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Lin C, Nguyen A, Ling I, Partow-Navid R, Leung S, Zadeh A, Ho I, Zaman JA. SuperMap algorithm: an efficient, safe and accurate modality for mapping and eliminating challenging cardiac arrhythmias. Future Cardiol 2024; 20:45-53. [PMID: 38530866 DOI: 10.2217/fca-2023-0123] [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] [Indexed: 03/28/2024] Open
Abstract
Even with the development of advanced catheter-based mapping systems, there remain several challenges in the electrophysiological evaluation and elimination of atrial arrhythmias. For instance, atrial tachycardias with irregular rates cannot be reliably mapped by systems that require stability in order to sequentially gather data points to be organized thereafter. Separately, these arrhythmias often arise following initial ablation for atrial fibrillation, posing logistic challenges. Here, we present the available literature summarizing the use of a non-contact mapping catheter, the AcQMap catheter, in conjunction with SuperMap, an algorithm that compiles a large number of non-contact data points from multiple catheter positions within the atria. These studies demonstrate the efficiency, safety and accuracy of this technology.
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Affiliation(s)
- Charlie Lin
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Nguyen
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ian Ling
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Rod Partow-Navid
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Steven Leung
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Andrew Zadeh
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Ivan Ho
- Keck School of Medicine, University of Southern California, CA 90033, USA
| | - Junaid Ab Zaman
- Keck School of Medicine, University of Southern California, CA 90033, USA
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Yoshida M, Tanaka T, Sakuma H, Sato T, Yamashiro K. Atrial balloon septoplasty facilitates trans-subclavian approach for left atrial tachycardia in a patient with hemiazygos continuation of inferior vena cava. HeartRhythm Case Rep 2024; 10:81-85. [PMID: 38264108 PMCID: PMC10801016 DOI: 10.1016/j.hrcr.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Masaharu Yoshida
- Heart Rhythm Center, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomomi Tanaka
- Heart Rhythm Center, Takatsuki General Hospital, Takatsuki, Japan
| | - Hiroki Sakuma
- Heart Rhythm Center, Takatsuki General Hospital, Takatsuki, Japan
| | - Taiki Sato
- Heart Rhythm Center, Takatsuki General Hospital, Takatsuki, Japan
| | - Kohei Yamashiro
- Heart Rhythm Center, Takatsuki General Hospital, Takatsuki, Japan
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Noten AME, Romanov A, De Schouwer K, Beloborodov V, Bhagwandien R, Hoogendijk MG, Mikheenko I, Wijchers S, Yap SC, Schwagten B, Szili-Torok T. Robotic magnetic navigation-guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation when compared to conventional ablation techniques. J Cardiovasc Electrophysiol 2023; 34:2472-2483. [PMID: 37767745 DOI: 10.1111/jce.16081] [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: 08/04/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is a pivotal part of ablative therapy for atrial fibrillation (AF). Currently, there are multiple techniques available to realize PVI, including: manual-guided cryoballoon (MAN-CB), manual-guided radiofrequency (MAN-RF), and robotic magnetic navigation-guided radiofrequency ablation (RMN-RF). There is a lack of large prospective trials comparing contemporary RMN-RF with the more conventional ablation techniques. This study prospectively compared three catheter ablation techniques as treatment of paroxysmal AF. METHODS This multicenter, prospective study included patients with paroxysmal AF who underwent their first ablation procedure. Procedural parameters (including procedural efficiency), complication rates, and freedom of AF during 12-month follow-up, were compared between three study groups which were defined by the utilized ablation technique. RESULTS A total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN-CB (78 ± 21 min) compared to MAN-RF (115 ± 41 min; p < .001) and compared to RMN-RF (129 ± 32 min; p < .001), whereas it was comparable between the two radiofrequency (RF) groups (p = .062). A 3% complication rate was observed, which was comparable between all groups. At 12-month follow-up, AF recurrence was observed in 40 patients (19%) and was significantly lower in the robotic group (MAN-CB 19 [24%], MAN-RF 16 [23%], RMN-RF 5 [8%] AF recurrences, p = .045) (multivariate hazard ratio of RMN-RF on AF recurrence 0.32, 95% confidence interval: 0.12-0.87, p = .026). CONCLUSION RMN-guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time-efficient ablation technique, whereas RMN nowadays has comparable efficiency with manual RF ablation.
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Koen De Schouwer
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Vladimir Beloborodov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Rohit Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bruno Schwagten
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Vonderlin N, Siebermair J, Mahabadi A, Pesch E, Koehler M, Dobrev D, Janosi RA, Rassaf T, Wakili R. Characterization of temporal electrical activity patterns for detection of critical isthmus regions of recurrent atypical atrial flutter. Clin Cardiol 2023; 46:574-583. [PMID: 36971117 DOI: 10.1002/clc.24009] [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: 12/19/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Identifying the critical isthmus region (CIR) of atrial re-entry tachycardias (AT) is challenging. The Lumipoint® (LP) software, developed for the Rhythmia® mapping system, aims to facilitate the successful ablation of ATs by identifying the CIR. OBJECTIVE The objective of this study was to evaluate the quality of LP regarding the percentage of arrhythmia-relevant CIR in patients with atypical atrial flutter (AAF). METHODS In this retrospective study, we analyzed 57 AAF forms. Electrical activity (EA) was mapped over tachycardia cycle length resulting in a two-dimensional EA pattern. The hypothesis was that EA minima suggest potential CIRs with slow-conduction-zone. RESULTS A total of n = 33 patients were included, with the majority of patients being already preablated (69.7%). LP algorithm identified a mean of 2.4 EA minima and 4.4 suggested CIRs per AAF form. Overall, we observed a low probability of identifying only the relevant CIR (POR) at 12.3% but a high probability that at least one CIR is detected (PALO) at 98.2%. Detailed analysis revealed EA minima depth (≤20%) and width (>50 ms) as the best predictors of relevant CIRs. Wide minima occurred rarely (17.5%), while low minima were more frequently present (75.4%). Minima depth of EA ≤ 20% showed the best PALO/POR overall (95% and 60%, respectively). Analysis in recurrent AAF ablations (five patients) revealed that CIR in de novo AAF was already detected by LP during the index procedure. CONCLUSION The LP algorithm provides an excellent PALO (98.2%), but poor POR (12.3%) to detect the CIR in AAF. POR improved by preselection of the lowest and widest EA minima. In addition, there might be the role of initial bystander CIRs becoming relevant for future AAFs.
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Affiliation(s)
- Nadine Vonderlin
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Amir Mahabadi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Elena Pesch
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Miriam Koehler
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine and Research Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Rolf Alexander Janosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology and Vascular Medicine, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Li CH, Lo LW, Jain A, Hsieh YC, Lin YJ, Chang SL, Chung FP, Hu YF, Chao TF, Liao JN, Chang TY, Lin CY, Lugtu IC, Ton AN, Liu SH, Cheng WH, Liu CM, Wu CI, Chen SA. Patterns and Characteristics of SKYLINE-Lumipoint Feature in the Catheter Ablation of Atypical Atrial Flutter: Insight from a Novel Lumipoint Module of Rhythmia Mapping System. J Pers Med 2022; 12. [PMID: 35887599 DOI: 10.3390/jpm12071102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Atypical atrial flutter (aAFL) is not uncommon, especially after a prior cardiac surgery or extensive ablation in atrial fibrillation (AF). Aims: To revisit aAFL, we used a novel Lumipoint algorithm in the Rhythmia mapping system to evaluate tachycardia circuit by the patterns of global activation histogram (GAH, SKYLINE) in assisting aAFL ablation. Methods: Fifteen patients presenting with 20 different incessant aAFL, including two naïve, six with a prior AF ablation, and seven with prior cardiac surgery were studied. Results: Reentry aAFL in SKYLINE typically was a multi-deflected peak with 1.5 GAH-valleys. Valleys were sharp and narrow-based. Most reentry aAFL (18/20, 90%) lacked a plateau and displayed a steep GAH-valley with 2 GAH-valleys per tachycardia. Each GAH-valley highlighted 1.9 areas in the map. Successful sites of ablation all matched one of the highlighted areas based on GAH-valleys < 0.4. These sites corresponded with the areas highlighted by GAH-score < 0.4 in reentry aAFL, and by GAH-score < 0.2 in localized-reentry aAFL. Conclusions: The present study showed benefits of the LumipointTM module applied to the RhythmiaTM mapping system. The results were the efficient detection of the slow conduction, better identification of ablation sites, and fast termination of the aAFL with favorable outcomes.
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Gitenay E, Bars C, Bremondy M, Ayari A, Maillot N, Baptiste F, Taormina A, Fofana A, Siame S, Kalifa J, Seitz J. Localized Atrial Tachycardia and Dispersion Regions in Atrial Fibrillation: Evidence of Spatial Concordance. J Clin Med 2021; 10:jcm10143170. [PMID: 34300336 PMCID: PMC8304729 DOI: 10.3390/jcm10143170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation. Objective: To investigate the spatial relationship between localized AT episodes and dispersion/ablation regions during persistent AF ablation procedures. Methods: We analyzed 72 consecutive patients who presented for an index persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms. We characterized spontaneous or post-ablation ATs’ mechanism and location in regard to dispersion regions and ablation lesions. Results: In 72 consecutive patients admitted for persistent AF ablation, 128 ATs occurred in 62 patients (1.9 ± 1.1/patient). Seventeen ATs were recorded before any ablation. In a total of 100 ATs with elucidated mechanism, there were 58 localized sources and 42 macro-reentries. A large number of localized ATs arose from regions exhibiting dispersion during AF (n = 49, 84%). Importantly, these ATs’ locations were generally remote from the closest ablation lesion (n = 42, 72%). Conclusions: In patients undergoing a persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms, localized ATs originate within dispersion regions but remotely from the closest ablation lesion. These results suggest that ATs represent a stabilized manifestation of co-existing AF drivers rather than ablation-induced arrhythmias.
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Ramak R, Chierchia GB, Paparella G, Monaco C, Miraglia V, Cecchini F, Bisignani A, Mojica J, Al Housari M, Sofianos D, Kazawa S, Overeinder I, Bala G, Ströker E, Sieira J, Osorio TG, Brugada P, de Asmundis C. Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm. J Interv Card Electrophysiol 2021; 61:187-195. [PMID: 32643104 PMCID: PMC8195776 DOI: 10.1007/s10840-020-00808-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. METHODS Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. RESULTS Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. CONCLUSION The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.
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Affiliation(s)
- Robbert Ramak
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Federico Cecchini
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thiago Guimaraes Osorio
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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9
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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10
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Ebner B, Grant J, Vincent L, Maning J, Olorunfemi O, Olarte N, Colombo R, Lambrakos L, Mendoza I. Comparison of in-hospital outcomes of patients undergoing catheter ablation for typical versus atypical atrial flutter. J Interv Card Electrophysiol 2021; 63:295-302. [PMID: 33770337 DOI: 10.1007/s10840-021-00982-4] [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: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catheter ablation (CA) is indicated as definitive therapy for patients with either typical or atypical atrial flutter (TAFlutter and AAFlutter, respectively) which is unresponsive to medical therapy. There is a paucity of data regarding in-hospital outcomes of patients undergoing CA. METHODS Retrospective study using the NIS to identify patients ≥18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAFlutter, AAFlutter, and CA. RESULTS A total of 17,390 patients underwent CA for Aflutter (33% AAFlutter and 67% TAFlutter). The TAFlutter group was younger (mean 65.9 years vs. 67.2 years), with less females (30% vs. 43%, p ≤ 0.001 for both) compared to the AAFlutter group. The TAFlutter group had a higher rate of diabetes, tobacco use, obesity, and chronic obstructive pulmonary disease (p ≤ 0.001 for all). The AAFlutter cohort had increased prior strokes and atrial fibrillation (p ≤ 0.001 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAFlutter compared to 2.1 in TAFlutter (p ≤ 0.001). There were significantly higher proportions of thromboembolic events, transfusions, and longer length of stay in the TAFlutter group (p ≤ 0.001 for all) with the AAFlutter group having significantly higher rates of cardioversion, implantation of cardiac devices, and increased hospital charges (p ≤ 0.001 for all); no significant difference was found in mortality after controlling for comorbidities. CONCLUSIONS We found higher complication rates in CA for patients with TAFlutter, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AFlutter may underlie these differences, and warrant further study.
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Affiliation(s)
- Bertrand Ebner
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA.
| | - Jelani Grant
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Louis Vincent
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Jennifer Maning
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Odunayo Olorunfemi
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neal Olarte
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosario Colombo
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
| | - Litsa Lambrakos
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivan Mendoza
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
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11
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Haverkamp W. Therapie von Herzrhythmusstörungen mit Antiarrhythmika: kein Ende einer Ära. Aktuelle Kardiologie 2020. [DOI: 10.1055/a-1278-9766] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungAntiarrhythmika sind eine Medikamentengruppe, die vor mehr als 100 Jahren eingeführt wurde. Jahrzehntelang wurden sie relativ breit und großzügig eingesetzt. Die Erkenntnis, dass proarrhythmische Effekte relativ häufig sind, und die Entwicklung neuer nicht medikamentöser Behandlungsalternativen (z. B. die Katheterablation bei Vorhofflimmern) haben dazu geführt, dass sich ihr klinischer Stellenwert in den letzten Jahren geändert hat. Schon seit Längerem wird das Ende der Antiarrhythmikaära prophezeit. In der Realität ergibt sich allerdings ein anderes Bild. Registerdaten zeigen, dass fast die Hälfte der Patienten mit Vorhofflimmern, die sich einer Katheterablation unterziehen, im weiteren Verlauf ein Antiarrhythmikum erhält. Eine unverändert wichtige Rolle spielen Antiarrhythmika (insbesondere Amiodaron) auch im Notfall und bei Patienten mit häufigen malignen ventrikulären Arrhythmien. Einen zunehmend relevanter werdenden Anwendungsbereich stellen angeborene Arrhythmien
(langes-QT-Syndrom, Brugada-Syndrom, katecholaminerge polymorphe Kammertachykardien) dar. Antiarrhythmika gehören damit weiterhin zum Armamentarium des rhythmologisch orientierten Arztes. Es darf gehofft werden, dass neue Formen des EKG- und Patienten-Monitorings (z. B. Smartphone-EKGs) dazu betragen werden, die Überprüfung der Therapiewirksamkeit zu vereinfachen und die Therapiesicherheit zu optimieren.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie u. Metabolismus, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Deutschland
- Kardiologie im Spreebogen, Berlin, Deutschland
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12
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Peller M, Lodziński P, Balsam P, Maciejewski K, Ozierański K, Krzowski B, Opolski G. Reduction of myocardial necrosis using "CLOSE" protocol during pulmonary vein isolation-Preliminary results from ACTIVE-AF trial. J Arrhythm 2020; 36:1039-1044. [PMID: 33335622 PMCID: PMC7733585 DOI: 10.1002/joa3.12424] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND New protocols of pulmonary veins isolation (PVI) result in easier and more efficient procedure performance. Ablation index (AI) is the novel tool which helps to achieve transmural lesions during catheter ablation. However, benefit of this protocol in the reduction of myocardial injury is still not known. PURPOSE The aim of the study was to compare myocardial injury during catheter ablation using standard and AI protocol. METHODS To the analysis we included 24 patients with paroxysmal atrial fibrillation, who underwent radiofrequency catheter PVI using CARTO system (Biosense Webster, Inc). In all patients cardiac troponin I (cTnI) levels were assessed before and 24 hours after the procedure. In 12 patients PVI was performed using continuous applications (dragging technique) and in 12 patients during PVI ablation AI protocol was implemented. To unify analyzed groups, we excluded patients with additional ablation lines (including line separating ipsilateral pulmonary veins). RESULTS In analyzed group mean age was 59.3 ± 7.7 years and 18 (75%) patients were male. There were no differences in the clinical characteristic between both subgroups. Trend in shorter total x-ray time was observed in AI group compared with dragging group (8.6 ± 5.4 vs. 5.3 ± 3.2 min.; P = .093) with no differences in total procedure time (146.3 ± 28.9 vs. 153.2 ± 37.1 min.; P = .616). Twenty-four hours after the PVI procedure cTnI levels were significantly lower in AI group than in dragging group (1.984 ± 0.644 vs. 3.369 ± 1.818 ng/mL; P = .026), with no difference in mean baseline cTnI levels (0.004 ± 0.006 vs. 0.015 ± 0.032 ng/mL; P = .304). CONCLUSION Presented study revealed that compared with standard, continuous applications, AI protocol implementation results in reduction of myocardial injury during catheter PVI in patients with paroxysmal atrial fibrillation.
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Affiliation(s)
- Michał Peller
- 1st. Department of CardiologyMedical University of WarsawWarsawPoland
| | - Piotr Lodziński
- 1st. Department of CardiologyMedical University of WarsawWarsawPoland
| | - Paweł Balsam
- 1st. Department of CardiologyMedical University of WarsawWarsawPoland
| | | | | | - Bartosz Krzowski
- 1st. Department of CardiologyMedical University of WarsawWarsawPoland
| | - Grzegorz Opolski
- 1st. Department of CardiologyMedical University of WarsawWarsawPoland
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13
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Jungen C, Akbulak R, Kahle AK, Eickholt C, Schaeffer B, Scherschel K, Dinshaw L, Muenkler P, Schleberger R, Nies M, Gunawardene MA, Klatt N, Hartmann J, Merbold L, Jularic M, Willems S, Meyer C. Outcome after tailored catheter ablation of atrial tachycardia using ultra-high-density mapping. J Cardiovasc Electrophysiol 2020; 31:2645-2652. [PMID: 32748442 DOI: 10.1111/jce.14703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/06/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tailored catheter ablation of atrial tachycardias (ATs) is increasingly recommended as a potentially easy treatment strategy in the era of high-density mapping (HDM). As follow-up data are sparse, we here report outcomes after HDM-guided ablation of ATs in patients with prior catheter ablation or cardiac surgery. METHODS AND RESULTS In 250 consecutive patients (age 66.5 ± 0.7 years, 58% male) with ATs (98% prior catheter ablation, 13% prior cardiac surgery) an HDM-guided catheter ablation was performed with the support of a 64-electrode mini-basket catheter. A total of 354 ATs (1.4 ± 0.1 ATs per patient; mean cycle length 304 ± 4.3 ms; 64% macroreentry, 27% localized reentry, and 9% focal) with acute termination of 95% were targeted in the index procedure. A similar AT as in the index procedure recurred in five patients (2%) after a median follow-up time of 535 days (interquartile range (IQR) 25th-75th percentile: 217-841). Tailored ablation of reentry ATs with freedom from any arrhythmia was obtained in 53% after a single procedure and in 73% after 1.4 ± 0.4 ablation procedures (range: 1-4). A total of 228 patients (91%) were free from any arrhythmia recurrence after 210 days (IQR: 152-494) when including optimal usual care. CONCLUSIONS Tailored catheter ablation of ATs guided by HDM has a high acute success rate. The recurrence rate of the index AT is low. In patients with extensive atrial scaring further ablation procedures need to be considered to achieve freedom from any arrhythmia.
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Affiliation(s)
- Christiane Jungen
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ruken Akbulak
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Benjamin Schaeffer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Katharina Scherschel
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Leon Dinshaw
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Paula Muenkler
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Ruben Schleberger
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Moritz Nies
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | | | - Niklas Klatt
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Meyer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany.,Institute of Neuronal and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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14
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Choi Y, Kim S, Baek JY, Kim SH, Kim JY, Kim TS, Hwang Y, Kim JH, Jang SW, Lee MY, Oh YS. Acute and long-term outcome of redo catheter ablation for recurrent atrial tachycardia and recurrent atrial fibrillation in patients with prior atrial fibrillation ablation. J Interv Card Electrophysiol 2020; 61:227-234. [PMID: 32556924 DOI: 10.1007/s10840-020-00795-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: 02/17/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF. METHODS We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects. RESULTS Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom. CONCLUSIONS RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF.
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Affiliation(s)
- Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sunhwa Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ju Yeol Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Tae-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
| | - Youmi Hwang
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Ji-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Man Young Lee
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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15
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Khan Z, Hamandi M, Khan H, DiMaio JM, Evans M. Convergent epicardial-endocardial ablation for treatment of long-standing persistent atrial fibrillation: A review of literature. J Card Surg 2020; 35:1306-1313. [PMID: 32333456 DOI: 10.1111/jocs.14562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM OF STUDY The convergent procedure (CVP) is a hybrid ablation technique via a subxiphoid incision that has recently emerged as a treatment option for non-paroxysmal atrial fibrillation (npAF). By combining endocardial and epicardial ablation into a simultaneous or staged procedure, the pulmonary vein and posterior left atrium can be isolated with transmural lesion sets while minimizing the risk of proarrhythmic gaps that are a known limitation with endocardial linear lesion sets. We reviewed the 12-month outcomes in patients who underwent CVP compared to those who underwent endocardial catheter ablation (CA) and surgical ablation (SA). METHODS A literature search was conducted using the PubMed database for publications related to CVP. Selected studies included detailed 12-month follow-up of patients, patient characteristics, periprocedural complications, use of antiarrhythmic drugs (AADs), and monitoring method. RESULTS Five studies with 340 patients who underwent CVP between January 2009 and March 2017 were selected for this review. A total of 8.5% of patients had paroxysmal AF (pAF), 42.2% had persistent AF (peAF), and 49.1% had long-standing persistent AF (lspAF). At 12 months, 81.9% of patients were in sinus rhythm, while 54.1% of patients were in sinus rhythm while not taking AADs. The overall complication rate was 10%. CONCLUSION CVP had better 1-year efficacy in eliminating AF when compared to CA. However, SA, specifically the Cox Maze IV, had lower rates of AF recurrence in the npAF patient population. Despite its promising 1-year efficacy rates, the periprocedural complication rate for CVP was significantly higher than both CA and SA.
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Affiliation(s)
- Zoheb Khan
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Mohanad Hamandi
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Hafiza Khan
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - John Michael DiMaio
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Matthew Evans
- Electrophysiology, Baylor Scott & White The Heart Hospital, Denton, Texas
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16
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Kuck KH, Brugada J, Schlüter M, Braegelmann KM, Kueffer FJ, Chun KRJ, Albenque JP, Tondo C, Calkins H. The FIRE AND ICE Trial: What We Know, What We Can Still Learn, and What We Need to Address in the Future. J Am Heart Assoc 2019; 7:e010777. [PMID: 30561258 PMCID: PMC6405614 DOI: 10.1161/jaha.118.010777] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Karl-Heinz Kuck
- 1 Department of Cardiology Asklepios Klinik St Georg Hamburg Germany
| | | | - Michael Schlüter
- 1 Department of Cardiology Asklepios Klinik St Georg Hamburg Germany
| | | | | | | | - Jean-Paul Albenque
- 5 Cardiologie Générale, Interventionnelle - Rhythmologie Clinique Pasteur Toulouse France
| | - Claudio Tondo
- 6 Heart Rhythm Center Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy.,7 Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Hugh Calkins
- 8 Department of Arrhythmia Services Johns Hopkins Medical Institutions Baltimore MD
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17
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Peigh G, Wasserlauf J, Sattayaprasert P, Verma N, Knight BP. Use of the cryoballoon to ablate pulmonary vein‐dependent left atrial flutter. Pacing Clin Electrophysiol 2019; 42:1589-1593. [DOI: 10.1111/pace.13826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/30/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Graham Peigh
- Division of CardiologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
| | - Jeremiah Wasserlauf
- Division of CardiologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
| | | | - Nishant Verma
- Division of CardiologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
| | - Bradley P. Knight
- Division of CardiologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
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18
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Keramati AR, Calkins H. Persistent atrial fibrillation; It is time to regroup. J Cardiovasc Electrophysiol 2019; 30:2627-2628. [PMID: 31502372 DOI: 10.1111/jce.14159] [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: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 11/28/2022]
Abstract
Pulmonary vein isolation (PVI) is the only proven ablation strategy for paroxysmal and persistent atrial fibrillation (AF). However, when AF recurs despite durable PVI in a subgroup of patients with persistent AF, there is no scientifically proven ablation strategy to pursue. Here, we summarized how we approach persistent AF at Johns Hopkins Hospital.
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Affiliation(s)
- Ali R Keramati
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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19
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Percell RL, Sharpe ED, Lassen TM, Maas SR, Heiss LJ, Hansen DA. Zero-fluoroscopy Radiofrequency Redo Ablation of Atrial Tachycardia Following Pulmonary Vein Isolation: A Tale of Two Systems. J Innov Card Rhythm Manag 2018; 9:3385-3389. [PMID: 32477787 PMCID: PMC7252657 DOI: 10.19102/icrm.2018.091101] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/12/2018] [Indexed: 11/16/2022] Open
Abstract
Regular atrial tachycardia (AT) is one of the most important proarrhythmic complications that may occur following left atrial pulmonary vein isolation (PVI). These tachycardias that develop after atrial fibrillation ablation may lead to worse symptoms than those from the original arrhythmia existing prior to the index ablation procedure. Ablation of various types of supraventricular tachycardias without the use of fluoroscopy has been shown to be feasible in both children and adults using three-dimensional mapping systems. We describe the case of a 71-year-old woman who developed a focal AT after a successful PVI procedure. The initial ablation failed with one mapping system. Repeat electrophysiologic study despite antiarrhythmic medications revealed the same focal AT, which was successfully ablated with a different mapping system. Both ablations were performed without fluoroscopy.
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Affiliation(s)
- Robert L Percell
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | - Erin D Sharpe
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | - Teresa M Lassen
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | - Steffani R Maas
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | - Lori J Heiss
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | - Dale A Hansen
- Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
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20
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Ciaccio EJ, Peters NS, Garan H. Use of an automaton model to suggest methods for cessation of intractable fibrillatory activity. Comput Biol Med 2018; 102:357-368. [PMID: 30097173 DOI: 10.1016/j.compbiomed.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/09/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common heart arrhythmia, and permanent AF is an intractable medical problem. If cessation of permanent AF were possible, via extensive substrate ablation or multisite stimulation, it could significantly improve the public health. METHOD A cellular automaton composed of 576 × 576 computerized grid nodes, described in detail previously, was used to test hypotheses concerning the cessation of fibrillatory electrical activity. A refractory period gradient across the grid, and addition of randomly located nonconducting fibers, were utilized as conditions leading to fibrillatory activity. A premature S1-S2 stimulus was applied to one grid corner, resulting in unidirectional conduction block at some locations, followed by rotational activity and random propagation of activation wavelets throughout the grid, none of which terminated spontaneously. Simulated ablation lesions of dimension 20 × 20 grid nodes, imparted at core locations of rotational activity, and multisite electrode stimulation (MES) applied at nodes where recovery of excitability had occurred, were used in attempts to terminate fibrillatory activity. Six impositions of random fiber location were utilized in separate trials. RESULTS Simulated ablation lesions eliminated the targeted swirling vortices; however, additional vortices then often appeared at other locations. After ablating approximately one third of the grid area, localized vortices were eliminated, but individual wavelets continued to propagate about longer viable pathways forming at ablation lesions. Thus extensive ablation was unsuccessful in terminating arrhythmia. However, MES applied uniformly throughout the grid, with a coupling interval slightly longer than the maximum refractory period, terminated fibrillatory activity in some trials. More efficaciously, application of MES with a coupling interval half the maximum refractory period of the grid succeeded in capture of activation at all nodes, and when followed by a doubling of the MES coupling interval, resulted in cessation of all fibrillatory activity. CONCLUSIONS It is possible to terminate simulated fibrillatory activity in a computerized grid that would otherwise be intractable, using multisite stimulation with a coupling interval related to the maximum refractory period of the substrate. If each MES stimulating electrode could be individually controlled, it would be possible to apply a stimulation pattern mimicking the normal heart activation sequence.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Oesterlein TG, Loewe A, Lenis G, Luik A, Schmitt C, Dossel O. Automatic Identification of Reentry Mechanisms and Critical Sites During Atrial Tachycardia by Analyzing Areas of Activity. IEEE Trans Biomed Eng 2018; 65:2334-2344. [DOI: 10.1109/tbme.2018.2794321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mujović N, Marinković M, Marković N, Vučićević V, Lip GYH, Bunch TJ, Potpara TS. The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set. Sci Rep 2018; 8:9875. [PMID: 29959347 DOI: 10.1038/s41598-018-28072-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023] Open
Abstract
Early recurrence of atrial fibrillation (ERAF) after catheter-ablation (CA) can be a transient phenomenon due to inflammation, or a harbinger of late AF recurrence due to CA lesion (re)conduction. We studied the relationship between ERAF and the 3-month CA lesions integrity. Forty one consecutive AF patients who underwent a pulmonary vein isolation (PVI), roof line (RL) and mitral isthmus line (MIL) CA were enrolled. At 3 months all patients underwent invasive assessment of the lesion set integrity irrespective of ERAF. The PVI, RL and MIL ablation was successful in 100.0%, 95.1% and 82.9% patients, respectively. At the 3-month remapping, a gap in PVI-lesion(s), RL or MIL was identified in 61.0%, 31.7% and 36.6% patients, respectively. Patients with (n = 17, 41.5%) compared to those without ERAF (n = 24) had a significantly higher rate of any PV-reconnection (88.2% vs. 41.7%), the right PV(s)-reconnection (82.5% vs. 29.2%) and the RL gap (52.9% vs. 16.7%), as well as a higher number of reconnected right PVI-segments, all p < 0.05. On multivariate analysis, only the number of reconnected right PVI-segments was associated with ERAF (OR 4.26, p = 0.004). The ERAF following PVI + RL + MIL ablation was significantly related to 3-month PV-reconnections and the presence of RL gaps.
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Hermida A, Kubala M, Traullé S, Buiciuc O, Quenum S, Hermida JS. Prevalence and predictive factors of left atrial tachycardia occurring after second-generation cryoballoon ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2017; 29:46-54. [PMID: 29024212 DOI: 10.1111/jce.13364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Assess the prevalence and predictors of left atrial tachycardia (LAT) after cryoballoon ablation of pulmonary veins. METHODS AND RESULTS Patients who underwent catheter ablation of pulmonary veins with a second-generation cryoballoon for symptomatic paroxysmal (151 of 270, 56%) or persistent (119 of 270, 44%) atrial fibrillation were entered in a single-center prospective registry. Patients who experienced postcryoballoon LAT (pcryo-LAT) were selected on the basis of 12-lead ECG characteristics. Left atrial origin was confirmed during conventional EP study and electroanatomical activation mapping, and patients were treated by RF catheter ablation. Pcryo-LAT was observed in 15 (5.6%) of 270 patients and was attributed to a reentrant mechanism in 11 patients (73%). The other four cases of pcryo-LAT were due to focal atrial tachycardia associated with reconnection of one pulmonary vein. In comparison with patients who remained in sinus rhythm, LA area (HR = 1.09; CI 1.01, 1.2; P = 0.02), LVEF (HR = 0.94; CI 0.90, 0.97; P < 0.001), and LVEF <50% (HR = 8.5; CI 3.1, 23.6; P < 0.001) were predictors of pcryo-LAT. After multivariate Cox analysis, only left ventricular ejection fraction < 50% remained predictive of pcryo-LAT, (HR = 7.8, CI 2.3 26.7, P = 0.002). With a mean survival of 23 months, 73% of patients who experienced pcryo-LAT were in sinus rhythm versus 78% of patients without pcryo-LAT (log rank P = 0.85). CONCLUSION The prevalence of pcryo-LAT in patients with atrial fibrillation is low. Left ventricular ejection fraction < 50% is associated with an increased risk of pcryo-LAT. When treated by RF catheter ablation, the presence of pcryo-LAT is not a predictive factor of subsequent recurrence of atrial fibrillation during follow-up.
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Affiliation(s)
- Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France
| | - Maciej Kubala
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France
| | - Sarah Traullé
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France
| | - Otilia Buiciuc
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France
| | - Serge Quenum
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France
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Mujović N, Marinković M, Marković N, Stanković G, Lip GYH, Blomstrom-Lundqvist C, Bunch TJ, Potpara TS. Persistency of left atrial linear lesions after radiofrequency catheter ablation for atrial fibrillation: Data from an invasive follow-up electrophysiology study. J Cardiovasc Electrophysiol 2017; 28:1403-1414. [PMID: 28836709 DOI: 10.1111/jce.13322] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/27/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on the roof line (RL) and mitral isthmus line (MIL) reconnections after atrial fibrillation (AF) catheter ablation (CA) are scarce. OBJECTIVE We studied the RL and MIL completeness and localization of reconnection sites in consecutive patients after their first-ever AF-CA. METHODS We prospectively included 41 consecutive AF patients who underwent predefined lesion sets of two circumferential lines (CLs) for ipsilateral pulmonary vein isolation (PVI) combined with a RL and lateral MIL. Three months after CA, all patients underwent invasive follow-up procedure for line persistency evaluation, irrespective of clinical outcome. RESULTS At the time of index ablation, PVI-CLs, RL, and MIL was completed in 41 (100%), 39 (95%), and 34 (83%) of patients, respectively. At the 3-month follow-up procedure, reconnections of PVI-CLs, RL, and MIL were found in 61% (25/41), 28% (11/39), and 24% (8/34) of patients, respectively. The 3-month reconnections were located commonly in the anterior and posterior PVI-CL segments, and rarely in the right third of RL and in the posterior part of MIL. The 3-month reconnections were rarely seen at the sites of acute reconnections during index procedure (6%, 20%, and 25% of the PVI-CL segments, RL segments, and MIL segments, respectively). CONCLUSIONS To our knowledge, this is the first study systematically investigating the reconnection of standardized left atrium linear lesions such as RL and MIL after RF-CA for AF in consecutive patients. The RL and MIL 3-month reconnection rates were relatively low (28% and 24%), with poor anatomical concordance between the sites with acute and 3-month reconnections.
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Affiliation(s)
- Nebojša Mujović
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Goran Stanković
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gregory Y H Lip
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA.,Department of Internal Medicine, Stanford University, Palo Alto, CA, USA
| | - Tatjana S Potpara
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Bulava A, Mokráček A, Eisenberger M, Kurfirst V, Dušek L. Middle-term results of hybrid atrial fibrillation ablation using AtriCure system. Cor Vasa 2017. [DOI: 10.1016/j.crvasa.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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SCHAEFFER BENJAMIN, HOFFMANN BORISA, MEYER CHRISTIAN, AKBULAK RUKENÖ, MOSER JULIA, JULARIC MARIO, EICKHOLT CHRISTIAN, NÜHRICH JANAM, KUKLIK PAWEL, WILLEMS STEPHAN. Characterization, Mapping, and Ablation of Complex Atrial Tachycardia: Initial Experience With a Novel Method of Ultra High-Density 3D Mapping. J Cardiovasc Electrophysiol 2016; 27:1139-1150. [DOI: 10.1111/jce.13035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 04/03/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- BENJAMIN SCHAEFFER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - BORIS A. HOFFMANN
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - CHRISTIAN MEYER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - RUKEN Ö. AKBULAK
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - JULIA MOSER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - MARIO JULARIC
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - CHRISTIAN EICKHOLT
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - JANA M. NÜHRICH
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - PAWEL KUKLIK
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
| | - STEPHAN WILLEMS
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; DZHK Hamburg Germany
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Traykov V. Focal atrial tachycardias and atrial flutter: are they hot enough to make a thematic issue? Curr Cardiol Rev 2015; 11:101-2. [PMID: 25695115 PMCID: PMC4356715 DOI: 10.2174/1573403x10999141013122732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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