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Kokubu Y, Watanabe T, Yamada T, Morita T, Kawasaki M, Kikuchi A, Kondo T, Kawai T, Nishimoto Y, Seo M, Nakamura J, Kayama K, Tamura Y, Fujita T, Chang Y, Tanichi M, Oshita T, Fukuda Y, Fukunami M. A Rare Case of a Common Inferior Pulmonary Vein Presumed to Be a Remnant of the Common Pulmonary Vein. Intern Med 2024; 63:407-411. [PMID: 37316270 PMCID: PMC10901698 DOI: 10.2169/internalmedicine.2005-23] [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: 03/25/2023] [Accepted: 05/08/2023] [Indexed: 06/16/2023] Open
Abstract
A 74-year-old woman with an implanted physiological DDD pacemaker visited our department complaining of palpitations due to atrial fibrillation (AF). Catheter ablation therapy for AF was scheduled. Preoperative multidetector computed tomography showed that the inferior pulmonary vein (PV) was a common trunk, and the left and right superior PVs branched from the center of the left atrial roof. In addition, mapping of the left atrium before AF ablation revealed no potential in either the inferior PV or common trunk. We performed left and right superior PV and posterior wall isolation. After ablation, AF was not observed on pacemaker recordings.
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Affiliation(s)
- Yuki Kokubu
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Tetsuya Watanabe
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Takahisa Yamada
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Takashi Morita
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Masato Kawasaki
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Atsushi Kikuchi
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Takumi Kondo
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Tsutomu Kawai
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yuji Nishimoto
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Masahiro Seo
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Jun Nakamura
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Kiyomi Kayama
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yuto Tamura
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Takeshi Fujita
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yongchol Chang
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Masanao Tanichi
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Takuya Oshita
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Yuto Fukuda
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
| | - Masatake Fukunami
- Department of Cardiovascular Medicine, Hyogo Prefectural Nishinomiya Hospital, Japan
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Zhao Y, Wang Y, Hu C, Liu Y, Cheng Y, Chen H, Shu X. Left atrial strain superior to structural remodeling in identifying occult atrial fibrillation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1301-1307. [PMID: 37615292 DOI: 10.1002/jcu.23544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Occult atrial fibrillation (AF) is a significant risk factor for occult stroke but is difficult to detect. Myocardial strain, based on speckle tracking echocardiography (STE), can detect subclinical changes in left atrial (LA) function. This study aimed to investigate the diagnostic value of LA strain in identifying asymptomatic AF patients with normal electrocardiograms and healthy volunteers. METHODS A total of 354 subjects were retrospectively enrolled. Patients were divided into two groups based on whether they had AF during echocardiography. Patients with sinus rhythm during echocardiography were further divided into healthy control group and occult AF group. Patients with AF during echocardiography were further divided into paroxysmal AF group and persistent AF group. LA mechanical function measured by STE was compared between patients with asymptomatic AF and volunteers. Conventional echocardiographic indicators were measured. The diagnostic value of LA strain for identifying asymptomatic AF was assessed by univariate and multivariate regression analysis and receiver operating characteristic (ROC) curves. RESULTS Occult AF patients had higher NT-proBNP levels, larger RA area, larger LAVmax and decreased LAEF than control group. However, occult AF patients had lower NT-proBNP levels, RA area and LAVmax and higher LAEF than paroxysmal and persistent AF. The measured LA reservoir strain (LASr), LA conduit strain (LAScd), LA contraction strain (LASct) of occult AF group was significantly lower than that of control group. However, occult AF patients had preserved LAScd and LASct than paroxysmal and persistent AF. RA area, LAEF and LASr were remarkable correlation with occult AF after adjustment for NT-proBNP, LAVmax, and LAScd. The area under curve of ROC for LASr was the greatest among RA area, LAEF and LASr, with a cut-off value of 34.1% (sensitivity: 75.4%, specificity: 87.6%). CONCLUSION LASr can identify occult AF in the asymptomatic population. Patients with LASr values ≤34.1% have a higher incidence of occult cardiac dysfunction. These findings help identify patients with occult AF and further risk stratification for the AF population.
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Affiliation(s)
- Yingjie Zhao
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yanan Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Chunqiang Hu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yufei Cheng
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
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3
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Qi D, Zhang J. Relationship between anatomical characteristics of pulmonary veins and atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1235433. [PMID: 37795484 PMCID: PMC10546190 DOI: 10.3389/fcvm.2023.1235433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background The aim of the current study was to investigate the potential relationship between anatomical characteristics of pulmonary veins (PVs) and atrial fibrillation recurrence (AFR) following radiofrequency catheter ablation (RFCA), specifically focusing on PV diameter and cross-sectional orifices index (CSOA). The analysis was based on a comprehensive review of currently available literature, providing valuable insights for the prevention and treatment of AFR. Methods Data was collected from five databases, including PubMed, MEDLINE, EMBASE, and Cochrane, spanning the period from 2004 to October 2022. The search strategy utilized Medical Subject Headings (MeSH) terms related to PV diameter, PV size, PV anatomy, and AFR. Indicators of PV diameter and CSOA from the included studies were collected and analyzed, with Weight mean difference (WMD) and 95% confidence intervals (CIs) representing continuous variables. Results The meta-analysis included six studies. The results revealed that patients with AFR had a significant larger mean PV diameter compared to those without AFR (MD 0.33; 95% CI: 0.01, 0.66; P = 0.04; I2 = 33.80%). In a meta-analysis of two studies involving a total of 715 participants, we compared the diameters of the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV) between patients with AFR and patients without AFR. The results showed that there were no statistically significant differences between the two groups in any of the four data items (all P > 0.05). Additionally, the pooled estimate revealed that LSPV-CSOA, LIPV-COSA, RSPV-COSA, and RIPV-CSOA were greater in the AFR group compared to the non-AFR group, but the differences were not statistically significant (all P > 0.05). Conclusion We found evidence supporting the notion that the PV diameter of patients who experienced AFR after RFCA was significantly larger than that of patients without AFR. The findings suggested that the PV diameter could serve as a potential predictor of the risk of AFR following RFCA.
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Affiliation(s)
| | - Jianjun Zhang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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4
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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5
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You L, Zhang X, Yang J, Wang L, Zhang Y, Xie R. The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study. Front Cardiovasc Med 2021; 8:719452. [PMID: 34722655 PMCID: PMC8551484 DOI: 10.3389/fcvm.2021.719452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10 and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by these three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence following catheter ablation. Methods: There were 238 patients involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group), and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated. Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs. no recurrence, 56.58 ± 18.37 vs. 65.59 ± 18.83, respectively, p = 0.003), left atrial (LA) anteroposterior dimension (recurrence vs. no recurrence, 36.56 ± 4.65 vs. 35.00 ± 4.37, respectively; p = 0.028), and LA vertical dimension (recurrence vs. no recurrence, 56.31 ± 6.96 vs. 53.72 ± 6.52, respectively; p = 0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961-0.997). Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze, and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.
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Affiliation(s)
- Ling You
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohong Zhang
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Yang
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lianxia Wang
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Zhang
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruiqin Xie
- Second Hospital of Hebei Medical University, Shijiazhuang, China
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6
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Firouznia M, Feeny AK, LaBarbera MA, McHale M, Cantlay C, Kalfas N, Schoenhagen P, Saliba W, Tchou P, Barnard J, Chung MK, Madabhushi A. Machine Learning-Derived Fractal Features of Shape and Texture of the Left Atrium and Pulmonary Veins From Cardiac Computed Tomography Scans Are Associated With Risk of Recurrence of Atrial Fibrillation Postablation. Circ Arrhythm Electrophysiol 2021; 14:e009265. [PMID: 33576688 DOI: 10.1161/circep.120.009265] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Marjan Firouznia
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University
| | - Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Michael A LaBarbera
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Meghan McHale
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Catherine Cantlay
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Natalie Kalfas
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Paul Schoenhagen
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Imaging Institute (P.S.), Diagnostic Radiology, Cleveland Clinic
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - John Barnard
- Quantitative Health Sciences, Lerner Research Institute (J.B.), Diagnostic Radiology, Cleveland Clinic
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Anant Madabhushi
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University.,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic.,Louis Stokes Cleveland Veterans Administration Medical Center, OH (A.M.)
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7
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Cardiac Computed Tomography for Atrial Fibrillation Patients Undergoing Ablation: Implications for the Prediction of Early Recurrence. J Thorac Imaging 2021; 35:186-192. [PMID: 31145188 DOI: 10.1097/rti.0000000000000425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to correlate early recurrence of atrial fibrillation (AF) after ablation with noninvasive imaging using cardiac computed tomography (CT). METHODS CT image data of 260 patients who had undergone wide area circumferential ablation (WACA) between October 2005 and August 2010 as well as from 30 subjects in sinus rhythm without a history of AF (control group) were retrospectively analyzed. To evaluate early outcome of AF ablation, all AF patients underwent follow-up with a 30-day event monitor 3 to 4 months after ablation. In addition, a cardiac CT was also performed 3 to 4 months after ablation to exclude pulmonary vein (PV) stenosis. The presence of early AF was correlated with anatomic and functional PV and left atrial parameters, as assessed by cardiac CT. RESULTS A total of 70 patients (26.9%) were found to have early recurrence of AF. However, we found no association between PV or left atrial anatomic or functional parameters derived from cardiac imaging with early AF recurrence. Furthermore, no correlation (P>0.05) between AF recurrence and coronary artery stenosis, anatomic origin of the sinoatrial, or atrioventricular nodal arteries was observed. Finally, PV contraction did not predict AF recurrence. However, when comparing PV contraction in WACA patients with the control group, a significant (P<0.05) reduction in left superior PV and right superior PV contractility was found in patients after radiofreqency ablation. CONCLUSIONS In our relatively large cohort, cardiac CT did not yield any anatomic or functional markers for the prediction of early AF recurrence after undergoing WACA. However, our data may provide insights into functional changes that occur following ablation procedures.
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8
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Ronsoni RM, Silvestrini TL, Essebag V, Lopes RD, Lumertz Saffi MA, Luz Leiria TL. Association of the left common ostium with clinical outcome after pulmonary vein isolation in atrial fibrillation. Indian Pacing Electrophysiol J 2020; 21:95-100. [PMID: 33271275 PMCID: PMC7952770 DOI: 10.1016/j.ipej.2020.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/01/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Electrical pulmonary vein isolation (PVI) is used for the invasive treatment of atrial fibrillation (AF). However, despite the procedure’s technical evolution, the rate of AF recurrence due to electrical reconnection of the PVs is high. The aims of this study was to assess the influence of left common pulmonary venous ostium (LCO) on clinical outcomes following PVI. Methods Retrospective cohort of 254 patients who underwent the first procedure of PVI from the years 2013–2018 was assessed. Patients with persistent AF of long duration and extra-pulmonary focus associated with triggers for arrhythmia were excluded. Patients were stratified into two groups according to the presence of a LCO and received follow up for atrial tachyarrhythmia-free survival. The mean follow-up period was 28 ± 1.73 months. Results The majority were men (68.5%), with a mean age of 54 ± 12 years. With respect to the atrial anatomy, LCO occurred in 23.6% of cases after pulmonary venous angiotomography. The arrhythmia-free survival rate was 79.5% in the follow-up period. The Cox regression model was utilized and the adjusted hazard ratio for LCO was 0.36 (95% CI 0.15–0.87; p = 0.02) in terms of age, body mass index, left atrium diameter, bi-directional blocking of the cavotricuspid isthmus, persistent AF, left ventricular ejection fraction adjusted model. Conclusion Anatomic abnormality with the presence of the LCO is present in a quarter of patients undergoing AF ablation, which is associated with a lower rate of arrhythmia recurrence in our population. Pulmonary vein isolation is used for the invasive treatment of atrial fibrillation. The majority of arrhythmias triggers have their origins in the anatomic abnormality. Pulmonary vein isolation using radiofrequency ablation.
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Affiliation(s)
- Rafael M Ronsoni
- Instituto de Ritmologia Cardíaca, Joinville, Santa Catarina, Brazil; Universidade da Região de Joinville, Joinville, Santa Catarina, Brazil.
| | | | - Vidal Essebag
- Electrophysiology Department, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Tiago Luiz Luz Leiria
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil
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9
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Vaishnav AS, Alderwish E, Coleman KM, Saleh M, Makker P, Bhasin K, Bernstein NE, Skipitaris NT, Mountantonakis SE. Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score. J Interv Card Electrophysiol 2020; 61:293-302. [PMID: 32602004 DOI: 10.1007/s10840-020-00799-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective pulmonary vein isolation (PVI) with cryoablation depends on adequate occlusion of pulmonary veins (PV) by the cryoballoon and is therefore likely to be affected by PV and left atrial (LA) anatomical characteristics and variants. Thus, the objective of this study was to investigate the effect of LA and PV anatomy, evaluated by computed tomography (CT), on acute and long-term outcomes of cryoablation for atrial fibrillation (AF). METHODS Fifty-eight patients (64.72 + 9.44 years, 60.3% male) undergoing cryoablation for paroxysmal or early persistent AF were included. Pre-procedural CT images were analyzed to evaluate LA dimensions and PV anatomical characteristics. Predictors of recurrence were identified using regression analysis. RESULTS 60.3% of patients had two PVs on each side with separate ostia, whereas 29.3% and 10.3% had right middle and left common PVs, respectively. The following anatomic characteristics were found to be independent predictors of recurrence: right superior PV ostial max:min diameter ratio > 1.32, left superior PV ostial max:min diameter ratio > 1.2, right superior PV antral circumference > 69.1 mm, right inferior PV antral circumference > 61.38 mm, right superior PV angle > 22.7°. Using these factors, LA diameter and right middle PV, a scoring model was created for prediction of "unfavorable" LA-PV anatomy (AUC = 0.867, p = 0.000009, score range = 0-7). Score of ≥ 4 predicted need for longer cryoenergy ablation (p = 0.039) and more frequent switch to radiofrequency energy (p = 0.066) to achieve PVI, and had a sensitivity of 83.3% and specificity of 82.5% to predict clinical recurrence. CONCLUSION CT-based scoring system is useful to identify "unfavorable" anatomy prior to cryo-PVI, which can result in procedural difficulty and poor outcomes.
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Affiliation(s)
- Aditi S Vaishnav
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Edris Alderwish
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kristie M Coleman
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Moussa Saleh
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Parth Makker
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kabir Bhasin
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Neil E Bernstein
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Nicholas T Skipitaris
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Stavros E Mountantonakis
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA.
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10
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Coutiño H, Ströker E, Takarada K, Mugnai G, Abugattas J, Sieira J, Salghetti F, Terasawa M, Varnavas V, Maj R, Osório TG, Neach D, Brugada P, Asmundis C, Chierchia G. Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1456-1462. [DOI: 10.1111/pace.13810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/11/2019] [Accepted: 09/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Hugo‐Enrique Coutiño
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Ken Takarada
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Juan‐Pablo Abugattas
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Francesca Salghetti
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Muryo Terasawa
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Varnavas Varnavas
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Riccardo Maj
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Diego Neach
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Carlo Asmundis
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Gian‐Battista Chierchia
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
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11
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Li B, Ma H, Guo H, Liu P, Wu Y, Fan L, Cao Y, Jian Z, Sun C, Li H. Pulmonary vein parameters are similar or better predictors than left atrial diameter for paroxysmal atrial fibrillation after cryoablation. ACTA ACUST UNITED AC 2019; 52:e8446. [PMID: 31482999 PMCID: PMC6720024 DOI: 10.1590/1414-431x20198446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
Abstract
Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031–0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004–0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.
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Affiliation(s)
- Bolin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Honglan Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Medical College, Xi'an, Shaanxi, China
| | - Huihui Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lihong Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yumeng Cao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhijie Jian
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongbing Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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12
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Nakamura Y, Sohara H, Ihara M. Acute efficacy and clinical outcomes using HotBalloon for pulmonary vein isolation in patients with a left common pulmonary vein. J Cardiovasc Electrophysiol 2019; 30:1241-1249. [DOI: 10.1111/jce.13988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - Hiroshi Sohara
- The Heart Rhythm CenterTokyo Heart Center Shinagawa‐ku Tokyo Japan
| | - Minoru Ihara
- The Heart Rhythm CenterTokyo Heart Center Shinagawa‐ku Tokyo Japan
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13
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Lee WC, Lee YW, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC. Common pulmonary vein on the recurrence of atrial tachyarrhythmia after pulmonary vein isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:882-889. [PMID: 31049997 DOI: 10.1111/pace.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023]
Abstract
AIMS Catheter ablation has become an effective treatment modality for atrial fibrillation (AF). However, the relationship between common pulmonary vein (PV) and recurrent atrial tachyarrhythmia (ATA) after PV isolation (PVI) remains controversial. This study aimed to explore the function of common PV on the risk of recurrent ATA after PVI. METHODS We identified a total of 191 patients who received radiofrequency catheter ablation for paroxysmal AF at our hospital between July 2010 and December 2017 for retrospective chart review. We collected the following data for analysis: results of preprocedural computed tomography, including the anatomy of PV and left atrial (LA) volume; the incidence of early- and late-onset recurrence of ATA. We compared these characteristics between the two groups defined by the presence or absence of the late-onset recurrence of ATA. RESULTS Compared to the no ATA recurrence group, the ATA recurrence group had larger LA size, larger LA end-diastolic and systolic volumes, larger maximal diameter of PV, higher prevalence of common PV, and higher incidence of early-onset recurrence of ATA. In multivariate logistic regression analyses, presence of common PV and early-onset recurrence were independently associated with late-onset recurrence of ATA. Compared to patients without common PV, patients with common PV had larger diameter of PV and higher incidence of late-onset recurrent ATA. CONCLUSION In patients with paroxysmal AF, early-onset recurrence of ATA and the presence of common PV were independently associated with late-onset recurrent ATA after radiofrequency catheter ablation.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Wei Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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14
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Morphology and morphometry of pulmonary veins and the left atrium in multi-slice computed tomography. Surg Radiol Anat 2019; 41:721-730. [PMID: 30826845 PMCID: PMC6570701 DOI: 10.1007/s00276-019-02210-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Abstract
Purpose Pulmonary veins are involved in pathogenesis and treatment of atrial fibrillation and structures at risk during thoracic surgeries. There is lack of data regarding pulmonary vein morphology and morphometry in normal population. Methods The study was conducted using 135 chest computed tomography studies with intra-venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. 13 had atrial fibrillation.
The studies were analyzed using radiological workstation. Results Mean dimensions of the left atrium: transverse 52 mm, coronal 49 mm, and sagittal 35 mm. The mean volume of the left atrium was 93 cm3. The mean volume of the left atrium in patients with atrial fibrillation was 176 cm3. The sagittal dimension and the volume of the left atrium were correlated with age, r = 0.43 and r = 0.42, respectively. Surface area of the left inferior pulmonary vein ostium was 136 mm2, significantly less than the surface area of other ostia of pulmonary veins. The mean distance between two pulmonary veins was 5.42 mm on the right and 4.02 mm on the left side. 13 types of pulmonary veins outflow patterns were described on the right side and 5 types on the left side. 66.7% of right pulmonary veins and 82% of the left pulmonary veins emptied into the left atrium with two venous trunks on each side (the typical pattern). Conclusions Morphological features of pulmonary veins and morphometry of the left atrium and pulmonary veins are important for clinical purposes and are in accordance with previous papers.
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15
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Wang Y, Xu Y, Ling Z, Chen W, Su L, Du H, Xiao P, Liu Z, Yin Y. Radiofrequency catheter ablation for paroxysmal atrial fibrillation: outcomes during a 3-year follow-up period. J Int Med Res 2019; 47:1636-1648. [PMID: 30803295 PMCID: PMC6460609 DOI: 10.1177/0300060519828522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective This study was performed to observe the effect of radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and to explore the risk factors for late recurrence of atrial fibrillation (LRAF) after a single RFCA session. Methods In this retrospective study, 243 patients with PAF underwent RFCA and were followed up regularly. Results At a median follow-up of 37 months after a single procedure, 60.5% of patients maintained sinus rhythm (SR), and at a median follow-up of 42 months after multiple procedures, 74.9% of patients maintained SR. The statistically significant risk factors for LRAF after a single RFCA session were the left atrial diameter (LAD), left inferior pulmonary vein superior–inferior diameter (LIPV SID), PV number variation, circumferential pulmonary vein isolation (CPVI) combined with additional ablation, and early recurrence of atrial fibrillation (ERAF). The best cut-off value for LAD was 35.5 mm. Conclusions During a 3-year follow-up, about 70% of the patients with PAF maintained SR. LRAF after a single procedure was associated with the LAD, LIPV SID, PV number variation, CPVI combined with additional ablation, and ERAF.
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Affiliation(s)
- Yubing Wang
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China.,2 Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Yanping Xu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zhiyu Ling
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Weijie Chen
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Li Su
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Huaan Du
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Peilin Xiao
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zengzhang Liu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Yuehui Yin
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
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16
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Xu B, Xing Y, Xu C, Peng F, Sun Y, Wang S, Guo H. A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:717-726. [DOI: 10.1111/jce.13876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Buyun Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yangbo Xing
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Chao Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yong Sun
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Shengkai Wang
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Hangyuan Guo
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
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17
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Odozynski G, Forno ARJD, Lewandowski A, Nascimento HG, d'Avila A. Paroxysmal Atrial Fibrillation Catheter Ablation Outcome Depends on Pulmonary Veins Anatomy. Arq Bras Cardiol 2018; 111:824-830. [PMID: 30365602 PMCID: PMC6263456 DOI: 10.5935/abc.20180181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background Pulmonary veins (PV) are often the trigger to atrial fibrillation (AF).
Occasionally, left PVs converge on a common trunk (LCT) providing a simpler
structure for catheter ablation. Objective To compare the clinical characteristics and outcomes of ablation in
paroxysmal atrial fibrillation (PAF) of patients with or without LCT. Methods Case-control study of patients undergoing first-ever catheter ablation
procedure for drug refractory PAF. The information was taken from patients'
records by means of a digital collection instrument, and indexed to an
online database (Syscardio(r)). Clinical characteristics and procedures were
compared between patients with or without LCT (LCT x n-LCT), adopting a
level of statistical significance of 5%. The primary endpoint associated
with efficacy was lack of atrial arrhythmia over the follow-up time. Results One hundred and seventy two patients with PAF were included in the study, 30
(17%) LCT and 142 (83%) n-LCT. The clinical characteristics, comorbidities,
symptoms scale and risk scores did not differ between the groups. There was
AF recurrence in 27% of PAF patients in the n-LCT group and only 10% of
patients in the LCT group (OR: 3.4 p: 0.04) after a follow-up of 34 ±
17 months and 26 ± 15 months respectively. Conclusion Patients with a LCT have a significantly lower recurrence rate when compared
to patients without this structure. It is mandatory to report the results of
AF catheter ablation as a PV anatomical variation function.
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Affiliation(s)
- Gabriel Odozynski
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC - Brazil.,Serviço de Arritmia e Marcapasso - Hospital SOS Cardio, Florianópolis, SC - Brazil
| | | | - Andrei Lewandowski
- Serviço de Arritmia e Marcapasso - Hospital SOS Cardio, Florianópolis, SC - Brazil
| | | | - André d'Avila
- Serviço de Arritmia e Marcapasso - Hospital SOS Cardio, Florianópolis, SC - Brazil
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18
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Pulmonary vein volume predicts the outcome of radiofrequency catheter ablation of paroxysmal atrial fibrillation. PLoS One 2018; 13:e0201199. [PMID: 30044877 PMCID: PMC6059453 DOI: 10.1371/journal.pone.0201199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/10/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Catheter ablation of atrial fibrillation (AF) is an effective therapy for selected groups of patients. We evaluated whether quantification of left atrium (LA) or pulmonary vein (PV) by using multi-detector computed tomography (MDCT) may predict the success rate of PV isolation procedure. METHODS We included 118 patients younger than 65 years with symptomatic AF (73 paroxysmal, PAF; 45 non-paroxysmal, non-PAF). All patients underwent 256-slice MDCT prior to circumferential PV isolation to evaluate anatomy, volume and dimensions of LA and PV. RESULTS After a mean follow-up of 14 months, complete success was achieved in 50 patients (68.5%) of PAF and in 26 patients (57.8%) of non-PAF. In the PAF group, total PV volume was found to be an independent predictor of AF recurrence, whereas LA volume was not. Logistic regression analysis showed that the probability of AF recurrence was higher in patients with total PV volume greater than 12.0 cm3/BSA (m2) (AUC 0.682, 95%CI 0.541-0.822). In the non-PAF group, no independent risk factor of LA or PV size was observed for the postoperative recurrence. CONCLUSIONS The PV volume quantification may predict the success of AF ablation in PAF patients.
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19
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Skowerski M, Wozniak-Skowerska I, Hoffmann A, Nowak S, Skowerski T, Sosnowski M, Wnuk-Wojnar AM, Mizia-Stec K. Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation. BMC Cardiovasc Disord 2018; 18:146. [PMID: 30005637 PMCID: PMC6045862 DOI: 10.1186/s12872-018-0884-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG). Methods The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0. Results Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively. Conclusions The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.
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Affiliation(s)
- M Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - I Wozniak-Skowerska
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Hoffmann
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - S Nowak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - T Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
| | - M Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - A M Wnuk-Wojnar
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - K Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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20
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Kocyigit D, Yalcin MU, Gurses KM, Selin Ardali, Turk G, Canpolat U, Evranos B, Yorgun H, Hazirolan T, Aytemir K. Pulmonary vein orientation is independently associated with outcomes following cryoballoon-based atrial fibrillation ablation. J Cardiovasc Comput Tomogr 2018; 12:281-285. [PMID: 29500095 DOI: 10.1016/j.jcct.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/13/2018] [Accepted: 01/23/2018] [Indexed: 01/10/2023]
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21
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Lambert L, Marek J, Fingrova Z, Havranek S, Kuchynka P, Cerny V, Simek J, Burgetova A. The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2018; 12:418-424. [PMID: 29945850 DOI: 10.1016/j.jcct.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Catheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort. METHODS An analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed. RESULTS In overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm2 [IQR = 97] vs. 222 mm2 [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm2 vs. 364 ± 282 mm2; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively. CONCLUSIONS The anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Josef Marek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Zdenka Fingrova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - Petr Kuchynka
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Vladimir Cerny
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jan Simek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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Roney CH, Bayer JD, Cochet H, Meo M, Dubois R, Jaïs P, Vigmond EJ. Variability in pulmonary vein electrophysiology and fibrosis determines arrhythmia susceptibility and dynamics. PLoS Comput Biol 2018; 14:e1006166. [PMID: 29795549 PMCID: PMC5997352 DOI: 10.1371/journal.pcbi.1006166] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/12/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022] Open
Abstract
Success rates for catheter ablation of persistent atrial fibrillation patients are currently low; however, there is a subset of patients for whom electrical isolation of the pulmonary veins alone is a successful treatment strategy. It is difficult to identify these patients because there are a multitude of factors affecting arrhythmia susceptibility and maintenance, and the individual contributions of these factors are difficult to determine clinically. We hypothesised that the combination of pulmonary vein (PV) electrophysiology and atrial body fibrosis determine driver location and effectiveness of pulmonary vein isolation (PVI). We used bilayer biatrial computer models based on patient geometries to investigate the effects of PV properties and atrial fibrosis on arrhythmia inducibility, maintenance mechanisms, and the outcome of PVI. Short PV action potential duration (APD) increased arrhythmia susceptibility, while longer PV APD was found to be protective. Arrhythmia inducibility increased with slower conduction velocity (CV) at the LA/PV junction, but not for cases with homogeneous CV changes or slower CV at the distal PV. Phase singularity (PS) density in the PV region for cases with PV fibrosis was increased. Arrhythmia dynamics depend on both PV properties and fibrosis distribution, varying from meandering rotors to PV reentry (in cases with baseline or long APD), to stable rotors at regions of high fibrosis density. Measurement of fibrosis and PV properties may indicate patient specific susceptibility to AF initiation and maintenance. PV PS density before PVI was higher for cases in which AF terminated or converted to a macroreentry; thus, high PV PS density may indicate likelihood of PVI success. Atrial fibrillation is the most commonly encountered cardiac arrhythmia, affecting a significant portion of the population. Currently, ablation is the most effective treatment but success rates are less than optimal, being 70% one-year post-treatment. There is a large effort to find better ablation strategies to permanently cure the condition. Pulmonary vein isolation by ablation is more or less the standard of care, but many questions remain since pulmonary vein ectopy by itself does not explain all of the clinical successes or failures. We used computer simulations to investigate how electrophysiological properties of the pulmonary veins can affect rotor formation and maintenance in patients suffering from atrial fibrillation. We used complex, biophysical representations of cellular electrophysiology in highly detailed geometries constructed from patient scans. We heterogeneously varied electrophysiological and structural properties to see their effects on rotor initiation and maintenance. Our study suggests a metric for indicating the likelihood of success of pulmonary vein isolation. Thus either measuring this clinically, or running patient-specific simulations to estimate this metric may suggest whether ablation in addition to pulmonary vein isolation should be performed. Our study provides motivation for a retrospective clinical study or experimental study into this metric.
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Affiliation(s)
- Caroline H. Roney
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Jason D. Bayer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- Univ. Bordeaux, IMB UMR 5251, CNRS, F-33400 Talence, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- Hôpital Cardiologique du Haut-L’évêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Bordeaux, France
| | - Marianna Meo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- Hôpital Cardiologique du Haut-L’évêque, Université de Bordeaux, LIRYC Institute: IHU LIRYC ANR-10-IAHU-04 and Equipex MUSIC ANR-11-EQPX-0030, Bordeaux, France
| | - Edward J. Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- Univ. Bordeaux, IMB UMR 5251, CNRS, F-33400 Talence, France
- * E-mail:
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Impact of Pulmonary Vein Anatomy on Long-term Outcome of Cryoballoon Ablation for Atrial Fibrillation. Curr Med Sci 2018; 38:259-267. [DOI: 10.1007/s11596-018-1874-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 12/15/2017] [Indexed: 01/30/2023]
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24
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Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2018; 51:133-142. [PMID: 29445983 DOI: 10.1007/s10840-018-0324-4] [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: 01/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The purposes of this study were to investigate pulmonary vein cross-sectional orifice area (PV-CSOA) using intracardiac echocardiography (ICE) and to determine its association with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). METHODS We studied 77 patients undergoing initial RFCA for AF (55 paroxysmal and 22 persistent AF patients, mean age 61 ± 12 years, 59 men). The PV-CSOA was measured in each patient and expressed as an index divided by the body surface area-left superior (LSPV-CSOA), left inferior (LIPV-CSOA), right superior (RSPV-CSOA), and right inferior (RIPV-CSOA). RESULTS After a mean follow-up of 21 ± 14 months, 61 patients maintained sinus rhythm (non-recurrence group) and AF recurred in 16 patients (recurrence group). The LSPV-CSOA index was significantly greater in the recurrence group compared with the non-recurrence group (146 ± 41 vs. 126 ± 30 mm2/m2, p = 0.04). A Cox regression multivariate analysis revealed that the LSPV-CSOA was the independent predictor of AF recurrence (HR 1.02, 95% CI 1.01-1.04, p = 0.01). The LSPV-CSOA cutoff value of 154 mm2/m2 predicts AF recurrence with 50% positive predictive value and 89% negative predictive value. CONCLUSIONS The present study suggests that ICE can be used as an alternative imaging tools for assessing the PV-CSOA during RFCA and that the LSPV-CSOA index was a useful independent predictor of AF recurrence after RFCA.
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Beiert T, Lodde PC, Linneborn LP, Werner J, Prinz L, Stöckigt F, Linhart M, Lickfett L, Nickenig G, Schrickel JW, Andrié RP. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:22-27. [DOI: 10.1111/pace.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/18/2017] [Accepted: 11/26/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Pia C. Lodde
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lutz P.T. Linneborn
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jessica Werner
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lisa Prinz
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Florian Stöckigt
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Markus Linhart
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lars Lickfett
- Clinic for Cardiology and Pneumology; Mönchengladbach Germany
| | - Georg Nickenig
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jan W. Schrickel
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - René P. Andrié
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
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Delgado V, Di Biase L, Leung M, Romero J, Tops LF, Casadei B, Marrouche N, Bax JJ. Structure and Function of the Left Atrium and Left Atrial Appendage. J Am Coll Cardiol 2017; 70:3157-3172. [DOI: 10.1016/j.jacc.2017.10.063] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 12/12/2022]
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Desai Y, Levy MR, Iravanian S, Clermont EC, Kelli HM, Eisner RL, El-Chami MF, Leon AR, Delurgio DB, Merchant FM. Clinical and anatomic predictors of need for repeat atrial fibrillation ablation. World J Cardiol 2017; 9:742-748. [PMID: 29081907 PMCID: PMC5633538 DOI: 10.4330/wjc.v9.i9.742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/14/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify predictors of need for repeat procedures after initial atrial fibrillation (AF) ablation.
METHODS We identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance (CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics (determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician.
RESULTS From a cohort of 331 patients, 142 patients (43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo after the index procedure. Both male gender (81% vs 71%, P = 0.05) and lower ejection fraction (57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein (PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation (odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures.
CONCLUSION Increased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.
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Affiliation(s)
- Yaanik Desai
- Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Mathew R Levy
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Shahriar Iravanian
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Edward C Clermont
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Heval M Kelli
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Robert L Eisner
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Mikhael F El-Chami
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Angel R Leon
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - David B Delurgio
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Faisal M Merchant
- Emory University School of Medicine, Atlanta, GA 30322, United States
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
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Heeger CH, Tscholl V, Wissner E, Fink T, Rottner L, Wohlmuth P, Bellmann B, Roser M, Mathew S, Sohns C, Reißmann B, Lemeš C, Maurer T, Santoro F, Riedl J, Goldmann B, Landmesser U, Ouyang F, Kuck KH, Rillig A, Metzner A. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study. Heart Rhythm 2017; 14:1111-1118. [DOI: 10.1016/j.hrthm.2017.05.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 11/28/2022]
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29
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Shigeta T, Okishige K, Yamauchi Y, Aoyagi H, Nakamura T, Yamashita M, Nishimura T, Ito N, Tsuchiya Y, Asano M, Shimura T, Suzuki H, Kurabayashi M, Keida T, Sasano T, Hirao K. Clinical assessment of cryoballoon ablation in cases with atrial fibrillation and a left common pulmonary vein. J Cardiovasc Electrophysiol 2017; 28:1021-1027. [DOI: 10.1111/jce.13267] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Takatoshi Shigeta
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Kaoru Okishige
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Yasuteru Yamauchi
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Hideshi Aoyagi
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Tomofumi Nakamura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Mitsumi Yamashita
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Takuro Nishimura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Naruhiko Ito
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Yusuke Tsuchiya
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Mitsutoshi Asano
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Tsukasa Shimura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Hidetoshi Suzuki
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | | | | | - Tetsuo Sasano
- Arrhythmia Center; Tokyo Medical and Dental University; Tokyo Japan
| | - Kenzo Hirao
- Arrhythmia Center; Tokyo Medical and Dental University; Tokyo Japan
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Varela M, Bisbal F, Zacur E, Berruezo A, Aslanidi OV, Mont L, Lamata P. Novel Computational Analysis of Left Atrial Anatomy Improves Prediction of Atrial Fibrillation Recurrence after Ablation. Front Physiol 2017; 8:68. [PMID: 28261103 PMCID: PMC5306209 DOI: 10.3389/fphys.2017.00068] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/25/2017] [Indexed: 11/16/2022] Open
Abstract
The left atrium (LA) can change in size and shape due to atrial fibrillation (AF)-induced remodeling. These alterations can be linked to poorer outcomes of AF ablation. In this study, we propose a novel comprehensive computational analysis of LA anatomy to identify what features of LA shape can optimally predict post-ablation AF recurrence. To this end, we construct smooth 3D geometrical models from the segmentation of the LA blood pool captured in pre-procedural MR images. We first apply this methodology to characterize the LA anatomy of 144 AF patients and build a statistical shape model that includes the most salient variations in shape across this cohort. We then perform a discriminant analysis to optimally distinguish between recurrent and non-recurrent patients. From this analysis, we propose a new shape metric called vertical asymmetry, which measures the imbalance of size along the anterior to posterior direction between the superior and inferior left atrial hemispheres. Vertical asymmetry was found, in combination with LA sphericity, to be the best predictor of post-ablation recurrence at both 12 and 24 months (area under the ROC curve: 0.71 and 0.68, respectively) outperforming other shape markers and any of their combinations. We also found that model-derived shape metrics, such as the anterior-posterior radius, were better predictors than equivalent metrics taken directly from MRI or echocardiography, suggesting that the proposed approach leads to a reduction of the impact of data artifacts and noise. This novel methodology contributes to an improved characterization of LA organ remodeling and the reported findings have the potential to improve patient selection and risk stratification for catheter ablations in AF.
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Affiliation(s)
- Marta Varela
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London London, UK
| | - Felipe Bisbal
- Arrhythmia Unit-Heart Institute (iCor), Hospital Universitari Germans Trias i Pujol Badalona, Spain
| | - Ernesto Zacur
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College LondonLondon, UK; Department of Engineering Science, University of OxfordOxford, UK
| | - Antonio Berruezo
- Unitat de Fibrillació Auricular, Hospital Clínic, Universitat de Barcelona Barcelona, Spain
| | - Oleg V Aslanidi
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London London, UK
| | - Lluis Mont
- Unitat de Fibrillació Auricular, Hospital Clínic, Universitat de Barcelona Barcelona, Spain
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London London, UK
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Stabile G, Anselmino M, Soldati E, De Ruvo E, Solimene F, Iuliano A, Sciarra L, Bongiorni MG, Calò L, Gaita F. Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2016; 48:201-207. [PMID: 27714605 DOI: 10.1007/s10840-016-0189-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/16/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Left atrial volume (LA) and pulmonary vein (PV) anatomy may potentially relate to technical challenges in achieving stable and effective catheter position in case of atrial fibrillation (AF) ablation by means of "one-shot" catheters. The aim of this study was to investigate whether LA volume and PV anatomy, evaluated by computed tomography (CT) or magnetic resonance (MR) prior to ablation, predict acute and midterm outcome of AF ablation by nMARQ™. METHODS We included 75 patients (mean age 58 ± 11 years, 67 % male) with symptomatic paroxysmal AF. All patients underwent CT/MR scanning prior to catheter ablation to evaluate LA volume and PV anatomy. All the patients underwent PV isolation by nMARQ™, an open-irrigated mapping and radiofrequency (RF) decapolar ablation catheter. Ablation was guided by electroanatomic mapping allowing RF energy delivery in the antral region of PVs from ten irrigated electrodes simultaneously. RESULTS Mean LA volume was 75 ± 40 ml. A normal anatomy (4 PVs) was documented in 40 (53 %) patients and abnormal anatomy (common truncus or accessory PVs) in 35 patients. Mean procedural and fluoroscopy times were 94 ± 55 and 8 ± 5 min, respectively, without significant differences among patients with normal or abnormal anatomy (92 ± 45 vs 95 ± 64 min, p = 0.85 and 6 ± 3 vs 8 ± 4 min, p = 0.65, respectively). Mean ablation time was 14 ± 3 min, and 99 % of the targeted veins were isolated with a mean of 23 ± 5 RF pulses per patient. After a mean follow-up of 17 ± 8 months, 23 (31 %) patients had an atrial arrhythmia recurrence. Neither LA volume nor PV anatomy was a predictor of outcome. CONCLUSIONS LA volume and PV anatomy did not affect procedural data and outcome in patients who underwent PV isolation by an open-irrigated mapping and RF decapolar ablation catheter.
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Affiliation(s)
| | - Matteo Anselmino
- Dipartimento di Scienze Mediche, Università di Torino, Torino, Italy
| | - Ezio Soldati
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | | | | | | | | | - Fiorenzo Gaita
- Dipartimento di Scienze Mediche, Università di Torino, Torino, Italy
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Buist TJ, Gal P, Ottervanger JP, Smit JJJ, Ramdat Misier AR, Delnoy PPHM, Adiyaman A, Jager PL, Elvan A. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2016; 10:251-7. [DOI: 10.1016/j.jcct.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/07/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Sanchis L, Prat S, Sitges M. Cardiovascular Imaging in the Electrophysiology Laboratory. ACTA ACUST UNITED AC 2016; 69:595-605. [PMID: 27107802 DOI: 10.1016/j.rec.2016.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/09/2016] [Indexed: 10/21/2022]
Abstract
In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.
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Affiliation(s)
- Laura Sanchis
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Susanna Prat
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Sitges
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Kiliszek M, Kozluk E, Franaszczyk M, Lodzinski P, Piatkowska A, Ploski R, Opolski G. The 4q25, 1q21, and 16q22 polymorphisms and recurrence of atrial fibrillation after pulmonary vein isolation. Arch Med Sci 2016; 12:38-44. [PMID: 26925117 PMCID: PMC4754358 DOI: 10.5114/aoms.2015.48284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/20/2014] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The efficacy of pulmonary vein isolation (PVI) in atrial fibrillation (AF) is well documented. Several single nucleotide polymorphisms (SNPs) are associated with AF, mainly in the 4q25 locus, but also in 16q22 and 1q21. The aim of our study was to test the association between those SNPs and short- and long-term results of PVI. MATERIAL AND METHODS Patients with AF who underwent PVI between 2006 and 2009 were included in the study. Pulmonary vein isolation was performed using a 4-mm non-irrigated ablation catheter, circular mapping catheter, and the LocaLisa system. All patients were genotyped for the 4q25, 16q22, and 1q21 SNPs. RESULTS Two-hundred and thirty-eight patients were included. The median follow-up was 45 months. Six-month efficacy was 59.7%. None of the polymorphisms was linked with the risk of AF recurrence after 6 months in univariate analysis. In multivariate analysis rs2200733 in the recessive model was linked significantly with AF recurrence (odds ratio 1.87, p = 0.008). None of the polymorphisms predicted AF recurrence in long-term follow-up. CONCLUSIONS There is a trend in the relationship between TT genotype of the rs2200733 polymorphism and increased rate of AF recurrence after PVI in short-term (6 months) follow-up. None of the tested SNPs 4q25, 16q22, and 1q21 correlated with the results of a single AF ablation in long-term follow-up.
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Affiliation(s)
- Marek Kiliszek
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Edward Kozluk
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maria Franaszczyk
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Lodzinski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Piatkowska
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Klimek-Piotrowska W, Hołda MK, Piątek K, Koziej M, Hołda J. Normal distal pulmonary vein anatomy. PeerJ 2016; 4:e1579. [PMID: 26793429 PMCID: PMC4715466 DOI: 10.7717/peerj.1579] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/17/2015] [Indexed: 01/23/2023] Open
Abstract
Background. It is well known that the pulmonary veins (PVs), especially their myocardial sleeves play a critical role in the initiation and maintenance of atrial fibrillation. Understanding the PV anatomy is crucial for the safety and efficacy of all procedures performed on PVs. The aim of this study was to present normal distal PV anatomy and to create a juxtaposition of all PV ostium variants. Methods. A total of 130 randomly selected autopsied adult human hearts (Caucasian) were examined. The number of PVs ostia was evaluated and their diameter was measured. The ostium-to-last-tributary distance and macroscopic presence of myocardial sleeves were also evaluated. Results. Five hundred forty-one PV ostia were identified. Four classical PV ostia patterns (two left and two right PVs) were observed in 70.8% of all cases. The most common variant was the classical pattern with additional middle right PV (19.2%), followed by the common ostium for the left superior and the inferior PVs (4.44%). Mean diameters of PV ostia (for the classical pattern) were: left superior = 13.8 ± 2.9 mm; left inferior = 13.3 ± 3.4 mm; right superior = 14.3 ± 2.9 mm; right inferior = 13.7 ± 3.3 mm. When present, the additional middle right PV ostium had the smallest PV ostium diameter in the heart (8.2 ± 4.1 mm). The mean ostium-to-last-tributary (closest to the atrium) distances were: left superior = 15.1 ± 4.6 mm; left inferior = 13.5 ± 4.0 mm; right superior = 11.8 ± 4.0 mm; right inferior = 11.0 ± 3.7 mm. There were no statistically significant differences between sexes in ostia diameters and ostium-to-last-tributary distances. Conclusion. Only 71% of the cases have four standard pulmonary veins. The middle right pulmonary vein is present in almost 20% of patients. Presented data can provide useful information for the clinicians during interventional procedures or radiologic examinations of PVs.
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Affiliation(s)
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Piątek
- Department of Anatomy, Jagiellonian University Medical College , Krakow , Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College , Krakow , Poland
| | - Jakub Hołda
- Department of Anatomy, Jagiellonian University Medical College , Krakow , Poland
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Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
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Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
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Martín-Garre S, Pérez-Castellano N, Quintanilla JG, Ferreiros J, Pérez-Villacastín J. Predictores de pérdida luminal de venas pulmonares tras ablación por radiofrecuencia. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Pulmonary vein orientation assessment: Is it necessary in patients undergoing contact force sensing guided radiofrequency catheter ablation of atrial fibrillation. IJC HEART & VASCULATURE 2015; 8:1-5. [PMID: 28785670 PMCID: PMC5497231 DOI: 10.1016/j.ijcha.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/06/2014] [Accepted: 03/24/2015] [Indexed: 11/22/2022]
Abstract
Purpose We hypothesized that pulmonary vein (PV) orientation influences tissue contact of the contact force (CF) sensing radiofrequency ablation catheter (CFC) and therefore atrial fibrillation (AF) free survival after pulmonary vein isolation (PVI). The aim of this study was to determine the association between PV orientation, CF and AF free survival in patients undergoing CFC PVI. Methods Sixty consecutive patients undergoing CFC PVI were included. ECG-triggered cardiac CT scans were obtained in all patients before PVI, and the PV orientation was measured at the insertion in the LA for all PVs in both the transverse and frontal plane. PVs were assigned to 1 of 4 orientation groups: ventral–caudal, dorsal–caudal, ventral–cranial and dorsal–cranial. Results Mean age was 59 years, 88% had paroxysmal AF. AF free survival off anti-arrhythmic drugs after a median follow-up of 12 months was 58% after a single PVI procedure. No association was found between PV orientation and CF. Furthermore, no association was found between PV orientation and AF free survival. In univariate analysis, the number of lesions with a mean CF of 10 g was associated with AF free survival. However, in multivariate analysis, only the AF duration was significantly associated with AF free survival. Conclusions This study shows that in patients undergoing PVI with the CFC ablation system, PV orientation does not affect CF and is not associated with AF free survival. PV orientation assessment does not appear to be necessary in patients undergoing CFC PVI.
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Hauser TH, Essebag V, Baldessin F, McClennen S, Yeon SB, Manning WJ, Josephson ME. Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2015; 17:49. [PMID: 26082185 PMCID: PMC4470356 DOI: 10.1186/s12968-015-0151-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The relationship between pulmonary vein (PV) anatomy and successful catheter ablation of atrial fibrillation (AF) is poorly understood METHODS First-pass contrast enhanced PV magnetic resonance angiography was performed in 71 consecutive patients prior to PV isolation. PV diameter and cross-sectional area (CSA) were measured prior to PV isolation. Any symptomatic or asymptomatic AF >10s was considered a recurrence. Early recurrence was defined as recurrent AF ≤30 days after PV isolation, while late recurrence of AF was defined as recurrent AF >30 days after. RESULTS At 1 year, 57% had any recurrence of AF while 41% had late recurrence of AF. Study subjects with one or more PV diameter in the top 10(th) percentile had trend toward more early recurrent AF (HR 1.99, p = 0.053). Study subjects with one or more PV CSA in the top 10th percentile had more late recurrent AF (HR 2.25, p = 0.039) and a trend toward more early recurrent AF (HR 1.94, p = 0.064). With multivariate analysis, PV size was not associated with early recurrent AF, but late recurrent AF was associated with one or more large PV, increased left atrial size, and non-paroxysmal AF. Study subjects with all three of these risk factors had a 100% rate of late recurrent AF at 1 year, while those with none had a 7% rate of late recurrent AF. CONCLUSIONS Larger PV size is independently associated with more late recurrent AF after PV isolation. Determination of PV size prior to PV isolation may predict procedural success.
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Affiliation(s)
- Thomas H. Hauser
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
| | - Vidal Essebag
- />Division of Cardiology, McGill University Health Center, Montreal, Canada
| | | | - Seth McClennen
- />Harbor Medical Associates, South Weymouth, Massachusetts
| | - Susan B. Yeon
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
- />Division of Cardiology, McGill University Health Center, Montreal, Canada
- />Azienda Ospedaliera Treviso, Treviso, Italy
- />Harbor Medical Associates, South Weymouth, Massachusetts
- />UpToDate, Waltham, Massachusetts
- />Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Warren J. Manning
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
- />Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark E. Josephson
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
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Güler E, Güler GB, Demir GG, Kizilirmak F, Güneş HM, Barutçu I, Kiliçaslan F. Effect of Pulmonary Vein Anatomy and Pulmonary Vein Diameters on Outcome of Cryoballoon Catheter Ablation for Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:989-96. [PMID: 25974075 DOI: 10.1111/pace.12660] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence. METHODS We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined. RESULTS The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF. Paroxysmal AF and persistent AF were detected in 55.6% (30) and 44.4% (24) of the patients, respectively. Mean procedural and fluoroscopy times were 73 ± 19 minutes and 16 ± 4 minutes, respectively. The number of the patients with PV variation of right pulmonary vein (RPV) with >2 ostia and accessory PV was 27.8% (15) and 18.5% (10). During the follow-up, 20.4% (11) of patients had AF recurrence. Patients with recurrence had greater transverse LA size (62 ± 6 mm vs 57 ± 5 mm, P: 0014), longitudinal LA size (65 ± 5 mm vs 61 ± 6 mm, P: 0025), LA volume (78 ± 17 mL vs 65 ± 14 mL, P: 0011), fluoroscopy time (20.4 ± 4.6 minutes vs 15.7 ± 3.5 minutes, P: 0001), RPV with >2 ostia (72.7% vs 27.3%, P: 0001), right upper pulmonary vein (RUPV) diameter (21.6 ± 2.8 cm vs 15.8 ± 2.1 cm; P < 0001), and persistent AF (33.3% vs 66.7%, P: 0046). In multivariate analysis, RUPV diameter (β: 1006; P: 0010; odds ratio [OR]: 2736; 95% confidence interval [CI]: [1267-5906]) and fluoroscopy time (β: 0327; P: 0050; OR: 1386; 95% CI: [1000-1921]) were determined as independent predictors for AF recurrence. CONCLUSIONS Transverse and longitudinal LA size, LA volume, fluoroscopy time, presence of persistent AF, RUPV size, and the number of RPV ostia are associated with AF recurrence following cryoballoon-based ablation. RUPV size and fluoroscopy time are predictors for recurrence.
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Affiliation(s)
- Ekrem Güler
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
| | - Gamze Babur Güler
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
| | | | - Filiz Kizilirmak
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
| | - Haci Murat Güneş
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
| | - Irfan Barutçu
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
| | - Fethi Kiliçaslan
- Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey
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Nedios S, Kosiuk J, Koutalas E, Kornej J, Sommer P, Arya A, Richter S, Rolf S, Husser D, Hindricks G, Bollmann A. Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2015; 43:237-44. [DOI: 10.1007/s10840-015-0010-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Kim JB, Yang DH, Kang JW, Jung SH, Choo SJ, Chung CH, Song JK, Lee JW. Left atrial function following surgical ablation of atrial fibrillation: prospective evaluation using dual-source cardiac computed tomography. Yonsei Med J 2015; 56:608-16. [PMID: 25837164 PMCID: PMC4397428 DOI: 10.3349/ymj.2015.56.3.608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The Maze procedure has shown excellent efficacy in the elimination of atrial fibrillation (AF); however, little is known about the quality of functional recovery in the left atrium (LA) following successful sinus rhythm conversion by the Maze procedure. MATERIALS AND METHODS We prospectively enrolled 12 patients (aged 52.5±10.1 years, 1 female) with valvular AF undergoing mitral valve surgery combined with the Maze procedure. Parameters of LA function in three anatomic compartments [anterior, posterior, and LA appendage (LAA)] were evaluated using electrocardiography-gated dual-source cardiac CT at one month and at six months after surgery. Twelve subjects matched by age, gender, and body surface area served as controls. RESULTS At one month after surgery, ejection fraction (EF) and emptying volume (EV) of the LA were 14.9±7.4% and 21.3±9.7 mL, respectively, and they were significantly lower than those of the control group (EF, 47.9±11.2%; EV, 46.0±10.7%; p<0001). These values did not significantly change throughout late periods (p=0.22 and 0.21, respectively). Functional contributions of the anterior, posterior, and appendage compartments (EV of each compartment/overall EV) were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection (n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects (p<0.001). CONCLUSION Contractile functions of the LA significantly decreased after the Maze procedure. Functional contributions of three compartments of the LA were also altered. The influence of LAA preservation on postoperative LA functions needs to be evaluated through studies of larger populations.
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Affiliation(s)
- Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Predictors of Luminal Loss in Pulmonary Veins After Radiofrequency Ablation. ACTA ACUST UNITED AC 2015; 68:1085-91. [PMID: 25911168 DOI: 10.1016/j.rec.2014.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The reported incidences of stenosis after radiofrequency ablation of pulmonary veins are highly variable. Moreover, most studies have focused on severe stenosis and have overlooked mild stenosis. Our aims were to study postablation morphological changes in the pulmonary veins and to evaluate preablation magnetic resonance imaging predictors for stenosis. METHODS Eighty consecutive patients with atrial fibrillation underwent cardiac magnetic resonance imaging before undergoing radiofrequency ablation. Magnetic resonance imaging was repeated a median of 95 days after ablation. Ostium area/ellipticity and atrial volume were blindly assessed. We evaluated the presence of stenosis and classified it as mild (< 50% area reduction), moderate (50%-70%), and severe (> 70%). RESULTS Postablation stenosis was identified in 78 of 322 veins (24.2%). The stenosis was mild in 66 (84.6%), moderate in 11 (14.1%), and severe in 1 (1.3%). All of them were asymptomatic. The left inferior pulmonary vein showed the highest frequency of stenosis, which was detected in 26% of them (P < .001). A multiple regression analysis revealed that left inferior pulmonary vein (odds ratio = 3.089; P = .02) and a greater preablation ostium area (odds ratio = 1.009; P < .001) were independent predictors for postablation stenosis. Age (odds ratio = 1.033) showed a strong trend to statistical significance (P = .06). CONCLUSIONS After ablation, vein ostia size is reduced and stenosis is detected in less than one third of patients. Most cases are mild, and severe stenosis is rare. Postablation stenosis is more likely to develop in older patients, those with larger vein ostia, and in the left inferior pulmonary veins.
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Kiuchi K, Yoshida A, Takei A, Fukuzawa K, Itoh M, Imamura K, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Hirata KI, Kanda G, Okajima K, Shimane A, Yamada S, Taniguchi Y, Yasaka Y, Kawai H. Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation. J Arrhythm 2015; 31:286-92. [PMID: 26550084 DOI: 10.1016/j.joa.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA. METHODS Sixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7 mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated. RESULTS After the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02-1.12, p=0.001; odds ratio: 0.41, CI: 0.21-0.77, p=0.006). CONCLUSION Enlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence.
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Akihiro Yoshida
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Asumi Takei
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Mitsuaki Itoh
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Kimitake Imamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ryudo Fujiwara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Atsushi Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Tomoyuki Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Soichiro Yamashita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Gaku Kanda
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Katsunori Okajima
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Akira Shimane
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Shinichiro Yamada
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yasuyo Taniguchi
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Hiroya Kawai
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
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Kanaji Y, Miyazaki S, Iwasawa J, Ichihara N, Takagi T, Kuroi A, Nakamura H, Taniguchi H, Hachiya H, Iesaka Y. Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation. J Cardiol 2015; 67:115-21. [PMID: 25847091 DOI: 10.1016/j.jjcc.2015.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/22/2015] [Accepted: 02/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) provides accurate imaging of the pulmonary vein (PV) and left atrial (LA) anatomy. This study aimed to evaluate the prevalence and morphological characteristics of anatomical variants that could influence atrial fibrillation (AF) ablation procedures. METHODS AND RESULTS One thousand forty consecutive patients (62±10 years, 243 female, 644 paroxysmal AF) undergoing pre-procedural imaging with a 320-row CT and their first AF ablation procedure were analyzed. A total of 194 (18.7%) patients had anatomical variants. Left, right, and inferior common PVs were observed in 118, 5, and 6 patients, respectively. Three right and left PVs were observed in 44 and 4 patients, respectively. Three patients had remnants of PVs after lobectomies, and significant PV stenosis was observed in one. Supernumerary PVs that drained into the LA and diverticula were observed in eight patients. One patient had a string-like structure connecting the LA septum and posterior LA, and the others had membranous structures incompletely compartmentalizing the LA. Three patients had persistent left superior vena cavae, two strong deviations of the LA and PVs, and one dexiocardia. All patients underwent successful PV isolation during the index procedure. CONCLUSIONS Patients referred for AF ablation often have anatomical variants, which could influence the procedure. This information might aid in planning procedural strategies, and reducing unexpected procedural complications in AF ablation.
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Affiliation(s)
- Yoshihisa Kanaji
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
| | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Noboru Ichihara
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takamitsu Takagi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Schluermann F, Krauss T, Biermann J, Hartmann M, Trolese L, Pache G, Bode C, Asbach S. In vivo contact force measurements and correlation with left atrial anatomy during catheter ablation of atrial fibrillation. Europace 2015; 17:1526-32. [PMID: 25745072 DOI: 10.1093/europace/euu410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/24/2014] [Indexed: 12/28/2022] Open
Abstract
AIMS Lesion formation during catheter ablation crucially depends on catheter-tissue contact. We sought to evaluate the impact of anatomical characteristics of the left atrium (LA) and the pulmonary veins (PVs) on contact force (CF) measurements. METHODS AND RESULTS An anatomical map of the LA was obtained in 25 patients prior to catheter ablation of atrial fibrillation. Contact force (operator blinded) and local bipolar electrogram amplitudes (EGM) were measured in eight pre-defined segments around the PVs. After unblinding, points with low CF (≤5 g) were corrected to CF >5 g, and the distance between points was measured. In a pre-procedural computed tomography of the heart, LA volume as well as sizes and circumferences of the PV ostia were measured and correlated to CF measurements. Four hundred and twenty-six points in eight pre-defined LA locations were assessed. Low CF (<5 g) was found in 25.0% (43.5%) of points superior, 33.3% (66.7%) anterior, 32.1% (44.4%) inferior, and 15.5% (15.9%) posterior to the right (left) PVs. The mean distance after correction was 5.8 ± 3.4 mm. Local bipolar electrogram amplitudes between low- and high-CF points did not differ (1.21 ± 1.54 vs. 1.13 ± 1.3 mV, P = ns). The mean CF at the left PVs was significantly lower than at the right PVs (7.91 ± 3.74 vs. 13.95 ± 6.34 g, P < 0.001), with the lowest CF anterior to the left PVs (5.2 ± 3.6 g). Contact force measurements did not correlate to LA volume, size, and circumference of the PVs. CONCLUSION Contact force during LA mapping significantly differs according to the location within the LA. These differences are independent of LA volume and anatomy of the PV ostia.
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Affiliation(s)
- Fabienne Schluermann
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Tobias Krauss
- Department of Radiology, University Hospital, Freiburg, Germany
| | - Juergen Biermann
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Maximilian Hartmann
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Luca Trolese
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Gregor Pache
- Department of Radiology, University Hospital, Freiburg, Germany
| | - Christoph Bode
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Stefan Asbach
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
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Rettmann ME, Holmes DR, Breen JF, Ge X, Karwoski RA, Monahan KH, Bahnson TD, Packer DL, Robb RA. Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 118:198-206. [PMID: 25476706 PMCID: PMC4365943 DOI: 10.1016/j.cmpb.2014.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/16/2014] [Accepted: 11/04/2014] [Indexed: 06/04/2023]
Abstract
RATIONALE AND OBJECTIVES Geometric analysis of the left atrium and pulmonary veins is important for assessing reverse structural remodeling following cardiac ablation therapy. Most volumetric analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or in image slices. In this work, we describe a technique for making semi-automatic measurements of left atrial volume and pulmonary vein diameters from high resolution CT scans and demonstrate its use for analyzing reverse structural remodeling following cardiac ablation therapy. METHODS The left atrium and pulmonary veins are segmented from high-resolution computed tomography (CT) volumes using a 3D volumetric approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. Left atrial volume and pulmonary vein ostial diameters are then automatically computed from the segmented structures. Validation experiments are conducted to evaluate accuracy and repeatability of the measurements. Accuracy is assessed by comparing left atrial volumes computed with the proposed methodology to a manual slice-by-slice tracing approach. Repeatability is assessed by making repeated volume and diameter measurements on duplicated and randomized datasets. The proposed techniques were then utilized in a study of 21 patients from the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) pilot study who were scanned both before and approximately 3 months following ablation therapy. RESULTS In the high resolution CT scans the left atrial volume measurements show high accuracy with a mean absolute difference of 2.3±1.9 cm(3) between volumes computed with the proposed methodology and a manual slice-by-slice tracing approach. In the intra-rater repeatability study, the mean absolute difference in left atrial volume was 4.7±2.5 cm(3) and 4.4±3.4 cm(3) for the two raters. Intra-rater repeatability for pulmonary vein diameters ranged from 0.9 to 2.3 mm. The inter-rater repeatability for left atrial volume was 5.8±5.1 cm(3) and inter-rater repeatability for pulmonary vein diameter measurements ranged from 1.4 to 2.3 mm. In the patient study, significant (p<.05) decreases in left atrial volume and all four pulmonary vein diameters were observed. The absolute change in LA volume was 20.0 cm(3), 95%CI [12.6, 27.5]. The left inferior pulmonary vein diameter decreased 2.1 mm, 95%CI [0.4, 3.7], the left superior pulmonary vein diameter decreased 3.2 mm, 95%CI [1.0, 5.4], the right inferior pulmonary vein diameter decreased 1.5 mm, 95%CI [0.3, 2.7], and the right superior pulmonary vein diameter decreased 2.8 mm, 95%CI [1.4, 4.3]. CONCLUSIONS Using the proposed techniques, we demonstrate high accuracy of left atrial volume measurements as well as high repeatability for left atrial volume and pulmonary vein diameter measurements. Following cardiac ablation therapy, a significant decrease was observed for left atrial volume as well as all four pulmonary vein diameters.
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Affiliation(s)
- Maryam E Rettmann
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - David R Holmes
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Jerome F Breen
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Xin Ge
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Ronald A Karwoski
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Kristi H Monahan
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Tristram D Bahnson
- Duke Center for Atrial Fibrillation, Duke University Medical Center; Division of Cardiac Electrophysiology, Department of Medicine, Duke University, Durham, NC 27708, United States
| | - Douglas L Packer
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
| | - Richard A Robb
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
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49
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Gal P, Ooms JFW, Ottervanger JP, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPHM, Jager PL, Elvan A. Association between pulmonary vein orientation and atrial fibrillation-free survival in patients undergoing endoscopic laser balloon ablation. Eur Heart J Cardiovasc Imaging 2015; 16:799-806. [DOI: 10.1093/ehjci/jeu321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/18/2014] [Indexed: 11/14/2022] Open
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50
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Vizzardi E, Curnis A, Latini MG, Salghetti F, Rocco E, Lupi L, Rovetta R, Quinzani F, Bonadei I, Bontempi L, D'Aloia A, Dei Cas L. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown) 2014; 15:235-53. [PMID: 23114271 DOI: 10.2459/jcm.0b013e328358554b] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation is the most common arrhythmia managed in clinical practice and it is associated with an increased risk of mortality, stroke and peripheral embolism. Unfortunately, the incidence of atrial fibrillation recurrence ranges from 40 to 50%, despite the attempts of electrical cardioversion and the administration of antiarrhythmic drugs. In this review, the literature data about predictors of atrial fibrillation recurrence are highlighted, with special regard to clinical, therapeutic, biochemical, ECG and echocardiographic parameters after electrical cardioversion and ablation. Identifying predictors of success in maintaining sinus rhythm after cardioversion or ablation may allow a better selection of patients to undergo these procedures. The aim is to reduce healthcare costs and avoid exposing patients to unnecessary procedures and related complications. Recurrent atrial fibrillation depends on a combination of several parameters and each patient should be individually assessed for such a risk of recurrence.
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Affiliation(s)
- Enrico Vizzardi
- Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
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