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Karatela MF, Dowell RS, Friedman DJ, Jackson KP, Thomas KL, Piccini JP. Peak frequency mapping of atypical atrial flutter. J Cardiovasc Electrophysiol 2024; 35:950-964. [PMID: 38477184 DOI: 10.1111/jce.16221] [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: 10/06/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PF mapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters. METHODS AND RESULTS LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD-Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low-voltage as 0.1-0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t-testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low-voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58 vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4 vs. 245.1 Hz, p < .0001). CONCLUSION Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical atrial flutter.
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Affiliation(s)
- Maham F Karatela
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Robert S Dowell
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Abbott, St. Paul, Minnesota, USA
| | - Daniel J Friedman
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kevin P Jackson
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin L Thomas
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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4
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Di Cori A, Mazzocchetti L, Parollo M, Giannotti M, Canu A, Barletta V, Volpe SD, De Lucia R, Viani S, Segreti L, Soldati E, Zucchelli G, Bongiorni MG. Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations. J Interv Card Electrophysiol 2024; 67:43-51. [PMID: 35037145 DOI: 10.1007/s10840-022-01121-3] [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: 09/02/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE We evaluated the clinical impact of the high-density (HD) mapping compared with the standard low-density (LD) ablation catheter mapping technique in the treatment of AFLs. METHODS We retrospectively evaluated short and long outcomes of patients approached with an HD and a LD electro-anatomical strategy for atypical AFLs. RESULTS Eighty-seven patients were included. Patients were almost male (60%), relatively old (65 ± 8 years), with a moderate CHA2DS2Vasc score (2.3 ± 1.3), a preserved ejection fraction (58 ± 6), and moderate atrial dilatation (44 ± 7 mm). Baseline clinical characteristics were comparable between groups (p = NS). Among AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p = NS). Sinus rhythm restoration during ablation was more frequently observed in the HD group (79% vs 56%, p = 0.037), without differences in mapping time, procedural time, and radiological dose (p = NS). Overall AFL/AT/AF recurrence rate at 1, 2, and 3 years was lower in the HD group (14% vs 37% p = 0.02, 14% vs 48% p = 0.002 and 14% vs 50% p < 0.001, respectively) with a time-dependent trend only in the LD group (37% vs 48% vs 50% at 1, 2, and 3 years respectively, p = 0.059). HD mapping (OR 0.17; 95% CI 0.04-0.66) and younger age (OR 1.09; 95% CI 1.01-1.19) resulted independent predictors of overall arrhythmias at follow-up. CONCLUSIONS Short- and long-term outcomes of atypical AFL ablation were better in the case of HD mapping, which resulted independent predictor of arrhythmia recurrences.
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Affiliation(s)
- Andrea Di Cori
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Mazzocchetti
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Mario Giannotti
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Antonio Canu
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Salvatore Della Volpe
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Ezio Soldati
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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6
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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] [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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Pott A, Teumer Y, Weinmann K, Baumhardt M, Schweizer C, Buckert D, Bothner C, Rottbauer W, Dahme T. Substrate-based ablation of atypical atrial flutter in patients with atrial cardiomyopathy. IJC HEART & VASCULATURE 2022; 40:101018. [PMID: 35495579 PMCID: PMC9043977 DOI: 10.1016/j.ijcha.2022.101018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
Background Standard therapy of atypical atrial flutter (AFL) aims at deploying ablation lines between two non-conducting anatomical structures, thereby creating a line of block within the re-entry circuit. We have developed an ablation strategy, where we incorporate voltage information as a surrogate for atrial fibrosis from the electro-anatomical map (EAM) during AFL ablation procedures to create individualized, substrate-based ablation lines along the area of most pronounced low-voltage within the reentry-circuit. Objective The aim of this study was to evaluate acute procedural success and long-term outcome of a substrate-based ablation (SBA) strategy in comparison to a standard anatomically based ablation (ABA) strategy for the ablation of atypical AFL. Methods Patients that underwent ablation for AFL at our institution were included. SBA procedures were compared to ABA procedures. Endpoints were acute termination of AFL and recurrence of the index AFL or any other AFL during follow-up. Results We included 47 patients, 24 individuals (51.1%) in the SBA group and 23 patients (48.9%) in the ABA group. Most patients had signs of atrial cardiomyopathy, namely enlarged left atrial diameter (LAD) and extended amount of left atrial low-voltage areas (LVA). Termination of AFL occurred in 27 of 29 (93.1%) AFL in the SBA group and in 28 of 31 (90.3%) AFL in the ABA group (p = 0.99). Freedom from recurrence of any atypical AFL after 2.5 years was 21.5% in the ABA group compared to 48.8% in the SBA group (p = 0.047). Conclusion Substrate-based ablation is as effective as an anatomically-based ablation in the acute termination of AFL but yields better rhythm outcome with less recurrence of AFL in patients with atrial cardiomyopathy.
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Luik A, Schmidt K, Haas A, Unger L, Tzamalis P, Brüggenjürgen B. Ablation of Left Atrial Tachycardia following Catheter Ablation of Atrial Fibrillation: 12-Month Success Rates. J Clin Med 2022; 11:jcm11041047. [PMID: 35207318 PMCID: PMC8874450 DOI: 10.3390/jcm11041047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment of atrial tachycardia following catheter ablation of atrial fibrillation is often challenging. Electrophysiological studies using high-resolution 3D mapping systems have contributed significantly to their understanding, and new ablation approaches have shown high rates of acute terminations with low recurrences for the clinical AT. However, patient populations are very heterogeneous, and long-term data of the freedom from any atrial tachycardia or any arrhythmia are still sparse. To evaluate long-term success, a unified patient population and predefined ablation strategies are preferred. In this study, we present 12-month success and mean 30 month follow-up data of catheter ablation of left atrial tachycardia. All 35 patients had a history of pulmonary vein isolation (PVI), 71% of which had a previous substrate modification. A total of 54 ATs, with a mean cycle length 297 ± 86 ms, 31 macro-reentries, and 4 localized reentries, were targeted. The ablation strategy to be used was given by the study protocol, depending on the type of reentry and the number of critical isthmuses. All available ablation strategies were included: standard (anatomical) lines, individual lines, critical isthmuses, and focal ablation. All ATs were terminated by ablation. A total of 91% terminated upon the first ablation strategy. Freedom from any AT after 12 months was 82%, and from any arrhythmia, it was 77%. The multi-procedure success after 30 months was 65% for any AT and 55% for any arrhythmia. In conclusion, individual ablation strategies based on the reentry mechanism and the number of critical isthmuses seems promising and demonstrates a high long-term clinical success. Tachycardia comprising a single critical isthmus can be ablated by critical isthmus ablation only. These patients present with the highest 12-month and long-term success rates.
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Affiliation(s)
- Armin Luik
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
- Correspondence: ; Tel.: +49-721-9740
| | - Kerstin Schmidt
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Annika Haas
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Laura Unger
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany;
| | - Panagiotis Tzamalis
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Bernd Brüggenjürgen
- Institute for Health Services Research and Technical Orthopaedics, Hanover Medical School, 30625 Hannover, Germany;
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Comparison of the Anterior Septal Line and Mitral Isthmus Line for Perimitral Atrial Flutter Ablation Using Robotic Magnetic Navigation. J Interv Cardiol 2022; 2022:1793590. [PMID: 35185396 PMCID: PMC8826208 DOI: 10.1155/2022/1793590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/13/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Perimitral atrial flutter (PMAFL) is one of the most common macro-reentrant left atrial tachycardias. Mitral isthmus (MI) linear ablation is a common strategy for the treatment of PMAFLs, and anterior septum (AS) linear ablation has emerged as a novel ablation approach. We aimed at assessing the effectiveness of AS linear ablation using robotic magnetic navigation for PMAFL ablation. Methods In this retrospective study, a total of 36 consecutive patients presented with AFL as the unique arrhythmia or accompanied with atrial fibrillation (AF) who underwent catheter ablation were enrolled. Patients were classified into two groups according to the different ablation strategies, the MI line group (10 patients) and the AS line group (26 patients). Results The clinical baseline characteristics of patients in the two groups were nearly identical. There were no significant differences in procedure time (148.7 ± 46.1 vs. 123.2 ± 30.1 min, P=0.058) or radiofrequency ablation time (25.9 ± 11.4 vs. 23.5 ± 12.6 min) between the two groups. Fluoroscopy time was longer in the MI line group (8.0 ± 4.4 vs. 5.1 ± 2.7 min, P=0.024), and the acute success rate was higher in the AS line group versus the MI line group (96.2% vs. 70%, P=0.025). The long-term freedom from arrhythmia survival rate was higher in the AS line group (73%) than in the MI line group (40%) after a mean follow-up time of 37.4 months with a 3-month blanking period (P=0.049). Conclusions AS linear ablation is an effective and safe strategy for PMAFL ablation using robotic magnetic navigation.
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Influence of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract83495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The treatment of left atrial flutter is a problem that requires a deep understanding of the underlying complex mechanism of arrhythmia. Although a considerable experience exists already in understanding the mechanisms underlying atrial flutter after ablation or surgery, little is known about atypical forms of atrial flutter in patients who have not previously undergone ablation or other cardiac surgery.
Clinical case description: We present a clinical case of interventional treatment of a patient with atypical atrial flutter who had not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter.
Conclusion: When performing a surgical intervention, high-density mapping will help to visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help to minimize the RF exposure during the treatment.
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Ioannidis P, Christoforatou E, Zografos T, Charalambopoulos P, Kouvelas K, Christoulas G, Syros P, Tsitsinakis G, Kappou T, Tsoumeleas A, Floros S, Tagoulis D, Ntarladimas I, Tagoulis I, Avzotis D, Manolis AS, Vassilopoulos C. Incidence, electrophysiological characteristics, and long-term follow-up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block. J Arrhythm 2021; 37:584-596. [PMID: 34141011 PMCID: PMC8207388 DOI: 10.1002/joa3.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo-block). We aimed to study the incidence, the electrophysiological characteristics, and the long-term outcome of these patients. METHODS Seventy-two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high-density mapping. RESULTS Mitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high-density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF. CONCLUSION Perimitral atrial flutter with MI pseudo-block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonis S. Manolis
- First Department of CardiologyAthens University School of MedicineAthensGreece
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Nair GM, Nery PB. Complex Atrial Tachycardias. JACC Clin Electrophysiol 2020; 6:827-829. [DOI: 10.1016/j.jacep.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
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The evolution of mapping and ablation techniques in the treatment of atrial tachycardias occurring after atrial fibrillation ablation. J Interv Card Electrophysiol 2020; 60:493-511. [PMID: 32405890 DOI: 10.1007/s10840-020-00759-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A possible consequence of atrial fibrillation (AF) ablation is the occurrence of organized atrial tachycardias (ATs). ATs after AF ablation (ATAAF) may be more symptomatic than AF itself, thus necessitating catheter ablation. We evaluated the prognostic significance of clinical and invasive characteristics for long-term sinus rhythm (SR) maintenance following ATAAF ablation and assessed the effect of technological developments on these results. METHODS AND RESULTS Fifty-six consecutive patients with symptomatic ATAAF participated in the study and 114 ATAAF were revealed (2.04 ± 0.93 per patient). Sixty-eight ATAAF (60%) were macroreentrant and 33 (29%) were microreentrant circuits, while 13 (11%) were focal automatic tachycardias. The mean follow-up was 40 ± 18 months with 34 (61%) patients maintaining SR. Treatment with contact force (CF) catheters and EnSite AutoMap module (n = 11) showed significantly better AT/AF free rates at 1-year follow-up (10/11, 91%) compared with treatment using CF catheters but not AutoMap module (n = 13) (8/13, 62%) and treatment with use of neither of these modalities (n = 32) (16/32, 50%). Among patients with macroreentrant circuits around the mitral annulus or left atrial roof (n = 38), the group treated with complete linear lesions in anatomical isthmuses (n = 25) showed significantly better SR maintenance (19/25, 76%) compared with patients (n = 13) treated by empirical ablation in critical functional areas (6/13, 46%). CONCLUSIONS Technology advancement contributes substantially to long-term success in SR maintenance, by achieving detailed mapping and more effective ablation of ATAAF. The targeting of macroreentrant circuits by creating anatomical linear lesions appears to provide better results.
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Siebermair J, Kochhäuser S, Kupusovic J, Köhler MI, Pesch E, Vonderlin N, Kaya E, Janosi RA, Rassaf T, Wakili R. Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience. J Cardiovasc Electrophysiol 2020; 31:1631-1639. [PMID: 32314838 DOI: 10.1111/jce.14505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Simon Kochhäuser
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Jana Kupusovic
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Miriam I. Köhler
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elena Pesch
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Nadine Vonderlin
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elif Kaya
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Rolf A. Janosi
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
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