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Noujaim C, Tabaja C, Wazni OM, Santangeli P. Lesion Characteristics of Pulsed Field Ablation. Card Electrophysiol Clin 2025; 17:137-145. [PMID: 40412863 DOI: 10.1016/j.ccep.2025.02.002] [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] [Indexed: 05/27/2025]
Abstract
Pulsed field ablation (PFA) has emerged as a promising, nonthermal technique for arrhythmia ablation, leveraging high-voltage electrical fields to induce electroporation and create precise ablation lesions. Unlike traditional thermal methods such as radiofrequency ablation (RFA) and cryoablation, PFA selectively targets myocardial cells while sparing surrounding tissues, reducing the risk of collateral damage. This review focuses on the key characteristics of PFA lesion formation, drawing comparisons with RFA and cryoablation based on histopathology, imaging, and electroanatomical mapping.
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Affiliation(s)
- Charbel Noujaim
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chadi Tabaja
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama M Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
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2
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Kwan E, Hunt B, Paccione EN, Orkild BA, Bergquist JA, Ishidoya Y, Yazaki K, Mendes JK, DiBella EVR, MacLeod RS, Dosdall DJ, Ranjan R. Functional and Structural Remodeling as Atrial Fibrillation Progresses in a Persistent Atrial Fibrillation Canine Model. JACC Clin Electrophysiol 2025; 11:720-734. [PMID: 39614863 PMCID: PMC12043413 DOI: 10.1016/j.jacep.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/19/2024] [Accepted: 10/02/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Contractile, electrical, and structural remodeling has been associated with atrial fibrillation (AF), but the progression of functional and structural changes as AF sustains has not been previously evaluated serially. OBJECTIVES Using a rapid-paced persistent AF canine model, the authors aimed to evaluate the structural and functional changes serially as AF progresses. METHODS Serial electrophysiological studies in a chronic rapid-paced canine model (n = 19) prior to AF sustaining and repeated at 1, 3, and 6 months of sustained AF were conducted to measure changes in atrial conduction speed and direction. Cardiac late gadolinium enhancement magnetic resonance imaging was performed prior to and following sustained AF to evaluate structural remodeling. RESULTS As AF progressed, the overall area of the left atrium with fibrosis increased. Over time, conduction speeds slowed, with speeds decreasing by 0.15 m/s after 3 months and 0.26 m/s after 6 months of sustained AF. Regions that developed fibrosis experienced greater slowing compared with healthy regions (0.32 ± 0.01 m/s decrease vs 0.21 ± 0.01 m/s decrease; P < 0.001). Conduction directions became more aligned (conduction direction heterogeneity decreased from 19.7 ± 0.1° to 17.5 ± 0.1° after 6 months of sustained AF; P < 0.001). Fibrotic regions had a greater decrease in conduction direction heterogeneity (2.7 ± 0.3° vs 2.0 ± 0.2°; P = 0.008). CONCLUSIONS As AF progressed, functional changes occurred globally throughout the left atrium. Conduction speed slowed, and conduction directions became more aligned over time, with the greatest changes occurring within regions that developed fibrosis.
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Affiliation(s)
- Eugene Kwan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA
| | - Bram Hunt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA
| | - Eric N Paccione
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Ben A Orkild
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Jake A Bergquist
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Yuki Ishidoya
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA
| | - Kyoichiro Yazaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA
| | - Jason K Mendes
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ed V R DiBella
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Rob S MacLeod
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA.
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3
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Miklavčič D, Verma A, Krahn PRP, Štublar J, Kos B, Escartin T, Lombergar P, Coulombe N, Terricabras M, Jarm T, Kranjc M, Barry J, Mattison L, Kirchhof N, Sigg DC, Stewart M, Wright G. Biophysics and electrophysiology of pulsed field ablation in normal and infarcted porcine cardiac ventricular tissue. Sci Rep 2024; 14:32063. [PMID: 39738639 PMCID: PMC11686391 DOI: 10.1038/s41598-024-83683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025] Open
Abstract
Pulsed Field Ablation (PFA) is a new ablation method being rapidly adopted for treatment of atrial fibrillation, which shows advantages in safety and efficiency over radiofrequency and cryo-ablation. In this study, we used an in vivo swine model (10 healthy and 5 with chronic myocardial infarct) for ventricular PFA, collecting intracardiac electrograms, electro-anatomical maps, native T1-weighted and late gadolinium enhancement MRI, gross pathology, and histology. We used 1000-1500 V pulses, with 1-16 pulse trains to vary PFA dose. Lesions were assessed at 24 h, 7 days, and 6 weeks in healthy and at 48 h in infarcted ventricles. Comparisons of lesion sizes using a numerical model enabled us to determine lethal electric field thresholds for cardiac tissue and its dependence on the number of pulse trains. Similar thresholds were found in normal and infarcted hearts. Numerical modeling and temperature-sensitive MRI confirmed the nonthermal nature of PFA, with less than 2% of a lesion's volume at the highest dose used being attributed to thermal damage. Longitudinal cardiac MRI and histology provide a comprehensive description of lesion maturation. Lesions shrink between 24 h and 7 days post-ablation and then remain stable out to 6 weeks post-ablation. Periprocedural electrograms analysis yields good correlation with lesion durability and size.
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Affiliation(s)
- Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia.
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Philippa R P Krahn
- Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Jernej Štublar
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia
- Department of Cardiology Cardiovascular Surgery, University Clinical Medical Centre, Ljubljana, Slovenia
| | - Bor Kos
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia
| | - Terenz Escartin
- Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Peter Lombergar
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia
| | | | | | - Tomaž Jarm
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia
| | - Matej Kranjc
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, Ljubljana, Slovenia
| | | | | | | | | | | | - Graham Wright
- Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
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Stevenson WG, Richardson TD, Kanagasundram AN, Tandri H. State of the Art: Mapping Strategies to Guide Ablation in Ischemic Heart Disease. JACC Clin Electrophysiol 2024; 10:2744-2761. [PMID: 39520431 DOI: 10.1016/j.jacep.2024.09.016] [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: 07/22/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 11/16/2024]
Abstract
Catheter ablation to prevent ventricular tachycardia (VT) that emerges late after a myocardial infarction aims to interrupt the re-entry substrate. Interruption of potential channels and regions of slow conduction that can be identified during stable sinus or paced rhythm is often effective and a number of substrate markers for guiding this approach have been described. While there is substantial agreement with different markers in some patients, the different markers select different regions for ablation in others. Mapping during VT to identify critical re-entry circuit isthmuses is likely more specific, and most useful when VT is incessant or frequent during the procedure or when sinus rhythm substrate ablation fails. Both approaches are often combined. These methods for identifying and characterizing post-infarct-related arrhythmia substrate and the re-entry circuits are reviewed.
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Affiliation(s)
- William G Stevenson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Travis D Richardson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh N Kanagasundram
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harikrishna Tandri
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Ishidoya Y, Kwan E, Hunt B, Lange M, Sharma T, Dosdall DJ, Macleod RS, Kholmovski EG, Bunch TJ, Ranjan R. Effective ablation settings that predict chronic scar after atrial ablation with HELIOSTAR™ multi-electrode radiofrequency balloon catheter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01948-y. [PMID: 39592538 DOI: 10.1007/s10840-024-01948-y] [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: 02/29/2024] [Accepted: 11/12/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND Radiofrequency balloon (RFB) ablation (HELIOSTAR™, Biosense Webster) has been developed to improve pulmonary vein ablation efficiency over traditional point-by-point RF ablation approaches. We aimed to find effective parameters for RFB ablation that result in chronic scar verified by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). METHODS A chronic canine model (n = 8) was used to ablate in the superior vena cava (SVC), the right superior and the left inferior pulmonary vein (RSPV and LIPV), and the left atrial appendage (LAA) with a circumferential ablation approach (RF energy was delivered to all electrodes simultaneously) for 20 s or 60 s. The electroanatomical map with the ablation tags was projected onto the 3-month post-ablation LGE-CMR. Tags were divided into two groups depending on whether they correlated with CMR-based scar (ScarTags) or non-scar tissue (Non-ScarTags). The effective parameters for scar formation were estimated by multivariate logistic regression. RESULTS This study assessed 80 lesions in the SVC, 80 lesions in the RSPV, 20 lesions in the LIPV, and 30 lesions in the LAA (168 ScarTags and 42 Non-ScarTags). In the multivariate analysis, two variables were associated with chronic scar formation: temperature of electrode before energy application (odds ratio (OR) 0.805, p = 0.0075) and long RF duration (OR 2.360, p = 0.0218), whereas impedance drop was not associated (OR 0.986, p = 0.373). CONCLUSION Lower temperature of the electrode before ablation and long ablation duration are critical parameters for durable atrial scar formation with RFB ablation.
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Affiliation(s)
- Yuki Ishidoya
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Bram Hunt
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Matthias Lange
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | - Derek J Dosdall
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rob S Macleod
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Eugene G Kholmovski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Muthu P, Prajapati P, Vemulapalli H, Rodriguez-Riascos JF, Raman A, Srivathsan K. Ablation of premature ventricular complexes originating from papillary muscle using pulsed field energy: the first in USA experience. Heart Rhythm 2024:S1547-5271(24)03532-X. [PMID: 39515501 DOI: 10.1016/j.hrthm.2024.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Affiliation(s)
- Padmapriya Muthu
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | - Poojan Prajapati
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | - Hema Vemulapalli
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Aria Raman
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
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7
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Dong J, Kwan E, Bergquist JA, Steinberg BA, Dosdall DJ, DiBella EVR, MacLeod RS, Bunch TJ, Ranjan R. Ablation-induced left atrial mechanical dysfunction recovers in weeks after ablation. J Interv Card Electrophysiol 2024; 67:1547-1556. [PMID: 38587576 DOI: 10.1007/s10840-024-01795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The immediate impact of catheter ablation on left atrial mechanical function and the timeline for its recovery in patients undergoing ablation for atrial fibrillation (AF) remain uncertain. The mechanical function response to catheter ablation in patients with different AF types is poorly understood. METHODS A total of 113 AF patients were included in this retrospective study. Each patient had three magnetic resonance imaging (MRI) studies in sinus rhythm: one pre-ablation, one immediate post-ablation (within 2 days after ablation), and one post-ablation follow-up MRI (≤ 3 months). We used feature tracking in the MRI cine images to determine peak longitudinal atrial strain (PLAS). We evaluated the change in strain from pre-ablation, immediately after ablation to post-ablation follow-up in a short-term study (< 50 days) and a 3-month study (3 months after ablation). RESULTS The PLAS exhibited a notable reduction immediately after ablation, compared to both pre-ablation levels and those observed in follow-up studies conducted at short-term (11.1 ± 9.0 days) and 3-month (69.6 ± 39.6 days) intervals. However, there was no difference between follow-up and pre-ablation PLAS. The PLAS returned to 95% pre-ablation level within 10 days. Paroxysmal AF patients had significantly higher pre-ablation PLAS than persistent AF patients in pre-ablation MRIs. Both type AF patients had significantly lower immediate post-ablation PLAS compared with pre-ablation and post-ablation PLAS. CONCLUSION The present study suggested a significant drop in PLAS immediately after ablation. Left atrial mechanical function recovered within 10 days after ablation. The drop in PLAS did not show a substantial difference between paroxysmal and persistent AF patients.
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Affiliation(s)
- Jiawei Dong
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University fo Utah, Salt Lake City, UT, USA
| | - Edward V R DiBella
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rob S MacLeod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
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Lu X, Li J, Hsi DH, Zhang J, Han Y, Ta S, Wang J, He J, Zhao J, Han C, Yao L, Ou X, Shan B, Wang B, Zhao X, Hu R, Liu L, Liu L. Feasibility and safety of percutaneous intramyocardial septal cryoablation: A canine model with 6-month follow-up. Cryobiology 2024; 116:104933. [PMID: 38925358 DOI: 10.1016/j.cryobiol.2024.104933] [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: 11/26/2023] [Revised: 05/28/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
Echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) is a novel treatment option for hypertrophic obstructive cardiomyopathy (HOCM). The safety and feasibility of using this procedure for cryoablation are unknown. We aimed to investigate the feasibility and safety of echocardiography-guided percutaneous intramyocardial septal cryoablation (PIMSCA) for septal thickness reduction in a canine model. Eight canines underwent PIMSCA, and had electrocardiography, echocardiography(ECG), myocardial contrast echocardiography (MCE), serological and pathological examinations during the preoperative, immediate postoperative, and 6-month follow-up. All eight canines underwent successful cryoablation and continued to be in sinus rhythm during ablation and without malignant arrhythmias. MCE showed that the ablation area had decreased myocardial perfusion after the procedure. Troponin I levels were significantly elevated [0.010 (0.005, 0.297) ng/mL vs. 3.122 (1.152, 7.990) ng/mL, p < 0.05)]. At 6-month follow-up after the procedure, all animals were alive, with thinning of the interventricular septum (7.26 ± 0.52 mm vs. 3.86 ± 0.29 mm, p < 0.05). Echocardiography showed no significant decrease in the left ventricular ejection fractions (LVEF) (54.32 ± 2.93 % vs. 54.70 ± 2.47 %, p > 0.05) or changes by pulse-wave Doppler E/A (1.17 ± 0.43 vs. 1.07 ± 0.43, p > 0.05), E/e' (8.09 ± 1.49 vs. 10.05 ± 2.68, p > 0.05). Pathological findings proved the effectiveness of cryoablation in myocardial tissues. We observed pericardial effusions and premature ventricular complexes (PVCs) associated with the procedure. Our findings provided preliminary evidence of the safety and feasibility of PIMSCA in reducing interventricular septum, which provides a potentially new treatment option for HOCM.
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Affiliation(s)
- Xiaonan Lu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Li
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - David H Hsi
- Heart & Vascular Institute, Stamford Hospital, CT, and Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Juan Zhang
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yupeng Han
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shengjun Ta
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Wang
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jin He
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia Zhao
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Han
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lu Yao
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xumei Ou
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bo Shan
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bo Wang
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xueli Zhao
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rui Hu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lanyu Liu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Liwen Liu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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9
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Ngan HT, Tse HF. Expanding indications for pulsed-field ablation beyond the treatment of cardiac arrhythmias? Heart Rhythm 2024; 21:268-269. [PMID: 38065420 DOI: 10.1016/j.hrthm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Ho-Ting Ngan
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China; Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, Shenzhen, China; Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong SAR, China; Center for Translational Stem Cell Biology, Hong Kong SAR, China.
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10
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Scanavacca MI, Kulchetscki RM, Rochitte CE, Pisani CF. Cardiac Magnetic Resonance to Evaluate Complete Substrate Elimination after Endocardial Ventricular Tachycardia Ablation in Chagas Disease. Arq Bras Cardiol 2024; 121:e20230421. [PMID: 38422351 PMCID: PMC11098567 DOI: 10.36660/abc.20230421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Mauricio I. Scanavacca
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
| | - Rodrigo M. Kulchetscki
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
| | - Carlos E. Rochitte
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Imagem Cardiovascular, São Paulo , SP – Brasil
| | - Cristiano F. Pisani
- Instituto do Coração do Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Arritmia, São Paulo , SP – Brasil
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11
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Guglielmo M, Rier S, Zan GD, Krafft AJ, Schmidt M, Kunze KP, Botnar RM, Prieto C, van der Heijden J, Van Driel V, Ramanna H, van der Harst P, van der Bilt I. Cardiac magnetic resonance for early atrial lesion visualization post atrial fibrillation radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2024; 35:258-266. [PMID: 38065834 DOI: 10.1111/jce.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Incomplete atrial lesions resulting in pulmonary vein-left atrium reconnection after pulmonary vein antrum isolation (PVAI), are related to atrial fibrillation (AF) recurrence. Unfortunately, during the PVAI procedure, fluoroscopy and electroanatomic mapping cannot accurately determine the location and size of the ablation lesions in the atrial wall and this can result in incomplete PVAI lesions (PVAI-L) after radiofrequency catheter ablation (RFCA). AIM We seek to evaluate whether cardiac magnetic resonance (CMR), immediately after RFCA of AF, can identify PVAI-L by characterizing the left atrial tissue. METHODS Ten patients (63.1 ± 5.7 years old, 80% male) receiving a RFCA for paroxysmal AF underwent a CMR before (<1 week) and after (<1 h) the PVAI. Two-dimensional dark-blood T2-weighted short tau inversion recovery (DB-STIR), Three-dimensional inversion-recovery prepared long inversion time (3D-TWILITE) and three-dimensional late gadolinium enhancement (3D-LGE) images were performed to visualize PVAI-L. RESULTS The PVAI-L was visible in 10 patients (100%) using 3D-TWILITE and 3D-LGE. Conversely, On DB-STIR, the ablation core of the PAVI-L could not be identified because of a diffuse high signal of the atrial wall post-PVAI. Microvascular obstruction was identified in 7 (70%) patients using 3D-LGE. CONCLUSION CMR can visualize PVAI-L immediately after the RFCA of AF even without the use of contrast agents. Future studies are needed to understand if the use of CMR for PVAI-L detection after RFCA can improve the results of ablation procedures.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sophie Rier
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Giulia De Zan
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Rene M Botnar
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Claudia Prieto
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | | | - Vincent Van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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Gracia E, Miranda-Arboleda AF, Hoyos C, Matos CD, Osorio J, Romero JE, Zei PC. Understanding Lesion Creation Biophysics and Improved Lesion Assessment during Radiofrequency Catheter Ablation. The Perfect Combination to Achieve Durable Lesions in Atrial Fibrillation Ablation. Rev Cardiovasc Med 2024; 25:44. [PMID: 39077337 PMCID: PMC11263146 DOI: 10.31083/j.rcm2502044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 07/31/2024] Open
Abstract
Atrial fibrillation (AF) is a prevalent arrhythmia, while pulmonary vein isolation (PVI) has become a cornerstone in its treatment. The creation of durable lesions is crucial for successful and long-lasting PVI, as inconsistent lesions lead to reconnections and recurrence after ablation. Various approaches have been developed to assess lesion quality and transmurality in vivo, acting as surrogates for improved lesion creation and long-term outcomes utilizing radiofrequency (RF) energy. This review manuscript examines the biophysics of lesion creation and different lesion assessment techniques that can be used daily in the electrophysiology laboratory when utilizing RF energy. These methods provide valuable insights into lesion effectiveness, facilitating optimized ablation procedures and reducing atrial arrhythmia recurrences. However, each approach has its limitations, and a combination of techniques is recommended for comprehensive lesion assessment during AF catheter ablation. Future advancements in imaging techniques, such as magnetic Resonance Imaging (MRI), optical coherence tomography, and photoacoustic imaging, hold promise in further enhancing lesion evaluation and guiding treatment strategies.
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Affiliation(s)
- Ely Gracia
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Andres F. Miranda-Arboleda
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Carlos D. Matos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, FL 33133, USA
| | - Jorge E. Romero
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paul C. Zei
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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13
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Ma Y, Guo L, Hu M, Yan Q, Liu H, Yi F. Left atrial appendage occlusion combined with cryoballoon or radiofrequency ablation: One-year follow-up comparison. Front Cardiovasc Med 2023; 10:1153158. [PMID: 37180810 PMCID: PMC10169712 DOI: 10.3389/fcvm.2023.1153158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background A one-stop procedure involving catheter ablation and left atrial appendage occlusion (LAAO) is an option for high-risk atrial fibrillation patients. Few studies have reported the efficacy and safety of cryoballoon ablation (CBA) combined with LAAO, and no studies have compared the combination of LAAO with CBA or radiofrequency ablation (RFA). Methods A total of 112 patients were enrolled in the present study; 45 patients received CBA combined with LAAO (group 1), and 67 patients received RFA combined with LAAO (group 2). Patient follow-up was performed for 1 year to detect peri-device leaks (PDLs) and safety outcomes (defined as a composite of peri-procedural and follow-up adverse events). Results The number of PDLs at the median 59 days follow-up was comparable between the two groups (33.3% in group 1 vs. 37.3% in group 2, p = 0.693). Safety outcomes were also comparable between the two groups (6.7% in group 1 vs. 7.5% in group 2, p = 1.000). Multivariable regression showed that PDLs risk and safety outcomes were all similar between the two groups. Subgroup analysis of PDLs indicated no significant differences. Follow-up safety outcomes were related to anticoagulant medication, and patients without PDLs were more likely to discontinue antithrombotic therapy. The total procedure and ablation times were all significantly shorter for group 1. Conclusion When compared with left atrial appendage occlusion combined with radiofrequency, left atrial appendage occlusion combined with cryoballoon ablation has the same risk of peri-device leaks and safety outcomes, but the procedure time was significantly reduced.
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Affiliation(s)
| | | | | | | | | | - Fu Yi
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Shaanxi, China
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14
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Watanabe R, Okumura Y, Nagashima K, Wakamatsu Y, Yamada A, Kurokawa S. Chronic Ablation Lesions after Cryoballoon and Hot Balloon Ablation of Atrial Fibrillation. J NIPPON MED SCH 2023; 90:69-78. [PMID: 36436916 DOI: 10.1272/jnms.jnms.2023_90-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronological changes in ablation lesions after cryoballoon ablation (CBA) and hot balloon ablation (HBA) of atrial fibrillation (AF) remain unclear. METHODS Of 90 patients who underwent initial balloon-based catheter ablation of AF and cardiac magnetic resonance imaging (cMRI) 3 months after ablation, data from 48 propensity score-matched patients (24 per group; 34 males; age 62±10 years) were analyzed. High-density pulmonary vein-left antrum (PV-LA) voltage mapping was performed after PV isolation, and low voltage areas around the PV ostia were defined as the total acute ablation lesion area (cm2). cMRI-derived dense fibrotic tissue localized around PVs was defined as the total chronic ablation lesion area (cm2). The percentage of total ablation lesion areas to total PV-LA surface area (%ablation lesion) was calculated during each phase, and %acute ablation lesion and %chronic ablation lesion areas were compared in patients who had undergone CBA and HBA. RESULTS The %acute ablation lesion area was larger for the CBA group than for the HBA group (30.8±5.8% vs. 23.0±5.5%, p < 0.001). There was no difference in %chronic cMRI-derived ablation lesion area (24.8±10.8% vs. 21.1±11.6%, p = 0.26) between groups. The rates of chronic AF recurrence were 12.5% and 8.3%, respectively (p = 0.45; log-rank test). LA volume and LA surface area were strongly associated with AF recurrence, but %chronic ablation lesion area was not (27±8% vs. 23±12%, p = 0.39). CONCLUSION Large acute ablation lesions after CBA were smaller during the chronic phase. The size of chronic ablation lesions and the rate of AF recurrence were both similar for CBA and HBA.
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Affiliation(s)
- Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Akimasa Yamada
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Zhang C, Zhu L, Tang S, Wang J, Li Y, Chen X, Bian C, Liu D, Ao G, Luo T. Feasibility and safety of trans-biliary cryoablation: Preclinical evaluation of a novel flexible cryoprobe. Cryobiology 2022:S0011-2240(22)00354-6. [PMID: 36414042 DOI: 10.1016/j.cryobiol.2022.11.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Cryoablation, as a well-characterized technology, has multifarious clinical applications in solid malignancy. However, trans-biliary cryoablation for malignant biliary obstruction has not been reported yet. Thus, this study aimed to determine the efficacy and safety of trans-biliary cryoablation with a novel CO2 gas-based flexible cryoprobe in standardized preclinical settings. For fresh porcine liver ex vivo, the freezing efficacy of cryoablation was evaluated by using fresh porcine liver. The real-time CO2 flow rate, freezing temperature and freezing range were examined and the frozen appearance was visualized. In vivo study, acute and chronical effects were investigated by using the models of canine bile duct. Histopathology and laboratory examination were performed. The lowest temperature that the electrode could deliver to the tissue was -60.7 °C. At 60s after freezing, the tissue temperature dropped to -22.6 °C and -4.3 °C at 0.1 and 0.2 cm from the electrode center, respectively. The frozen size was greater in liver tissue ex vivo than that in bile duct tissue in vivo. No biliary hemorrhage, perforation, stricture, obstruction, and adjacent organ injury were observed. With histopathologic examination, acute intercellular vacuoles were observed in the lamina propria adjacent to the lumen. Chronic changes, including uneven coagulative necrosis, fibro-proliferation, inflammatory infiltration and connective tissue thickening were observed in the lamina propria of the all biliary samples. The results demonstrated CO2 gas-based trans-biliary cryoablation is safe and efficacious. These findings may provide a potential new modality for primary malignant biliary obstruction and malignant obstruction within a biliary stent and contribute to cryoablation of clinical practice.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Linzhong Zhu
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Shousheng Tang
- CAS Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100080, 100091, PR China
| | - Jukun Wang
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Yu Li
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Xin Chen
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Chunjing Bian
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Dongbin Liu
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Guokun Ao
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, PR China.
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Ghannam M, Liang J, Attili A, Cochet H, Jais P, Latchamsetty R, Jongnarangsin K, Morady F, Gordon D, Bogun F. Magnetic Resonance Imaging and Histopathology of Catheter Ablation Lesions after Ventricular Tachycardia Ablation in Patients with Nonischemic Cardiomyopathy. Heart Rhythm 2022; 19:1642-1649. [PMID: 35772697 DOI: 10.1016/j.hrthm.2022.06.027] [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: 04/24/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) imaging may help identify radiofrequency ablation lesions. This has been poorly described in patients with non-ischemic cardiomyopathy (NICM). OBJECTIVES To describe LGE-CMR characteristics of ablation lesions in patients with NICM and correlate with histopathology. METHODS Twenty-six patients (24 males, 38±14 ejection fraction, 61±9 age), with CMR imaging after VT ablation were included. Areas of both dark and bright core lesions correlating with prior radiofrequency ablation lesions were identified. Histology was performed on an explanted heart. RESULTS The mean time between the ablation procedure and the LGE-CMR study was 8[2-20] months. Twenty-three/26 patients demonstrated dark-core lesions (volume 2.16±1.8 cm3, thickness 3.6±1.3 mm) with a transmurality of 42±16%, overlaying areas of intramural or transmural LGE. Fourteen/26 patients demonstrated bright core lesions (volume 0.8±0.6 cm3, depth 4.15±1.76 mm) with a transmurality of 34±14%, which was located in areas without underlying LGE in 11/13 patients. Both dark and bright core lesions were visualized on standard clinical LGE-CMR imaging obtained in the acute setting and chronic settings (within 3 days and up to 2090 days post ablation). Histopathologic analysis demonstrated coagulation necrosis in the area that corresponded to dark core lesions in the post ablation CMR. CONCLUSION Ablation lesions can be detected by LGE-CMR after VT ablation in NICM patients and have a different appearance than scar tissue. These lesions can be observed in the acute and chronic settings after ablations.
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Affiliation(s)
| | | | | | - Hubert Cochet
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Pierre Jais
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | | | | | | | - David Gordon
- Department of Pathology University of Michigan, Ann Arbor, MI, USA
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Mont L, Roca-Luque I, Althoff TF. Ablation Lesion Assessment with MRI. Arrhythm Electrophysiol Rev 2022; 11:e02. [PMID: 35444808 PMCID: PMC9014705 DOI: 10.15420/aer.2021.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.
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Affiliation(s)
- Lluís Mont
- Arrhythmia Section, Cardiovascular Institute, Clínic – University Hospital Barcelona Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute, Clínic – University Hospital Barcelona Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute, Clínic – University Hospital Barcelona Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Department of Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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Nakamura K, Sasaki T, Koyama K, Naito S. A confluent non-enhanced dark core on serial late gadolinium enhancement imaging after a moderator band-ventricular tachycardia ablation. Indian Pacing Electrophysiol J 2022; 22:154-157. [PMID: 35134485 PMCID: PMC9091750 DOI: 10.1016/j.ipej.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 10/26/2022] Open
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Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. Europace 2021; 24:874-886. [PMID: 34964469 DOI: 10.1093/europace/euab279] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is an important alternative to antiarrhythmic drugs in the treatment of symptomatic atrial fibrillation. However, the inability to consistently achieve durable isolation of the pulmonary veins hampers the long-term efficacy of PVI procedures. The large number of factors involved in RF lesion formation and the complex interplay of these factors complicate reliable creation of durable and transmural ablation lesions. Various surrogate markers of ablation lesion formation have been proposed that may provide information on RF lesion completeness. Real-time assessment of these surrogates may aid in the creation of transmural ablation lesions, and therefore, holds potential to decrease the risk of PV reconnection and consequent post-PVI arrhythmia recurrence. Moreover, titration of energy delivery until lesions is transmural may prevent unnecessary ablation and subsequent adverse events. Whereas several surrogate markers of ablation lesion formation have been described over the past decades, a 'gold standard' is currently lacking. This review provides a state-of-the-art overview of ablation strategies that aim to enhance durability of RF-PVI, with special focus on real-time available surrogates of RF lesion formation in light of the biophysical basis of RF ablation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Mizutani Y, Yanagisawa S, Kanashiro M, Yamashita D, Yonekawa J, Makino Y, Hiramatsu T, Ichimiya H, Uchida Y, Watanabe J, Ichimiya S, Inden Y, Murohara T. Earliest pulmonary vein potential-guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: A result from two randomized clinical studies. J Cardiovasc Electrophysiol 2021; 32:2933-2942. [PMID: 34535938 DOI: 10.1111/jce.15246] [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] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION With regard to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during PV isolation (earliest potential [EP]-guided CBA) has been previously demonstrated. The present study aimed to evaluate the long-term outcome of the EP-guided CBA. METHODS AND RESULTS This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time-to-isolation (TTI) after cryoapplication exceeded 60 and 45 s in the first and second studies, respectively. We compared the clinical outcomes for 1 year after the procedure between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients). The primary endpoint was the recurrence of atrial arrhythmia after ablation. No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤ 90 s (98.5% vs. 90.0%, p < .001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1 year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; p = .019). CONCLUSIONS The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1 year after ablation.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Daiki Yamashita
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Jun Yonekawa
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Takatsugu Hiramatsu
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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van Rijn D, Hendriks AA, Noten AMME, van Heerebeek L, Khan M. Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation. JACC Case Rep 2021; 3:1409-1412. [PMID: 34557681 PMCID: PMC8446027 DOI: 10.1016/j.jaccas.2021.06.016] [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: 01/22/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
Pulmonary vein isolation (PVI) using cryoballoon causes acute tissue edema of the osteal region of the pulmonary veins and the left atrium. In two cases combining PVI with an implantation of a left atrial appendage closure device led to malsizing of the device, device shouldering, and a paraprosthetic residual flow. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Dafne van Rijn
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Astrid A Hendriks
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Anne-Marie M E Noten
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Loek van Heerebeek
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Muchtiar Khan
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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22
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Kohli U, Shah M. Cryoablation: Another arrow in the Ablationist's Quiver. Indian Pacing Electrophysiol J 2021; 21:273-274. [PMID: 34481588 PMCID: PMC8414323 DOI: 10.1016/j.ipej.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University School of Medicine and West Virginia University Children's Hospital, Morgantown, WV, United States
| | - Maully Shah
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
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23
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Kolandaivelu A, Bruce CG, Ramasawmy R, Yildirim DK, O'Brien KJ, Schenke WH, Rogers T, Campbell-Washburn AE, Lederman RJ, Herzka DA. Native contrast visualization and tissue characterization of myocardial radiofrequency ablation and acetic acid chemoablation lesions at 0.55 T. J Cardiovasc Magn Reson 2021; 23:50. [PMID: 33952312 PMCID: PMC8101152 DOI: 10.1186/s12968-020-00693-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Low-field (0.55 T) high-performance cardiovascular magnetic resonance (CMR) is an attractive platform for CMR-guided intervention as device heating is reduced around 7.5-fold compared to 1.5 T. This work determines the feasibility of visualizing cardiac radiofrequency (RF) ablation lesions at low field CMR and explores a novel alternative method for targeted tissue destruction: acetic acid chemoablation. METHODS N = 10 swine underwent X-ray fluoroscopy-guided RF ablation (6-7 lesions) and acetic acid chemoablation (2-3 lesions) of the left ventricle. Animals were imaged at 0.55 T with native contrast 3D-navigator gated T1-weighted T1w) CMR for lesion visualization, gated single-shot imaging to determine potential for real-time visualization of lesion formation, and T1 mapping to measure change in T1 in response to ablation. Seven animals were euthanized on ablation day and hearts imaged ex vivo. The remaining animals were imaged again in vivo at 21 days post ablation to observe lesion evolution. RESULTS Chemoablation lesions could be visualized and displayed much higher contrast than necrotic RF ablation lesions with T1w imaging. On the day of ablation, in vivo myocardial T1 dropped by 19 ± 7% in RF ablation lesion cores, and by 40 ± 7% in chemoablation lesion cores (p < 4e-5). In high resolution ex vivo imaging, with reduced partial volume effects, lesion core T1 dropped by 18 ± 3% and 42 ± 6% for RF and chemoablation, respectively. Mean, median, and peak lesion signal-to-noise ratio (SNR) were all at least 75% higher with chemoablation. Lesion core to myocardium contrast-to-noise (CNR) was 3.8 × higher for chemoablation. Correlation between in vivo and ex vivo CMR and histology indicated that the periphery of RF ablation lesions do not exhibit changes in T1 while the entire extent of chemoablation exhibits T1 changes. Correlation of T1w enhancing lesion volumes indicated in vivo estimates of lesion volume are accurate for chemoablation but underestimate extent of necrosis for RF ablation. CONCLUSION The visualization of coagulation necrosis from cardiac ablation is feasible using low-field high-performance CMR. Chemoablation produced a more pronounced change in lesion T1 than RF ablation, increasing SNR and CNR and thereby making it easier to visualize in both 3D navigator-gated and real-time CMR and more suitable for low-field imaging.
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Affiliation(s)
- Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chris G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Biophysics and Biochemistry Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Kendall J O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Medstar Washington Hospital Center, Washington, DC, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Biophysics and Biochemistry Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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24
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Sørensen SK, Johannessen A, Worck R, Hansen ML, Hansen J. Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden: The RACE-AF Randomized Controlled Trial. Circ Arrhythm Electrophysiol 2021; 14:e009573. [PMID: 33835823 PMCID: PMC8136462 DOI: 10.1161/circep.120.009573] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Recurrent paroxysmal atrial fibrillation (AF) after catheter ablation is presumably caused by failure to achieve durable pulmonary vein isolation (PVI). The primary methods of PVI are radiofrequency catheter ablation (RF) and cryoballoon catheter ablation (CRYO), but these methods have not been directly compared with respect to PVI durability and the effect thereof on AF burden (% of time in AF). Methods: Accordingly, we performed a randomized trial including 98 patients (68% male, 61 [55–67] years) with paroxysmal AF assigned 1:1 to PVI by contact-force sensing, irrigated radiofrequency catheter, or second-generation cryoballoon catheter. Implantable cardiac monitors were inserted ≥1 month before PVI for assessment of AF burden and recurrence, and all patients, irrespective of AF recurrence, underwent a second procedure 4 to 6 months after PVI to determine PVI durability. Results: In the second procedure, 152 out of 199 (76%) pulmonary veins (PVs) were found durably isolated after RF and 161 out of 200 (81%) after CRYO (P=0.32), corresponding to durable isolation of all veins in 47% of patients in both groups (P=1.0). Median AF burden before PVI was 5.4% (interquartile range, 0.5%–13.0%) versus 4.0% (0.6%–18.1%), RF versus CRYO (P=0.71), and reduced to 0.0% (0.0%–0.1%) and 0.0% (0.0%–0.5%), respectively (P=0.58)—a reduction of 99.9% (92.9%–100.0%) and 99.3% (85.9%–100.0%; P=0.36). AF burden after PVI significantly correlated to the number of durably isolated PVs (P<0.01), but 9 out of 45 (20%) patients with durable isolation of all veins had recurrence of AF within 4 to 6 months after PVI (excluding a 3-month blanking period). Conclusions: PVI by RF and CRYO produce similar moderate to high PVI durability. Both treatments lead to marked reductions in AF burden, which is related to the number of durably isolated PVs. However, for one-fifth of paroxysmal AF patients, complete and durable PVI was not sufficient to prevent even short-term AF recurrence. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03805555.
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Affiliation(s)
- Samuel K Sørensen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Arne Johannessen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - René Worck
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Morten L Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Jim Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
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25
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Dabbagh GS, Ghannam M, Siontis KC, Attili A, Cochet H, Jais P, Eng MJ, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Magnetic Resonance Mapping of Catheter Ablation Lesions After Post-Infarction Ventricular Tachycardia Ablation. JACC Cardiovasc Imaging 2020; 14:588-598. [PMID: 33248970 DOI: 10.1016/j.jcmg.2020.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 08/14/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study sought to describe cardiac magnetic resonance (CMR) characteristics of ablation lesions within post-infarction scar. BACKGROUND Chronic ablation lesions created during radiofrequency ablation of ventricular tachycardia (VT) in the setting of prior myocardial infarction have not been described in humans. METHODS Seventeen patients (15 men, ejection fraction 25 ± 8%, 66 ± 6 years of age) with CMR imaging prior to repeat ablation procedures for VT were studied. Electroanatomic maps from first-time procedures and subsequent CMR images were merged and retrospectively compared with electroanatomic maps from repeat procedures. RESULTS The delay between the index ablation procedure and the CMR study was 30 ± 29 months. Late gadolinium-enhanced CMR revealed a confluent nonenhancing subendocardial dark core within the infarct-related scar tissue in all patients. Intracardiac thrombi were ruled out by transthoracic and intracardiac echocardiography. These core lesions matched the distribution of prior ablation lesions, and corresponded to unexcitable areas at repeat procedures. CONCLUSIONS Ablation lesions can be detected by CMR after VT ablation in post-infarction patients and have a different appearance than scar tissue. These lesions can be observed many months after an initial ablation.
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Affiliation(s)
- Ghaith Sharaf Dabbagh
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hubert Cochet
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Pierre Jais
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Mehdi Johoor Eng
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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26
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Ren Z, Jia P, Wang S, Li S, Li H, Guo R, Zhang J, Zhang J, Yang H, Meng W, Zheng Y, Xu Y, Zhao D. Acute left atrial ridge lesion after cryoballoon ablation: How does this affect left atrial appendage closure combined procedure? J Cardiovasc Electrophysiol 2020; 31:2865-2873. [PMID: 33405334 DOI: 10.1111/jce.14718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute left atrial ridge (LAR) lesions have been observed following atrial fibrillation (AF) ablation. However, LAR lesions had not yet been quantitatively evaluated and their influence on procedure combining cryoballoon (CB) ablation with left atrial appendage closure (LAAC) remained to be explored. METHODS The profile of LAR lesions was measured by transesophageal echocardiography (TEE) in 117 consecutive nonvalvular AF patients, who underwent the combined procedure of CB ablation and LAAC. We thoroughly investigated how LAR lesions correlated with baseline variables and clinical outcomes. RESULTS A total of 95 out of 96 available TEE images presented prominent acute LAR lesions. In terms of dimensions, there was a greater change in width (Δwidth = 3.6 ± 2.3 mm) than the thickness (Δthickness = 2.6 ± 3.5 mm), and the outer ostium was narrowed (Δouter ostium diameter = -3.4 ± 4.0 mm), while the inner ostium remained unchanged. A higher nadir temperature when freezing the left superior pulmonary vein (LSPV) led to an LAR lesion with a two times greater width (adjusted odds ratio = 1.16; 95% confidence interval, 1.02-1.31). In the evaluation of LAAC outcomes, four patients implanted with Watchman devices had minimal residual flow at the inferior border, while two implanted with LAmbre devices developed residual flow at the LAR side. Clinical outcomes were similar between groups divided by lesion size. CONCLUSION Acute LAR lesions frequently occurred following the CB ablation combined procedure, and lesion width positively correlates with LSPV nadir temperature. The presence of these lesions affects the measurement of pacifier devices but has little impact on that of occluder devices.
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Affiliation(s)
- Zhongyuan Ren
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Soochow University Medical College, Suzhou, China
| | - Peng Jia
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University School of Medicine, Wuhan, China
| | - Shuang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hailing Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Guo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingying Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haotian Yang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weilun Meng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixing Zheng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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27
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Bunch TJ. Electrophysiology Coup d'Oeil: The Art of Papillary Muscle PVC Ablation. JACC Clin Electrophysiol 2020; 6:1393-1394. [PMID: 33121668 DOI: 10.1016/j.jacep.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Affiliation(s)
- T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
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28
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Baba M, Yoshida K, Naruse Y, Hattori A, Yui Y, Kimata A, Ito Y, Tsumagari Y, Tsuneoka H, Shinoda Y, Harunari T, Hanaki Y, Hasebe H, Misaki M, Abe D, Nogami A, Ieda M, Takeyasu N. Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods. MEDICINA-LITHUANIA 2020; 56:medicina56090465. [PMID: 32932837 PMCID: PMC7557836 DOI: 10.3390/medicina56090465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: Pulmonary vein (PV) reconnection is a major reason for recurrence after catheter ablation of paroxysmal atrial fibrillation (PAF). However, the timing of the recurrence varies between patients, and recurrence >1 year after ablation is not uncommon. We sought to elucidate the characteristics of atrial fibrillation (AF) that recurred in different follow-up periods. Materials and Methods: Study subjects comprised 151 consecutive patients undergoing initial catheter ablation of PAF. Left atrial volume index (LAVi) and atrial/brain natriuretic peptide (ANP/BNP) levels were systematically measured annually over 3 years until AF recurred. Results: Study subjects were classified into four groups: non-recurrence group (n = 84), and short-term- (within 1 year) (n = 30), mid-term- (1–3 years) (n = 26), and long-term-recurrence group (>3 years) (n = 11). The short-term-recurrence group was characterized by a higher prevalence of diabetes mellitus (hazard ratio 2.639 (95% confidence interval, 1.174–5.932), p = 0.019 by the Cox method), frequent AF episodes (≥1/week) before ablation (4.038 (1.545–10.557), p = 0.004), and higher BNP level at baseline (per 10 pg/mL) (1.054 (1.029–1.081), p < 0.0001). The mid-term-recurrence group was associated with higher BNP level (1.163 (1.070–1.265), p = 0.0004), larger LAVi (mL/m2) (1.033 (1.007–1.060), p = 0.013), and longer AF cycle length at baseline (per 10 ms) (1.194 (1.058–1.348), p = 0.004). In the long-term-recurrence group, the ANP and BNP levels were low throughout follow-up, as with those in the non-recurrence group, and AF cycle length was shorter (0.694 (0.522–0.924), p = 0.012) than those in the other recurrence groups. Conclusions: Distinct characteristics of AF were found according to the time to first recurrence after PAF ablation. The presence of secondary factors beyond PV reconnections could be considered as mechanisms for the recurrence of PAF in each follow-up period.
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Affiliation(s)
- Masako Baba
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Kentaro Yoshida
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
- Correspondence:
| | - Yoshihisa Naruse
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Ai Hattori
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Yoshiaki Yui
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Akira Kimata
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Yoko Ito
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Yasuaki Tsumagari
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Hidekazu Tsuneoka
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Yasutoshi Shinoda
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Tomohiko Harunari
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Yuichi Hanaki
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Hideyuki Hasebe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Masako Misaki
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Daisuke Abe
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
| | - Noriyuki Takeyasu
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama 309-1793, Japan; (M.B.); (Y.N.); (A.H.); (Y.Y.); (A.K.); (Y.I.); (Y.T.); (H.T.); (Y.S.); (T.H.); (Y.H.); (M.M.); (D.A.); (N.T.)
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (H.H.); (A.N.); (M.I.)
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Yamashita K, Kamali R, Kwan E, MacLeod RS, Dosdall DJ, Ranjan R. Effective Ablation Settings That Predict Chronic Scar After Left Atrial Ablation. JACC Clin Electrophysiol 2020; 6:143-152. [DOI: 10.1016/j.jacep.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
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Yamashita K, Kwan E, Kamali R, Ghafoori E, Steinberg BA, MacLeod RS, Dosdall DJ, Ranjan R. Blanking period after radiofrequency ablation for atrial fibrillation guided by ablation lesion maturation based on serial MR imaging. J Cardiovasc Electrophysiol 2020; 31:450-456. [PMID: 31916637 DOI: 10.1111/jce.14340] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent guidelines recommend a 3-month blanking period after atrial fibrillation (AF) ablations, which are based on clinical observation. Our goal was to quantify the timeline of the radiofrequency ablation lesion maturation using serial late gadolinium enhancement-magnetic resonance imaging (LGE-MRI) and to develop a blanking period estimate based on visible lesion maturation. METHODS Inclusion criteria targeted patients who underwent AF ablation and at least four MRI scans: at baseline before ablation, within 24 hours after (acute), between 24 hours and 90 days after (subacute), and more than 90 days after ablation (chronic). Central nonenhanced (NE) and surrounding hyperenhanced (HE) area volumes were measured and normalized to chronic lesion volume. RESULTS This study assessed 75 patients with 309 MRIs. The acute lesion was heterogeneous with a HE region surrounding a central NE region in LGE-MRI; the acute volume of the total (HE + NE) lesion was 2.62 ± 0.46 times larger than that of the chronic lesion. Acute T2-weighted imaging also showed a relatively large area of edema. Both NE and HE areas gradually receded over time and NE was not observed after 30 days. Larger initial NE volume was associated with a significantly greater chronic scar volume and this total lesion volume receded to equal the chronic lesion size at approximately 72.5 days (95% prediction interval: 57.4-92.2). CONCLUSION On the basis of serial MRI, atrial ablation lesions are often fully mature before the typical 90-day blanking period, which could support more timely clinical decision making for arrhythmia recurrence.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Eugene Kwan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Roya Kamali
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Elyar Ghafoori
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | | | - Rob S MacLeod
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Derek J Dosdall
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- Nora Eccles Harrison, Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
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31
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Yamashita K, Ghafoori E, Silvernagel J, Ashton J, J Dosdall D, MacLeod R, Ranjan R. The Effective Contact Force to Minimize Edema Relative to Chronic Lesion Formation During Radiofrequency Ablation in Ventricular Wall. Int Heart J 2019; 60:1407-1414. [PMID: 31735778 DOI: 10.1536/ihj.19-128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Radiofrequency (RF) ablation results in creation of acute edema which can lead to temporary disruption of electrical propagation.The goal of this study was to find the effective contact force (CF) to minimize edema formation in comparison to the lesion size.Ventricular RF lesions (n = 49) were created by a CF-sensing catheter in a canine model (n = 10) with varying force for 30 seconds. Animals underwent T2-weighted (T2w) and late gadolinium enhancement MRI (LGE-MRI) immediately after ablation and at 12 weeks. Acute LGE lesion volume, acute edema, and chronic LGE lesion volume were measured. Acute edema/acute LGE lesion volume ratio was used to divide the lesions into two groups.Mean edema/lesion volume ratio was 5.0 ± 2.8. The lesions were divided into greater edema group (n = 8) and smaller edema group (n = 41) based on a cutoff edema/lesion volume ratio. When comparing the two groups, the CF and force time integral (FTI) were significantly lower in the greater edema group. There was no difference in catheter power setting, tip temperature change, impedance drop, and bipolar electrogram voltage change. Acute LGE volume and chronic lesion depth were significantly smaller in the greater edema group. Moreover, receiver-operator characteristic curve for the smaller edema lesion group showed that the most discriminant cutoff values for CF and FTI were 12.4 g and 584 gs, respectively.To minimize edema size while still forming permanent lesions, ablation should be performed with FTI > 584 gs or CF > 12.4 g.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison CVRTI, University of Utah
| | - Elyar Ghafoori
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | - Josh Silvernagel
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | | | - Derek J Dosdall
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
- Division of Cardiothoracic Surgery, University of Utah
| | - Robert MacLeod
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
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Fukuda K. Evidence of Acute Tissue Edema after Cryoballoon Ablation for Atrial Fibrillation. Int Heart J 2019; 60:497-498. [DOI: 10.1536/ihj.19-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Koji Fukuda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital
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Yamashita K, Ranjan R. Imaging for Risk Stratification in Atrial Fibrillation with Heart Failure. Cardiol Clin 2019; 37:147-156. [PMID: 30926016 PMCID: PMC6446587 DOI: 10.1016/j.ccl.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and is associated with heart failure (HF). Cardiac imaging modalities play an important role in risk assessment and managing AF. This article reviews the use of cardiac imaging for risk assessment and to optimize treatment strategy in patients with AF and HF. First, the clinical role of echocardiography, computed tomography, and cardiac magnetic resonance for risk stratification is provided. Second, the value of imaging in catheter ablation is reviewed, including preoperative assessment, optimizing patient selection for ablation, use during the ablation procedure, and postoperative scar assessment.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112, USA.
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Preoperative imaging in search of ventricular tachycardia circuit. Heart Rhythm 2018; 16:595-596. [PMID: 30445169 DOI: 10.1016/j.hrthm.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 11/24/2022]
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