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Raymond-Paquin A, Pillai A, Myadam R, Mankad P, Lovejoy S, Koneru JN, Ellenbogen KA. Atypical atrial flutter catheter ablation in the era of high-density mapping. J Interv Card Electrophysiol 2023; 66:1807-1815. [PMID: 36645578 DOI: 10.1007/s10840-023-01475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mapping and ablating atypical atrial flutters (AAFLs) have evolved greatly with advances in high-density 3D mapping systems over the last years. METHODS The objectives are to evaluate the feasibility of AAFL catheter ablation based on high-density mapping and minimizing entrainment and to better characterize AAFL circuits. Consecutive patients who underwent AAFL ablation using the EnSite Precision™ system and HD Grid™ mapping catheter (Abbott, Chicago, IL) between 06/2018 and 1/2022 were included. Mitral isthmus-dependent and roof-dependent AAFLs were classified as conventional circuits. All other AAFL circuits were classified as non-conventional circuits and were defined based on the location of the critical isthmus. RESULTS Sixty-two patients underwent AAFL ablation (mean age 68±11 years). A total of 95 AAFLs were mapped and 92 (97%) were successfully ablated. Fifty-three (85%) patients had a previous AF/AFL ablation. Forty-four (46%) AAFL circuits were classified as conventional and 51 (54%) as non-conventional. Conventional AAFL circuits had longer critical isthmuses (19.0±9.0 vs 10.8±6.3mm, p<0.001), a lower prevalence of slow conduction at the critical isthmus (59% vs 86%, p=0.005), and a longer radiofrequency time to AAFL termination (117±119 vs 51±66 s, p=0.002). Entrainment was attempted in 19 (20%) flutters and its use declined significantly over the study period. Procedural success rates remained high whether entrainment was used or not. Freedom of any atrial tachycardia was 65% over a follow-up of 13.8±9.0 months. CONCLUSIONS AAFL catheter ablation can be achieved with high procedural success rate using a contemporary strategy based on high-density mapping alone. Non-conventional circuits are frequent and present unique electrophysiological characteristics.
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Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000, Bélanger Street, Montreal, Quebec, H1T 1C8, Canada.
| | - Ajay Pillai
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rahul Myadam
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Pranav Mankad
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jayanthi N Koneru
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Mukai M, Miyazaki S, Hasegawa K, Ishikawa E, Aoyama D, Nodera M, Kaseno K, Miyahara K, Matsui A, Shiomi Y, Tama N, Ikeda H, Fukuoka Y, Ishida K, Uzui H, Tada H. Cryothermal atrial linear ablation in patients with atrial fibrillation: An insight from the comparison with radiofrequency atrial linear ablation. J Cardiovasc Electrophysiol 2020; 31:1075-1082. [PMID: 32108407 DOI: 10.1111/jce.14420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Atrial linear lesions are generally created with radiofrequency energy. We sought to evaluate the feasibility of cryothermal atrial linear ablation. METHODS AND RESULTS Twenty-one atrial fibrillation (AF) patients underwent linear ablation on the left atrial (LA) roof, mitral isthmus (MI), and cavotricuspid isthmus (CTI) with 8-mm-tip cryocatheters following pulmonary vein isolation. The data were compared with those of 31 patients undergoing linear ablation with irrigated-tip radiofrequency catheters. Conduction block was successfully created in 18 of 20 (90%), 9 of 21 (43%), and 20 of 20 (100%) on the LA roof, MI, and CTI by endocardial cryoablation alone with 19.0 (12.0-24.0), 30.0 (23.0-34.0), and 14.0 (14.0-16.0) minute cryo applications, respectively. The presence of either an interposed circumflex artery or pouch at the MI was significantly associated with failed MI block (P = .04). Conduction block was created in 25 of 31 (83.9%), 27 of 31 (87.1%), and 30 of 31 (96.8%) on the roof, MI, and CTI, respectively, by radiofrequency ablation. During the 17.5 (13.0-31.7) months of follow-up, freedom from AF/atrial tachycardia (AT) was significantly higher in the cryo group (P = .05); especially, recurrent AT was more frequent in the RF group (8/31 vs 1/21; P = .03). Conduction block across the roof, MI, and CTI was durable in 6 of 12 (50.0%), 4 of 12 (33.3%), and 9 of 12 (75.0%) patients during second procedures. All nine patients (except one) with recurrent ATs had at least one roof or MI conduction resumption. CONCLUSIONS Cryoablation is effective for creating a roof and CTI linear block, however, creating MI block by endocardial ablation alone was often challenging. Conduction resumption of LA linear block is common and recurrent arrhythmias, especially iatrogenic ATs, are more frequently observed after radiofrequency linear ablation.
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Affiliation(s)
- Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Eri Ishikawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kosuke Miyahara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Akira Matsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshitomo Fukuoka
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Potapova KV, Nosov VP, Koroleva LY, Amineva NV. [Atrial Flutter: up-to-date Problem Evaluation with Clinical Positions]. ACTA ACUST UNITED AC 2020; 60:70-80. [PMID: 32245357 DOI: 10.18087/cardio.2020.1.n693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
The review provides current ideas about the etiology and prevalence of atrial flutter (AF), mechanism and substrate of arrhythmogenesis, and principles of clinical and electrophysiological classification of this arrhythmia. Methods for conservative and surgical treatments of AF, including their comparative aspect, are described in detail. The review presented recent data on efficacy and potential risks of different approaches to reversing the arrhythmia. The authors indicated a need for early diagnosis and strict control of the sinus rhythm in AF, which would help a successful intervention not only to completely cure the existing arrhythmia but also to prevent other heart rhythm disorders, primarily atrial fibrillation.
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Affiliation(s)
| | - V P Nosov
- Privolzhsky Research Medical University
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4
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Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias: Evolution or History Repeating Itself? JACC Clin Electrophysiol 2019; 4:707-723. [PMID: 29929663 DOI: 10.1016/j.jacep.2018.03.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)-sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.
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Affiliation(s)
- Nilshan Ariyarathna
- Cardiology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - William G Stevenson
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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5
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Yin J, Yang M, Yu S, Fu H, Huang H, Yang B, Liu Y, He B, Bao M, Wu G, Lu Z, Liu H, Liu X, Dong L, Huang C, Zhao Q. Effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after pulmonary vein electrical isolation in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:910-917. [PMID: 30907035 DOI: 10.1111/jce.13924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Early atrial fibrillation (AF) recurrences are common and have been shown to predict AF recurrences late after AF ablation during follow-up. Neiguan point acupuncture has been recognized to be therapeutic in treating AF in clinical practice. METHODS AND RESULTS Eighty-five patients were enrolled in succession due to persistent AF. All patients were randomized divided into control group and acupuncture group. In the control group (n = 45), amiodarone was orally taken from the first day after pulmonary vein isolation (PVI). In the acupuncture group (n = 40), patients were treated with Neiguan point acupuncture for 7 days and amiodarone was prescribed as same as the control group after PVI. The levels of inflammatory factors were analyzed before operation, 1 week after the operation and 3 months later. After 3 months, the acupuncture group had a lower rate of early recurrences than the control group (5/40 [12.5%] vs 15/45 [33.3%], P = 0.039). The inflammatory factors level in the two groups were significantly increased after ablation. However, compared with the control group, the levels of TNF-α, IL-6, CRP, TGF-β1, MMP2 in the acupuncture group significantly lower (P < 0.05). In a multivariate analysis, acupuncture was an independent factor associated with a lower rate of early recurrences during the blanking period (odds ratio, 0.17; 95% confidence interval, 0.05-0.63; P = 0.008). CONCLUSION Neiguan point acupuncture combined with amiodarone is superior to amiodarone alone in reducing early recurrences of patients with persistent AF after PVI. The efficacy of Neiguan acupuncture therapy on the early recurrence is associated with the decreased inflammation factors.
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Affiliation(s)
- Junkui Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Shengbo Yu
- Department of Cardiology, Weihai Municipal Hospital, Weihai, Henan
| | - Haixia Fu
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial Peoples Hospital, Zhengzhou, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Mingwei Bao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Gang Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Huangfen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Libin Dong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
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Jefairi NA, Camaioni C, Sridi S, Cheniti G, Takigawa M, Nivet H, Denis A, Derval N, Mathilde Merle, Laurent F, Montaudon M, Sacher F, Hocini M, Haissaguerre M, Jais P, Cochet H. Relationship between atrial scar on cardiac magnetic resonance and pulmonary vein reconnection after catheter ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:727-740. [DOI: 10.1111/jce.13908] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nora Al Jefairi
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Claudia Camaioni
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Soumaya Sridi
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Masateru Takigawa
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Hubert Nivet
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Arnaud Denis
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
| | - Nicolas Derval
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Mathilde Merle
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Francois Laurent
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Michel Montaudon
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Frederic Sacher
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Mélèze Hocini
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Michel Haissaguerre
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Pierre Jais
- Department of Cardiac Pacing and ElectrophysiologyHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
| | - Hubert Cochet
- Department of Cardiovascular ImagingHôpital Cardiologique du Haut‐Lévêque, CHU de BordeauxPessac France
- Department of Healthcare TechnologiesIHU LIRYC, Université de Bordeaux–InsermPessac France
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Steroids prevent early recurrence of atrial fibrillation following catheter ablation: a systematic review and meta-analysis. Biosci Rep 2018; 38:BSR20180462. [PMID: 30185438 PMCID: PMC6435499 DOI: 10.1042/bsr20180462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/11/2018] [Accepted: 08/31/2018] [Indexed: 12/17/2022] Open
Abstract
Previous studies have reported that steroids may reduce the risk of atrial fibrillation (AF) recurrence after catheter ablation, but data regarding this issue have been controversial. Therefore, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies to ascertain the association of steroids and AF recurrence after ablation. PubMed, Embase, and Cochrane online databases were searched from inception to December 2017. The primary outcome of the meta-analysis was short-term or long-term AF recurrence following a single ablation procedure with or without the use of steroids. Both fixed- and random-effects models were used to calculate the overall effect estimates. Eight studies (four RCTs and four observational studies), with a total 992 patients, were included in the present study. Our meta-analysis shows that steroid use was associated with reduced AF occurrence at 3 months (odd ratio (OR) = 0.53, 95% confidence interval (CI) = 0.31–0.90, P=0.02) and 12–14 months (OR = 0.67, 95% CI = 0.47–0.95, P=0.02) after radiofrequency (RF) catheter ablation (RFCA). No clear benefit was observed for AF recurrence at 2–3 days, 1 or 24 months of follow-up. Steroid use was associated with decreased risk of early AF recurrence 3 and 12–14 months after ablation. No clear relationship was observed for 2–3 days, 1 and 24 months of follow-up and further data are needed to clarify these results.
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Duytschaever M, Demolder A, Phlips T, Sarkozy A, El Haddad M, Taghji P, Knecht S, Tavernier R, Vandekerckhove Y, De Potter T. PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): results from a multicentre randomized trial. Eur Heart J 2017; 39:1429-1437. [DOI: 10.1093/eurheartj/ehx666] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/02/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mattias Duytschaever
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
- Department of Cardiology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Anthony Demolder
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Milad El Haddad
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
- Department of Cardiology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Philippe Taghji
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Sebastien Knecht
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Rene Tavernier
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Yves Vandekerckhove
- Department of Cardiology, St-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Tom De Potter
- Department of Cardiology, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
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Leo M, Pedersen MF, Rajappan K, Ginks M, Bashir Y, Betts TR. Premature termination of radiofrequency delivery during pulmonary vein isolation due to oesophageal temperature alerts: impact on acute and chronic pulmonary vein reconnection. Europace 2017; 19:954-960. [PMID: 27247012 DOI: 10.1093/europace/euw102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Oesophageal temperature monitoring is currently used during atrial fibrillation (AF) ablation to prevent atrio-oesophageal fistula. The aim of our study was to investigate if oesophageal temperature alerts, leading to early termination of radiofrequency (RF) energy and/or reduction in power during pulmonary vein isolation, can promote pulmonary vein reconnection (PVR). Methods and results Patients undergone two consecutive AF ablation procedures with a three-dimensional electro-anatomical mapping system and oesophageal temperature monitoring were studied. Any lesions causing oesophageal temperature rises >39°C during the index procedure, leading to premature cessation of RF and/or reduction in power, were labelled on the left atrial geometry in a different colour from standard uninterrupted RF lesions. Acute (at the time of the index procedure) and chronic (at the time of there-do procedure) PVR and the site of subsequent re-isolation were compared with the lesion markers for temperature alerts from the index procedure. Fifty-four patients were included (36 male, mean age 68 ± 8, 59% persistent AF). Forty-six PVs (21% of the total) in 30 patients (56%) had been subject to at least one temperature alert during the index procedure. In 12 patients, 23 PVs had acute PVR requiring further ablation. At the re-do procedure, 103 PVs were found to be reconnected in 44 patients. No correlation was found between the occurrence of temperature alerts at the index procedure and acute or chronic PVR in the associated PV. Conclusion Just over half of patients undergoing PV isolation will have an oesophageal temperature alert, however, precautionary oesophageal temperature monitoring does not compromise ablation efficacy.
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10
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Kim YR, Nam GB, Han S, Kim SH, Kim KH, Lee S, Kim J, Choi KJ, Kim YH. Effect of Short-Term Steroid Therapy on Early Recurrence During the Blanking Period After Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2015; 8:1366-72. [PMID: 26541350 DOI: 10.1161/circep.115.002957] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/30/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early recurrence (ER) of atrial tachyarrhythmias during the first 3 months (blanking period) after atrial fibrillation ablation can be highly symptomatic, often requiring emergency treatment. Short-term steroid therapy may suppress ER during the blanking period. METHODS AND RESULTS We prospectively enrolled 138 patients who were randomly assigned to 2 groups (steroid group and control group). An intravenous bolus of 0.5 mg/kg of methylprednisolone for 2 days followed by 12 mg daily of oral methylprednisolone for 4 days was given to the steroid group patients. The primary end point was ER during the blanking period (3 months post ablation). During the blanking period, 51 of the 138 (37.0%) patients experienced ER after atrial fibrillation ablation. The steroid group had a lower rate of ER than the control group (15/64 [23.4%] versus 36/74 [48.6%], P=0.003). There was no difference between the 2 groups about late recurrence during a 24-month follow-up (log-rank test, P=0.918). In a multivariate analysis, short-term steroid therapy was independently associated with a lower rate of ER during the blanking period (adjusted OR, 0.45; 95% confidence interval, 0.25-0.83; P=0.01). CONCLUSIONS Periprocedural short-term moderate intensity steroid therapy reduces ER (≈3 months) after catheter ablation of atrial fibrillation. It is not effective in preventing late (3≈24 m) atrial fibrillation recurrence. CLINICAL TRIAL REGISTRATION URL: www.who.int/ictrp; Unique identifier: KCT0000107.
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Affiliation(s)
- Yoo Ri Kim
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Gi-Byoung Nam
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.).
| | - Seungbong Han
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Sung-Hwan Kim
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Ki-Hun Kim
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Sulhee Lee
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Jun Kim
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - Kee-Joon Choi
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
| | - You-Ho Kim
- From the Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital (Y.R.K.) and Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital (S.-H.K.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (G.-B.N., J.K., Y.-H.K.); Department of Applied Statistics, Gachon University, Seongnam, South Korea (S.H.); and Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea (K.-H.K.)
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11
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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12
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Thermal expansion imaging for monitoring lesion depth using M-mode ultrasound during cardiac RF ablation: in vitro study. Int J Comput Assist Radiol Surg 2015; 10:681-93. [DOI: 10.1007/s11548-015-1203-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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13
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Chik WW, Barry MA, Pouliopoulos J, Byth K, Midekin C, Bhaskaran A, Sivagangabalan G, Thomas SP, Ross DL, McEwan A, Kovoor P, Thiagalingam A. Electrogram-Gated Radiofrequency Ablations With Duty Cycle Power Delivery Negate Effects of Ablation Catheter Motion. Circ Arrhythm Electrophysiol 2014; 7:920-8. [DOI: 10.1161/circep.113.001112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac and respiratory movements cause catheter instability. Lateral catheter sliding over target endocardial surface can lead to poor tissue contact and unpredictable lesion formation. We describe a novel method of overcoming the effects of lateral catheter sliding movements using an electrogram-gated pulsed power ablation.
Methods and Results—
All ablations were performed on a thermochromic gel myocardial phantom. Ablation settings were randomized to conventional (nongated) 30 W versus electrogram-gated at 20% duty cycle (30 W average power) at 0-, 3-, 6-, and 9-mm lateral sliding distances. Forty-eight radiofrequency ablations were performed. Deeper lesions were created in electrogram-gated versus conventional ablations at 3 mm (4.36±0.08 versus 4.05±0.17 mm;
P
=0.009), 6 mm (4.39±0.10 versus 3.44±0.15 mm;
P
<0.001), and 9 mm (4.41±0.06 versus 2.94±0.16 mm;
P
<<0.001) sliding distances. Electrogram-gated ablations created consistent lesions at a quicker rate of growth in depth when compared with conventional ablations (
P
<0.001).
Conclusions—
(1) Lesion depth decreases and length increases in conventional ablations with greater degrees of lateral catheter movements; (2) electrogram-gated pulsed radiofrequency delivery negated the effects from lateral catheter movement by creating consistently deeper lesions irrespective of the degree of catheter movement; and (3) target lesion depths were reached significantly faster in electrogram-gated than in conventional ablations.
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Affiliation(s)
- William W.B. Chik
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Michael Anthony Barry
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Jim Pouliopoulos
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Karen Byth
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Christine Midekin
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Abhishek Bhaskaran
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Gopal Sivagangabalan
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Stuart P. Thomas
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - David L. Ross
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Alistair McEwan
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- From the Cardiology Department, Westmead Hospital (W.W.B.C., M.A.B., J.P., K.B., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), Sydney Medical School (W.W.B.C., M.A.B., J.P., C.M., A.B., G.S., S.P.T., D.L.R., P.K., A.T.), and School of Electrical and Information Engineering (M.A.B., A.M.), University of Sydney, Sydney, New South Wales, Australia
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14
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Wu Z, Gudur MSR, Deng CX. Transmural ultrasound imaging of thermal lesion and action potential changes in perfused canine cardiac wedge preparations by high intensity focused ultrasound ablation. PLoS One 2013; 8:e82689. [PMID: 24349337 PMCID: PMC3861459 DOI: 10.1371/journal.pone.0082689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
Intra-procedural imaging is important for guiding cardiac arrhythmia ablation. It is difficult to obtain intra-procedural correlation of thermal lesion formation with action potential (AP) changes in the transmural plane during ablation. This study tested parametric ultrasound imaging for transmural imaging of lesion and AP changes in high intensity focused ultrasound (HIFU) ablation using coronary perfused canine ventricular wedge preparations (n = 13). The preparations were paced from epi/endocardial surfaces and subjected to HIFU application (3.5 MHz, 11 Hz pulse-repetition-frequency, 70% duty cycle, duration 4 s, 3500 W/cm2), during which simultaneous optical mapping (1 kframes/s) using di-4-ANEPPS and ultrasound imaging (30 MHz) of the same transmural surface of the wedge were performed. Spatiotemporally correlated AP measurements and ultrasound imaging allowed quantification of the reduction of AP amplitude (APA), shortening of AP duration at 50% repolarization, AP triangulation, decrease of optical AP rise, and change of conduction velocity along tissue depth direction within and surrounding HIFU lesions. The threshold of irreversible change in APA correlating to lesions was determined to be 43±1% with a receiver operating characteristic (ROC) area under curve (AUC) of 0.96±0.01 (n = 13). Ultrasound imaging parameters such as integrated backscatter, Rayleigh (α) and log-normal (σ) parameters, cumulative extrema of σ were tested, with the cumulative extrema of σ performing the best in detecting lesion (ROC AUC 0.89±0.01, n = 13) and change of APA (ROC AUC 0.79±0.03, n = 13). In conclusion, characteristic tissue and AP changes in HIFU ablation were identified and spatiotemporally correlated using optical mapping and ultrasound imaging. Parametric ultrasound imaging using cumulative extrema of σ can detect HIFU lesion and APA reduction.
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Affiliation(s)
- Ziqi Wu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Madhu S. R. Gudur
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Cheri X. Deng
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
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15
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Kumar S, Michaud GF. Unipolar Electrogram Morphology to Assess Lesion Formation During Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:1050-2. [DOI: 10.1161/circep.113.001145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saurabh Kumar
- From the Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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16
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17
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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18
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Chorro FJ, Ibañez-Catalá X, Trapero I, Such-Miquel L, Pelechano F, Cánoves J, Mainar L, Tormos A, Cerdá JM, Alberola A, Such L. Ventricular fibrillation conduction through an isthmus of preserved myocardium between radiofrequency lesions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:286-98. [PMID: 23240900 DOI: 10.1111/pace.12060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 10/14/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Selective local acceleration of myocardial activation during ventricular fibrillation (VF) contributes information on the interactions between neighboring zones during the arrhythmia. This study analyzes these interactions, centering the observations on an isthmus of myocardium between two radiofrequency (RF) lesions. METHODS In nine isolated rabbit hearts, a gap of preserved myocardium was established between two RF lesions in the anterolateral left ventricle (LV) wall. Before, during, and after increasing the spatial heterogeneity of VF by local myocardial stretching, VF epicardial recordings were obtained. RESULTS Local stretch in the anterior LV wall decreased the excitable window (17 ± 7 ms vs 26 ± 7 ms; P < 0.05) and increased the dominant frequency (DFr; 18.9 ± 5.0 Hz vs 15.2 ± 3.6 Hz; P < 0.05) in this zone, without changes in the non-stretched posterolateral zone (25 ± 4 ms vs 27 ± 6 ms, ns and 14.1 ± 2.7 Hz vs 14.3 ± 3.0 Hz, ns). The DFr ratio at both sides of the gap was inversely correlated to the excitable window ratio (R = -0.57; P = 0.002). Before (31% vs 26%), during (29% vs 22%), and after stretch suppression (35% vs 25%), the wavefronts passing through the gap from the posterolateral to the anterior LV wall were seen to predominate. The number of wavefronts that passed from the anterior to the posterolateral LV wall was related to the excitable window in this zone (R = 0.41; P = 0.03). CONCLUSIONS The VF acceleration induced in the stretched zone does not increase the flow of wavefronts toward the non-stretched zone in the adjacent gap of preserved myocardium. The absence of significant changes in the electrophysiological parameters of the non-stretched myocardium limits the arrival of wavefronts in this zone.
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Affiliation(s)
- Francisco J Chorro
- Service of Cardiology, Valencia University Clinic Hospital Incliva, Valencia, Spain.
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19
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Dössel O, Krueger MW, Weber FM, Wilhelms M, Seemann G. Computational modeling of the human atrial anatomy and electrophysiology. Med Biol Eng Comput 2012; 50:773-99. [PMID: 22718317 DOI: 10.1007/s11517-012-0924-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/21/2012] [Indexed: 01/08/2023]
Abstract
This review article gives a comprehensive survey of the progress made in computational modeling of the human atria during the last 10 years. Modeling the anatomy has emerged from simple "peanut"-like structures to very detailed models including atrial wall and fiber direction. Electrophysiological models started with just two cellular models in 1998. Today, five models exist considering e.g. details of intracellular compartments and atrial heterogeneity. On the pathological side, modeling atrial remodeling and fibrotic tissue are the other important aspects. The bridge to data that are measured in the catheter laboratory and on the body surface (ECG) is under construction. Every measurement can be used either for model personalization or for validation. Potential clinical applications are briefly outlined and future research perspectives are suggested.
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Affiliation(s)
- Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany.
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20
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Kowalski M, Grimes MM, Perez FJ, Kenigsberg DN, Koneru J, Kasirajan V, Wood MA, Ellenbogen KA. Histopathologic characterization of chronic radiofrequency ablation lesions for pulmonary vein isolation. J Am Coll Cardiol 2012; 59:930-8. [PMID: 22381429 DOI: 10.1016/j.jacc.2011.09.076] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/29/2011] [Accepted: 09/27/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study describes the histopathologic and electrophysiological findings in patients with recurrence of atrial fibrillation (AF) after pulmonary vein (PV) isolation who underwent a subsequent surgical maze procedure. BACKGROUND The recovery of PV conduction is commonly responsible for recurrence of AF after catheter-based PV isolation. METHODS Twelve patients with recurrent AF after acutely successful catheter-based antral PV isolation underwent a surgical maze procedure. Full-thickness surgical biopsy specimens were obtained from the PV antrum in areas of visible endocardial scar. Before biopsy, intraoperative epicardial electrophysiological recordings were taken from each PV using a circular mapping catheter. RESULTS Twenty-two PVs were biopsied from the 12 patients 8 ± 11 months after ablation. Eleven of the 22 specimens (50%) revealed transmural scar, and 11 (50%) showed viable myocardium with or without scar. Each biopsy specimen demonstrated evidence of injury, most commonly endocardial thickening (n = 21 [95%]) and fibrous scar (n = 18 [82%]). Seven of the 22 specimens (32%) showed conduction block at surgery. Transmural scar was more likely to be seen in the biopsy specimens from the PVs with conduction block than in specimens from the PVs showing reconnection. However, viable myocardium alone or mixed with scar was seen in 2 specimens from PVs with conduction block. CONCLUSIONS PVs showing electrical reconnection after catheter-based antral ablation frequently reveal anatomic gaps or nontransmural lesions at the sites of catheter ablation. Nontransmural lesions are noted in some PVs with persistent conduction block, suggesting that lesion geometry may influence PV conduction. The histological findings show that nontransmural ablation can produce a dynamic cellular substrate with features of reversible injury. Delayed recovery from injury may explain late recurrences of AF after PV isolation.
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Affiliation(s)
- Marcin Kowalski
- Department of Clinical Cardiac Electrophysiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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21
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The anatomical basis of pulmonary vein reconnection after ablation for atrial fibrillation: wounds that never felt a scar? J Am Coll Cardiol 2012; 59:939-41. [PMID: 22381430 DOI: 10.1016/j.jacc.2011.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/21/2011] [Accepted: 11/29/2011] [Indexed: 01/20/2023]
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Mercader M, Swift L, Sood S, Asfour H, Kay M, Sarvazyan N. Use of endogenous NADH fluorescence for real-time in situ visualization of epicardial radiofrequency ablation lesions and gaps. Am J Physiol Heart Circ Physiol 2012; 302:H2131-8. [PMID: 22408016 DOI: 10.1152/ajpheart.01141.2011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiofrequency ablation (RFA) aims to produce lesions that interrupt reentrant circuits or block the spread of electrical activation from sites of abnormal activity. Today, there are limited means for real-time visualization of cardiac muscle tissue injury during RFA procedures. We hypothesized that the fluorescence of endogenous NADH could be used as a marker of cardiac muscle injury during epicardial RFA procedures. Studies were conducted in blood-free and blood-perfused hearts from healthy adult Sprague-Dawley rats and New Zealand rabbits. Radiofrequency was applied to the epicardial surface of the heart using a 4-mm standard blazer ablation catheter. A dual camera optical mapping system was used to monitor NADH fluorescence upon ultraviolet illumination of the epicardial surface and to record optical action potentials using the voltage-sensitive probe RH237. Epicardial lesions were seen as areas of low NADH fluorescence. The lesions appeared immediately after ablation and remained stable for several hours. Real-time monitoring of NADH fluorescence allowed visualization of viable tissue between the RFA lesions. Dual recordings of NADH and epicardial electrical activity linked the gaps between lesions to postablation reentries. We found that the fluorescence of endogenous NADH aids the visualization of injured epicardial tissue caused by RFA. This was true for both blood-free and blood-perfused preparations. Gaps between NADH-negative regions revealed unablated tissue, which may promote postablation reentry or provide pathways for the conduction of abnormal electrical activity.
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Affiliation(s)
- Marco Mercader
- The George Washington University Medical Faculty Associates, Division of Cardiology, Washington, DC, USA
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Castrejón-Castrejón S, Ortega M, Pérez-Silva A, Doiny D, Estrada A, Filgueiras D, López-Sendón JL, Merino JL. Organized atrial tachycardias after atrial fibrillation ablation. Cardiol Res Pract 2011; 2011:957538. [PMID: 21941669 PMCID: PMC3175708 DOI: 10.4061/2011/957538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 04/17/2011] [Accepted: 05/17/2011] [Indexed: 11/20/2022] Open
Abstract
The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required.
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Affiliation(s)
- Sergio Castrejón-Castrejón
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, Paseo de la castellana, No 261, 28046 Madrid, Spain
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CHIK WILLIAMW, BARRY MA, MALCHANO ZACH, WYLIE BRYAN, POULIOPOULOS JIM, HUANG KAIMIN, LU JUNTANG, THAVAPALACHANDRAN SUJITHA, ROBINSON DAVID, SAADAT VAHID, THOMAS STUARTP, ROSS DAVIDL, KOVOOR PRAMESH, THIAGALINGAM ARAVINDA. In Vivo Evaluation of Virtual Electrode Mapping and Ablation Utilizing a Direct Endocardial Visualization Ablation Catheter. J Cardiovasc Electrophysiol 2011; 23:88-95. [DOI: 10.1111/j.1540-8167.2011.02169.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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YOKOKAWA MIKI, BHANDARI ANILK, TADA HIROSHI, SUZUKI ATSUSHI, KAWAMURA MITSUHARU, HO IVAN, CANNOM DAVIDS. Comparison of the Point-by-Point versus Catheter Dragging Technique for Curative Radiofrequency Ablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:15-22. [DOI: 10.1111/j.1540-8159.2010.02944.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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KIM YONGHYUN, LIM HONGEUY, PAK HUINAM, KWAK JAEJIN, PARK JAESEOK, CHOI JONGIL, PARK SANGWEON, KIM YOUNGHOON. Role of Residual Potentials Inside Circumferential Pulmonary Veins Ablation Lines in the Recurrence of Paroxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol 2010; 21:959-65. [DOI: 10.1111/j.1540-8167.2010.01748.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eyerly SA, Hsu SJ, Agashe SH, Trahey GE, Li Y, Wolf PD. An in vitro assessment of acoustic radiation force impulse imaging for visualizing cardiac radiofrequency ablation lesions. J Cardiovasc Electrophysiol 2009; 21:557-63. [PMID: 20021518 DOI: 10.1111/j.1540-8167.2009.01664.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lesion placement and transmurality are critical factors in the success of cardiac transcatheter radiofrequency ablation (RFA) treatments for supraventricular arrhythmias. This study investigated the capabilities of catheter transducer based acoustic radiation force impulse (ARFI) ultrasound imaging for quantifying ablation lesion dimensions. METHODS AND RESULTS RFA lesions were created in vitro in porcine ventricular myocardium and imaged with an intracardiac ultrasound catheter transducer capable of acquiring spatially registered B-mode and ARFI images. The myocardium was sliced along the imaging plane and photographed. The maximum ARFI-induced displacement images of the lesion were normalized and spatially registered with the photograph by matching the surfaces of the tissue in the B-mode and photographic images. The lesion dimensions determined by a manual segmentation of the photographed lesion based on the visible discoloration of the tissue were compared to automatic segmentations of the ARFI image using 2 different calculated thresholds. ARFI imaging accurately localized and sized the lesions within the myocardium. Differences in the maximum lateral and axial dimensions were statistically below 2 mm and 1 mm, respectively, for the 2 thresholding methods, with mean percent overlap of 68.7 +/- 5.21% and 66.3 +/- 8.4% for the 2 thresholds used. CONCLUSION ARFI imaging is capable of visualizing myocardial RFA lesion dimensions to within 2 mm in vitro. Visualizing lesions during transcatheter cardiac ablation procedures could improve the success of the treatment by imaging lesion line discontinuity and potentially reducing the required number of ablation lesions and procedure time.
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Affiliation(s)
- Stephanie A Eyerly
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
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Khaykin Y, Skanes A, Champagne J, Themistoclakis S, Gula L, Rossillo A, Bonso A, Raviele A, Morillo CA, Verma A, Wulffhart Z, Martin DO, Natale A. A randomized controlled trial of the efficacy and safety of electroanatomic circumferential pulmonary vein ablation supplemented by ablation of complex fractionated atrial electrograms versus potential-guided pulmonary vein antrum isolation guided by intracardiac ultrasound. Circ Arrhythm Electrophysiol 2009; 2:481-7. [PMID: 19843915 DOI: 10.1161/circep.109.848978] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The study was conducted to compare relative safety and efficacy of pulmonary vein antrum isolation (PVAI) using intracardiac echocardiographic guidance and circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF) using radiofrequency energy. METHODS AND RESULTS Sixty patients (81% men; 81% paroxysmal; age, 56+/-8 years) failing 2+/-1 antiarrhythmic drugs were randomly assigned to undergo CPVA (n=30) or PVAI (n=30) at 5 centers between December 2004 and October 2007. CPVA patients had circular lesions placed at least 1 cm outside of the veins. Ipsilateral veins were ablated en block with the end point of disappearance of potentials within the circular lesion. Left atrial roof line and mitral isthmus line were ablated without verification of block. For patients in AF postablation or with AF induced with programmed stimulation, complex fractionated electrograms were mapped and ablated to the end point of AF termination or disappearance of complex fractionated electrograms. PVAI did not include complex fractionated electrogram ablation. Esophageal temperature was monitored and kept within 2 degrees C of baseline or under 39 degrees C. Success was defined as absence of atrial tachyarrhythmias (AF/AT) off antiarrhythmic drugs. There was no difference between CPVA and PVAI regarding to baseline variables, catheter used, duration of the procedure, or RF delivery. Fluoroscopy time was longer with PVAI (54+/-17 minutes versus 77+/-18 minutes, P=0.0001). No significant complications occurred in either arm. PVAI was more likely to achieve control of AF/AT off antiarrhythmic drugs (57% versus 27%, P=0.02) at 2+/-1 years of follow-up. CONCLUSIONS A single PVAI procedure is more likely to result in freedom from AF/AT off antiarrhythmic drugs than CPVA supplemented by complex fractionated electrogram ablation in select patients.
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Affiliation(s)
- Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada.
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Manusama R, Timmermans C, Pison L, Philippens S, Perez D, Rodriguez LM. Typical atrial flutter can effectively be treated using single one-minute cryoapplications: results from a repeat electrophysiological study. J Interv Card Electrophysiol 2009; 26:65-72. [PMID: 19521755 PMCID: PMC2746293 DOI: 10.1007/s10840-009-9405-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Purpose Catheter-based cryoablation (cryo) has proven to be as effective as radiofrequency energy (RF) ablation for the treatment of arrhythmias. Nevertheless, the duration of cryoapplications has been reported as being significantly longer than RF applications. Methods Thirty-seven consecutive patients (28 men; mean age 59 ± 14 years) with typical atrial flutter (AFL) underwent cryo of the cavotricuspid isthmus (CTI). Applications of 1 min were delivered with a 10-French, 10-mm tipped catheter (CryoCor™). If bidirectional CTI block was not obtained after 12 1-min applications, applications of 3 min were selectively delivered to areas of conduction breakthrough. The endpoint of the procedure was creation of bidirectional CTI block and non-inducibility of AFL. Results A median of 7 (range 3 to 12) 1-min applications were given along the CTI with a mean temperature of −88.6 ± 2.3°C. Mean fluoroscopy and procedure time were 27 ± 14 min and 110 ± 28 min respectively. Five patients required additional 3-min applications; in one patient an overextended ablation catheter prevented the completion of the index-procedure. The acute success rate of the index-procedure was 97%. In 12/24 patients, two with AFL recurrence, resumption of CTI conduction was found 4 months post-ablation. In all patients bidirectional CTI block was re-obtained after a median of one 1-min application. No additional AFL recurrences occurred, after a mean follow-up of 37 ± 3 (range 30 to 44) months. Conclusions Cryo of AFL can successfully be performed using the same application duration as used for RF ablation. Both acute and long-term results are comparable to RF ablation. AFL recurrences occurred in only a minority of patients with resumption of CTI conduction.
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Affiliation(s)
- Randy Manusama
- Department of Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, P.O. Box 5800, AZ 6202, Maastricht, The Netherlands
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Anatomic aspects of the atrioventricular junction influencing radiofrequency Cox maze IV procedures. J Thorac Cardiovasc Surg 2008; 136:419-23. [DOI: 10.1016/j.jtcvs.2008.03.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/12/2008] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
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Daubert JP. Iatrogenic left atrial tachycardias: where are we? J Am Coll Cardiol 2007; 50:1788-90. [PMID: 17964044 DOI: 10.1016/j.jacc.2007.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
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Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation. J Am Coll Cardiol 2007; 50:1781-7. [DOI: 10.1016/j.jacc.2007.07.044] [Citation(s) in RCA: 262] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 06/29/2007] [Accepted: 07/01/2007] [Indexed: 11/15/2022]
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Akar JG, Al-Chekakie MO, Hai A, Brysiewicz N, Porter M, Varma N, Santucci P, Wilber DJ. Surface Electrocardiographic Patterns and Electrophysiologic Characteristics of Atrial Flutter Following Modified Radiofrequency MAZE Procedures. J Cardiovasc Electrophysiol 2007; 18:349-55. [PMID: 17394449 DOI: 10.1111/j.1540-8167.2007.00761.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The radiofrequency MAZE is becoming a common adjunct to cardiac surgery in patients with atrial fibrillation. While a variety of postoperative arrhythmias have been described following the original Cox-MAZE III procedure, the electrophysiological characteristics and surgical substrate of post-radiofrequency MAZE flutter have not been correlated. We sought to determine the location, ECG patterns, and electrophysiological characteristics of post-radiofrequency MAZE atrial flutter. METHODS Nine consecutive patients with post-radiofrequency MAZE flutter presented for catheter ablation 9 +/- 10 months after surgery. RESULTS Only one patient (11%) had an ECG appearance consistent with typical isthmus-dependent right atrial (RA) flutter. However, on electrophysiological study, 3/9 patients (33%) had typical right counter-clockwise flutter entrained from the cavo-tricuspid isthmus, despite description of surgical isthmus ablation. Six patients (67%) had left atrial (LA) circuits. These involved the mitral annulus in 5/6 cases (83%) despite description of surgical mitral isthmus ablation in the majority (60%). LA flutters had a shorter cycle length compared with RA flutters (253 +/- 39 msec and 332 +/- 63 msec respectively, P < 0.05). After a mean of 8 +/- 4 months following ablation, 8/9 patients (89%) were in sinus rhythm. CONCLUSION Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter.
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Affiliation(s)
- Joseph G Akar
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Cesario DA, Mahajan A, Shivkumar K. Lesion-forming technologies for catheter ablation of atrial fibrillation. Heart Rhythm 2007; 4:S44-50. [PMID: 17336884 DOI: 10.1016/j.hrthm.2006.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Indexed: 11/20/2022]
Affiliation(s)
- David A Cesario
- UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the UCLA, Los Angeles, California 90095-1679, USA
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Bunch TJ, Day JD. Unraveling the mysteries of catheter ablation for atrial fibrillation: from clinical observations to mechanistic explorations. J Cardiovasc Electrophysiol 2007; 18:266-8. [PMID: 17284285 DOI: 10.1111/j.1540-8167.2006.00746.x] [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] [Indexed: 11/29/2022]
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Yano K, Hirao K, Horikawa T, Tanaka M, Isobe M. Electrophysiology of a gap created on the canine atrium. J Interv Card Electrophysiol 2007; 17:1-9. [PMID: 17253120 DOI: 10.1007/s10840-006-9059-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It is crucial to detect the unablated regions (="gap") in the radiofrequency linear ablation of atrial tachyarrhythmias. The purpose of this study was to examine the relationship between the electropysiological properties of the gap created in the canine atrium and its anatomicohistologic findings. METHODS AND RESULTS In 17 dogs, a linear epicardial radiofrequency ablation lesion was created on the right atrial wall with a gap of surviving tissue in the mid-portion of the lesion. For each gap, the local electrogram (LE) from the gap and conduction pattern through the gap were recorded using an electrode catheter and a plaque electrode during pacing from each side of the gap and the gap size was measured. The gaps >5 mm exhibited a conductive property and the gaps <3 mm had no conduction property according to 3-D mapping. The size of the conductive gaps was larger than that of the non-conductive gaps (7.1 +/- 2.6 vs. 2.6 +/- 2.5 mm, p < 0.0001). The LE configurations were categorized into single, double and continuous potentials and single potentials were demonstrated only in wide gaps >7 mm. There was a significant inversed correlation between the duration of the LE and gap size and also between the LE duration and the conduction velocity. Histological examination showed that the conduction properties through the gap depended mainly on its size. CONCLUSIONS The conductivity through the gap, which was affected by the size of the gap, may be evaluated by the duration and configuration of the local electrogram recorded from the gap.
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Affiliation(s)
- Kei Yano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
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