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Gomes DA, Bello AR, Freitas P, Pereira JC, Matos DN, Lopes P, Rodrigues G, Carmo J, Gama F, Guerreiro S, Santos PG, Costa FM, Ferreira J, Carmo P, Abecasis J, Cavaco D, Morgado FB, Ferreira AM, Adragão P. Left Atrial Wall Thickness Measured by a Machine Learning Method Predicts AF Recurrence After Pulmonary Vein Isolation. J Cardiovasc Electrophysiol 2025; 36:323-330. [PMID: 39611529 DOI: 10.1111/jce.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 11/11/2024] [Accepted: 11/14/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND Left atrial (LA) remodeling plays a significant role in the progression of atrial fibrillation (AF). Although LA wall thickness (LAWT) has emerged as an indicator of structural remodeling, its impact on AF outcomes remains unclear. We aimed to determine the association between LAWT and AF recurrence after pulmonary vein isolation (PVI), as well as to evaluate the relationship between LAWT and LA fibrosis. METHODS Single-center registry of patients enrolled for radiofrequency PVI from 2016 to 2018. In all cases, a pre-ablation CT was performed within less than 48 h. Mean LAWT was retrospectively measured by a semi-automated machine learning method (ADAS 3D). A subgroup of patients also underwent pre-ablation cardiac MRI. The primary endpoint was time to AF recurrence after a 3-month blanking period. RESULTS A total of 439 patients (mean age 61 ± 12 years, 62% male, 78% with paroxysmal AF) were included. The mean LAWT was 1.4 ± 0.2 mm (0.9-1.9 mm). During a median follow-up of 5.8 (IQR: 4.9-6.6) years, 238 patients (54%) had an AF relapse. After adjusting for 8 clinical and imaging potential confounders, LAWT remained an independent predictor of time-to-recurrence (aHR: 4.25 [95% CI: 1.65-10.95], p = 0.003). AF recurrence rates were 11%, 15%, and 21%/year across terciles of increasing LAWT (log-rank p < 0.001). Additionally, the AF recurrence rate increased across the spectrum of LA structural remodeling, ranging from 8% (normal LAWT and LAVI) to 30%/year (LAWT and LAVI both increased). In the 62 patients who also underwent pre-ablation MRI, a moderate relationship between LAWT and fibrosis (assessed by late-gadolinium enhancement) was found (Spearman R 0.468; p < 0.001). CONCLUSION Mean LAWT, easily assessed by commercially available machine learning software, is an independent predictor of time to AF recurrence after PVI in the long term. Whether patients with increased LAWT should receive tailored therapy deserves further investigation.
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Affiliation(s)
- Daniel A Gomes
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Ana Rita Bello
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Pedro Freitas
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Joana Certo Pereira
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Daniel Nascimento Matos
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Pedro Lopes
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Gustavo Rodrigues
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - João Carmo
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Francisco Gama
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Sara Guerreiro
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Pedro Galvão Santos
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Francisco Moscoso Costa
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Pedro Carmo
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - João Abecasis
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Diogo Cavaco
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Francisco Bello Morgado
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - António M Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Pedro Adragão
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal
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Hwang T, Kwon O, Yu HT, Yang S, Kim D, Kim T, Uhm J, Joung B, Lee M, Hwang C, Pak H, for UTMOST Investigators. Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: UTMOST AF. J Arrhythm 2024; 40:267-277. [PMID: 38586840 PMCID: PMC10995596 DOI: 10.1002/joa3.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/25/2024] [Accepted: 02/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background High-power short-duration (HPSD) ablation creates wide, shallow lesions using radiofrequency (RF) heating. It is uncertain if adjusting RF energy based on atrial wall thickness provides extra benefits. We studied the safety and effectiveness of tailored HPSD energy based on left atrial (LA) wall thickness (LAWT) for circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF). Methods We enrolled 212 patients (68.4% male, mean age: 59.5 ± 11.0 years) and randomly assigned them to two groups: LAWT-guided CPVI (WT, n = 108) and conventional CPVI (control, n = 104). Both groups used an open irrigated-tip deflectable catheter to apply 50 W for 10 s to the posterior LA, while controls used 60 W for 15 s on other LA regions. RF delivery time in WT was titrated (15 s at LAWT > 2.1 mm, 13 s at 1.4-2.1 mm, and 11 s at <1.4 mm) according to the computed tomogram-myocardial thickness color map. Results After a mean follow-up of 13.4 ± 7.0 months, the WT and control groups showed no significant difference regarding clinical recurrence rate (13.9% vs. 5.8%, respectively; p = .061) and major complication rate (4.6% vs. 3.8%, respectively; p > .999). The total procedure time, cardioversion rate, and post-procedural AAD prescription rates did not significantly differ between the groups. Conclusions The LAWT-guided energy titration strategy did not result in improved procedural safety and efficacy compared to the conventional 50-60 W-HPSD CPVI in patients with PAF.
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Affiliation(s)
- Taehyun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Oh‐Seok Kwon
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Song‐Yi Yang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - for UTMOST Investigators
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
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Kuroda M, Takeo A, Kobayashi H, Kuji R, Mori H, Tsutsui K, Fukunaga M, Nagashima M, Korai K, Ando K, Hiroshima K. Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model. J Interv Card Electrophysiol 2024; 67:589-597. [PMID: 37691083 DOI: 10.1007/s10840-023-01633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Lesion formation during catheter ablation is influenced by the power, contact force (CF), time, and catheter stability. However, the influence of the irrigation effects on lesion formation remains unknown. METHODS An ex vivo experiment using conductive gel was performed. Using three different catheter designs (TactiFlex ™ SE [TF], IntellaNav MiFi ™ OI [MiFi], QDOT MICRO™ [QDOT]), a cross-sectional analysis of the lesion size and surface lesion type of 10g/40W lesions with a combination of various ablation times was performed in protocol 1. A longitudinal analysis (combination of various powers [30, 40, and 50W] and various ablation times with a 10g setting) was performed to investigate the influence of the auto-regulated irrigation system (QDOT) on lesion formation in protocol 2. RESULTS The lesion formation with the QDOT catheter tended to create larger ablation lesions, while that with the TF catheter created smaller lesions than the other catheters. The lesion surface characteristics were divided into two patterns: ring (MiFi catheter and QDOT) and crescent (TF) patterns. The auto-regulated irrigation system did not influence the lesion formation, and the relationship between the lesion formation and RF energy exhibited similar changes regardless of the ablation power setting. CONCLUSION The lesion formation and lesion surface characteristics differed among the different irrigation tip designs. An auto-regulated irrigation system did not affect the lesion creation or surface lesion characteristics. Care should be given to the inter-product differences in the lesion characteristics during RF catheter ablation, partly due to the irrigation flow control and tip design.
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Affiliation(s)
- Maiko Kuroda
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Ayaka Takeo
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Kobayashi
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Rei Kuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hitoshi Mori
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Kenta Tsutsui
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michio Nagashima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kengo Korai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Bai Y, Jia R, Wang X, Chan J, Cui K. Association of left atrial wall thickness with recurrence after cryoballoon ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:657-667. [PMID: 37966658 DOI: 10.1007/s10840-023-01691-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Transmural injury plays a role in successful atrial fibrillation ablation. The effect of left atrial wall thickness (LAWT) on the efficacy of radiofrequency ablation has been identified, but data on the relationship between LAWT and cryoballoon for paroxysmal atrial fibrillation (PAF) are lacking. We aim to explore the relationship between LAWT and recurrence after cryoballoon ablation (CBA). METHODS We studied 364 patients (mean age 62 years) with PAF who underwent a second-generation CBA and pre-procedure cardiac CTA. LAWT and left atrial volume index (LAVI) were obtained based on pre-procedure cardiac CTA measurements. Follow-up was at least 12 months and predictors of atrial tachyarrhythmia recurrence during follow-up were assessed. RESULTS Patients were followed up for a median of 19 (12-28) months, with an atrial tachyarrhythmia-free rate of 77.5% after cryoablation. Greater LAVI (50.0 ± 19.6 mL/m2 vs. 44.3 ± 15.4 mL/m2, P = 0.018) and greater LAWT (1.67 ± 0.24 vs. 1.46 ± 0.25 mm, P < 0.001) were associated with atrial tachyarrhythmia recurrence. The mean LAWT of PV antrum correlated with TTI (R = 0.252, P < 0.001). Adding LAWT to the established risk model improved both the discrimination and reclassification effects (IDI: 0.099, 95% CI: 0.065-0.134, P < 0.001; NRI: 0.685, 95% CI: 0.455-0.915, P < 0.001). In a multivariable Cox proportional hazard model, the mean LAWT of PV antrum (hazard ratio [HR]:3.657, 95%CI: 2.319-5.765, P < 0.001) was an independent predictor of atrial tachyarrhythmia recurrence after cryoablation. CONCLUSIONS The mean LAWT of PV antrum, obtained from preoperative measurements on CT, was associated with atrial tachyarrhythmia recurrence after cryoablation.
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Affiliation(s)
- Yixuan Bai
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ruikun Jia
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Xinmeng Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Juan Chan
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Lee SR, Park HS, Kwon S, Choi EK, Oh S. Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1811-1819. [PMID: 37595097 DOI: 10.1111/jce.16026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Although left atrial wall thickness (LAWT) is known to be varied, a fixed target Ablation Index (AI) based pulmonary vein isolation (PVI) has been suggested in catheter ablation for atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of PVI applying tailored AI based on LAWT assessed by cardiac computed tomography (CT). METHODS The thick segment was defined as the segment including ≥LAWT grade 3 (≥1.5 mm). The fixed AI strategy was defined as AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments regardless of LAWT. The tailored AI strategy consisted of AI increasing the targets to 500 on the anterior/roof segments and to 400 on the posterior/inferior/carina segments when ablating the thick segment. After PVI, acute pulmonary vein (PV) reconnection, defined by the composite of residual potential and early reconnection, was evaluated. RESULTS A total of 156 patients (paroxysmal AF 72%) were consecutively included (86 for the fixed AI group and 70 for the tailored AI group). The tailored AI group showed a significantly lower rate of segments with acute PV reconnection than the fixed AI group (8% vs. 5%, p = .007). The tailored AI group showed a trend for shorter ablation time for PVI. One-year AF/atrial tachycardia free survival rate was similar in two groups (87.2% in the fixed AI group and 90.0% in the tailored AI group, p = .606). CONCLUSION Applying tailored AI based on the LAWT was a feasible and effective strategy to reduce acute PV reconnection after PVI.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Division of Cardiology, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Sohns C, Bergau L, El-Hamriti M, Fox H, Molatta S, Braun M, Khalaph M, Imnadze G, Sommer P. Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation. Cardiol J 2022; 29:917-926. [PMID: 33346368 PMCID: PMC9788747 DOI: 10.5603/cj.a2020.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary. METHODS Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance. RESULTS Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion. CONCLUSIONS Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El-Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery and Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- 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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Boussoussou M, Szilveszter B, Vattay B, Kolossváry M, Vecsey-Nagy M, Salló Z, Orbán G, Péter P, Katalin P, Vivien NK, István O, Maurovich-Horvat P, Merkely B, Gellér L, Szegedi N. The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation. Int J Cardiovasc Imaging 2022; 38:1601-1611. [PMID: 35138472 PMCID: PMC11142952 DOI: 10.1007/s10554-022-02533-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
Abstract
Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHA2DS2-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.
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Affiliation(s)
- Melinda Boussoussou
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary.
| | - Bálint Szilveszter
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Borbála Vattay
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Márton Kolossváry
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Milán Vecsey-Nagy
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Zoltán Salló
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Gábor Orbán
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Perge Péter
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Piros Katalin
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Nagy Klaudia Vivien
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Osztheimer István
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | | | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - László Gellér
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Nándor Szegedi
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
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Liu W, Li S, Han B. It Is Necessary to Re-understand the Low-Voltage Area in Atrial Fibrillation Patients. Front Cardiovasc Med 2022; 9:919873. [PMID: 35783829 PMCID: PMC9247271 DOI: 10.3389/fcvm.2022.919873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
The presence of a low-voltage areas (LVAs) is a major feature of the progression of atrial fibrillation. Typically, the LVA is determined by invasive left atrial voltage mapping. In addition to pulmonary vein electrical isolation, Voltage-guided substrate modification by targeting LVAs in addition to PVI has been shown to be superior to conventional PVI “only” approaches regarding freedom from AF recurrences after ablation. Recent studies have found Atrial wall thickness correlates with low voltage areas, and the degree of atrial myocardial fibrosis can be better assessed by CT or MRI in combination with voltage mapping, which might help reduce the recurrence of AF after catheter ablation.
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Affiliation(s)
- Wei Liu
- Bengbu Medical College, Bengbu, China
| | - Shijie Li
- Bengbu Medical College, Bengbu, China
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
- *Correspondence: Shijie Li
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
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Kuo JY, Jin X, Sun JY, Chang SH, Chi PC, Sung KT, Mok GSP, Yun CH, Chang SC, Chung FP, Yu CH, Wu TH, Hung CL, Yeh HI, Lam CSP. Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:857360. [PMID: 35557544 PMCID: PMC9086706 DOI: 10.3389/fcvm.2022.857360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. Objectives We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. Methods We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. Results LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6–15.3) vs. 12.0 (10.2–13.7); p = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); p < 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement <0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70–0.86) among all LA wall indices. Conclusions Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF.
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Affiliation(s)
- Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Xuanyi Jin
- National Heart Centre Singapore, and Duke-National University of Singapore, Singapore, Singapore
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Jing-Yi Sun
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Sheng-Hsiung Chang
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Po-Ching Chi
- Division of Cardiology, Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Kuo-Tzu Sung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Greta S. P. Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macao, Macao SAR, China
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shun-Chuan Chang
- Holistic Education Center, Mackay Medical College, New Taipei City, Taiwan
| | - Fa-Po Chung
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hsiang Yu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tung-Hsin Wu
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- *Correspondence: Tung-Hsin Wu
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
- Chung-Lieh Hung
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Carolyn S. P. Lam
- National Heart Centre Singapore, and Duke-National University of Singapore, Singapore, Singapore
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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10
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Oh S, Joo YH, Lee E, Lee SR, Cha MJ, Choi EK, Lee JC, Lee W. Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV reconnection, and thicker wall could be associated with reconnection.
Objectives
This study aimed to evaluate the wall thickness of the PV antrum in reconnection sites using a three-dimensional (3D) wall thickness map.
Methods
A total of 91 patients who underwent a second ablation procedure due to AF recurrence were evaluated. The locations of the PV reconnection sites were confirmed in electroanatomical maps. A 3D atrial wall thickness (AWT) map was created using computed tomography scan data. The AWT values of the ablation lines of the index procedure were graded in each segment of the PV antrum: grade 1, 0.5 < AWT ≤ 1.0 mm; grade 2, 1.0 < AWT ≤ 1.5 mm; grade 3, 1.5 < AWT ≤ 2.0 mm; grade 4, 2.0 < AWT ≤ 2.5 mm; grade 5, AWT > 2.5 mm.
Results
A total of 281 PV reconnection sites among 1256 segments of the PV antrum in 79 patients were detected. The average AWT grades were 2.7 ± 1.0 and 2.2 ± 1.0 in the reconnected and non-reconnected segments, respectively (P < 0.01). Higher AWT grades were observed in the reconnected superior segments of the left superior PV, carina and inferior segments of the left inferior PV, superior and posterior segments of the right superior PV, and posterior and inferior segments of the right inferior PV.
Conclusion
The reconnected segments of the PV antrum showed thicker myocardium than the non-reconnected ones in patients with recurrent AF after catheter ablation. A wall thickness map for PV isolation could be considered for customized ablation in order to reduce PV reconnection.
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11
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Beyer C, Tokarska L, Stühlinger M, Feuchtner G, Hintringer F, Honold S, Fiedler L, Schönbauer MS, Schönbauer R, Plank F. Structural Cardiac Remodeling in Atrial Fibrillation. JACC Cardiovasc Imaging 2021; 14:2199-2208. [PMID: 34147453 DOI: 10.1016/j.jcmg.2021.04.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study sought to evaluate preablation computed tomography angiography (CTA) for atrial and epicardial features to predict atrial fibrillation (AF) recurrence after ablation. BACKGROUND Structural atrial remodeling is a process associated with occurrence or persistence of AF. Different anatomical imaging features have been proposed to influence atrial remodeling both negatively and positively as substrate for AF. METHODS Patients with nonvalvular AF underwent cardiac CTA before pulmonary vein isolation at 2 high-volume centers. Left atrial (LA) and right atrial volumes, LA wall thickness (LAWT), and epicardial adipose tissue volume and attenuation were evaluated. Additional subanalyses of electroanatomical maps were made. Follow-up was performed for at least 12 months, including subanalysis of repeated cardiac CTA studies. Interrater variability was assessed. RESULTS Of 732 patients, 270 (36.9%) had AF recurrence after a mean of 7 months. CT analysis revealed larger indexed LA volume (47.3 mL/m2 vs 43.6 mL/m2; P = 0.0001) and higher mean anterior (1.91 mm vs 1.65 mm; P < 0.0001) and posterior (1.61 mm vs 1.39 mm; P = 0.001) LAWT in patients with AF recurrence. Epicardial adipose tissue volume in patients with AF recurrence was higher (144.5 mm³ vs 128.5 mm³; P < 0.0001) and further progressed significantly in a subset of 85 patients after 2 years (+11.8 mm2 vs -3.5 mm2; P = 0.041). Attenuation levels were lower, indicating a higher lipid component associated with AF recurrence (-69.1 HU vs -67.5 HU; P = 0.001). A total of 103 atrial voltage maps were highly predictive of AF recurrence and showed good discriminatory power for patients with low voltage >50% and LAWT (1.55 ± 0.5 mm vs 1.81 ± 0.6 mm; P = 0.032). Net reclassification improvement (NRI) showed a significant incremental benefit (NRI = 0.279; P < 0.0001) when adding LAWT to established risk models. CONCLUSIONS Atrial wall thickness, epicardial fat volume, and attenuation are associated with AF recurrence in patients undergoing ablation therapy.
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Affiliation(s)
- Christoph Beyer
- Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - Lyudmyla Tokarska
- Department of Internal Medicine II, Landesklinicum Wiener Neustadt Hospital, Wiener Neustadt, Austria
| | - Markus Stühlinger
- Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Florian Hintringer
- Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - Sarah Honold
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Lukas Fiedler
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Robert Schönbauer
- Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria; Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Fabian Plank
- Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria.
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12
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Mangiafico V, Saberwal B, Lavalle C, Raharja A, Ahmed Z, Papageorgiou N, Ahsan S. The role of CT in detecting AF substrate. Trends Cardiovasc Med 2020; 31:457-466. [PMID: 33068722 DOI: 10.1016/j.tcm.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Despite technological advancements and evolving ablation strategies, atrial fibrillation catheter ablation outcome remains suboptimal for a cohort of patients. Imaging-based biomarkers have the potential to play a pivotal role in the overall assessment and prognostic stratification of AF patients, allowing for tailored treatments and individualized care. Alongside consolidated evaluation parameters, novel imaging biomarkers that can detect and stage the remodelling process and correlate it to electrophysiological phenomena are emerging. This review aims to provide a better understanding of the different types of atrial substrate, and how Computed Tomography can be used as a pre-ablation risk stratification tool by assessing the various novel imaging biomarkers, providing a valuable insight into the mechanisms that sustain AF and potentially allowing for a patient-specific ablation strategy.
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Affiliation(s)
- Valentina Mangiafico
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Bunny Saberwal
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Antony Raharja
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Zuhair Ahmed
- Queen Mary University of London, London, England.
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
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13
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Piątek‐Koziej K, Hołda J, Tyrak K, Bolechała F, Strona M, Koziej M, Lis M, Jasińska KA, Hołda MK. Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular imaging and invasive procedures. J Cardiovasc Electrophysiol 2019; 31:220-226. [DOI: 10.1111/jce.14307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/15/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Katarzyna Piątek‐Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Kamil Tyrak
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Maciej Lis
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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14
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Left atrial wall thickness is associated with the low-voltage area in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2019; 58:315-321. [DOI: 10.1007/s10840-019-00611-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022]
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15
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Fochler F, Yamaguchi T, Kheirkahan M, Kholmovski EG, Morris AK, Marrouche NF. Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia. Circ Arrhythm Electrophysiol 2019; 12:e007174. [DOI: 10.1161/circep.119.007174] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
Macroreentrant atrial tachycardia (AT) accounts for 40% to 60% of recurrent atrial arrhythmias after atrial fibrillation (AF) ablation. To describe late gadolinium enhancement magnetic resonance imaging (LGE-MRI)–detected scar-based dechanneling as new ablation strategy to treat ATs after AF ablation.
Methods:
Data from 102 patients who underwent initial AF ablation and repeat ablation for recurrent atrial arrhythmia within 1-year follow-up were analyzed. All patients underwent LGE-MRI before initial and repeat ablation. Depending on the recurrent rhythm, patients with AF and AT recurrence were assigned to group 1 or 2, respectively. Group 1 underwent fibrosis homogenization as second procedure. Group 2 underwent LGE-MRI–detected scar-based dechanneling. Both groups underwent reisolation of pulmonary veins if necessary.
Results:
Forty-six patients (45%) presented with AF, and 56 patients (55%) presented with AT recurrence during follow-up after initial ablation. In the first 25 patients from group 2, the AT was electroanatomically mapped, and a critical isthmus was defined. It was found that those isthmi were located in the regions with nontransmural scarring detected by LGE-MRI. In the last 31 patients from group 2, an empirical LGE-MRI–based dechanneling was performed solely based on the LGE-MRI results. During 1-year follow-up after second ablation, 67% patients in group 1 and 64% patients in group 2 were free from recurrence (log-rank,
P
=1.000). In group 2, 64% in the electroanatomically guided and 65% in the LGE-MRI dechanneling group were free from recurrence (log-rank,
P
=0.900).
Conclusions:
Anatomic targeting of LGE-MRI–detected gaps and superficial atrial scar is feasible and effective to treat recurrent arrhythmias post-AF ablation. Homogenization of existing scar is the appropriate treatment for recurrent AF, whereas dechanneling of existing isthmi seems the right approach for patients recurring with AT.
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Affiliation(s)
- Franziska Fochler
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
- Clinic for Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt/Saale, Germany (F.F.)
| | - Takanori Yamaguchi
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
- Department of Cardiovascular Medicine, Saga University, Japan (T.Y.)
| | - Mobin Kheirkahan
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
| | - Eugene G. Kholmovski
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City (E.G.K.)
| | - Alan K. Morris
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
| | - Nassir F. Marrouche
- Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.)
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16
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Zuo K, Li K, Liu M, Li J, Liu X, Liu X, Zhong J, Yang X. Correlation of left atrial wall thickness and atrial remodeling in atrial fibrillation: Study based on low-dose-ibutilide-facilitated catheter ablation. Medicine (Baltimore) 2019; 98:e15170. [PMID: 30985700 PMCID: PMC6485781 DOI: 10.1097/md.0000000000015170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Atrial remodeling plays a significant role during the progression of atrial fibrillation (AF). Left atrial wall thickness (LAT) is a subjective and easily acquirable indicator referring to structural remodeling. Therefore, we aimed to investigate the association between LAT and atrial remodeling substrate, and to explore the predictive role of LAT about strong maintenance substrate and poor response to catheter ablation.LAT was measured by cardiac computed tomography in 2 selected locations (roof and floor) in 100 persistent AF patients. Then the low-dose-ibutilide-facilitated catheter ablation was performed and atrial maintenance substrate was categorized as weak, mild, and strong, based on the response to circumferential pulmonary vein isolation or complex fractionated atrial electrograms ablation. During follow-up, the success rate was evaluated. LAT showed a progressive thickening tendency from weak, mild, to strong maintenance substrate (roof: 2.2 mm vs. 2.6 mm vs. 3.9 mm, P < .0001; floor: 1.7 mm vs. 2.0 mm vs. 2.5 mm, P < .0001). During follow-up, the success rate of ablation was decreased with the maintenance substrate strengthening (weak 80%, mild 64.53%, strong 31.43%, P = .009). LA roof thickness >3.10 mm might be the predictor to strong atrial maintenance substrate and poor response to ablation.LAT was associated with the remodeling extent of atrial maintenance substrate and might predict the response to catheter ablation. These findings could help the clinicians to select the appropriate ablative strategy and predict the complexity and prognosis before catheter ablation.
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Affiliation(s)
- Kun Zuo
- Heart Center & Beijing Key Laboratory of Hypertension
| | - Kuibao Li
- Heart Center & Beijing Key Laboratory of Hypertension
| | - Min Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Heart Center & Beijing Key Laboratory of Hypertension
| | - Xiaoqing Liu
- Heart Center & Beijing Key Laboratory of Hypertension
| | - Xingpeng Liu
- Heart Center & Beijing Key Laboratory of Hypertension
| | | | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension
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17
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Impacts of the body size on the left atrial wall thickness and atrial fibrillation recurrence after catheter ablation. Heart Vessels 2019; 34:1351-1359. [DOI: 10.1007/s00380-019-01357-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/01/2019] [Indexed: 12/27/2022]
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