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Squara F, Supple G, Liuba I, Wasiak M, Zado E, Desjardins B, Marchlinski FE. Value of high-output pace-mapping of the right phrenic nerve for enabling safe radiofrequency ablation of atrial fibrillation: insights from three-dimensional computed tomography segmentation. Europace 2024; 26:euae207. [PMID: 39082747 PMCID: PMC11321358 DOI: 10.1093/europace/euae207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
AIMS Right phrenic nerve (RPN) injury is a disabling but uncommon complication of atrial fibrillation (AF) radiofrequency ablation. Pace-mapping is widely used to infer RPN's course, for limiting the risk of palsy by avoiding ablation at capture sites. However, information is lacking regarding the distance between the endocardial sites of capture and the actual anatomic RPN location. We aimed at determining the distance between endocardial sites of capture and anatomic CT location of the RPN, depending on the capture threshold. METHODS AND RESULTS In consecutive patients undergoing AF radiofrequency ablation, we defined the course of the RPN on the electroanatomical map with high-output pacing at up to 50 mA/2 ms, and assessed RPN capture threshold (RPN-t). The true anatomic course of the RPN was delineated and segmented using CT scan, then merged with the electroanatomical map. The distance between pacing sites and the RPN was assessed. In 45 patients, 1033 pacing sites were analysed. Distances from pacing sites to RPN ranged from 7.5 ± 3.0 mm (min 1) when RPN-t was ≤10 mA to 19.2 ± 6.5 mm (min 9.4) in cases of non-capture at 50 mA. A distance to the phrenic nerve > 10 mm was predicted by RPN-t with a ROC curve area of 0.846 [0.821-0.870] (P < 0.001), with Se = 80.8% and Sp = 77.5% if RPN-t > 20 mA, Se = 68.0% and Sp = 91.6% if RPN-t > 30 mA, and Se = 42.4% and Sp = 97.6% if non-capture at 50 mA. CONCLUSION These data emphasize the utility of high-output pace-mapping of the RPN. Non-capture at 50 mA/2 ms demonstrated very high specificity for predicting a distance to the RPN > 10 mm, ensuring safe radiofrequency delivery.
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Affiliation(s)
- Fabien Squara
- Department of Cardiology, Pasteur University Hospital, 30 avenue de la Voie Romaine, 06000 Nice, France
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Gregory Supple
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ioan Liuba
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Michal Wasiak
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Erica Zado
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Benoit Desjardins
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Francis E Marchlinski
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Sy RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, Kalman JM. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation. Heart Lung Circ 2024; 33:828-881. [PMID: 38702234 DOI: 10.1016/j.hlc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 05/06/2024]
Abstract
Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.
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Affiliation(s)
- Peter M Kistler
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
| | - Prash Sanders
- University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Chris R Bain
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Karin M Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wai-Kah Choo
- Gold Coast University Hospital, Gold Coast, Qld, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam T Eslick
- University of Sydney, Sydney, NSW, Australia; The Canberra Hospital, Canberra, ACT, Australia
| | | | - Ingrid K Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Emily Kotschet
- Victorian Heart Hospital, Monash Health, Melbourne, Vic, Australia
| | - Han S Lim
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Northern Health, Melbourne, Vic, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Silvana F Marasco
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Canberra, ACT, Australia
| | - Karen P Phillips
- Brisbane AF Clinic, Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Raymond W Sy
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia
| | - Tracey Toy
- The Alfred Hospital, Melbourne, Vic, Australia
| | - Troy W Watts
- Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Rukshen Weerasooriya
- Hollywood Private Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia
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3
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Goto K, Miyazaki S, Nishimura T, Takamiya T, Tao S, Takigawa M, Sasano T. Can phrenic nerve injury be anticipated by larger cryoballoons? Pacing Clin Electrophysiol 2024; 47:124-126. [PMID: 37864811 DOI: 10.1111/pace.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
Recently, a novel size-adjustable cryoballoon has been introduced in clinical practice, which can be inflated to two different diameters (28 and 31 mm). The 31 mm cryoballoon is specifically designed to achieve better contact with remodeled pulmonary veins (PVs) that have wider ostia while avoiding deep cannulation, thereby potentially reducing the risk of phrenic nerve injury (PNI) associated with deep balloon cannulation. However, we encountered two cases of PNI during cryoballoon ablation using the novel system among our initial 25 consecutive case series. Herein, we present two cases that exhibited PNI during freezing of the right superior PV with a size-adjustable balloon. While larger balloons are expected to create a larger area of isolation, the safety of this novel balloon system needs to be evaluated in a large-scale clinical study.
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Affiliation(s)
- Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Cappello IA, Pannone L, Della Rocca DG, Sorgente A, Del Monte A, Mouram S, Vetta G, Kronenberger R, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, La Meir M, Belsack D, Sarkozy A, Brugada P, Tanaka K, Chierchia GB, Gharaviri A, de Asmundis C. Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes. Europace 2023; 25:euad328. [PMID: 38064697 PMCID: PMC10751806 DOI: 10.1093/europace/euad328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. METHODS AND RESULTS All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). CONCLUSION In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
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Affiliation(s)
- Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
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Tsuji T, Aoyama D, Ishida T, Nomura R, Kakehashi S, Mukai M, Hasegawa K, Uzui H, Tada H. Contrast-enhanced computed tomography in the venous rather than the arterial phase is essential for the evaluation of the right phrenic nerve. Pacing Clin Electrophysiol 2023; 46:1526-1535. [PMID: 37899685 DOI: 10.1111/pace.14842] [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: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Preprocedural detection of the running course of the right pericardiophrenic bundles (PBs) is considered to be useful in preventing phrenic nerve (PN) injury during catheter ablation for atrial fibrillation (AF). However, previous studies using the arterial phase of contrast-enhanced computed tomography (CT) reported a relatively low right PBs detection rate. METHODS This study included 63 patients with AF who underwent catheter ablation and preoperative contrast-enhanced CT imaging of the venous and arterial phases (66.7 ± 10.2 years; 44 male). The venous phase of contrast-enhanced CT significantly improved the detection rate of PBs compared to the arterial phase (96.8% vs. 60.3%, p < .001), and PBs were detected in the venous phase only in 23 (36.7%) patients. No significant differences were observed between the right PBs detection rate using non-contrast CT versus the arterial phase of contrast-enhanced CT (p = .37). Patients without visualization of the right PBs during the arterial phase had a higher frequency of chronic heart failure (p = .0083), lower left ventricular ejection fraction (p = .021), and a higher CHADS2 score (p = .048) than those with visualization. In five patients whose right PBs could only be detected during the venous phase of contrast-enhanced CT, the reconstructed running course of the right PBs corresponded with the PN generated by electrical high-output pacing. CONCLUSION Contrast-enhanced CT images of the venous phase, rather than the arterial phase, are useful in detecting the right PBs, especially in patients with heart failure or reduced left ventricular ejection fraction.
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Affiliation(s)
- Toshihiko Tsuji
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomokazu Ishida
- Department of Radiography, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ryohei Nomura
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Berruezo A, Penela D, Jáuregui B, de Asmundis C, Peretto G, Marrouche N, Trayanova N, de Chillou C. Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias. Europace 2023; 25:euad183. [PMID: 37622578 PMCID: PMC10450789 DOI: 10.1093/europace/euad183] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 08/26/2023] Open
Abstract
Catheter ablation is nowadays considered the treatment of choice for numerous cardiac arrhythmias in different clinical scenarios. Fluoroscopy has traditionally been the primary imaging modality for catheter ablation, providing real-time visualization of catheter navigation. However, its limitations, such as inadequate soft tissue visualization and exposure to ionizing radiation, have prompted the integration of alternative imaging modalities. Over the years, advancements in imaging techniques have played a pivotal role in enhancing the safety, efficacy, and efficiency of catheter ablation procedures. This manuscript aims to explore the utility of imaging, including electroanatomical mapping, cardiac computed tomography, echocardiography, cardiac magnetic resonance, and nuclear cardiology exams, in helping electrophysiology procedures. These techniques enable accurate anatomical guidance, identification of critical structures and substrates, and real-time monitoring of complications, ultimately enhancing procedural safety and success rates. Incorporating advanced imaging technologies into routine clinical practice has the potential to further improve clinical outcomes of catheter ablation procedures and pave the way for more personalized and precise ablation therapies in the future.
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Affiliation(s)
- Antonio Berruezo
- Arrhythmia Unit, Teknon Medical Centre, Carrer de Vilana, 12, 08022 Barcelona, Spain
| | - Diego Penela
- Arrhythmia Unit, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano Milan, Italy
| | - Beatriz Jáuregui
- Arrhythmia Unit - Miguel Servet University Hospital, P.º de Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Blvd Géneral Jacques 137, 1050 Ixelles, Brussels, Belgium
| | - Giovanni Peretto
- Arrhythmia Unit, Ospedale San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Nassir Marrouche
- Department of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Applied Math and Statistics, Johns Hopkins University, Baltimore, MD 21218, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Christian de Chillou
- INSERM IADI U1254, University Hospital Nancy, University of Lorraine, 29 Av. du Maréchal de Lattre de Tassigny, 54000 Nancy, France
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M K, M M, G K, K B, W P, J W, J L. Tracing the Right Phrenic Nerve - A Systematic Review and Meta-Analysis. J Atr Fibrillation 2020; 13:2305. [PMID: 34950302 DOI: 10.4022/jafib.2305] [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: 03/16/2020] [Revised: 04/12/2020] [Accepted: 06/20/2020] [Indexed: 11/10/2022]
Abstract
Background The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis of the overall prevalence of right phrenic nerve injury (RPNI), its course and its association with the superior and inferior pulmonary veins. Methods Through December 2017, a database search was performed on PubMed, Science Direct, EMBASE, SciELO, and Web of Science. The references were also extensively searched in the included articles. Results Detection of the RPN may vary according to the identification method. It ranges from 100% in postmortem studies, 93% in intraoperative, to 57.88% in computer tomography (CT) imaging. Based on the included studies (n-507), the distance from the right superior pulmonary vein (RSPV) ostium to the RPN was 12.48mm (±6.21). In postmortem studies, the distance was 6.92mm (±3.94); in pre or intraoperative techniques, 13.32mm (±5.96) if noninvasive, 13.97mm (±7.8) if invasive. Distances ranged from 0DC342.6 mm. For the right inferior pulmonary vein (RIPV) (n-125) the mean distance was 16.53mm (±8.92) with distances from 0.4 68mm. The risk of RPNI with distance-included studies was 12.46% (47 RPNI in 377 cases). In the meta-analysis, the distance from the RSPV to the RPN that was associated with an increased risk of RPNI was 7.36mm. Conclusions RPNI is a relatively rare complication. A firm understanding of its course, relation to the PV ostium, and detection are vital for preventing future injuries and complications.
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Affiliation(s)
- Kuniewicz M
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Mazur M
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Karkowski G
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Budnicka K
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przybycień W
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Walocha J
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lelakowski J
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
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8
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Maj R, Borio G, Ströker E, Sieira J, Rizzo A, Galli A, Varnavas V, Al Housari M, Sofianos D, Kazawa S, Terasawa M, Bala G, Cecchini F, Iacopino S, Osório TG, Sora N, Brugada P, De Asmundis C, Chierchia GB. Phrenic nerve palsy during right-sided pulmonary veins cryoapplications: new insights from pulmonary vein anatomy addressed by computed tomography. J Interv Card Electrophysiol 2020; 60:85-92. [PMID: 32060817 DOI: 10.1007/s10840-020-00713-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE There is still sparse information regarding phrenic nerve palsy (PNP) during the cryoablation of both right-sided pulmonary vein (PV) and its anatomical predictors. METHODS Consecutive patients who had undergone pulmonary vein isolation (PVI) using CB-A and suffered PNP during both right-sided PVs were retrospectively included in our study. Two other groups were then selected among patients who experienced PNP during RIPV application only (group 2) and RSPV application only (group 3). RESULTS The incidence of PNI during both right-sided PVs cryoapplications was 2.1%, (32 of 1542 patients). There were no significant clinical differences between the 3 groups. Time from basal temperature to -40 °C significantly differed among the groups for both RIPV (p = 0.0026) and RSPV applications (p = 0.0382). Patients with PNP occurring during RSPV applications had significantly larger RSPV cross-sectional area compared to patients without PNP (p = 0.0116), while in patients with PNP during RIPV application, the angle of RIPV ostium on the transverse plane was significantly smaller compared to patients without PNP (p = 0.0035). The carina width was significantly smaller in patients with PNP occurring during both right-sided PVs cryoapplications compared to patients in which PNP occurred only during one right-sided PV application (p < 0.0001); a cutoff value of 8.5 mm had a sensitivity of 87.3% and a specificity of 75.0%. CONCLUSION PNP in both right-sided PVs applications is a complication that occurred in 2.1% of cases during CB-A. Pre-procedural evaluation of right PVs anatomy might be useful in evaluating the risk of PNP.
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Affiliation(s)
- Riccardo Maj
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Gianluca Borio
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alessandro Rizzo
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alessio Galli
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Varnavas Varnavas
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Muryo Terasawa
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Federico Cecchini
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Villa Maria Cecilia, Via Corriera, 1, 48033, Cotignola, RA, Italy
| | | | - Nicoleta Sora
- Thoraxcentrum, Blekingesjukhuset, Karlskrona, Sweden
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
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9
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Bourier F, Vlachos K, Lam A, Martin CA, Takigawa M, Kitamura T, Massoullié G, Cheniti G, Frontera A, Duchateau J, Pambrun T, Klotz N, Derval N, Denis A, Hocini M, Haïssaguerre M, Cochet H, Jaïs P, Sacher F. Three-dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures. J Cardiovasc Electrophysiol 2019; 30:2790-2796. [PMID: 31646698 DOI: 10.1111/jce.14249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D-mapping system image integration module and computed tomographic (CT)-derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. METHODS AND RESULTS CT left atrium-angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D-overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). CONCLUSION 3D-overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.
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Affiliation(s)
- Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Grégoire Massoullié
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
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10
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Akkaya E, Berkowitsch A, Greiss H, Hamm CW, Sperzel J, Neumann T, Kuniss M. PLAAF score as a novel predictor of long-term outcome after second-generation cryoballoon pulmonary vein isolation. Europace 2019; 20:f436-f443. [PMID: 29161372 DOI: 10.1093/europace/eux295] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
Aims Predictors of atrial arrhythmia recurrence have not been described in a long-term follow-up study of patients undergoing pulmonary vein isolation (PVI) using the cryoballoon technique. We aimed to evaluate the efficacy of a second-generation cryoballoon and identify pre-procedural predictors of 3-year outcome after PVI. Methods and results For this observational cohort study, we enrolled 440 patients ablated at our institution with a second-generation cryoballoon. The endpoint was the first documented recurrence (>30 s) of atrial fibrillation (AF), atrial flutter, or atrial tachycardia after a 3-month blanking period. The impact of several pre-existing variables on clinical outcome was evaluated by univariate and multivariate analyses using the Cox proportional hazards regression model. The PLAAF (persistent AF, left atrial area, abnormal PV anatomy, AF history, female gender) score was defined to predict outcome. After a median follow-up of 36 months (interquartile range 25/75-27/42), the endpoint was achieved in 95 of 440 (21.6%) patients. Cox regression analysis showed that persistent AF, left atrial (LA) area, abnormal PV anatomy, AF history, and female gender independently predicted recurrence. The calculated optimal cut-offs for LA area and AF history were 21 cm2 and 3 years, respectively. Patients with a PLAAF score of 0 showed the best outcome, with an arrhythmia-free survival of 86.7%. Conclusion PVI using the cryoballoon technique shows acceptable long-term results depending on predictors described by the new PLAAF score, which may facilitate patient selection for PVI.
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Affiliation(s)
- Ersan Akkaya
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Alexander Berkowitsch
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Harald Greiss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.,Medical Clinic I, Justus-Liebig University, Giessen, Germany
| | - Johannes Sperzel
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Neumann
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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11
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Sano M, Urushida T, Matsukura G, Sakakibara T, Suwa K, Naruse Y, Ohtani H, Saotome M, Maekawa Y. Clinical feasibility of pulmonary vein orifice pacing for the prediction of phrenic nerve injury during cryoballoon ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1200-1206. [DOI: 10.1111/jce.13962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Makoto Sano
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Tsuyoshi Urushida
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Gaku Matsukura
- Department of CardiologyHamamatsu Red Cross Hospital Hamamatsu Japan
| | - Tomoaki Sakakibara
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Kenichiro Suwa
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Yoshihisa Naruse
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Hayato Ohtani
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Masao Saotome
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Internal Medicine IIIHamamatsu University School of Medicine Hamamatsu Japan
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12
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Canpolat U, Kocyigit D, Aytemir K. Complications of Atrial Fibrillation Cryoablation. J Atr Fibrillation 2017; 10:1620. [PMID: 29487676 PMCID: PMC5821627 DOI: 10.4022/jafib.1620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Duygu Kocyigit
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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13
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Canpolat U. What makes pulmonary vein anatomy important and preprocedural imaging useful during catheter ablation for atrial fibrillation? Europace 2017; 19:1754. [PMID: 27733474 DOI: 10.1093/europace/euw252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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14
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Parikh V, Kowalski M. Comparison of Phrenic Nerve Injury during Atrial Fibrillation Ablation between Different Modalities, Pathophysiology and Management. J Atr Fibrillation 2016; 8:1314. [PMID: 27957229 DOI: 10.4022/jafib.1314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation ablation has emerged as an effective tool in the management of symptomatic atrial fibrillation. Currently, the electrophysiologists are striving to maximize the success while minimizing complications. Phrenic nerve injury (PNI) is one of the concerning complications, especially in cases of cryoballoon ablation. Due to anatomical proximity to atrial tissue, phrenic nerve is particularly susceptible to injury. With evolving monitoring techniques it is now possible to minimize the likelihood of a permanent PNI. However, the challenge remains to detect PNI at the earliest and to avoid further damage to the nerve. In this review, we discuss pertinent anatomical principles, techniques to avoid PNI and management in cases where PNI is encountered.
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Affiliation(s)
- Valay Parikh
- Division of Electrophysiology, Department of Cardiology, Staten Island University Hospital, Northwell Health System, NY
| | - Marcin Kowalski
- Division of Electrophysiology, Department of Cardiology, Staten Island University Hospital, Northwell Health System, NY
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15
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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: 2.9] [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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16
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Mugnai G, de Asmundis C, Velagic V, Hünük B, Ströker E, Wauters K, Irfan G, Overeinder I, Hacioglu E, Hernandez-Ojeda J, Poelaert J, Verborgh C, Paparella G, Brugada P, Chierchia GB. Phrenic nerve injury during ablation with the second-generation cryoballoon: analysis of the temperature drop behaviour in a large cohort of patients. Europace 2015; 18:702-9. [PMID: 26564954 DOI: 10.1093/europace/euv346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/14/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The present study sought to analyse the relationship between the temperature drop during the cryoenergy application and the occurrence of phrenic nerve injury (PNI) in a large cohort of patients having undergone second-generation cryoballoon ablation (CB-A). METHODS AND RESULTS The first 550 consecutive patients having undergone CB-A for atrial fibrillation were enrolled. Attained temperatures at 20, 30, 40, and 60 s during cryoablation in the right-sided pulmonary veins (PVs) were collected. Diagnosis of PNI was made if reduced motility or paralysis of the hemidiaphragm was detected. The incidence of PNI in the study population was 7.3% (40/550); among them, only four (0.7%) did not resolve until discharge and one (0.2%) still persisted at 23 months. Patients with PNI exhibited significantly lower temperatures at 20, 30, and 40 s after the beginning of the cryoapplication in the right superior PV (RSPV) (P = 0.006, P = 0.003, and P = 0.003, respectively). The temperature drop expressed as Δ temperature/Δ time was also significantly higher in patients with PNI. Low temperature during the early phases of the freezing cycle (less than -38°C at 40 s) predicted PNI with a sensitivity of 80.5%, a specificity of 77%, and a negative predictive value of 97.9%. Among patients with a fast temperature drop during RSPV ablation, an RSPV diameter >23.55 × 17.95 mm significantly predicted PNI occurrence. CONCLUSION The analysis of the temperature course within the first 40 s after the initiation of the freezing cycle showed that the temperature dropped significantly faster in patients with PNI during ablation in the RSPV.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Vedran Velagic
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Burak Hünük
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Kristel Wauters
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Ghazala Irfan
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Ebru Hacioglu
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Jaime Hernandez-Ojeda
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | | | - Gaetano Paparella
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, Brussels 1090, Belgium
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17
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CHIERCHIA GIANBATTISTA, MUGNAI GIACOMO, HUNUK BURAK, STRÖKER ERWIN, VELAGIĆ VEDRAN, SAITOH YUKIO, IRFAN GHAZALA, HACIOGLU EBRU, CICONTE GIUSEPPE, BRUGADA PEDRO, DE ASMUNDIS CARLO. Impact on Clinical Outcome of Premature Interruption of Cryoenergy Delivery Due to Phrenic Nerve Palsy During Second Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 26:950-955. [DOI: 10.1111/jce.12718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/04/2015] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - GIACOMO MUGNAI
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - BURAK HUNUK
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - ERWIN STRÖKER
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - VEDRAN VELAGIĆ
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - YUKIO SAITOH
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - GHAZALA IRFAN
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - EBRU HACIOGLU
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - GIUSEPPE CICONTE
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
| | - PEDRO BRUGADA
- Heart Rhythm Management Center; UZ Brussel-VUB; Brussels Belgium
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18
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Takami M, Misiri J, Lehmann HI, Parker KD, Johnson SB, Sarmiento RI, Packer DL. Spatial and Time-Course Thermodynamics During Pulmonary Vein Isolation Using the Second-Generation Cryoballoon in a Canine In Vivo Model. Circ Arrhythm Electrophysiol 2015; 8:186-92. [DOI: 10.1161/circep.114.002137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Thermodynamics in the left atrium–pulmonary vein (PV) junction, phrenic nerve, and esophagus during PV isolation (PVI) using the second-generation cryoballoon are not known.
Methods and Results—
Twenty dogs underwent PVI using second-generation cryoballoon. Ablations were performed for ≤2 deliveries based on PVI without a bonus freeze. Inner balloon, balloon surface, and tissue temperatures were monitored during cryoablation. The tissue thermocouples were placed on the epicardial surface of the left atrium–PV junction, as well as on the phrenic nerve and within the esophagus. A total of 259 cryoballoon and 229 tissue tissue thermocouples profiles during 53 cryoablations of 40 PVs were analyzed. Acutely, PVI was achieved in 36 of 40 PVs (90%). Conductive tissue cooling spread radially from the balloon–left atrium–PV contact point. The lowest tissue temperatures were dependent on the distance of the tissue thermocouples to the balloon surface (
r
=0.85;
P
<0.001). In addition, blood flow leaks around the balloon had a warming effect on the balloon and tissue temperature profiles. Chronic isolation (mean, 48±16 days) was achieved in 27 of 36 PVs (75%). In 8 of 9 acutely isolated but with chronic reconnection PVs, the blood flow leak location was concordant with chronic reconnection gap. Although only 1 esophageal ulcerated lesion was observed, neither phrenic nerve palsy nor severe PV stenosis was seen in any dogs.
Conclusions—
Variance in tissue thermodynamics during cryothermal ablation depends on the distance from balloon and peri-balloon blood flow leaks. This information may be useful for successful PVI without severe complications.
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Affiliation(s)
| | - Juna Misiri
- From the Mayo Clinic/St. Marys Campus, Rochester, MN
| | | | - Kay D. Parker
- From the Mayo Clinic/St. Marys Campus, Rochester, MN
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