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Heeger CH, Kuck KH, Tilz RR. Very high-power short-duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series. J Cardiovasc Electrophysiol 2024; 35:547-556. [PMID: 37855621 DOI: 10.1111/jce.16113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
The QDOT MICRO™ Catheter is a novel open-irrigated contact force-sensing radiofrequency ablation catheter. It offers very high-power short-duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.
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Affiliation(s)
- Christian-H Heeger
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roland R Tilz
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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2
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Benali K, Lai VD, Hammache N, Magnin-Poull I, de Chillou C, Sellal JM. Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters. J Interv Card Electrophysiol 2022; 66:931-940. [PMID: 36251129 DOI: 10.1007/s10840-022-01393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory. METHODS Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation. RESULTS Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95-2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60-0.97, p = 0.046). CONCLUSION This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, CHU de Saint-Etienne, 42270, Saint-Priest-En-Jarez, France. .,INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.
| | - Van Duc Lai
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Isabelle Magnin-Poull
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Christian de Chillou
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Jean-Marc Sellal
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
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Guckel D, Lucas P, Isgandarova K, Hamriti ME, Bergau L, Fink T, Sciacca V, Braun M, Khalaph M, Imnadze G, Nölker G, Sommer P, Sohns C. Impact of pulmonary vein variant anatomy and cross-sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single-shot guided pulmonary vein isolation. J Interv Card Electrophysiol 2022; 65:251-260. [PMID: 35764853 PMCID: PMC9550688 DOI: 10.1007/s10840-022-01279-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/12/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). This study aimed to evaluate ablation efficacy and freedom from arrhythmia recurrence using the novel POLARx compared to the Arctic Front Advance Pro (AFA) CB system including the analysis of individual PV characteristics. METHODS A total of 687 patients underwent CB-guided ablation for AF. Arrhythmia recurrence was defined as an ECG documented episode of any AF/atrial tachycardia (AT) > 30 s. Anatomical characteristics were assessed using magnetic resonance imaging (MRI). For each PV, the cross-sectional orifice area (CSOA) was determined. Follow-up examinations were scheduled after 3, 6, and 12 months. RESULTS Acute PVI was achieved in all patients. Twelve-month AF-free survival was similar between the groups (POLARx 43/86 (50%) vs. AFA 318/601 (53%), Log-rank (LR) p = 0.346). MRI found a comparable percentage of patients with normal PV anatomy (POLARx 71/86 (83%) vs. AFA 530/601 (85%), p = 0.162). Patients with variant PV characteristics presented with a significantly impaired 12-month AF-free survival (normal PVs 326/585 (56%) vs. variant PVs 27/102 (27%), LR p < 0.001) independent of the applied CB ablation system. PAF patients with AF recurrence presented with significantly larger CSOA of the left-sided PVs and the right superior PVs (LSPV: p < 0.001; LIPV: p < 0.001; RSPV: p < 0.001). In PERS AF, no association between CSOA and ablation outcome was observed. Multivariate analyses identified PERS AF (hazard ratio (HR) 2.504, confidence interval (CI), 1.900-3.299, p < 0.001) and variant PV anatomy (HR 2.124, CI 1.608-2.805, p < 0.001) as independent predictors for AF recurrence. CONCLUSIONS Both CB ablation systems are associated with comparable 12-month AF-free survival rates. Variant PV anatomy seems to be predictive for AF recurrence. An association between CSOA and the outcome after CB-guided PVI was demonstrated for PAF.
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Affiliation(s)
- Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Lucas
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Khuraman Isgandarova
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Georg Nölker
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Clinic for Internal Medicine II/Cardiology, Christliches Klinikum Unna Mitte, Unna, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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5
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Ronsoni RDM, Silvestrini TL, Saffi MAL, Leiria TLL. Impact of the left common ostium following pulmonary vein isolation in
AF
: Systematic review and meta‐analysis. J Arrhythm 2022; 38:287-298. [PMID: 35785389 PMCID: PMC9237303 DOI: 10.1002/joa3.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) through catheter ablation is the basis for the treatment of atrial fibrillation (AF). The left common ostium (LCO) is a high prevalence anatomical variation and has conflicting results in the effects on the prognosis following ablation. We undertook a systematic review and meta‐analysis of studies that compared the arrhythmia recurrence rate after radiofrequency ablation or cryoablation balloon between patients with normal pattern pulmonary vein and patients with LCO. Methods and Results Results were pooled using a fixed or random effect, at the discretion of heterogeneity (>25%), in addition, we associated subgroup analysis in these cases and when clinically indicated. Fourteen non‐randomized studies totaling 3278 patients were included. In analyses using the two energies all patients: OR 1.01 (95% CI 0.84–1.23; P = .90, I2 = 67%) and excluding patients with any type of persistent AF (PeAF) and those submitted to linear atrial lesion (LAL) OR 0.80 (95% CI 0.52–1.22; P = .30, I2 = 71%). Using CRYO: all patients OR 1.34 (95% CI 1.03–1.74; P = .03, I2 = 0%). Using RF: all patients—OR 0.55 (95% CI 0.32–0.95; P = .03, I2 = 49%); excluding studies with long duration PeAF and the performance of LAL concomitant—OR 0.45 (95% CI 0.23–0.91; P = .03, I2 = 44%). Conclusion The results suggest a better prognosis in patients with LCO, submitted to PVI without additional LAL under RF energy in paroxysmal AF and short‐duration PeAF. In patients undergoing CRYO, the presence of LCO suggests a worse prognosis.
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Affiliation(s)
- Rafael de March Ronsoni
- Instituto de Ritmologia Cardíaca Joinville Brazil
- Universidade da Região de Joinville Joinville Brazil
| | | | | | - Tiago Luiz Luz Leiria
- Graduate Program in Health Sciences ‐ Instituto de Cardiologia of Rio Grande do Sul/Fundação Universitária de Cardiologia Porto Alegre Brazil
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6
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Martinez Urabayen U, Caballeros M, Soriano I, Ramos P, García Bolao I, Bastarrika G. Anatomic characteristics of the left atrium in subjects undergoing radiofrequency ablation for atrial fibrillation. Radiologia (Engl Ed) 2021; 63:391-399. [PMID: 34625194 DOI: 10.1016/j.rxeng.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/04/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. MATERIAL AND METHODS We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ± 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. RESULTS In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ± 2.6 mm vs. 16.7 ± 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ± 2.2 mm, p = 0.009) and larger left atrial volume (91.9 ± 24.9 cm3 vs. 70.7 ± 20.3 mm3, p = 0.001). After 22.1 ± 12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ± 23.0 mm3 vs. 71.1 ± 23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. CONCLUSION The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.
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Affiliation(s)
- U Martinez Urabayen
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Caballeros
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Madrid, Spain
| | - I Soriano
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Ramos
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - I García Bolao
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - G Bastarrika
- Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
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7
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Martínez Urabayen U, Caballeros M, Soriano I, Ramos P, García Bolao I, Bastarrika G. Características anatómicas de la aurícula izquierda en sujetos sometidos a ablación por radiofrecuencia de fibrilación auricular. Radiología 2021. [DOI: 10.1016/j.rx.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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8
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Szegedi N, Vecsey-Nagy M, Simon J, Szilveszter B, Herczeg S, Kolossváry M, Idelbi H, Osztheimer I, Klaudia Nagy V, Tahin T, Széplaki G, Delgado V, Bax JJ, Maurovich-Horvat P, Merkely B, Gellér L. Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation. Eur Heart J Cardiovasc Imaging 2021; 23:515-523. [PMID: 33693618 DOI: 10.1093/ehjci/jeab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. METHODS AND RESULTS We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15-2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19-0.71, P = 0.003). CONCLUSION Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.
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Affiliation(s)
- Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Hana Idelbi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Vivien Klaudia Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Tamás Tahin
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar.,Department of Radiology, Medical Imaging Center, Semmelweis University, 2 Koranyi Sandor Street, 1082 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
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9
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Ronsoni RM, Silvestrini TL, Essebag V, Lopes RD, Lumertz Saffi MA, Luz Leiria TL. Association of the left common ostium with clinical outcome after pulmonary vein isolation in atrial fibrillation. Indian Pacing Electrophysiol J 2020; 21:95-100. [PMID: 33271275 PMCID: PMC7952770 DOI: 10.1016/j.ipej.2020.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/01/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Electrical pulmonary vein isolation (PVI) is used for the invasive treatment of atrial fibrillation (AF). However, despite the procedure’s technical evolution, the rate of AF recurrence due to electrical reconnection of the PVs is high. The aims of this study was to assess the influence of left common pulmonary venous ostium (LCO) on clinical outcomes following PVI. Methods Retrospective cohort of 254 patients who underwent the first procedure of PVI from the years 2013–2018 was assessed. Patients with persistent AF of long duration and extra-pulmonary focus associated with triggers for arrhythmia were excluded. Patients were stratified into two groups according to the presence of a LCO and received follow up for atrial tachyarrhythmia-free survival. The mean follow-up period was 28 ± 1.73 months. Results The majority were men (68.5%), with a mean age of 54 ± 12 years. With respect to the atrial anatomy, LCO occurred in 23.6% of cases after pulmonary venous angiotomography. The arrhythmia-free survival rate was 79.5% in the follow-up period. The Cox regression model was utilized and the adjusted hazard ratio for LCO was 0.36 (95% CI 0.15–0.87; p = 0.02) in terms of age, body mass index, left atrium diameter, bi-directional blocking of the cavotricuspid isthmus, persistent AF, left ventricular ejection fraction adjusted model. Conclusion Anatomic abnormality with the presence of the LCO is present in a quarter of patients undergoing AF ablation, which is associated with a lower rate of arrhythmia recurrence in our population. Pulmonary vein isolation is used for the invasive treatment of atrial fibrillation. The majority of arrhythmias triggers have their origins in the anatomic abnormality. Pulmonary vein isolation using radiofrequency ablation.
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Affiliation(s)
- Rafael M Ronsoni
- Instituto de Ritmologia Cardíaca, Joinville, Santa Catarina, Brazil; Universidade da Região de Joinville, Joinville, Santa Catarina, Brazil.
| | | | - Vidal Essebag
- Electrophysiology Department, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Tiago Luiz Luz Leiria
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil
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10
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Bose A, Chevli PA, Berberian G, Januszkiewicz J, Ahmad G, Hashmath Z, Mishra AK, Laidlaw D. Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:409-417. [PMID: 33206281 DOI: 10.1007/s10840-020-00916-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/10/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Pulmonary vein (PV) isolation using cryoballoon ablation (CBA) is a common therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF). However, initial CBA is successful in only 70-80% of patients. The role of an atypical left common PV (LCPV) and PV anatomical indices on CBA outcomes remains unclear. METHODS We followed 80 patients (age 60.7 ± 9.7, 31 % women) with PAF undergoing CBA for 1-year post-procedure for the development of recurrent atrial arrhythmias (AA). Recurrence was assessed by documented AA on EKG or any form of long-term cardiac rhythm monitoring. The presence of an LCPV and individual PV diameters were evaluated using cardiac CT. Based on the maximum and minimum PV ostial diameters, the eccentricity index (EI), ovality index (OI), and PV ostial area (PVA) were calculated for all the veins. A multivariable Cox-proportional hazard model assessed whether the presence of an LCPV or PV anatomic indices (EI, OI, and PVA) predicted recurrence of AA following CBA. RESULTS After 1-year follow-up, 19 (23.7%) participants developed recurrence of AA. On multivariable regression, the presence of an LCPV did not predict the recurrence of AA (p = 0.38). Among the PV anatomical indices, on univariate analysis, only the area of the left inferior PV showed a trend towards predicting recurrence, though this result was not significant on multivariate analysis (p = 0.09). CONCLUSIONS In patients with PAF, neither the presence of an LCPV nor individual PV anatomical indices predicted recurrence of AA following CBA.
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Affiliation(s)
- Abhishek Bose
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, 01604, USA.
| | - Parag A Chevli
- Section of Hospital Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Ghasan Ahmad
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Zeba Hashmath
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay K Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Douglas Laidlaw
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, 01604, USA
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11
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Chen JY, Wu HDI, Chang KC. Pulmonary vein volume and myocardial sleeve extension estimated by 3D computed tomography and voltage mapping predict arrhythmogenic triggers of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:177-185. [PMID: 33011885 DOI: 10.1007/s10840-020-00892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Relationship between pulmonary vein (PV) anatomy and the pathophysiology of paroxysmal atrial fibrillation (PAF) remains incompletely studied. The aim of this study was to determine whether PV anatomy predicts arrhythmogenic PVs. METHODS Twenty-six consecutive PAF patients with spontaneous PAF or consistently frequent ectopic beats during electrophysiological study were enrolled. Computed tomography (CT) images for PVs were reconstructed into 3D images. The PV diameter and volume were measured based on the 3D images. The PV myocardial sleeve area was measured based on the 3D voltage mapping results. The PV myocardial sleeve area index was calculated by dividing the sleeve area of each PV by the average sleeve area of all PVs in each patient. RESULTS The diameter and volume of the arrhythmogenic PVs were larger than those of the non-arrhythmogenic PVs (21.08 ± 4.57 mm vs. 16.47 ± 3.31 mm, P < 0.001 and 7.70 ± 3.28 cm3 vs. 4.09 ± 1.99 cm3, P < 0.001, respectively). The myocardial sleeve area and sleeve area index of the arrhythmogenic PVs were also larger than those of the non-arrhythmogenic PVs (8.62 ± 5.33 cm2 vs. 4.77 ± 3.84 cm2, P < 0.001 and 1.59 ± 0.35 vs. 0.81 ± 0.38, P < 0.001, respectively). Multivariate analysis showed the PV myocardial sleeve area index was the independent predictor for arrhythmogenic PVs (P < 0.001). CONCLUSIONS PV size plays an important role in triggering PAF. A large myocardial sleeve extension is a powerful and independent predictor for arrhythmogenic PV, which may be useful anatomical markers to facilitate PAF ablation.
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Affiliation(s)
- Jan-Yow Chen
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung, 40447, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Dar Isaac Wu
- Department of Applied Mathematics and Institute of Statistics, National Chung Hsing University, Taichung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung, 40447, Taiwan. .,School of Medicine, China Medical University, Taichung, Taiwan.
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12
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Bengel P, Herting J, Zabel M, Lüthje L. Pulmonary vein ablation in a patient with a large left common pulmonary vein joining a large right common trunk. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 33204953 PMCID: PMC7649454 DOI: 10.1093/ehjcr/ytaa244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 07/03/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Jonas Herting
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, Georg-August University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Herz & Gefäßzentrum Göttingen, Göttingen, Germany
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13
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Pichard C, Nicolas A, Galand V, Coquard C, Behar N, Chérel C, Daubert JC, Mabo P, Leclercq C, Pavin D, Lederlin M, Martins RP. Cryoballoon ablation of atrial fibrillation in patients with atypical right pulmonary vein anatomy. Arch Cardiovasc Dis 2020; 113:690-700. [PMID: 32896517 DOI: 10.1016/j.acvd.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/23/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cryoballoon ablation is widely used for pulmonary vein isolation in patients with atrial fibrillation. There are no data regarding the clinical efficacy of cryoballoon ablation in patients with atypical right pulmonary vein anatomy. AIM We aimed to evaluate the impact of right pulmonary vein anatomy on the safety and efficacy of cryoballoon ablation. METHODS Patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. Left atrial computed tomography was performed before cryoballoon ablation to determine whether the right pulmonary vein anatomy was "normal" or "atypical". For patients with atypical anatomy, cryoballoon ablation was only performed for right superior and right inferior pulmonary veins, neglecting accessory pulmonary veins. RESULTS Overall, 303 patients were included: 254 (83.8%) with normal and 49 (16.2%) with atypical right pulmonary vein anatomy. First-freeze isolation for right superior and right inferior pulmonary veins occurred in 44 (89.8%) and 37 (75.5%) patients with atypical pulmonary vein anatomy, and in 218 (85.8%) and 217 (85.4%) patients with typical pulmonary vein anatomy, respectively (P not significant). Phrenic nerve palsies were only observed in patients with normal anatomy (0 vs. 26 [8.6%]; P=0.039). Mid-term survival free from atrial arrhythmia was similar, regardless of right pulmonary vein anatomy. CONCLUSIONS A significant proportion of patients have atypical right pulmonary vein anatomy. Procedural characteristics, acute pulmonary vein isolation success and mid-term procedural efficacy were similar, regardless of right pulmonary vein anatomy. In addition to left-side pulmonary vein isolation, cryoballoon ablation of right superior and right inferior pulmonary veins only, neglecting accessory pulmonary veins, is sufficient to obtain acute right-side pulmonary vein isolation and mid-term sinus rhythm maintenance in patients with atypical anatomy.
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14
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Bergau L, El Hamriti M, Rubarth K, Dagher L, Molatta S, Braun M, Khalaph M, Imnadze G, Nölker G, Nowak CP, Fox H, Sommer P, Sohns C. Cool enough? Lessons learned from cryoballoon-guided catheter ablation for atrial fibrillation in young adults. J Cardiovasc Electrophysiol 2020; 31:2857-2864. [PMID: 33345455 DOI: 10.1111/jce.14717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoballoon (CB)-guided ablation of atrial fibrillation (AF) is established in symptomatic AF patients. This study sought to determine the safety and efficacy of CB pulmonary vein isolation (PVI) in young adults. METHODS AND RESULTS A total of 93 consecutive patients aged <45 years referred to our center for AF ablation were included in this observational study. All patients received CB-guided PVI according to a standardized institutional protocol. Follow-up was performed in our outpatient clinic using 72-h Holter monitoring and periodic telephone interview. Recurrence was defined as any AF/atrial tachycardia (AT) episode >30 s following a 3-month blanking period. A propensity matched control group consisting of patients older than 45 years were used for further evaluation. Mean age was 35 ± 7 years, 22% suffered from persistent AF, 85% were male. Mean follow-up was 2.6 ± 2 years. At the end of the observational period, 83% of patients were free of any AF/AT episodes. There was an excellent overall 12-month success rate of 92%. In comparison to a matched group the overall recurrence rate was noticeably lower in the young group (15% vs. 27%). Increasing age was associated with a hazard ratio of 1.16 for recurrence. In a multivariate analysis model, left atrial diameter remained as significant predictor of AF/AT recurrence. The complication rate was low, no permanent phrenic nerve palsy was observed. CONCLUSION CB-guided PVI in young adults is safe and effective with favorable long-term results. It may be considered as first-line therapy in this relatively healthy population.
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Affiliation(s)
- Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kerstin Rubarth
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Lilas Dagher
- Department of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Georg Nölker
- Clinic for Cardiology, Katharinen-Hospital Unna, Unna, Germany
| | - Claus P Nowak
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery and Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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15
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Vaishnav AS, Alderwish E, Coleman KM, Saleh M, Makker P, Bhasin K, Bernstein NE, Skipitaris NT, Mountantonakis SE. Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score. J Interv Card Electrophysiol 2020; 61:293-302. [PMID: 32602004 DOI: 10.1007/s10840-020-00799-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective pulmonary vein isolation (PVI) with cryoablation depends on adequate occlusion of pulmonary veins (PV) by the cryoballoon and is therefore likely to be affected by PV and left atrial (LA) anatomical characteristics and variants. Thus, the objective of this study was to investigate the effect of LA and PV anatomy, evaluated by computed tomography (CT), on acute and long-term outcomes of cryoablation for atrial fibrillation (AF). METHODS Fifty-eight patients (64.72 + 9.44 years, 60.3% male) undergoing cryoablation for paroxysmal or early persistent AF were included. Pre-procedural CT images were analyzed to evaluate LA dimensions and PV anatomical characteristics. Predictors of recurrence were identified using regression analysis. RESULTS 60.3% of patients had two PVs on each side with separate ostia, whereas 29.3% and 10.3% had right middle and left common PVs, respectively. The following anatomic characteristics were found to be independent predictors of recurrence: right superior PV ostial max:min diameter ratio > 1.32, left superior PV ostial max:min diameter ratio > 1.2, right superior PV antral circumference > 69.1 mm, right inferior PV antral circumference > 61.38 mm, right superior PV angle > 22.7°. Using these factors, LA diameter and right middle PV, a scoring model was created for prediction of "unfavorable" LA-PV anatomy (AUC = 0.867, p = 0.000009, score range = 0-7). Score of ≥ 4 predicted need for longer cryoenergy ablation (p = 0.039) and more frequent switch to radiofrequency energy (p = 0.066) to achieve PVI, and had a sensitivity of 83.3% and specificity of 82.5% to predict clinical recurrence. CONCLUSION CT-based scoring system is useful to identify "unfavorable" anatomy prior to cryo-PVI, which can result in procedural difficulty and poor outcomes.
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Affiliation(s)
- Aditi S Vaishnav
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Edris Alderwish
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kristie M Coleman
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Moussa Saleh
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Parth Makker
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kabir Bhasin
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Neil E Bernstein
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Nicholas T Skipitaris
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Stavros E Mountantonakis
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA.
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16
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Polaczek M, Szaro P, Jakubowska L, Zych J, Religioni J, Orlowski TM. Pulmonary veins variations with potential impact in thoracic surgery: a computed-tomography-based atlas. J Thorac Dis 2020; 12:383-393. [PMID: 32274104 PMCID: PMC7139082 DOI: 10.21037/jtd.2020.01.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Pulmonary veins (PVs) are important during segmentectomy. Many case reports prove that they may be the source of bleeding during surgery, especially when anatomical variants are present. We decided to describe venous variations and prepare a computed tomography based atlas of our observations. Methods The study was conducted using 135 chest computed tomography studies with intra venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. Thirteen people had atrial fibrillation. Images were analysed using radiological workstation. Results The variations were divided into three categories: atypical topography of the PV, atypical venous outflow to the left atrium (LA), atypical venous vascularization of the lung bronchopulmonary segment. Retrobronchial course of the vein of the posterior segment of the right upper lobe was observed in 8.15%. The most common variant of atrial venous outflow was the direct outflow of the middle lobe vein, observed in 25.19% of cases and the long common trunk of left PVs in 11.11%. The split drainage from the middle lobe into the right superior pulmonary vein (RSPV) and the right inferior pulmonary vein (RIPV) was observed in 9.63% as the full drainage into the RIPV in 2.96%. Conclusions Long common trunk of left PVs and numerous variants of venous vascularisation of the middle lobe are the variations that may pose potential problems during thoracic surgeries. The frequency is high enough to justify the routine assessment of pulmonary vessels with computed tomography before surgery.
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Affiliation(s)
- Mateusz Polaczek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.,Third Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Pawel Szaro
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.,Department of Radiology, Sahlgrenska University of Gothenburg, Gothenburg, Sweden
| | - Lilia Jakubowska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Jacek Zych
- Third Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Jaroslaw Religioni
- Department of Surgery, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz M Orlowski
- Department of Surgery, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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17
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Heeger CH, Phan HL, Meyer-Saraei R, Fink T, Sciacca V, Liosis S, Brüggemann B, Große N, Fahimi B, Sano M, Kuck KH, Ouyang F, Vogler J, Eitel C, Tilz RR. Second-Generation Visually Guided Laser Balloon Ablation System for Pulmonary Vein Isolation: Learning Curve, Safety and Efficacy ― The MERLIN Registry ―. Circ J 2019; 83:2443-2451. [DOI: 10.1253/circj.cj-19-0766] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christian-H. Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
| | - Huong-Lan Phan
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Roza Meyer-Saraei
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Thomas Fink
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Vanessa Sciacca
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Spyridon Liosis
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Ben Brüggemann
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Niels Große
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Bezhad Fahimi
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Makoto Sano
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Feifan Ouyang
- Fuwai Hospital/National Center of Cardiovascular Diseases
| | - Julia Vogler
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
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18
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Istratoaie S, Roșu R, Cismaru G, Vesa ȘC, Puiu M, Zdrenghea D, Pop D, Buzoianu AD. The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation. ACTA ACUST UNITED AC 2019; 55:medicina55110727. [PMID: 31690031 PMCID: PMC6915429 DOI: 10.3390/medicina55110727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 minutes) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.
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Affiliation(s)
- Sabina Istratoaie
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
| | - Radu Roșu
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Gabriel Cismaru
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Ștefan C Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
| | - Mihai Puiu
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Dumitru Zdrenghea
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Dana Pop
- th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania.
| | - Anca D Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
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19
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Coutiño H, Ströker E, Takarada K, Mugnai G, Abugattas J, Sieira J, Salghetti F, Terasawa M, Varnavas V, Maj R, Osório TG, Neach D, Brugada P, Asmundis C, Chierchia G. Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins. Pacing Clin Electrophysiol 2019; 42:1456-1462. [DOI: 10.1111/pace.13810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/11/2019] [Accepted: 09/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Hugo‐Enrique Coutiño
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Ken Takarada
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Juan‐Pablo Abugattas
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Francesca Salghetti
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Muryo Terasawa
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Varnavas Varnavas
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Riccardo Maj
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Diego Neach
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Carlo Asmundis
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Gian‐Battista Chierchia
- Heart Rhythm Management CentrePostgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium
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Nakamura Y, Sohara H, Ihara M. Acute efficacy and clinical outcomes using HotBalloon for pulmonary vein isolation in patients with a left common pulmonary vein. J Cardiovasc Electrophysiol 2019; 30:1241-1249. [DOI: 10.1111/jce.13988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - Hiroshi Sohara
- The Heart Rhythm CenterTokyo Heart Center Shinagawa‐ku Tokyo Japan
| | - Minoru Ihara
- The Heart Rhythm CenterTokyo Heart Center Shinagawa‐ku Tokyo Japan
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21
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Lee WC, Lee YW, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC. Common pulmonary vein on the recurrence of atrial tachyarrhythmia after pulmonary vein isolation. Pacing Clin Electrophysiol 2019; 42:882-889. [PMID: 31049997 DOI: 10.1111/pace.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023]
Abstract
AIMS Catheter ablation has become an effective treatment modality for atrial fibrillation (AF). However, the relationship between common pulmonary vein (PV) and recurrent atrial tachyarrhythmia (ATA) after PV isolation (PVI) remains controversial. This study aimed to explore the function of common PV on the risk of recurrent ATA after PVI. METHODS We identified a total of 191 patients who received radiofrequency catheter ablation for paroxysmal AF at our hospital between July 2010 and December 2017 for retrospective chart review. We collected the following data for analysis: results of preprocedural computed tomography, including the anatomy of PV and left atrial (LA) volume; the incidence of early- and late-onset recurrence of ATA. We compared these characteristics between the two groups defined by the presence or absence of the late-onset recurrence of ATA. RESULTS Compared to the no ATA recurrence group, the ATA recurrence group had larger LA size, larger LA end-diastolic and systolic volumes, larger maximal diameter of PV, higher prevalence of common PV, and higher incidence of early-onset recurrence of ATA. In multivariate logistic regression analyses, presence of common PV and early-onset recurrence were independently associated with late-onset recurrence of ATA. Compared to patients without common PV, patients with common PV had larger diameter of PV and higher incidence of late-onset recurrent ATA. CONCLUSION In patients with paroxysmal AF, early-onset recurrence of ATA and the presence of common PV were independently associated with late-onset recurrent ATA after radiofrequency catheter ablation.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Wei Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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22
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Wang Y, Xu Y, Ling Z, Chen W, Su L, Du H, Xiao P, Liu Z, Yin Y. Radiofrequency catheter ablation for paroxysmal atrial fibrillation: outcomes during a 3-year follow-up period. J Int Med Res 2019; 47:1636-1648. [PMID: 30803295 PMCID: PMC6460609 DOI: 10.1177/0300060519828522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective This study was performed to observe the effect of radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and to explore the risk factors for late recurrence of atrial fibrillation (LRAF) after a single RFCA session. Methods In this retrospective study, 243 patients with PAF underwent RFCA and were followed up regularly. Results At a median follow-up of 37 months after a single procedure, 60.5% of patients maintained sinus rhythm (SR), and at a median follow-up of 42 months after multiple procedures, 74.9% of patients maintained SR. The statistically significant risk factors for LRAF after a single RFCA session were the left atrial diameter (LAD), left inferior pulmonary vein superior–inferior diameter (LIPV SID), PV number variation, circumferential pulmonary vein isolation (CPVI) combined with additional ablation, and early recurrence of atrial fibrillation (ERAF). The best cut-off value for LAD was 35.5 mm. Conclusions During a 3-year follow-up, about 70% of the patients with PAF maintained SR. LRAF after a single procedure was associated with the LAD, LIPV SID, PV number variation, CPVI combined with additional ablation, and ERAF.
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Affiliation(s)
- Yubing Wang
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China.,2 Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Yanping Xu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zhiyu Ling
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Weijie Chen
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Li Su
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Huaan Du
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Peilin Xiao
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zengzhang Liu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Yuehui Yin
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
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23
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Xu B, Xing Y, Xu C, Peng F, Sun Y, Wang S, Guo H. A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:717-726. [DOI: 10.1111/jce.13876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Buyun Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yangbo Xing
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Chao Xu
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Yong Sun
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Shengkai Wang
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
| | - Hangyuan Guo
- Department of Cardiology, Shaoxing People's HospitalZhejiang University School of MedicineShaoxing China
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24
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Zhao XX, Li KL, Wang RX, Zheng J, Liu XY, Dang SP, Yu ZM, Zhang CY, Yang XJ. Comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation catheter ablation using robotic magnetic navigation system. Clin Cardiol 2019; 42:418-424. [PMID: 30652336 PMCID: PMC6712313 DOI: 10.1002/clc.23156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/24/2023] Open
Abstract
Background No data exist on comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation (AF) ablation using robotic magnetic navigation system (MNS), respectively. Methods About 151 AF patients were prospectively enrolled and divided into paroxysmal AF group (n = 102) and persistent AF group (n = 49). Circumferential pulmonary vein antrum isolation (CPVI) was performed in all patients. Linear ablation at the left atrial roof and mitral isthmus was performed in patients with persistent AF in addition to CPVI. The procedural time, X‐ray exposure time, acute and long‐term success rates of CPVI, and procedure‐related complications were analyzed. The AF recurrence rates in the two groups were compared during 1 year, and Cox regression was used to analyze the recurrence risk factors. Results The acute success rates of CPVI in the two groups were 98.04% and 97.96%, respectively. There were no significant differences in the procedural time, X‐ray exposure time, and ablation time between the two groups (P > 0.05). No serious complications appeared in either group. The AF ablation success rates were 70.6% and 57.1% for the paroxysmal and persistent groups respectively at 12‐month follow‐up (P = 0.102). AF duration and coronary heart disease prior to ablation were associated with the higher AF recurrence in patients with persistent AF. Conclusion Ablation using MNS is effective and safe both in patients with paroxysmal and persistent AF. AF duration and coronary heart disease prior to ablation are two independent risk factors of AF recurrence in patients with persistent AF postoperatively.
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Affiliation(s)
- Xiao-Xi Zhao
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China.,Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jie Zheng
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiao-Yu Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Shi-Peng Dang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhi-Ming Yu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chang-Ying Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang-Jun Yang
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
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Skowerski M, Wozniak-Skowerska I, Hoffmann A, Nowak S, Skowerski T, Sosnowski M, Wnuk-Wojnar AM, Mizia-Stec K. Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation. BMC Cardiovasc Disord 2018; 18:146. [PMID: 30005637 PMCID: PMC6045862 DOI: 10.1186/s12872-018-0884-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG). Methods The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0. Results Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively. Conclusions The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.
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Affiliation(s)
- M Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - I Wozniak-Skowerska
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Hoffmann
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - S Nowak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - T Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
| | - M Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - A M Wnuk-Wojnar
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - K Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Huang S, Jin Q, Zhang N, Ling T, Pan W, Lin C, Luo Q, Han Y, Wu L. Impact of Pulmonary Vein Anatomy on Long-term Outcome of Cryoballoon Ablation for Atrial Fibrillation. Curr Med Sci 2018; 38:259-67. [DOI: 10.1007/s11596-018-1874-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 12/15/2017] [Indexed: 01/30/2023]
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27
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Yalin K, Abdin A, Lyan E, Sawan N, Liosis S, Elsner C, Jobs A, Brüggemann B, Koester J, Eitel I, Eitel C, Tilz RR. Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon. Clin Res Cardiol 2018; 107:570-7. [PMID: 29492703 DOI: 10.1007/s00392-018-1219-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The second-generation cryoballoon (CB) is increasingly used for treatment of persistent atrial fibrillation (AF). Data regarding the clinical outcome and mechanism of arrhythmia recurrence following persistent AF ablation using CB is sparse. In this study, we aimed to assess the efficacy of CB and mechanisms of atrial tachyarrhythmia (ATA) recurrence in patients with persistent AF. METHODS AND RESULTS A total of 133 patients (66 ± 10 years, 60% male) with symptomatic persistent AF, who were scheduled for PVI using the second-generation CB were enrolled. Follow-up included 24 h Holter recording at 3, 6 and 12 months. Any documented episode of ATA lasting more than 30 s was considered as a recurrent arrhythmic event. All targeted veins were isolated (100%). Phrenic nerve palsy with recovery during follow-up occurred in six patients (4.5%), no patient experienced tamponade or a cerebrovascular event. During 12.6 ± 5.4 months of follow-up, 89/133 (67%) patients were free of ATA recurrences. Multivariable analysis revealed recurrence in the blanking period (HR 11.46, 0.95 CI 3.92-33.49, p < 0.001), presence of cardiomyopathy (HR 2.75, 0.95 CI 1.09-6.96, p = 0.032) and PV abnormality (HR 3.56, 0.95 CI 1.21-10.43, p = 0.021) as predictors for late recurrence. CONCLUSION In patients with persistent AF, second-generation cryoballoon use is associated with an excellent safety profile and favorable outcomes. Arrhythmia recurrence during the blanking period, presence of cardiomyopathy and PV abnormality were independent predictors of long-term AF recurrence.
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Beiert T, Lodde PC, Linneborn LP, Werner J, Prinz L, Stöckigt F, Linhart M, Lickfett L, Nickenig G, Schrickel JW, Andrié RP. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. Pacing Clin Electrophysiol 2017; 41:22-27. [DOI: 10.1111/pace.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/18/2017] [Accepted: 11/26/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Pia C. Lodde
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lutz P.T. Linneborn
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jessica Werner
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lisa Prinz
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Florian Stöckigt
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Markus Linhart
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lars Lickfett
- Clinic for Cardiology and Pneumology; Mönchengladbach Germany
| | - Georg Nickenig
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jan W. Schrickel
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - René P. Andrié
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
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29
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Heeger CH, Tscholl V, Wissner E, Fink T, Rottner L, Wohlmuth P, Bellmann B, Roser M, Mathew S, Sohns C, Reißmann B, Lemeš C, Maurer T, Santoro F, Riedl J, Goldmann B, Landmesser U, Ouyang F, Kuck KH, Rillig A, Metzner A. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study. Heart Rhythm 2017; 14:1111-1118. [DOI: 10.1016/j.hrthm.2017.05.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 11/28/2022]
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30
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Maurer T, Sohns C, Deiss S, Rottner L, Wohlmuth P, Reißmann B, Heeger CH, Lemes C, Riedl J, Santoro F, Mathew S, Metzner A, Ouyang F, Kuck K, Wissner E. Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system. J Interv Card Electrophysiol 2017; 49:219-26. [DOI: 10.1007/s10840-017-0261-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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ROTTNER LAURA, METZNER ANDREAS, OUYANG FEIFAN, HEEGER CHRISTIAN, HAYASHI KENTARO, FINK THOMAS, LEMES CHRISTINE, MATHEW SHIBU, MAURER TILMAN, REIßMANN BRUNO, REXHA ENIDA, RIEDL JOHANNES, SAGUNER ARDANM, SANTORO FRANCESCO, KUCK KARLHEINZ, SOHNS CHRISTIAN. Direct Comparison of Point-by-Point and Rapid Ultra-High-Resolution Electroanatomical Mapping in Patients Scheduled for Ablation of Atrial Fibrillation. J Cardiovasc Electrophysiol 2017; 28:289-297. [DOI: 10.1111/jce.13160] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/15/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- LAURA ROTTNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ANDREAS METZNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - FEIFAN OUYANG
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTIAN HEEGER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - KENTARO HAYASHI
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - THOMAS FINK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTINE LEMES
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - SHIBU MATHEW
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - TILMAN MAURER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - BRUNO REIßMANN
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ENIDA REXHA
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - JOHANNES RIEDL
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ARDAN M. SAGUNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - FRANCESCO SANTORO
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - KARL-HEINZ KUCK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTIAN SOHNS
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
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Kiuchi K, Yoshida A, Takei A, Fukuzawa K, Itoh M, Imamura K, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Hirata KI, Kanda G, Okajima K, Shimane A, Yamada S, Taniguchi Y, Yasaka Y, Kawai H. Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation. J Arrhythm 2015; 31:286-92. [PMID: 26550084 DOI: 10.1016/j.joa.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA. METHODS Sixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7 mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated. RESULTS After the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02-1.12, p=0.001; odds ratio: 0.41, CI: 0.21-0.77, p=0.006). CONCLUSION Enlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence.
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Akihiro Yoshida
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Asumi Takei
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Mitsuaki Itoh
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Kimitake Imamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ryudo Fujiwara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Atsushi Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Tomoyuki Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Soichiro Yamashita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Gaku Kanda
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Katsunori Okajima
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Akira Shimane
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Shinichiro Yamada
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yasuyo Taniguchi
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Hiroya Kawai
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
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Kanaji Y, Miyazaki S, Iwasawa J, Ichihara N, Takagi T, Kuroi A, Nakamura H, Taniguchi H, Hachiya H, Iesaka Y. Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation. J Cardiol 2015; 67:115-21. [PMID: 25847091 DOI: 10.1016/j.jjcc.2015.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/22/2015] [Accepted: 02/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) provides accurate imaging of the pulmonary vein (PV) and left atrial (LA) anatomy. This study aimed to evaluate the prevalence and morphological characteristics of anatomical variants that could influence atrial fibrillation (AF) ablation procedures. METHODS AND RESULTS One thousand forty consecutive patients (62±10 years, 243 female, 644 paroxysmal AF) undergoing pre-procedural imaging with a 320-row CT and their first AF ablation procedure were analyzed. A total of 194 (18.7%) patients had anatomical variants. Left, right, and inferior common PVs were observed in 118, 5, and 6 patients, respectively. Three right and left PVs were observed in 44 and 4 patients, respectively. Three patients had remnants of PVs after lobectomies, and significant PV stenosis was observed in one. Supernumerary PVs that drained into the LA and diverticula were observed in eight patients. One patient had a string-like structure connecting the LA septum and posterior LA, and the others had membranous structures incompletely compartmentalizing the LA. Three patients had persistent left superior vena cavae, two strong deviations of the LA and PVs, and one dexiocardia. All patients underwent successful PV isolation during the index procedure. CONCLUSIONS Patients referred for AF ablation often have anatomical variants, which could influence the procedure. This information might aid in planning procedural strategies, and reducing unexpected procedural complications in AF ablation.
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Affiliation(s)
- Yoshihisa Kanaji
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
| | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Noboru Ichihara
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takamitsu Takagi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Pezawas T, Ristl R, Bilinski M, Schukro C, Schmidinger H. Single, remote-magnetic catheter approach for pulmonary vein isolation in patients with paroxysmal and non-paroxysmal atrial fibrillation. Int J Cardiol 2014; 174:18-24. [DOI: 10.1016/j.ijcard.2014.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/31/2014] [Accepted: 03/09/2014] [Indexed: 12/19/2022]
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McLellan AJ, Ling LH, Ruggiero D, Wong MC, Walters TE, Nisbet A, Shetty AK, Azzopardi S, Taylor AJ, Morton JB, Kalman JM, Kistler PM. Pulmonary vein isolation: The impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm 2014; 11:549-56. [DOI: 10.1016/j.hrthm.2013.12.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 10/25/2022]
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