1
|
Leung LWM, Akhtar Z, Hayat J, Gallagher MM. Protecting Against Collateral Damage to Non-cardiac Structures During Endocardial Ablation for Persistent Atrial Fibrillation. Arrhythm Electrophysiol Rev 2022; 11:e15. [PMID: 35990104 PMCID: PMC9376833 DOI: 10.15420/aer.2021.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/04/2022] Open
Abstract
Injury to structures adjacent to the heart, particularly oesophageal injury, accounts for a large proportion of fatal and life-altering complications of ablation for persistent AF. Avoiding these complications dictates many aspects of the way ablation is performed. Because avoidance involves limiting energy delivery in areas of interest, fear of extracardiac injury can impede the ability of the operator to perform an effective procedure. New techniques are becoming available that may permit the operator to circumvent this dilemma and deliver effective ablation with less risk to adjacent structures. The authors review all methods available to avoid injury to extracardiac structures to put these developments in context.
Collapse
Affiliation(s)
- Lisa WM Leung
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Zaki Akhtar
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Jamal Hayat
- Department of Gastroenterology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Wu SJ, Fan YF, Chien CY. Surgical Strategies for Cardiac Perforation After Catheter Ablation or Electrophysiology Study. Int Heart J 2021; 62:1257-1264. [PMID: 34789643 DOI: 10.1536/ihj.21-201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Catheter ablation is a treatment modality which has been increasingly used for cardiac arrhythmias. However, it is not complication-free, and cardiac perforation is one of its most life-threatening complications. As surgery is usually not the first-line treatment for this emergent episode, there were only very few sporadic surgical reports in the literature. This systemic review primarily aims to collect different surgical approaches for catheter-induced cardiac perforation to help surgeons manage this kind of uncommon and critical patients. Of the 452 initially screened articles, 22 studies (38 patients) were included in the systemic review. Of all the included patients, 84% (32/38) were found to have pericardial effusion acutely following catheter-related procedures, and 16% (6/38) experienced delayed-onset episodes. Regarding the surgical procedures, four patients underwent removal of clots only, eight patients underwent suture repair of the left ventricle (LV), nine patients underwent suture repair of the right ventricle (RV), five patients underwent suture repair of the LA, and four patients underwent sutureless repair of the LV and pulmonary vein (LV 1, RV 1, pulmonary vein 1). In addition to repair of perforation sites, the concomitant combined procedures included repair of intercostal vessels (complication of pericardiocentesis) for one patient, cryoablation for two patients, and maze procedure for one patient. For cardiac perforation following catheter ablation or electrophysiology study, although the majority of the patients are treated with pericardiocentesis and medical management at first, cardiovascular surgeons have to prepare to take over if the bleeding is persistent or if the cardiac tamponade is not relieved.
Collapse
Affiliation(s)
- Shye-Jao Wu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital
| | - Ya-Fen Fan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital
| |
Collapse
|
3
|
Wang YJ, Sun H, Fan XF, Zhang MC, Yang P, Zeng H, Liu L. Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT. BMC Cardiovasc Disord 2021; 21:84. [PMID: 33568060 PMCID: PMC7877049 DOI: 10.1186/s12872-021-01881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures. METHODS Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured. RESULTS The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001). CONCLUSIONS The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.
Collapse
Affiliation(s)
- Yan-Jing Wang
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Huan Sun
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China
| | - Xiao-Fei Fan
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Meng-Chao Zhang
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Ping Yang
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China
| | - Hong Zeng
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China. .,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China.
| | - Lin Liu
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.
| |
Collapse
|