1
|
Kawaji T, Aizawa T, Yamano S, Naka M, Bao B, Hojo S, Tezuka Y, Nakatsuma K, Matsuda S, Kato M, Yokomatsu T, Miki S. Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter. J Cardiovasc Electrophysiol 2024; 35:328-340. [PMID: 38105441 DOI: 10.1111/jce.16159] [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: 07/17/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The aim of the current study was to elucidated the reliable atrial fibrillation (AF) drivers identified by CARTOFINDER using OctaRay catheter. METHODS AND RESULTS The reliability of focal and rotational activations identified by CARTOFINDER using OctaRay catheter was assessed by the sequential recordings in each site of both atrium before and after pulmonary vein isolation (PVI) in 10 persistent AF patients. The outcome measures were the reproducibility rate during the sequential recordings and the stability rate between pre- and post-PVI as reliable focal and rotational activations. The study results were compared with those under use of PentaRay catheter (N = 18). Total 68928 points of 360 sites in OctaRay group and 24 177 points of 311 sites in PentaRay were assessed. More focal activation sites were identified in OctaRay group than PentaRay group (7.9% vs. 5.7%, p < .001), although the reproducibility rate and the stability rate were significantly lower in OctaRay group (45.3% vs. 58.9%, p < .001; 11.2% vs. 28.4%, p < .001). Meanwhile, the prevalence of reproducible focal activation sites among overall points was comparable (3.6% vs. 3.3%, p = .08). Regarding rotational activation, more rotational activation sites were identified in OctaRay group (5.1% vs. 0.2%, p < .001), and the reproducibility rate and the stability rate were significantly higher in OctaRay group (45.2% and 12.5% vs. 0.0%, p < .001). Both reliable focal and rotational activation sites were characterized by significantly shorter AF-cycle length (CL) and higher repetition of focal and rotational activations during the recordings compared with the sites of non or unreliable focal and rotational activations. CONCLUSION In CARTOFINDER, OctaRay catheter could identify reliable focal activation with high resolution and reliable rotational activation compared with PentaRay catheter. The repetitive focal and rotational activations with short AF-CL could be the potential target during ablation.
Collapse
Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Saki Yamano
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Misaki Naka
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Bingyuan Bao
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shun Hojo
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yuji Tezuka
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shintaro Matsuda
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| |
Collapse
|
2
|
Evtushenko A, Evtushenko V, Gusakova A, Suslova T, Varlamova Y, Zavadovskiy K, Lebedev D, Kutikhin A, Pavlyukova E, Mamchur S. Neurohumoral Markers of Cardiac Autonomic Denervation after Surgical Ablation of Long-Standing Persistent Atrial Fibrillation. Life (Basel) 2023; 13:1340. [PMID: 37374123 PMCID: PMC10300786 DOI: 10.3390/life13061340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Although the autonomic nervous system has an evident impact on cardiac electrophysiology and radiofrequency ablation (RFA) is the conventional technique for treating persistent atrial fibrillation, the specific effects of RFA have been insufficiently studied to date. Here, we investigated whether RFA affects neurohumoral transmitter levels and myocardial 123I-metaiodobenzylguanidine (123I-MIBG) uptake. To perform this task, we compared two groups of patients with acquired valvular heart disease: patients who had undergone surgical AF ablation and patients with sinus rhythm. The decrease in norepinephrine (NE) level in the coronary sinus had a direct association with the heart-to-mediastinum ratio (p = 0.02) and a negative correlation with 123I-MIBG uptake defects (p = 0.01). The NE level decreased significantly after the main surgery, both in patients with AF (p = 0.0098) and sinus rhythm (p = 0.0039). Furthermore, the intraoperative difference between the norepinephrine levels in the ascending aorta and coronary sinus (ΔNE) of -400 pg/mL was determined as a cut-off value to evaluate RFA efficacy, as denervation failed in all patients with ΔNE < -400 pg/mL. Hence, ΔNE can be utilized to predict the efficacy of the "MAZE-IV" procedure and to assess the risk of AF recurrence after RFA.
Collapse
Affiliation(s)
- Alexey Evtushenko
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Vladimir Evtushenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Anna Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Tatiana Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Yulia Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Konstantin Zavadovskiy
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Denis Lebedev
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Anton Kutikhin
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Elena Pavlyukova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Sergey Mamchur
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| |
Collapse
|
3
|
Cutler MJ, Sattayaprasert P, Pivato E, Jabri A, AlMahameed ST, Ziv O. Low voltage-guided ablation of posterior wall improves 5-year arrhythmia-free survival in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2475-2484. [PMID: 35332610 PMCID: PMC10084207 DOI: 10.1111/jce.15464] [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: 11/03/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The posterior wall (PW) has been proposed as a standard target for ablation beyond pulmonary vein antral isolation (PVI) in patients with persistent atrial fibrillation (AF). However, studies have shown inconsistent outcomes with the addition of PW ablation. The presence or absence of low voltage on the PW may explain these inconsistencies. We evaluated whether PW ablation based on the presence or absence of low voltage improves long-term arrhythmia-free outcomes. METHODS We retrospectively reviewed 5-year follow-up in 152 consecutive patients who received either standard ablation (SA) with PVI alone or PVI + PW ablation (PWA) based on physician discretion (n = 77) or voltage-guided ablation (VGA) with PVI and addition of PWA only if low voltage was present on the PW (n = 75). RESULTS The two groups were well matched for baseline characteristics. At 5-year follow-up, 64% of patients receiving VGA were atrial tachyarrhythmia (AT)/AF free compared to 34% receiving SA (HR 0.358 p < .005). PWA had similar AF recurrence in SA and VGA groups (0.30 vs. 0.27 p = .96) but higher AT recurrence when comparing SA and VGA groups (0.39 vs. 0.15 p = .03). In multivariate analysis, both VGA and PWA predicted AF arrhythmia-free survival (HR 0.33, p = .001 and HR 0.20, p = .008, respectively). For AT, VGA predicted arrhythmia-free survival (HR 0.22, p = .028), while PWA predicted AT recurrence (HR 4.704, p = .0219). CONCLUSION VGA of the posterior wall ablation beyond PVI in persistent AF significantly improves long-term arrhythmia-free survival when compared with non-voltage-guided ablation. PW ablation without voltage-guidance reduced AF recurrence but at the cost of a higher incidence of AT.
Collapse
Affiliation(s)
- Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah, USA
| | | | | | - Ahmad Jabri
- Case Western Reserve, MetroHealth Campus, Cleveland, Ohio, USA
| | | | - Ohad Ziv
- Case Western Reserve, MetroHealth Campus, Cleveland, Ohio, USA
| |
Collapse
|
4
|
Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis. Clin Physiol Funct Imaging 2020; 40:1-13. [PMID: 31556215 DOI: 10.1111/cpf.12595] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
Collapse
Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Molecular & Clinical Sciences Research Institute, St George University, London, UK
- Brunel University, London, UK
| |
Collapse
|
5
|
Li F, Tu X, Li D, Jiang Y, Cheng Y, Jia Y, Zhang X, Fu H, Hu H, Jiang J, Zeng R. Is ablation to atrial fibrillation termination of persistent atrial fibrillation the end point?: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18045. [PMID: 31764827 PMCID: PMC6882606 DOI: 10.1097/md.0000000000018045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ideal ablation strategy and end point for persistent atrial fibrillation (AF) have not been well founded. Defining periprocedural AF termination as the end point of catheter ablation is still controversial. This meta-analysis aimed to analyze the differences between periprocedural AF termination and non-termination in the long-term AF recurrence rate and postoperative complications. METHODS Randomized controlled trials (RCTs) were identified by a systematic search of electronic databases including PubMed, EMBASE, and Cochrane library from January 2008 to August 2019. The primary outcome was freedom from AF or any atrial arrhythmia without antiarrhythmic drugs at the long-term (≥12 months) follow-up. The secondary outcome was overall postoperative complication rates. The risk ratio (RR) with 95% confidence interval (CI) was pooled for these outcomes. A forest plot, fixed-effects model or random-effect model, Q test, I statistic, and Egger funnel plot were used in the statistical analysis. RESULTS Fourteen RCTs were included in this meta-analysis. Overall, no significant difference was found in freedom from AF at the long-term follow-up between patients in whom AF termination was achieved and not achieved (RR = 0.93, 95% CI = 0.78-1.09, P = .36, I = 69%). Patients with AF non-termination had a lower complication occurrence rate than those with AF termination (RR = 1.74, 95% CI = 1.11-2.73, P = .02, I = 0%). CONCLUSION Our meta-analysis suggests that AF termination is not a reliable procedural end point during ablation of persistent AF.
Collapse
Affiliation(s)
| | | | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
| | | | | | - Yu Jia
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
| | | | | | | | | | | |
Collapse
|
6
|
Liu C, Lo L, Lin Y, Lin C, Chang S, Chung F, Chao T, Hu Y, Tuan T, Liao J, Chen Y, Kuo L, Chang T, Hoang QM, Salim S, Vicera JJB, Wu C, Chuang C, Huang T, Chen S. Long‐term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1215-1228. [DOI: 10.1111/jce.13969] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Chih‐Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Li‐Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yenn‐Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Chin‐Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Shih‐Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Fa‐Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Tze‐Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yu‐Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Ta‐Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Jo‐Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yun‐Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Epidemiology and Preventive Medicine College of Public HealthNational Taiwan University Taipei Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Ting‐Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Quang Minh Hoang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Simon Salim
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Jennifer Jeanne B. Vicera
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Cheng‐I Wu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Chieh‐Mao Chuang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Ting‐Chung Huang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| |
Collapse
|
7
|
Kawaji T, Shizuta S, Yamagami S, Aizawa T, Komasa A, Yoshizawa T, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Clinical Utility of Intravenous Nifekalant Injection during Radiofrequency catheter Ablation for Persistent Atrial Fibrillation. J Atr Fibrillation 2018; 11:1839. [PMID: 30455835 DOI: 10.4022/jafib.1839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and results We retrospectively enrolled 157 consecutive persistentAF patientsundergoing first RFCA procedure withcomplex fractionated atrial electrogram (CFAE)ablation after pulmonary veins isolation and compared outcomes between patientswith (NFK group: N=79) and without (No-NFK group: N=78)additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF terminationwas significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P<0.001). Arrhythmia-free survival, however, was not significantly different between 2 groups (61.5% versus 54.1%, P=0.63).There was no significant difference between 2 groups in the prevalence of recurrent atrial tachycardia(25.0% versus 23.5%, P=0.89). Arrhythmia-free survivalin patients with AF termination during procedure was significantly higher thanthose without (73.0% versus 41.0%, P=0.002; adjusted hazard ratio 0.48, 95% confidence interval 0.17-0.84, P=0.02) amongNFK group,but not amongNo-NFK group (66.7% versus 53.2%, P=0.53). Conclusions Intravenous nifekalant injection during additional CFAE ablation did not improve sinus maintenancerate after RFCA procedure for AF, but AF termination by nifekalant injection could be a clinical predictor of better success rates after procedure.
Collapse
Affiliation(s)
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shintaro Yamagami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Akihiro Komasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yoshizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| |
Collapse
|
8
|
Otsuka T, Sagara K, Arita T, Yagi N, Suzuki S, Ikeda T, Yamashita T. Impact of electrophysiological and pharmacological noninducibility following pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. J Arrhythm 2018; 34:501-510. [PMID: 30327695 PMCID: PMC6174500 DOI: 10.1002/joa3.12085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/27/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Two methods for testing inducibility of atrial fibrillation (AF)-atrial pacing and isoproterenol infusion-have been proposed to determine the endpoint of catheter ablation. However, the utility of the combination for testing electrophysiological inducibility (EPI) and pharmacological inducibility (PHI) is unclear. METHODS After pulmonary vein isolation (PVI), inducibility of atrial tachyarrhythmia was assessed with the dual methods in 291 consecutive patients with AF (65% paroxysmal) undergoing initial catheter ablation. RESULTS The incidence of EPI was significantly higher in patients with persistent AF than paroxysmal AF (32.0% vs 11.7%, respectively, P < .001). The incidence of PHI was not significantly different between the two groups (25.2% vs 26.1%, respectively, P = .87). There was no significant difference in AF recurrence according to inducibility in paroxysmal AF. In persistent AF, however, patients achieving neither EPI nor PHI under PVI-only strategy had significantly lower rates of AF recurrence than those achieving either EPI or PHI and consequently requiring additional ablation for inducible atrial tachyarrhythmia (68.5% vs 49.0%, respectively; log-rank test, P = .022). In persistent AF, multivariate Cox regression analysis showed that achieving neither EPI nor PHI was a negative independent predictor of AF recurrence (HR 0.492, 95% CI 0.254-0.916, P = .026). CONCLUSIONS Achieving neither EPI nor PHI following PVI was associated with favorable outcome in patients with persistent AF. The combination of tests may discriminate patients responsive to the PVI-only strategy. Further selective approaches are necessary to improve outcome for inducible atrial tachyarrhythmia in patients with persistent AF.
Collapse
Affiliation(s)
- Takayuki Otsuka
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Koichi Sagara
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takuto Arita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Naoharu Yagi
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Shinya Suzuki
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Takeshi Yamashita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| |
Collapse
|
9
|
Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Chen SA. Beyond Pulmonary Vein Isolation: the Role of Additional Sites in Catheter Ablation of Atrial Fibrillation. Curr Cardiol Rep 2017; 19:86. [PMID: 28795289 DOI: 10.1007/s11886-017-0884-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the long-term procedural outcome remains suboptimal and there is a frequent need for repeat ablation procedure, especially in patients with non-paroxysmal AF. The review article summarizes the rationales, recent evidences, and strategies of ablation of extra-PV sites and its clinical outcomes. RECENT FINDINGS It is a consensus that durable PV isolations are a definite therapy in patients with paroxysmal AF. In non-paroxysmal AF, many laboratories still believe that adequate substrate ablation outside PVs is definitely required. Empirical linear ablation is not recommended because of difficulty in achieving complete linear block, unless macro-reentry atrial tachycardia developed during procedure. Most of laboratories applied complex fractionated atrial electrogram (CFAE) ablation after PV isolation in non-paroxysmal AF, but the efficacy is limited in the long-term follow-up studies. A combined approach using CFAE, non-linear similarity, and phase mapping strategy to identify rotors or focal sources for substrate modification increases the ablation outcome, when compared to CFAE ablation alone. Provocative test with mapping of non-PV triggers is also recommended in all patients to improve long-term ablation success. Ablation beyond PV isolation is important, especially in non-paroxysmal AF patients, to modify the diseased atrial substrate and eliminate the non-PV triggers, which in turn improve the ablation outcome.
Collapse
Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
| |
Collapse
|
10
|
Kochhäuser S, Verma A, Dalvi R, Suszko A, Alipour P, Sanders P, Champagne J, Macle L, Nair GM, Calkins H, Wilber DJ, Chauhan VS. Spatial Relationships of Complex Fractionated Atrial Electrograms and Continuous Electrical Activity to Focal Electrical Sources: Implications for Substrate Ablation in Human Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1220-1228. [PMID: 29759616 DOI: 10.1016/j.jacep.2017.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to evaluate the spatial relationships of focal electrical sources (FSs) to complex fractionated atrial electrograms (CFAE) and continuous electrical activity (CEA). BACKGROUND Fractionated atrial electrograms have been associated with atrial fibrillation (AF) drivers in computational studies and represent ablation targets in the management of persistent AF. METHODS We included a subset of 66 patients (age: 63 [56, 67] years, 69% persistent AF) with electroanatomic data from the SELECT AF (Selective complex fractionated atrial electrograms targeting for atrial fibrillation) randomized control trial that compared the efficacy of CFAE with CEA ablation in AF patients undergoing pulmonary vein antral ablation. Focal sources were identified based on bipolar electrogram periodicity and QS unipolar electrogram morphology. RESULTS A total of 77 FSs (median: 1 [1st quartile, 3rd quartile: 1, 2] per patient) were identified most commonly in the pulmonary vein antrum and left atrial appendage. The proportions of FSs inside CFAE and CEA regions were similar (13% vs. 1.3%, respectively; p = 0.13). Focal sources were more likely to be on the border zone of CFAEs than in CEAs (49% vs. 7.8%, respectively; p = 0.012). Following ablation, 53% of patients had ≥1 unablated extrapulmonary vein FS. The median number of unablated FS was higher in patients with AF recurrence post ablation than in patients without (median: 1 [0, 1] vs. 0 [0, 1], respectively; p = 0.026). CONCLUSIONS One-half of the FSs detected during AF localized to the border of CFAE areas, whereas most of the FSs were found outside CEA areas. CFAE or CEA ablation leaves a number of FS unablated, which is associated with AF recurrence. These findings suggest that many CFAEs may arise from passive wave propagation, remote from FS, which may limit their therapeutic efficacy in AF substrate modification.
Collapse
Affiliation(s)
- Simon Kochhäuser
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rupin Dalvi
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Adrian Suszko
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Pouria Alipour
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Prashanthan Sanders
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jean Champagne
- Institut de Cardiologie et Pneumologie de l'Université Laval, Quebec City, Quebec, Canada
| | | | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hugh Calkins
- Johns Hopkins University Hospital, Baltimore, Maryland
| | | | - Vijay S Chauhan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
11
|
Bordignon S, Perrotta L, Dugo D, Bologna F, Nagase T, Fuernkranz A, Chun KJ, Schmidt B. Electrical isolation of the left atrial appendage by Maze-like catheter substrate modification: A reproducible strategy for pulmonary vein isolation nonresponders? J Cardiovasc Electrophysiol 2017. [DOI: 10.1111/jce.13276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Daniela Dugo
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Alexander Fuernkranz
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - K.R. Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| |
Collapse
|
12
|
AMMAR-BUSCH SONIA, BOURIER FELIX, REENTS TILKO, SEMMLER VERENA, TELISHEVSKA MARTA, KATHAN SUSANNE, HOFMANN MONIKA, HESSLING GABRIELE, DEISENHOFER ISABEL. Ablation of Complex Fractionated Electrograms With or Without ADditional LINEar Lesions for Persistent Atrial Fibrillation (The ADLINE Trial). J Cardiovasc Electrophysiol 2017; 28:636-641. [DOI: 10.1111/jce.13206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- SONIA AMMAR-BUSCH
- Klinikum Coburg; Coburg Germany
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - FELIX BOURIER
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - TILKO REENTS
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - VERENA SEMMLER
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - MARTA TELISHEVSKA
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - SUSANNE KATHAN
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - MONIKA HOFMANN
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - GABRIELE HESSLING
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - ISABEL DEISENHOFER
- Department of Electrophysiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| |
Collapse
|
13
|
Lin YJ, Lo MT, Chang SL, Lo LW, Hu YF, Chao TF, Chung FP, Liao JN, Lin CY, Kuo HY, Chang YC, Lin C, Tuan TC, Vincent Young HW, Suenari K, Dan Do VB, Raharjo SB, Huang NE, Chen SA. Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2016; 2:667-678. [DOI: 10.1016/j.jacep.2016.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
|
14
|
Singh SM, d'Avila A, Kim YH, Aryana A, Mangrum JM, Michaud GF, Dukkipati SR, Barrett CD, Heist EK, Parides MK, Thorpe KE, Reddy VY. The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study). Eur Heart J 2016; 37:1614-21. [DOI: 10.1093/eurheartj/ehw003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/04/2016] [Indexed: 11/13/2022] Open
|
15
|
Kyprianou K, Pericleous A, Stavrou A, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Surgical perspectives in the management of atrial fibrillation. World J Cardiol 2016; 8:41-56. [PMID: 26839656 PMCID: PMC4728106 DOI: 10.4330/wjc.v8.i1.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/08/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials.
Collapse
|
16
|
Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Chen SA. Pearls and Pitfalls in Catheter Ablation of Persistent Atrial Fibrillation. Circ J 2016; 80:306-13. [DOI: 10.1253/circj.cj-15-1366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| |
Collapse
|
17
|
Gourraud JB, Andrade JG, Macle L, Mondésert B. Pharmacological Tests in Atrial Fibrillation Ablation. Arrhythm Electrophysiol Rev 2016; 5:170-176. [PMID: 28116081 DOI: 10.15420/aer.2016:27:2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The invasive management of atrial fibrillation (AF) has been considerably changed by the identification of major sites of AF initiation and/or maintenance within the pulmonary vein antra. Percutaneous catheter ablation of these targets has become the standard of care for sustained maintenance of sinus rhythm. Long-term failure of ablation is related to an inability to create a durable transmural lesion or to identify all of the non-pulmonary vein arrhythmia triggers. Pharmacological challenges during catheter ablation have been suggested to improve outcomes in both paroxysmal and persistent AF. Herein we review the mechanism and evidence for the use of pharmacological adjuncts during the catheter ablation of AF.
Collapse
Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Jason G Andrade
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
18
|
Barbhayia CR, Kumar S, Michaud GF. Mapping Atrial Fibrillation: 2015 Update. J Atr Fibrillation 2015; 8:1227. [PMID: 27957220 DOI: 10.4022/jafib.1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/11/2015] [Accepted: 08/16/2015] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation requires a trigger that initiates the arrhythmia and substrate that favors perpetuation. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimized. The most commonly used cardiac mapping approach is isochronal or activation mapping, which aims to create a spatial model of electrical wavefront propagation. Historically, activation mapping has been successful for mapping point source and single or double wave reentrant arrhythmias, while mapping multiple wavelets or driving sources that underlie most episodes of atrial fibrillation remains challenging. In the multiple wavelet model of AF there is no particular area critical to sustain atrial fibrillation, and a "critical mass" of atrium is required to maintain AF. Recent studies suggest endocardial and epicardial dissociation may play an important role. Investigation of driving sources that sustain AF has focused on the presence of rotors. Rotors in human AF have now been observed using multiple imaging modalities, however ablation strategies targeting rotors remain of unproven benefit. In addition, substrate mapping of AF is now feasible. Increasing degrees of atrial fibrosis on delayed enhancement magnetic resonance imaging (DE-MRI) has been shown to correlate with poor procedural outcomes for AF ablation, which suggests the increased burden of scar promotes more complex and extensive arrhythmia substrate. Atrial fibrosis is also identifiable using electrogram voltage tagging in an electro-anatomic mapping system. Patient-specific ablation strategies targeting areas of fibrosis are currently under investigation. Recent technological advances have facilitated greater understanding of the potential role for AF mapping and has allowed initiation of clinical studies to evaluate the effectiveness of mapping-based intervention. Multi-modality mapping is likely to play an increasingly important role in AF ablation, but is currently limited by the inability to simultaneously record and interpret electrical signals from both atria and from both the epicardium and endocardium.
Collapse
Affiliation(s)
| | - Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
19
|
Latchamsetty R, Oral H. Is ablation to termination the best strategy for ablation of persistent atrial fibrillation? Ablation to termination is not the best strategy during ablation. Circ Arrhythm Electrophysiol 2015; 8:972-80. [PMID: 26286306 DOI: 10.1161/circep.115.001722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Rakesh Latchamsetty
- From the Department of Internal Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Hakan Oral
- From the Department of Internal Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor.
| |
Collapse
|
20
|
Abozguia K, Cutler MJ, Ziv O. The presence of left atrial posterior wall fibrillation despite restoration of sinus rhythm after posterior box ablation. HeartRhythm Case Rep 2015; 1:416-418. [PMID: 28491597 PMCID: PMC5419696 DOI: 10.1016/j.hrcr.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Khalid Abozguia
- Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio
| | | | - Ohad Ziv
- Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
21
|
CUTLER MICHAELJ, JOHNSON JEREMY, ABOZGUIA KHALID, ROWAN SHANE, LEWIS WILLIAM, COSTANTINI OTTO, NATALE ANDREA, ZIV OHAD. Impact of Voltage Mapping to Guide Whether to Perform Ablation of the Posterior Wall in Patients With Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 27:13-21. [DOI: 10.1111/jce.12830] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/07/2015] [Accepted: 09/01/2015] [Indexed: 02/01/2023]
Affiliation(s)
- MICHAEL J. CUTLER
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - JEREMY JOHNSON
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - KHALID ABOZGUIA
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - SHANE ROWAN
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - WILLIAM LEWIS
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - OTTO COSTANTINI
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - ANDREA NATALE
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
- Texas Cardiac Arrhythmia Institute; Austin Texas USA
| | - OHAD ZIV
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| |
Collapse
|
22
|
Lim HS, Derval N, Komatsu Y, Zellerhoff S, Denis A, Shah AJ, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation? Circ Arrhythm Electrophysiol 2015; 8:963-71. [DOI: 10.1161/circep.114.001721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Han S. Lim
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Nicolas Derval
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Yuki Komatsu
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Stephan Zellerhoff
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Arnaud Denis
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Ashok J. Shah
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Frédéric Sacher
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Mélèze Hocini
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Pierre Jaïs
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| | - Michel Haïssaguerre
- From the Service de Cardiologie-Électrophysiologie et Stimulation Cardiaque, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Bordeaux, France (H.S.L., N.D., Y.K., S.Z., A.D., A.J.S., F.S., M.H., P.J., M.H.); and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France (N.D., A.D., F.S., M.H., P.J., M.H.)
| |
Collapse
|
23
|
Bunch TJ, Cutler MJ. Is pulmonary vein isolation still the cornerstone in atrial fibrillation ablation? J Thorac Dis 2015; 7:132-41. [PMID: 25713728 DOI: 10.3978/j.issn.2072-1439.2014.12.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 11/12/2014] [Indexed: 12/15/2022]
Abstract
Radiofrequency catheter ablation for atrial fibrillation (AF) has become a frequently used therapy after failure of at least one antiarrhythmic drug. The cornerstone of AF ablation has been durable pulmonary vein isolation. However, understanding the positive and negative outcomes of catheter ablation of AF is severely limited by diverse ablation methodologies that do not seem to result in durable pulmonary vein isolation. Without durable pulmonary isolation ablation, it is unclear if ablation strategies need to be modified to include extrapulmonary vein ablation targets in combination with pulmonary vein isolation or alone to improve long-term procedural success rates. The marked discrepancy between AF ablation procedure success rates and actual long-term pulmonary vein isolation rates does suggest that targeting other mechanisms can be considered to achieve similar or better results when compared to pulmonary vein isolation alone.
Collapse
Affiliation(s)
- T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah 84107, USA
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah 84107, USA
| |
Collapse
|
24
|
Location of epicardial adipose tissue affects the efficacy of a combined dominant frequency and complex fractionated atrial electrogram ablation of atrial fibrillation. Heart Rhythm 2015; 12:257-65. [DOI: 10.1016/j.hrthm.2014.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Indexed: 11/13/2022]
|