrillation (AF) and the correlation with ablation outcomes after pulmonary vein antral isolation (PVΑI) using a mapping system with high-resolution and high-spatial sampling. METHODS AND RESULTS We prospectively enrolled 80 consecutive patients (45 males, median age 60.26 years) with symptomatic paroxysmal AF who were scheduled for PVAI. Prior to PVAI, high-density bipolar voltage mapping (median number of 2,485 points) was carried out during sinus rhythm in all patients. Criteria for an adequate left atrium (LA) shell were > 2,000 points. Each acquired point was classified according to the peak-to-peak bipolar voltage electrogram based on two criteria (criterion A: healthy > 0.8 mV, border zone: 0.4-0.8 mV and scarred: < 0.4 mV, criterion Β: healthy: > 0.5 mV, border zone: 0.25-0.5 mV and scarred: < 0.25 mV). The extent of low-voltage area < 0.4 mV significantly predicted atrial tachyarrhythmia recurrence after the blanking period (P = 0.002). In univariate analysis, the presence of LA voltage areas < 0.4 mV more than 10% of the total surface area was the only significant predictor of arrhythmia recurrence. The analysis based on window B cutoff values failed to demonstrate any predictors of arrhythmia recurrence. CONCLUSION These data demonstrate that the existence of LA voltage areas < 0.4 mV more than 10% of the total LA surface area predicts arrhythmia recurrence following PVAI for paroxysmal AF.
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Affiliation(s)
- Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Maria Kalafateli
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Louiza Lioni
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Theodore Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Kosmas Valkanas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Nikolaos Karamichalakis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Dimitrios Asvestas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
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Neo M, Morris DG, Kuklik P, Lau DH, Dimitri H, Lim WW, Sanders P, Saint DA. Simultaneous conduction mapping and intracellular membrane potential recording in isolated atria. Can J Physiol Pharmacol 2015; 94:563-9. [PMID: 26771118 DOI: 10.1139/cjpp-2015-0194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a novel approach for simultaneously determining regional differences in action potential (AP) morphology and tissue electrophysiological properties in isolated atria. The epicardial surface of rat atrial preparations was placed in contact with a multi-electrode array (9 × 10 silver chloride electrodes, 0.1 mm diameter and 0.1 mm pitch). A glass microelectrode (100 MΩ) was simultaneously inserted into the endocardial surface to record intracellular AP from either of 2 regions (A, B) during pacing from 2 opposite corners of the tissue. AP duration at 80% of repolarisation and its restitution curve was significantly different only in region A (p < 0.01) when AP was initiated at different stimulation sites. Alternans in AP duration and AP amplitude, and in conduction velocity were observed during 2 separate arrhythmic episodes. This approach of combining microelectrode array and intracellular membrane potential recording may provide new insights into arrhythmogenic mechanisms in animal models of cardiovascular disease.
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Affiliation(s)
- Melissa Neo
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - David G Morris
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Pawel Kuklik
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Hany Dimitri
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Wei-Wen Lim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - David A Saint
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), School of Medical Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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van Poecke RMP, Maccaferri M, Tang J, Truong HT, Janssen A, van Orsouw NJ, Salvi S, Sanguineti MC, Tuberosa R, van der Vossen EAG. Sequence-based SNP genotyping in durum wheat. Plant Biotechnol J 2013; 11:809-17. [PMID: 23639032 DOI: 10.1111/pbi.12072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/08/2013] [Accepted: 03/15/2013] [Indexed: 05/10/2023]
Abstract
Marker development for marker-assisted selection in plant breeding is increasingly based on next-generation sequencing (NGS). However, marker development in crops with highly repetitive, complex genomes is still challenging. Here we applied sequence-based genotyping (SBG), which couples AFLP®-based complexity reduction to NGS, for de novo single nucleotide polymorphisms (SNP) marker discovery in and genotyping of a biparental durum wheat population. We identified 9983 putative SNPs in 6372 contigs between the two parents and used these SNPs for genotyping 91 recombinant inbred lines (RILs). Excluding redundant information from multiple SNPs per contig, 2606 (41%) markers were used for integration in a pre-existing framework map, resulting in the integration of 2365 markers over 2607 cM. Of the 2606 markers available for mapping, 91% were integrated in the pre-existing map, containing 708 SSRs, DArT markers, and SNPs from CRoPS technology, with a map-size increase of 492 cM (23%). These results demonstrate the high quality of the discovered SNP markers. With this methodology, it was possible to saturate the map at a final marker density of 0.8 cM/marker. Looking at the binned marker distribution (Figure 2), 63 of the 268 10-cM bins contained only SBG markers, showing that these markers are filling in gaps in the framework map. As to the markers that could not be used for mapping, the main reason was the low sequencing coverage used for genotyping. We conclude that SBG is a valuable tool for efficient, high-throughput and high-quality marker discovery and genotyping for complex genomes such as that of durum wheat.
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