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Kiedrowicz RM, Wielusinski M, Krasnik W, Jankowska O, Zakrzewski S, Duda L, Peregud-Pogorzelska M, Kladna A, Kazmierczak J. The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation. J Clin Med 2023; 12:5056. [PMID: 37568458 PMCID: PMC10420066 DOI: 10.3390/jcm12155056] [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: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes. METHODS A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments. RESULTS Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that AFR was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model. CONCLUSIONS Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.
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Affiliation(s)
- Radoslaw M. Kiedrowicz
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Maciej Wielusinski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Wojciech Krasnik
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Olga Jankowska
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Szymon Zakrzewski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Lukasz Duda
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | | | - Aleksandra Kladna
- Department of History of Medicine and Medical Ethics, Pomeranian Medical University, Rybacka 1, 70-204 Szczecin, Poland
| | - Jaroslaw Kazmierczak
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
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Kiedrowicz RM, Wielusinski M, Wojtarowicz A, Kazmierczak J. Predictors of the voltage derived left atrial fibrosis in patients with long-standing persistent atrial fibrillation. Cardiol J 2020; 29:660-669. [PMID: 32419127 PMCID: PMC9273256 DOI: 10.5603/cj.a2020.0069] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. Methods One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two- and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. Results Low-voltage areas (LVA; 15 cm2 [IQR 8–31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m2, valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA2DS2-VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA2DS2-VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. Conclusions A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence.
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Affiliation(s)
| | - Maciej Wielusinski
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
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Arbelo E, Brugada J, Hindricks G, Maggioni AP, Tavazzi L, Vardas P, Laroche C, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse GH, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines SA, Brugada J, Arbelo E, Hindriks G, Maggioni AP, Morgan J, Tavazzi L, Vardas P, Alonso A, Ferrari R, Komajda M, Tavazzi L, Wood D, Vardas P, Brugada J, Mairesse G, Taborsky M, Kautzner J, Lewalter T, Riahi S, Jais P, Anselme F, Theodorakis G, Inama G, Trines S, Kalarus Z, Villacastin JP, Maggioni AP, Manini M, Gracia G, Laroche C, Missiamenou V, Taylor C, Konte M, Fiorucci E, Lefrancq EF, Glémot M, McNeill PA, Bois T, Heidbüchel H, Nuyens D, Boland J, Dinraths V, Herzet JM, Hoffer E, Malmendier D, Massoz M, Pourbaix S, Ballant E, Blommaert D, Deceuninck O, Dormal F, Xhaet O, De Potter T, Geelen P, Derycker K, Duytschaever M, Tavernier R, Vandekerckhove Y, Vankats D, Bulava A, Hanis J, Sitek D, Blahova M, Cihak R, Hanyasova L, Jansova H, Peichl P, Tanzerova M, Wichterle D, Duda J, Haman L, Parizek P, Coling L, Neuzil P, Petru J, Sediva L, Skoda J, Chovancik J, Fiala M, Neuwirth R, Karlsdottir A, Pehrson S, Gerdes C, Jensen H, Lukac P, Nielsen JC, Hansen J, Johannessen A, Hansen PS, Pedersen A, Heath F, Hjortshoj S, Thogersen A, Da Costa A, Martel I, Romeyer-Bouchard C, Sadki N, Schmid A, Haissaguerre M, Hocini M, Knecht S, Sacher F, Ait Said M, Cauchemez B, Ledoux F, Thomas O, Cebron JP, Decarsin N, Gras D, Hervouet S, Durand C, Durand-Dubief A, Poty H, Babuty D, Pierre B, Albenque JP, Boveda S, Combes N, Mas R, Hermida JS, Kubala M, Godin B, Savouré A, Soublin Y, Defaye P, Jacon P, Brigadeau F, Corbut S, Flament-Balzola F, Kacet S, Klug D, Lacroix D, Copie X, Gilles L, Hocine Z, Paziaud O, Piot O, Crocq C, Kaballu G, Le Moal V, Lotton P, Mabo P, Pavin D, Andronache M, De Chillou C, Magnin-Poull I, Deharo JC, Durand C, Franceschi F, Peyrouse E, Prevot S, Etchegoin M, Extramiana F, Leenhardt A, Messali A, Heine T, Schneider A, Winter N, Brachmann J, Ritscher G, Schertel-Gruenler B, Simon H, Sinha AM, Turschner O, Wystrach A, Stemberg M, Kuck KH, Metzner A, Tilz R, Wissner E, Heitmann K, Willems S, Andresen D, Mueller S, Volkmer M, Schmidt B, Kostopoulou A, Livanis E, Voudris V, Efremidis M, Letsas K, Tsikrikas S, Christoforatou E, Ioannidis P, Katsivas A, Kourouklis S, Andrikopoulos G, Rassias I, Tzeis S, Dakos G, Paraskevaidis S, Stavropoulos G, Theofilogiannakos E, Vassilikos V, Bongiorni M, Zucchelli G, Raviele A, Themistoclakis S, Pratola C, Tritto M, Della Bella P, Mazzone P, Moltrasio M, Tondo C, Calo L, De Luca L, Guarracini F, Lioy E, Dozza L, Frigoli E, Giannelli L, Pappone C, Saviano M, Schiavina G, Vicedomini G, De Ponti R, Doni LA, Marazzi R, Salerno-Uriarte J, Tamborini C, Anselmino M, Ferraris F, Gaita F, Bertaglia E, Brandolino G, Zoppo F, De Groot N, Janse P, Jordaens L, Pison L, Roos C, Van Gelder I, Manusama R, Meijer A, Van der Voort P, Trines S, Compier MG, Kazmierczak J, Kornacewicz-Jach Z, Wielusinski M, Baran J, Kulakowski P, Dzidowski M, Fuglewicz A, Nowak K, Pruszkowska-Skrzep P, Wozniak A, Nowak S, Trusz-Gluza M, Almendral J, Atienza F, Castellanos E, De Diego C, Ortiz M, Moreno Planas J, Perez Castellano N, Benezet J, Farre Muncharaz J, Rubio Campal J, Hernandez Madrid A, Matia R, Arana E, Pedrote A, Cozar R, Peinado R, Valverde I, Arbelo E, Berruezo A, Calvo N, Guiu E, Husseini S, Mont Girbau L. The Atrial Fibrillation Ablation Pilot Study: an European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J 2014; 35:1466-78. [DOI: 10.1093/eurheartj/ehu001] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [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: 11/14/2022] Open
Affiliation(s)
- Elena Arbelo
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | | | - Aldo P. Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Frédéric Anselme
- Service De Cardiologie, Hôpital Charles Nicolle, Rouen Cedex, France
| | | | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Academy of Medicine, Zabrze, Poland
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | - Sam Riahi
- AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Milos Taborsky
- Internal Cardiology Department, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | - Serge A. Trines
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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