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Kashiwagi M, Kuroi A, Higashimoto N, Mori K, Terada K, Katayama Y, Takemoto K, Taruya A, Shiono Y, Tanimoto T, Kitabata H, Tanaka A. Association of left pulmonary vein trunk and subclinical atrial fibrillation in patients with cardiac implantable electronic device. Heart Vessels 2024:10.1007/s00380-024-02423-4. [PMID: 38822844 DOI: 10.1007/s00380-024-02423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
The relationship between subclinical atrial fibrillation (SCAF) and left pulmonary vein anatomy is unknown. This study sought to investigate whether left pulmonary vein trunk predict the development of SCAF in patients with cardiac implantable electronic device (CIED). We also examined the relationship between the duration of SCAF and left pulmonary vein trunk. We retrospectively enrolled 162 patients who underwent implantation of dual-chamber CIEDs and follow-up by remote monitoring system. Computed tomography was used to measure the length of the left pulmonary vein. During median follow up of 2.7 years, the episodes of > 6 min and > 24 h SCAF were observed in 61 (37.7%) and 24 (14.8%) patients, respectively. The diagnosis of sinus node disease (HR: 3.66 [2.06-6.52], P < 0.01 and HR: 2.68 [1.09-6.62], P = 0.04) and left atrial diameter (HR: 1.04 [1.00-1.07], P = 0.04 and HR: 1.05 [1.00-1.10], P = 0.04) were independent predictors for > 6 min and > 24 h SCAF, respectively. Length of the left pulmonary vein trunk was an independent predictor for > 6 min SCAF (HR: 1.06 [1.02-1.10], P < 0.01), but not for > 24 h SCAF (P = 0.06). Sinus node disease, size of the left atrium and length of the left pulmonary vein trunk were related to SCAF. The left pulmonary vein trunk might especially contribute as a trigger rather than as a driver of development of atrial fibrillation.
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Affiliation(s)
- Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Natsuki Higashimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Kazuya Mori
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Yosuke Katayama
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
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Housari MA, Miraglia V, Terasawa M, Kazawa S, Monte AD, Bala G, Pannone L, Della Rocca DG, Cosyns B, Droogmans S, Tanaka K, Belsack D, De Mey J, Overeinder I, Almorad A, Sieira J, Brugada P, Sarkozy A, Chierchia GB, de Asmundis C, Ströker E. Pulmonary Vein Remodeling Between Atrial Fibrillation Subtypes: A Matched Comparison Cardiac Computed Tomography-Based Study Between Patients With Paroxysmal and Persistent Atrial Fibrillation. Am J Cardiol 2023; 207:100-107. [PMID: 37734298 DOI: 10.1016/j.amjcard.2023.08.151] [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: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
Although pulmonary vein (PV) isolation (PVI) is the cornerstone for atrial fibrillation (AF) ablation, no data exist comparing PV anatomy between AF subtypes directly. We aimed to compare PV anatomic characteristics between paroxysmal (PAF) and persistent AF (PeAF) in a matched population using cardiac computed tomography (CCT). Fifty-eight PeAF patients (with CCT prior first AF ablation procedure, absence of valvular disease/previous cardiac intervention), and 58 age-, sex-, body surface area-matched PAF patients were evaluated for left atrial (LA) and PV anatomy: ostial area, ovality index (OVI), transverse/frontal angles. In PeAF vs PAF group, beside higher LA volume index (LAVI), PVs' ostial areas were significantly larger (between 64 - 101 mm2, P < 0.001 for all PVs; remaining valid after LAVI adjustment for left superior [LS], left inferior [LI], and right inferior [RI]PV); left PVs were less oval (0.7 - 0.11 OVI decrease, P =0.039 for LSPV; P = 0.012 for LIPV); LSPV (P = 0.019), LIPV (P < 0.001), RIPV (P = 0.029) were more posteriorly directed; whereas LSPV (P = 0.002), and right superior PV (P = 0.043) were more superiorly directed. Incidence of anatomic variations or early branching was not different. This study showed significant anatomical PV differences between patients with PeAF and PAF, in terms of PV orientation, ostial size and ovality. Anticipating such anatomical differences may aid in choosing the adequate catheter design and technology for PeAF ablation.
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Affiliation(s)
- Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium; Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shuichiro Kazawa
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium; Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, University Hosipital Brussels, Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, University Hosipital Brussels, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, University Hospital Brussels - Free University Brussels, European Reference Networks Guard-Heart, Brussels, Belgium.
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Kashiwagi M, Ojima T, Hayata K, Kitadani J, Takeuchi A, Kuroi A, Higashimoto N, Taniguchi M, Tanimoto T, Kitabata H, Tanaka A. Impact of pulmonary vein anatomy and left atrial size on postoperative atrial fibrillation after esophagectomy for esophageal cancer. Esophagus 2023; 20:626-634. [PMID: 37347342 DOI: 10.1007/s10388-023-01018-8] [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: 03/27/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) after esophagectomy and pre-existing cardiac substrate. METHODS We retrospectively analyzed 212 consecutive patients from between July 2010 and December 2022 who were scheduled to undergo esophagectomy for esophageal cancer without previous history of atrial fibrillation. All the patients underwent both echocardiography and contrast-enhanced multi-detector computed tomography (MDCT). RESULTS POAF occurred in 49 patients (23.1%). Multivariable logistic analysis demonstrated that independent predictors for POAF were age [OR; 1.06 (1.01-1.10), P < 0.01), three-field lymph node dissection [OR; 2.55 (1.25-5.23), P < 0.01), left atrial dilatation (> 35 mm) assessment by echocardiography [OR; 3.05 (1.49-6.25), P < 0.01) and common left pulmonary vein [OR; 3.03 (1.44-6.39), P < 0.01). The correlation coefficient was high for left atrial dimensions assessed by echocardiography and MDCT (r = 0.91, P < 0.01). Combination of left atrial dilatation by echocardiography and common left pulmonary vein had high odds ratio [OR; 8.10 (2.62-25.96), P < 0.01). Instead of echocardiographic assessment, combination of left atrial enlargement (> 35 mm) assessed by MDCT and common left pulmonary vein also showed high odds ratio for POAF [OR; 11.23 [2.19-57.63], P < 0.01). CONCLUSION Incidence of POAF after esophagectomy was related to both left atrial enlargement and common left pulmonary vein assessed by preoperative MDCT. Additional analysis of atrial size and pulmonary vein variation would facilitate preoperative assessment of the risk of POAF, but future studies must ascertain therapeutic strategy.
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Affiliation(s)
- Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Keiji Hayata
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Junya Kitadani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihiro Takeuchi
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Natsuki Higashimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Motoki Taniguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Benali K, Lai VD, Hammache N, Magnin-Poull I, de Chillou C, Sellal JM. Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters. J Interv Card Electrophysiol 2022; 66:931-940. [PMID: 36251129 DOI: 10.1007/s10840-022-01393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory. METHODS Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation. RESULTS Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95-2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60-0.97, p = 0.046). CONCLUSION This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, CHU de Saint-Etienne, 42270, Saint-Priest-En-Jarez, France. .,INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.
| | - Van Duc Lai
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Isabelle Magnin-Poull
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Christian de Chillou
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Jean-Marc Sellal
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
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Rossi S, Abdala L, Woodward A, Vavalle JP, Henriquez CS, Griffith BE. Rule-based definition of muscle bundles in patient-specific models of the left atrium. Front Physiol 2022; 13:912947. [PMID: 36311246 PMCID: PMC9597256 DOI: 10.3389/fphys.2022.912947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered clinically, and as the population ages, its prevalence is increasing. Although the CHA2DS2−VASc score is the most used risk-stratification system for stroke risk in AF, it lacks personalization. Patient-specific computer models of the atria can facilitate personalized risk assessment and treatment planning. However, a challenge faced in creating such models is the complexity of the atrial muscle arrangement and its influence on the atrial fiber architecture. This work proposes a semi-automated rule-based algorithm to generate the local fiber orientation in the left atrium (LA). We use the solutions of several harmonic equations to decompose the LA anatomy into subregions. Solution gradients define a two-layer fiber field in each subregion. The robustness of our approach is demonstrated by recreating the fiber orientation on nine models of the LA obtained from AF patients who underwent WATCHMAN device implantation. This cohort of patients encompasses a variety of morphology variants of the left atrium, both in terms of the left atrial appendages (LAAs) and the number of pulmonary veins (PVs). We test the fiber construction algorithm by performing electrophysiology (EP) simulations. Furthermore, this study is the first to compare its results with other rule-based algorithms for the LA fiber architecture definition available in the literature. This analysis suggests that a multi-layer fiber architecture is important to capture complex electrical activation patterns. A notable advantage of our approach is the ability to reconstruct the main LA fiber bundles in a variety of morphologies while solving for a small number of harmonic fields, leading to a comparatively straightforward and reproducible approach.
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Affiliation(s)
- Simone Rossi
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Simone Rossi, ; Boyce E. Griffith,
| | - Laryssa Abdala
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Andrew Woodward
- Advanced Medical Imaging Lab, UNC Chapel Hill, Chapel Hill, NC, United States
| | - John P. Vavalle
- Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Craig S. Henriquez
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Boyce E. Griffith
- Department of Mathematics, UNC Chapel Hill, Chapel Hill, NC, United States
- Department of Biomedical Engineering, UNC Chapel Hill, Chapel Hill, NC, United States
- McAllister Heart Institute, UNC Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Simone Rossi, ; Boyce E. Griffith,
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6
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Imnadze G, Sciacca V, Fink T, Braun M, Sohns C, El Hamriti M, Revishvili A, Sommer P. [What the ablationist should know about pulmonary vein anatomy]. Herzschrittmacherther Elektrophysiol 2022; 33:154-160. [PMID: 35581354 DOI: 10.1007/s00399-022-00858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
The importance of anatomy in daily clinical practice of the interventional electrophysiologist is crucial, especially for pulmonary vein isolation which is a predominantly anatomy-based approach. Many anatomical and morphological studies focusing on this topic were published in last two decades. In this article we are refreshing the knowledge of anatomy and morphology of the pulmonary veins and present them from a clinical perspective.
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Affiliation(s)
- Guram Imnadze
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland.
| | - Vanessa Sciacca
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Thomas Fink
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Martin Braun
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Christian Sohns
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Mustapha El Hamriti
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Amiran Revishvili
- Vishnevsky National Medical Research Centre of Surgery, Moskau, Russland
| | - Philipp Sommer
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
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7
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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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8
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Szegedi N, Vecsey-Nagy M, Simon J, Szilveszter B, Herczeg S, Kolossváry M, Idelbi H, Osztheimer I, Klaudia Nagy V, Tahin T, Széplaki G, Delgado V, Bax JJ, Maurovich-Horvat P, Merkely B, Gellér L. Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation. Eur Heart J Cardiovasc Imaging 2021; 23:515-523. [PMID: 33693618 DOI: 10.1093/ehjci/jeab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. METHODS AND RESULTS We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15-2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19-0.71, P = 0.003). CONCLUSION Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.
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Affiliation(s)
- Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Hana Idelbi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Vivien Klaudia Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Tamás Tahin
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar.,Department of Radiology, Medical Imaging Center, Semmelweis University, 2 Koranyi Sandor Street, 1082 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
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9
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Bengel P, Herting J, Zabel M, Lüthje L. Pulmonary vein ablation in a patient with a large left common pulmonary vein joining a large right common trunk. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 33204953 PMCID: PMC7649454 DOI: 10.1093/ehjcr/ytaa244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 07/03/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Jonas Herting
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Herz & Gefäßzentrum Göttingen, Göttingen, Germany
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10
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Larsen JM, Deyell MW, Macle L, Champagne J, Sarrazin JF, Leong-Sit P, Badra-Verdu M, Sapp J, Khairy P, Andrade JG. Impact of Left Common Pulmonary Veins in the Contact-Force vs. Cryoballoon Atrial Fibrillation Ablation (CIRCA-DOSE) Study. J Cardiovasc Electrophysiol 2020; 31:2300-2307. [PMID: 32627264 DOI: 10.1111/jce.14652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Concerns remain regarding the effectiveness of PVI using the fixed diameter non-compliant cryoballoon in the presence of a left common pulmonary vein (LCPV). We sought to evaluate the effectiveness of PVI performed by contact-force guided radiofrequency (CF-RF) versus second-generation cryoballoon-based ablation in patients with LCPV. METHODS AND RESULTS We enrolled 346 patients with paroxysmal AF and randomized them to CF-RF or cryoballoon ablation. PV anatomy was not assessed prior to enrolment, and there were no exclusions based on PV anatomy. All patients received an implantable cardiac monitor. LCPV was observed in 13.6% of patients (47/346). Left atrial time and fluoroscopy time did not differ between those with and without LCPV (P=0.58 and P=0.06, respectively). Freedom from any atrial tachyarrhythmia at one year was observed in 46.8% with LCPV and 54.5% without LCPV (P=0.06). In those with LCPV the freedom from any atrial tachyarrhythmia did not differ between those randomized to CF-RF or cryoballoon ablation (HR for recurrence 1.19, 95% CI 0.53-2.65, P=0.69). In those with LCPV the AF burden was reduced to a similar extent with CF-RF and cryoballoon ablation (99.7% vs. 99.5%, respectively; P=0.97). CONCLUSIONS In this randomized clinical trial, the presence of a LCPV was associated with a trend towards higher rates of arrhythmia recurrence following PVI. No significant difference in arrhythmia recurrence was observed between patients with LCPV randomized to cryoballoon ablation or contact-force guided RF ablation, suggesting that either ablation modality is suitable in this population. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE], NCT01913522) This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jacob M Larsen
- Department of Cardiology, Aalborg University Hospital, Denmark
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Canada
- Center for Cardiovascular Innovation, Vancouver, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
| | | | | | - Peter Leong-Sit
- Department of Medicine, University of Western Ontario, London, Canada
| | | | - John Sapp
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Canada
| | - Paul Khairy
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Canada
- Center for Cardiovascular Innovation, Vancouver, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
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11
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Kim S, Kim YH, Lee SH, Kim JS. Pulmonary Vein Enlargement as an Independent Predictor for New-Onset Atrial Fibrillation. J Clin Med 2020; 9:jcm9020401. [PMID: 32024250 PMCID: PMC7074413 DOI: 10.3390/jcm9020401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022] Open
Abstract
Pulmonary vein (PV) enlargement is associated with atrial fibrillation (AF). However, the predictive value of PV volume for new-onset AF has not been determined. We retrospectively assessed and enrolled non-AF subjects who underwent echocardiography and cardiac CT angiography (CCTA) around the same time and evaluated the development of AF longitudinally. PV volume was assessed by estimating the three-dimensional CCTA-derived mid-diastolic PV volume from the ostium to tertiary branches. Overall, 1105 subjects were enrolled. Among them, 29 developed AF during a mean follow-up of 4.28 ± 3.08 years after baseline CCTA and echocardiography. The AF group had a higher proportion of older aged subjects, a higher ratio of early mitral flow velocity (E) to early mitral annular tissue velocity (Em), higher Em, and larger left atrial (LAVI) and PV (PVVI) volume indices. PVVI was independently associated with male sex, left ventricular dimension, E/Em and LAVI. AF incidence increased markedly across each baseline PVVI tertile (2.2%, 5.1%, and 10.8%). In the multivariate Cox model, increased PVVI was independently associated with new-onset AF (hazard ratio (HR) = 5.401, 4.931–6.193, p = 0.007). Based on the analysis of multimodal cardiac imaging, our results provide mechanistic insights into PV remodeling and its potential role as a link between diastolic dysfunction and developing AF.
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Affiliation(s)
- Sunwon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, Korea; (S.K.); (Y.-H.K.)
| | - Yong-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, Korea; (S.K.); (Y.-H.K.)
| | - Seung-Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, Korea;
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, Korea; (S.K.); (Y.-H.K.)
- Correspondence: or ; Tel.: +82-31-8099-6349
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12
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Cheruiyot I, Munguti J, Olabu B, Gichangi P. A meta-analysis of the relationship between anatomical variations of pulmonary veins and atrial fibrillation. Acta Cardiol 2020; 75:1-9. [PMID: 30736723 DOI: 10.1080/00015385.2018.1544204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Our aim was to provide an evidence-based assessment of the relationship between pulmonary vein variants and atrial fibrillation (AF).Methods: A comprehensive systematic search was performed on the databases PubMed, EMBASE, Cochrane library and Science Direct. Following assessment of eligibility and methodologic quality, data on PV variants were extracted and pooled into a meta-analysis.Results: A total of 12 studies (1337 cases and 1250 controls) were included. Presence of a right middle pulmonary vein was significantly associated with AF (OR = 1.85, 95% CI 1.26-2.72, p = .002). No significant association was however noted between presence of a common pulmonary vein ostia and AF. In the analysis of ostial diameters, the strongest association was observed between increased left common ostia diameter and AF (OR = 2.71, 95% CI 0.99-4.44, p = .002), followed by right superior (OR = 2.39, 95% CI 1.76-3.02, p < .00001), left superior (OR = 2.30, 95% CI 1.48-3.13, p < .00001), right inferior (OR = 2.19, 95% CI 1.69-2.69, p < .00001) and left inferior (OR = 1.79, 95% CI 1.25-2.34, p < .00001) pulmonary veins.Conclusion: The findings of the current study support the hypothesis that pulmonary vein variations predispose to AF. Further studies into the role of structural abnormalities of the pulmonary veins variations in the genesis of AF are recommended.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Jeremiah Munguti
- Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Beda Olabu
- Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Peter Gichangi
- Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi, Kenya
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13
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Istratoaie S, Roșu R, Cismaru G, Vesa ȘC, Puiu M, Zdrenghea D, Pop D, Buzoianu AD. The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation. ACTA ACUST UNITED AC 2019; 55:medicina55110727. [PMID: 31690031 PMCID: PMC6915429 DOI: 10.3390/medicina55110727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 minutes) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.
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Affiliation(s)
- Sabina Istratoaie
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
| | - Radu Roșu
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Gabriel Cismaru
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Ștefan C Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
| | - Mihai Puiu
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Dumitru Zdrenghea
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Dana Pop
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Anca D Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
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14
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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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15
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Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, Garcia F. Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It. Circulation 2019; 137:2278-2294. [PMID: 29784681 DOI: 10.1161/circulationaha.117.031343] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. For these reasons, ICE has largely replaced transesophageal echocardiography as ideal imaging modality for guiding certain procedures, such as atrial septal defect closure and catheter ablation of cardiac arrhythmias, and has an emerging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluoroscopy, such as the interatrial or interventricular septum, papillary muscles, and intracavitary muscular ridges. Most recently, a three-dimensional (3D) volumetric ICE system has also been developed, with potential for greater anatomic information and a promising role in structural interventions. In this state-of-the-art review, we provide guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | - Luis C Saenz
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia. Instituto de Cardiologia. Centro Internacional de Arritmias "Andrea Natale," Fundacion Cardioinfantil, Bogota, Colombia (L.C.S.)
| | - Raphael Rosso
- Cardiac Eletrophysiology, Cardiology Division, Tel-Aviv Souraski Medical Center, Israel (R.R.)
| | | | - David Callans
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | | | - Fermin Garcia
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
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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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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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18
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Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during Pulmonary Vein Isolation. PLoS One 2016; 11:e0157886. [PMID: 27327662 PMCID: PMC4915682 DOI: 10.1371/journal.pone.0157886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022] Open
Abstract
Objective We had the objective to determine the impact of clinical parameters and anticoagulation status on cerebral microembolic signals (MES) during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Background Thromboembolism and stroke are the most feared complications of PVI. MES can help to evaluate embolic burden. It is unknown whether clinical parameters have an impact on embolic risk during PVI. Methods In this retrospective analysis we investigated the impact of clinical parameters, including the CHADS2- and CHA2DS2-VASc-score, pulmonary vein variants and echocardiographic parameters on MES rates in patients that underwent PVI using three different ablation approaches (radiofrequency ablation (iRF), pulmonary vein ablation catheter (PVAC) with deactivated electrode pair 1 or 5 (PVAC-red) or PVAC without deactivation (PVAC-all). Results 118 AF patients (61±12 years) were included between 2011 and 2013 (Median: 489 MES during PVI). Patients were more likely to have more MES (within 4th quartile) with the PVAC-all approach (60.7% vs. 25.0% (iRF) vs. 14.3% (PVAC-red) respectively (p<0.001). Patients with oral anticoagulation (OAC) pre-ablation were more likely to have lower MES-counts (1st-3rd quartile); (65.6% vs. 35.7%; p = 0.005). Additionally, patients with lower MES counts (1st-3rd quartile) had significantly higher INR values than those in the 4th quartile (1.78 vs. 1.09; p = 0.029). 2 patients developed a potentially thromboembolic event during the procedure. Conclusion Clinical predictors of cerebral emboli and stroke do not correlate with cerebral embolic burden during PVI. Pre-ablation OAC and increased INR values correlate with decreased MES-rates. Therefore, it might be beneficial to perform PVI with pre-ablation anticoagulation even in low risk patients.
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PADMANABHAN DEEPAK, ASIRVATHAM SAMUELJ. Friendly Fire-The Bane of Thermal Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:313-5. [DOI: 10.1111/pace.12825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | - SAMUEL J. ASIRVATHAM
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Division of Pediatrics and Adolescent Medicine; Mayo Clinic; Rochester Minnesota
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Ströker E, de Asmundis C, Saitoh Y, Velagić V, Mugnai G, Irfan G, Hünük B, Tanaka K, Belsack D, Buyl R, Brugada P, Chierchia GB. Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon. Heart Rhythm 2016; 13:342-51. [DOI: 10.1016/j.hrthm.2015.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 10/22/2022]
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21
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Zhou M, Liao Y, Tu X. The role of transcription factors in atrial fibrillation. J Thorac Dis 2015; 7:152-8. [PMID: 25713730 DOI: 10.3978/j.issn.2072-1439.2015.01.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 12/09/2014] [Indexed: 12/21/2022]
Abstract
Atrial fibrillation (AF) is a complex disease that results from genetic and environmental factors and their interactions. In recent years, genome-wide association studies (GWAS) and family-based linkage analysis have found amounts of genetic variants associated with AF. Some of them lie in coding sequences and thus mediate the encoded proteins, some in non-coding regions and influence the expression of adjacent genes. These variants exert influence on the development of cardiovascular system and normal cardiac electrical activity in different levels, and eventually contribute to the occurrence of AF. Among these affected genes, as a crucial means of transcriptional regulation, several transcription factors play important roles in the pathogenesis of AF. In this review, we will focus on the potential role of PITX2, PRRX1, ZHFX3, TBX5, and NKX2.5 in AF.
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Affiliation(s)
- Mengchen Zhou
- 1 Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan 430074, China ; 2 Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yuhua Liao
- 1 Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan 430074, China ; 2 Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
| | - Xin Tu
- 1 Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan 430074, China ; 2 Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
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Characterization of Pulmonary Vein Dimensions Using High-Definition 64-Slice Computed Tomography prior to Radiofrequency Catheter Ablation for Atrial Fibrillation. Cardiol Res Pract 2014; 2014:179632. [PMID: 25089213 PMCID: PMC4096392 DOI: 10.1155/2014/179632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/26/2014] [Indexed: 12/20/2022] Open
Abstract
Background. Contrast-enhanced computed tomography is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AFib) to guide the procedure. We analyzed pulmonary vein (PV) ostial diameter and volumes on a high-definition 64-slice CT (HDCT) scanner in patients with AFib prior to RFCA. Methods and Results. This retrospective study included 50 patients (mean age 60.2 ± 11.4 years, 30 males) undergoing cardiac HDCT scanning before RFCA for drug refractory AFib and 50 age-, BMI-, and sex-matched controls with normal sinus rhythm undergoing HDCT. PV ostial diameter and volume were measured and calculated using a semiautomatic calliper tool. Total ostial PV volume was significantly increased in patients with AFib as compared to controls (P < 0.005). Similarly, total ostial PV diameter was significantly increased in AFib compared to controls (P < 0.001). In AFib, the largest PV volume and diameters were measured in right superior PV (P < 0.05 versus controls). The difference in PV volume between patients and controls was most pronounced in right superior PVs (P = 0.015). Right middle PVs were found more often in patients with AFib (16/50; 32%) than in normal subjects (7/50; 14%). Conclusion. Enlargement of PV ostial area and enlargement of volume are frequent findings in patients with drug refractory AFib. These parameters may add to the risk stratification for AFib recurrence following RFCA.
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Rettmann ME, Holmes DR, Linte CA, Packer DL, Robb RA. Toward Standardized Mapping for Left Atrial Analysis and Cardiac Ablation Guidance. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2014; 9036:90361K. [PMID: 26401067 PMCID: PMC4576350 DOI: 10.1117/12.2043191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In catheter-based cardiac ablation, the pulmonary vein ostia are important landmarks for guiding the ablation procedure, and for this reason, have been the focus of many studies quantifying their size, structure, and variability. Analysis of pulmonary vein structure, however, has been limited by the lack of a standardized reference space for population based studies. Standardized maps are important tools for characterizing anatomic variability across subjects with the goal of separating normal inter-subject variability from abnormal variability associated with disease. In this work, we describe a novel technique for computing flat maps of left atrial anatomy in a standardized space. A flat map of left atrial anatomy is created by casting a single ray through the volume and systematically rotating the camera viewpoint to obtain the entire field of view. The technique is validated by assessing preservation of relative surface areas and distances between the original 3D geometry and the flat map geometry. The proposed methodology is demonstrated on 10 subjects which are subsequently combined to form a probabilistic map of anatomic location for each of the pulmonary vein ostia and the boundary of the left atrial appendage. The probabilistic map demonstrates that the location of the inferior ostia have higher variability than the superior ostia and the variability of the left atrial appendage is similar to the superior pulmonary veins. This technique could also have potential application in mapping electrophysiology data, radio-frequency ablation burns, or treatment planning in cardiac ablation therapy.
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Affiliation(s)
- M E Rettmann
- Biomedical Imaging Resource, Rochester, Minnesota 55905, USA
| | - D R Holmes
- Biomedical Imaging Resource, Rochester, Minnesota 55905, USA
| | - C A Linte
- Biomedical Engineering and Center for Imaging Science, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - D L Packer
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, Minnesota 55905, USA
| | - R A Robb
- Biomedical Imaging Resource, Rochester, Minnesota 55905, USA
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Xie WH, Chang C, Xu YJ, Li RG, Qu XK, Fang WY, Liu X, Yang YQ. Prevalence and spectrum of Nkx2.5 mutations associated with idiopathic atrial fibrillation. Clinics (Sao Paulo) 2013; 68:777-84. [PMID: 23778487 PMCID: PMC3674279 DOI: 10.6061/clinics/2013(06)09] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/13/2013] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence and spectrum of Nkx2.5 mutations associated with idiopathic atrial fibrillation (AF). METHODS A cohort of 136 unrelated patients with idiopathic atrial fibrillation and 200 unrelated, ethnically matched healthy controls were enrolled. The coding exons and splice junctions of the Nkx2.5 gene were sequenced in 136 atrial fibrillation patients, and the available relatives of mutation carriers and 200 controls were subsequently genotyped for the identified mutations. The functional characteristics of the mutated Nkx2.5 gene were analyzed using a dual-luciferase reporter assay system. RESULTS Two novel heterozygous Nkx2.5 mutations (p.N19D and p.F186S) were identified in 2 of the 136 unrelated atrial fibrillation cases, with a mutational prevalence of approximately 1.47%. These missense mutations co-segregated with atrial fibrillation in the families and were absent in the 400 control chromosomes. Notably, 2 mutation carriers also had congenital atrial septal defects and atrioventricular block. Multiple alignments of the Nkx2.5 protein sequences across various species revealed that the altered amino acids were completely conserved evolutionarily. Functional analysis demonstrated that the mutant Nkx2.5 proteins were associated with significantly reduced transcriptional activity compared to their wild-type counterpart. CONCLUSION These findings associate the Nkx2.5 loss-of-function mutation with atrial fibrillation and atrioventricular block and provide novel insights into the molecular mechanism involved in the pathogenesis of atrial fibrillation. These results also have potential implications for early prophylaxis and allele-specific therapy of this common arrhythmia.
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Affiliation(s)
- Wen-Hui Xie
- Shanghai Jiao Tong University School of Medicine, Shanghai Chest Hospital, Department of Nuclear Medicine, Shanghai 200030, China
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A New Classification for Right Top Pulmonary Vein. Ann Thorac Surg 2013; 95:1227-30. [DOI: 10.1016/j.athoracsur.2013.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 12/03/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
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26
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Wang W, Buehler D, Hamzei A, Wang X, Yuan X. Comprehensive surgical approach to treat atrial fibrillation in patients with variant pulmonary venous anatomy. J Thorac Cardiovasc Surg 2013; 145:790-5. [DOI: 10.1016/j.jtcvs.2012.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/31/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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Schmidt M, Straube F, Ebersberger U, Dorwarth U, Wankerl M, Krieg J, Hoffmann E. [Cardiac computed tomography and ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2012; 23:281-288. [PMID: 23212602 DOI: 10.1007/s00399-012-0239-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
Both cardiac computed tomography (CT) and interventional electrophysiology (EP) have evolved considerably in recent years. Technical improvements in CT have significantly reduced the radiation dose in cardiac applications. This imaging technology plays an important role in preprocedural planning and guidance of the procedures in many EP centers worldwide. Furthermore, CT is the imaging modality of choice to diagnose relevant complications in ablation of atrial fibrillation, e.g. pulmonary vein stenosis or atrioesophageal fistula. In anatomically driven ablation procedures, such as balloon-based procedures in atrial fibrillation, detailed analysis of the relevant cardiac structures is absolutely crucial not only to reduce radiation exposure and procedure times but also to improve ablation success and to reduce the occurrence of complications. Current software applications enable 3-dimensional reconstruction of cardiac images and the integration into electroanatomical navigation systems. This article reviews the available evidence in this field and highlights recent developments in image guidance for ablation of atrial fibrillation.
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Affiliation(s)
- Martin Schmidt
- Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum München-Bogenhausen, Englschalkingerstr. 77, 81925, München, Deutschland.
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Gu JY, Xu JH, Yu H, Yang YQ. Novel GATA5 loss-of-function mutations underlie familial atrial fibrillation. Clinics (Sao Paulo) 2012; 67:1393-9. [PMID: 23295592 PMCID: PMC3521801 DOI: 10.6061/clinics/2012(12)08] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to identify novel GATA5 mutations that underlie familial atrial fibrillation. METHODS A total of 110 unrelated patients with familial atrial fibrillation and 200 unrelated, ethnically matched healthy controls were recruited. The entire coding region of the GATA5 gene was sequenced in 110 atrial fibrillation probands. The available relatives of the mutation carriers and 200 controls were subsequently genotyped for the identified mutations. The functional effect of the mutated GATA5 was characterized using a luciferase reporter assay system. RESULTS Two novel heterozygous GATA5 mutations (p.Y138F and p.C210G) were identified in two of the 110 unrelated atrial fibrillation families. These missense mutations cosegregated with AF in the families and were absent in the 400 control chromosomes. A cross-species alignment of GATA5 protein sequence showed that the altered amino acids were completely conserved evolutionarily. A functional analysis revealed that the mutant GATA5 proteins were associated with significantly decreased transcriptional activation when compared with their wild-type counterpart. CONCLUSION The findings expand the spectrum of GATA5 mutations linked to AF and provide novel insights into the molecular mechanism involved in the pathogenesis of atrial fibrillation, suggesting potential implications for the early prophylaxis and personalized treatment of this common arrhythmia.
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Affiliation(s)
- Jian-Yun Gu
- Tongji University School of Medicine, Tongji Hospital, Department of Cardiology, Shanghai/China
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Wieringa WG, Pundziute G, Willems TP, de Smet BJGL. Clinical advances in imaging: how useful is computed tomography for guiding and evaluating cardiac interventions. Interv Cardiol 2011. [DOI: 10.2217/ica.11.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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