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Nakatani Y, Take Y, Takizawa R, Yoshimura S, Kaseno K, Yamashita E, Naito S. Catheter ablation of the left-sided variant of right top pulmonary vein in a case with persistent left superior vena cava. Pacing Clin Electrophysiol 2024; 47:661-663. [PMID: 37433156 DOI: 10.1111/pace.14780] [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: 01/24/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
A 50-year-old woman underwent catheter ablation for atrial fibrillation. Preoperative computed tomography revealed a left-sided variant of the right top pulmonary vein (PV) and a persistent left superior vena cava. The right top PV was successfully isolated through a wide antral circumferential ablation line simultaneously with the right PVs.
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Affiliation(s)
- Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
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Takizawa R, Nakatani Y, Take Y, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Yoshimura S, Sasaki T, Goto K, Miki Y, Kaseno K, Nakamura K, Naito S. The optimal slow pathway ablation site in atrioventricular nodal reentrant tachycardia cases with an inferiorly located His bundle. Pacing Clin Electrophysiol 2024; 47:525-532. [PMID: 38430478 DOI: 10.1111/pace.14960] [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: 10/12/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear. METHODS AND RESULTS In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior-to-inferior (SPSI), anterior-to-posterior (SPAP), and right-to-left (SPRL) directions. The HIS location was assessed in the same manner. The HIS location in the superior-to-inferior direction (HISSI), SPSI, SPAP, and SPRL were 17.7 ± 6.4, 1.7 ± 6.4, 13.6 ± 12.3, and -1.0 ± 13.0 mm, respectively. The HISSI was positively correlated with SPSI (R2 = 0.62; P < .01) and SPAP (R2 = 0.22; P < .01), whereas it was not correlated with SPRL (R2 = 0.01; P = .65). The distance between the HIS and SP ablation site was 17.7 ± 6.4 mm and was not affected by the location of HIS. The ratio of the amplitudes of atrial and ventricular potential recorded at the SP ablation site did not differ between the high HIS group (HISSI ≥ 13 mm) and low HIS group (HISSI < 13 mm) (0.10 ± 0.06 vs. 0.10 ± 0.06; P = .38). CONCLUSION In cases with an inferiorly located HIS, SP ablation should be performed at a lower and more posterior site than in typical cases.
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Affiliation(s)
- Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
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Nakatani Y, Take Y, Yoshimura S, Nakamura K, Naito S. Dual-chamber open-window mapping for an epicardial accessory pathway through the posterior coronary vein. HeartRhythm Case Rep 2024; 10:162-165. [PMID: 38404972 PMCID: PMC10885715 DOI: 10.1016/j.hrcr.2023.11.011] [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: 02/27/2024] Open
Affiliation(s)
- Yosuke Nakatani
- Division of Non-pharmacological Management of Cardiac Arrhythmias, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
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Nagase M, Nakashima T, Nakatani Y, Vlachos K, Morimoto M, Shibahara T, Ono D, Yamada T, Suzuki K, Yamaura M, Ido T, Takahashi S, Aoyama T. Demonstration of differential ventricular overdrive pacing during long RP' supraventricular tachycardia. Pacing Clin Electrophysiol 2024; 47:45-48. [PMID: 38041801 DOI: 10.1111/pace.14895] [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: 10/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
We described the differential ventricular overdrive pacing during long RP' supraventricular tachycardia and discussed about its response leading to the dianosis.
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Affiliation(s)
- Masaru Nagase
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takashi Nakashima
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yosuke Nakatani
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Konstantinos Vlachos
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France
| | - Mikihito Morimoto
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Taro Shibahara
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Daiju Ono
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Keita Suzuki
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Makoto Yamaura
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takahisa Ido
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shigekiyo Takahashi
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takuma Aoyama
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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Yoshimura S, Nakatani Y, Kaseno K, Nakamura K, Naito S. A-V-V-A response to single atrial premature depolarization in a narrow QRS tachycardia: What is the mechanism? J Arrhythm 2023; 39:965-968. [PMID: 38045453 PMCID: PMC10692860 DOI: 10.1002/joa3.12924] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 12/05/2023] Open
Abstract
We present an atypical response to single atrial premature depolarization (APD) in a long RP' tachycardia. APD advanced the His-bundle potential immediately after it and resulted in a VA block; however, tachycardia persisted and consequently exhibited an A-V-V-A response. We propose the mechanism for an A-V-V-A response to APD in a long RP' tachycardia.
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Affiliation(s)
- Shingo Yoshimura
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
| | - Yosuke Nakatani
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
| | - Kenichi Kaseno
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
| | - Kohki Nakamura
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
| | - Shigeto Naito
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
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Nakamura K, Sasaki T, Minami K, Aoki H, Kondo K, Yoshimura S, Kimura K, Haraguchi Y, Takizawa R, Nakatani Y, Miki Y, Goto K, Take Y, Kaseno K, Yamashita E, Naito S. Incidence, distribution, and electrogram characteristics of endocardial-epicardial connections identified by ultra-high-resolution mapping during a left atrial posterior wall isolation of atrial fibrillation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01663-0. [PMID: 37843676 DOI: 10.1007/s10840-023-01663-0] [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: 07/04/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The left atrial posterior wall (LAPW) can be a target for atrial fibrillation (AF) catheter ablation but is sometimes difficult to completely isolate due to the presence of endocardial-epicardial connections. We aimed to investigate the incidence and distribution of epicardial residual connections (epi-RCs) and the electrogram characteristics at epi-RC sites during an initial LAPW isolation. METHODS We retrospectively studied 102 AF patients who underwent LAPW mapping before and after a first-pass linear ablation along the superior and inferior LAPW (pre-ablation and post-ablation maps) using an ultra-high-resolution mapping system (Rhythmia, Boston Scientific). RESULTS Epi-RCs were observed in 41 patients (40.2%) and were widely distributed in the middle LAPW area and surrounding it. The sites with epi-RCs had a higher bipolar voltage amplitude and greater number of fractionated components than those without (median, 1.09 mV vs. 0.83 mV and 3.9 vs. 3.4 on the pre-ablation map and 0.38 mV vs. 0.27 mV and 8.5 vs. 4.2 on the post-ablation map, respectively; P < 0.001). Receiver operating characteristic analyses demonstrated that the number of fractionated components on the post-ablation map had a larger area under the curve of 0.847 than the others, and the sensitivity and specificity for predicting epi-RCs were 95.4% and 62.1%, respectively, at an optimal cutoff of 5.0. CONCLUSIONS Among the patients with epi-RCs after a first-pass LAPW linear ablation, areas with a greater number of fractionated components (> 5.0 on the post-ablation LAPW map) may have endocardial-epicardial connections and may be potential targets for touch-up ablation to eliminate the epi-RCs.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan.
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Hideyuki Aoki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kan Kondo
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi City, Gunma, 371-0004, Japan
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Nakatani Y, Takigawa M, Ramirez FD, Nakashima T, André C, Goujeau C, Carapezzi A, Anzai T, Krisai P, Takagi T, Kamakura T, Konstantinos V, Cheniti G, Tixier R, Welte N, Chauvel R, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Electrophysiologic Determinants of Isoelectric Intervals on Surface Electrocardiograms During Atrial Tachycardia: Insights From High-Density Mapping. JACC Clin Electrophysiol 2023; 9:2054-2066. [PMID: 37715740 DOI: 10.1016/j.jacep.2023.06.018] [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] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Substrate abnormalities can alter atrial activation during atrial tachycardias (ATs) thereby influencing AT-wave morphology on the surface electrocardiogram. OBJECTIVES This study sought to identify determinants of isoelectric intervals during ATs with complex atrial activation patterns. METHODS High-density activation maps of 126 ATs were studied. To assess the impact of the activated atrial surface on the presence of isoelectric intervals, this study measured the minimum activated area throughout the AT cycle, defined as the smallest activated area within a 50-millisecond period, by using signal processing algorithms (LUMIPOINT). RESULTS ATs with isoelectric intervals (P-wave ATs) included 23 macro-re-entrant ATs (40%), 26 localized-re-entrant ATs (46%), and 8 focal ATs (14%), whereas those without included 46 macro-re-entrant ATs (67%), 21 localized-re-entrant ATs (30%), and 2 focal ATs (3%). Multivariable regression identified smaller minimum activated area and larger very low voltage area as independent predictors of P-wave ATs (OR: 0.732; 95% CI: 0.644-0.831; P < 0.001; and OR: 1.042; 95% CI: 1.006-1.080; P = 0.023, respectively). The minimum activated area with the cutoff value of 10 cm2 provided the highest predictive accuracy for P-wave ATs with sensitivity, specificity, and positive and negative predictive values of 96%, 97%, 97%, and 95%, respectively. In re-entrant ATs, smaller minimum activated area was associated with lower minimum conduction velocity within the circuit and fewer areas of delayed conduction outside of the circuit (standardized β: 0.524; 95% CI: 0.373-0.675; P < 0.001; and standardized β: 0.353; 95% CI: 0.198-0.508; P < 0.001, respectively). CONCLUSIONS Reduced atrial activation area and voltage were associated with isoelectric intervals during ATs.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France.
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | | | - Tatsuhiko Anzai
- Department of Biostatistics, M and D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Vlachos Konstantinos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
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8
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Nakatani Y, Ramirez FD, Takigawa M, Nakashima T, André C, Goujeau C, Krisai P, Takagi T, Kamakura T, Vlachos K, Carapezzi A, Cheniti G, Tixier R, Welte N, Chauvel R, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Abnormal Atrial Potentials Recorded During Sinus Rhythm or Pacing Represent Substrates for Reentrant Atrial Tachycardia. Circ Arrhythm Electrophysiol 2023; 16:e012241. [PMID: 37728002 DOI: 10.1161/circep.123.012241] [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: 12/10/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Abnormal atrial potentials (AAPs) recorded during sinus rhythm/atrial pacing may indicate areas of slow conduction capable of supporting reentrant atrial tachycardia (AT). Therefore, we sought to examine the relationship between AAPs and AT circuits. METHODS One hundred twenty-three reentrant ATs in 104 patients were analyzed. AAPs, consisting of fragmented potentials and split potentials, were assessed using the Rhythmia LUMIPOINT algorithm. RESULTS There was 93±13% overlap between areas with AAPs during sinus rhythm/atrial pacing and areas of slow conduction along the reentry circuit during AT. The cumulative area of AAPs was smaller in patients with localized-reentrant ATs compared with anatomic macro-reentrant ATs (20.0 [14.6-30.5] versus 28.9 [21.8-35.6] cm2; P=0.021). Patients with perimitral ATs had larger areas of AAPs on the lateral wall whereas patients with roof-dependent ATs had larger areas of AAPs on the roof and posterior wall (P≤0.018 for all comparisons). The patchy scar that was associated with localized-reentrant AT exhibited a larger area of AAPs at its periphery than the scar that did not participate in localized-reentrant AT (3.1 [2.4-4.5] versus 1.0 [0.7-1.6] cm2; P<0.001). CONCLUSIONS AAPs recorded during sinus rhythm/atrial pacing are associated with areas of slow conduction during reentrant AT. The burden and distribution of AAPs may provide actionable insights into AT circuit features, including in cases in which ATs are difficult to map.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
- Division of Cardiology, University of Ottawa Heart Institute, Canada (F.D.R.)
- School of Epidemiology and Public Health, University of Ottawa, Canada (F.D.R.)
| | - Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | | | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
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Nakatani Y, Take Y, Sasaki W, Takizawa R, Nakamura K, Naito S. Transition between different types of biatrial tachycardia during catheter ablation: Implication for ablation strategy. HeartRhythm Case Rep 2023; 9:493-495. [PMID: 37492054 PMCID: PMC10363461 DOI: 10.1016/j.hrcr.2023.04.018] [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: 07/27/2023] Open
Affiliation(s)
- Yosuke Nakatani
- Address reprint requests and correspondence: Dr Yosuke Nakatani, Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3–12 Kameizumi-machi Kou, Maebashi, Gunma 371–0004, Japan.
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Nakatani Y, Sudo T, Suzuki J, Take Y, Takizawa R, Yoshimura S, Naito S. Cryoballoon ablation for atrial fibrillation in a patient with esophageal dilatation due to achalasia. HeartRhythm Case Rep 2023; 9:461-464. [PMID: 37492040 PMCID: PMC10363462 DOI: 10.1016/j.hrcr.2023.04.010] [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: 07/27/2023] Open
Affiliation(s)
- Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Toshinaga Sudo
- Division of Gastroenterological Surgery, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Junko Suzuki
- Division of Gastroenterological Surgery, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
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Takigawa M, Martin CA, Yamamoto T, Nakatani Y, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Nishimura T, Tao S, Miyazaki S, Goya M, Haïssaguerre M, Sasano T, Jaïs P. Demonstration of the discrepancy between AT-wave morphology on 12-lead ECG and AT mechanism in scar-related AT. Pacing Clin Electrophysiol 2023; 46:515-518. [PMID: 36690018 DOI: 10.1111/pace.14665] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
The 12-lead electrocardiogram (ECG) is a fundamental modality to help determine the mechanism and the localization of atrial tachycardias (ATs). Although macroreentrant ATs and focal ATs typically show F-waves and discrete P-waves respectively on the 12-lead ECG, this is not universally the case in scar-related ATs.1, We present three cases clearly showing the discrepancy between the AT morphology on the 12-lead ECG and the AT-mechanism.
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Affiliation(s)
- Masateru Takigawa
- Tokyo Medical and Dental University, Tokyo, Japan
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | | | - Yosuke Nakatani
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Susumu Tao
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | - Pierre Jaïs
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
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Nakatani Y, Take Y, Takizawa R, Naito S. Dual chamber open-window mapping with a novel multispline mapping catheter for a left posterolateral atrioventricular accessory pathway. HeartRhythm Case Rep 2023; 9:195-197. [PMID: 36970385 PMCID: PMC10030295 DOI: 10.1016/j.hrcr.2023.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Yosuke Nakatani
- Address reprint requests and correspondence: Dr. Yosuke Nakatani, Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3–12 Kameizumi-machi Kou, Maebashi, Gunma 371–0004, Japan.
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Almorad A, O'Neill L, Wielandts JY, Gillis K, De Becker B, Nakatani Y, De Asmundis C, Iacopino S, Pambrun T, Marc LM, Jaïs P, Haïssaguerre M, Duytschaever M, Chierchia JB, Derval N, Knecht S. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery. Front Cardiovasc Med 2022; 9:928974. [PMID: 36620626 PMCID: PMC9811118 DOI: 10.3389/fcvm.2022.928974] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Atrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery. Methods Sixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2). Results After the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) (p = 0.3). After 62 (48-84) months of follow-up and 2 (2-2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm (p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs (p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred. Conclusion Long-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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Affiliation(s)
- Alexandre Almorad
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Alexandre Almorad ✉
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Kris Gillis
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - La Meir Marc
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | | | - Jean-Baptista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Sébastien Knecht ✉
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14
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Nishibori Y, Akiyoshi K, Omori R, Nakatani Y, Akaishi Y, Tanaka A, Tokunaga S, Daga H. 105P The efficacy of nivolumab monotherapy for advanced gastric cancer depends on the HER2 status. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.141] [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: 12/05/2022] Open
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15
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Yamaguchi H, Wakuda K, Fukuda M, Kenmotsu H, Ito K, Tsuchiya-Kawano Y, Tanaka K, Harada T, Nakatani Y, Miura S, Yokoyama T, Nakamura T, Izumi M, Nakamura A, Ikeda S, Takayama K, Yoshimura K, Nakagawa K, Yamamoto N, Sugio K. 990P Osimertinib for RT-naïve CNS metastasis of EGFR mutation-positive NSCLC: Phase II OCEAN study (LOGIK 1603/WJOG 9116L), part of the first-line cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1117] [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] Open
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16
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Miki Y, Yoshimura S, Sasaki T, Takizawa R, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Nakatani Y, Kaseno K, Goto K, Take Y, Nakamura K, Niwamae N, Kamiyoshihara M, Naito S. Bilateral Cardiac Sympathetic Denervation for Treatment-Resistant Ventricular Arrhythmias in Heart Failure Patients with a Reduced Ejection Fraction. Int Heart J 2022; 63:692-699. [PMID: 35908853 DOI: 10.1536/ihj.21-601] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The sympathetic nervous system plays an important role in life-threatening ventricular arrhythmias (VAs). Bilateral cardiac sympathetic denervation (BCSD) is performed for refractory VAs. We sought to assess our institutional experience with BCSD in managing treatment-resistant monomorphic ventricular tachycardia (MMVT) in heart failure patients with a reduced ejection fraction (HFrEF).Four patients with HFrEF (EF 30.0 ± 8.2%, New York Heart Association [NYHA] class IV 1) underwent BCSD for MMVT (VT storm 3, repetitive VT requiring implantable cardioverter defibrillator [ICD] therapy 1) refractory to antiarrhythmic drugs, catheter ablation and ICD therapy. BCSD was effective for suppressing VT in 3 patients for whom deep sedation was effective for suppressing VT. One patient remained alive after 14 months of follow-up without episodes of VT. One patient died of acute myocardial infarction before discharge and 1 patient died from unknown cause at 3 days post-discharge. In contrast, BCSD was completely ineffective for suppressing VT in a patient with NYHA class IV for whom deep sedation and stellate ganglion block were ineffective. This patient died on the 10th post-CSD day, despite left ventricular assist device implantation. In all cases, BCSD was successfully performed without procedure-related complications.Despite the limited number of cases, our results showed that BCSD in patients with HFrEF suppressed refractory MMVT in acute-phase except for a patient with NYHA class IV; however, the prognoses were not good. BCSD may be a treatment option at an earlier stage of NYHA and a bridge to orthotopic heart transplantation, even if BCSD is effective for suppressing VAs.
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Affiliation(s)
- Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Nogiku Niwamae
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital
| | | | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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17
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Sasaki W, Nakatani Y, Take Y, Kishi S, Naito S. Transient left phrenic nerve paralysis after ethanol infusion into the vein of Marshall. J Cardiovasc Electrophysiol 2022; 33:1897-1900. [PMID: 35695797 DOI: 10.1111/jce.15593] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
An 80-year-old man underwent catheter ablation for atrial tachycardia (AT), which developed after catheter ablation for atrial fibrillation. The AT was diagnosed as dual-loop tachycardia, which included peri-mitral and roof-dependent ATs. An ethanol infusion into the vein of Marshall resulted in left phrenic nerve paralysis. During the procedure, the phrenic nerve paralysis was completely relieved.
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Affiliation(s)
- Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
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18
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Kamakura T, André C, Duchateau J, Nakashima T, Nakatani Y, Takagi T, Krisai P, Ascione C, Balbo C, Tixier R, Chauvel R, Cheniti G, Kusano K, Cochet H, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Derval N, Pambrun T. Distribution of atrial low voltage induced by vein of Marshall ethanol infusion. J Cardiovasc Electrophysiol 2022; 33:1687-1693. [PMID: 35637606 DOI: 10.1111/jce.15573] [Citation(s) in RCA: 2] [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: 02/07/2022] [Revised: 03/18/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion. METHODS AND RESULTS The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients. CONCLUSION VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France.,Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ciro Ascione
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Conrado Balbo
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Arnaud Denis
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
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19
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Nakashima T, Pambrun T, Vlachos K, Goujeau C, André C, Krisai P, Daniel Ramirez F, Pintican G, Kamakura T, Takagi T, Nakatani Y, Surget E, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Strategy for Repeat Procedures in Patients with Persistent Atrial Fibrillation: Systematic Linear Ablation with Adjunctive Ethanol Infusion into the Vein of Marshall versus Electrophysiology‐Guided Ablation. J Cardiovasc Electrophysiol 2022; 33:1116-1124. [DOI: 10.1111/jce.15472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/19/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - F. Daniel Ramirez
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
- Division of Cardiology, University of Ottawa Heart InstituteOttawaOntarioCanada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Jaïs
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
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20
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Nakatani Y, Nuñez-Garcia M, Cheniti G, Sridi-Cheniti S, Bustin A, Jia S, Goujeau C, André C, Nakashima T, Krisai P, Takagi T, Kamakura T, Derval N, Duchateau J, Pambrun T, Chauvel R, Sacher F, Hocini M, Haïssaguerre M, Sermesant M, Jais P, Cochet H. Preoperative Personalization of Atrial Fibrillation Ablation Strategy to Prevent Esophageal Injury: Impact of Changes in Esophageal Position. J Cardiovasc Electrophysiol 2022; 33:908-916. [PMID: 35274776 DOI: 10.1111/jce.15447] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Due to changes in esophageal position, preoperative assessment of the esophageal location may not mitigate the risk of esophageal injury in catheter ablation for atrial fibrillation (AF). This study aimed to assess esophageal motion and its impact on AF ablation strategies. METHODS AND RESULTS Ninety-seven AF patients underwent 2 computed tomography (CT) scans. The area at risk of esophageal injury (AAR) was defined as the left atrial surface ≤3 mm from the esophagus. On CT1, ablation lines were drawn blinded to the esophageal location to create 3 ablation sets: individual pulmonary vein isolation (PVI), wide antral circumferential ablation (WACA), and WACA with linear ablation (WACA+L). Thereafter, ablation lines for WACA and WACA+L were personalized to avoid the AAR. Rigid registration was performed to align CT1 onto CT2, and the relationship between ablation lines and the AAR on CT2 was analyzed. The esophagus moved by 3.6 [2.7 to 5.5] mm. The AAR on CT2 was 8.6 ± 3.3 cm2 , with 77% overlapping that on CT1. High body mass index was associated with the AAR mismatch (standardized β 0.382, P <0.001). Without personalization, AARs on ablation lines for individual PVI, WACA, and WACA+L were 0 [0-0.4], 0.8 [0.5-1.2], 1.7 [1.2-2.0] cm2 . Despite the esophageal position change, the personalization of ablation lines for WACA and WACA+L reduced the AAR on lines to 0 [0-0.5] and 0.7 [0.3-1.0] cm2 (P <0.001 for both). CONCLUSION The personalization of ablation lines based on a preoperative CT reduced ablation to the AAR despite changes in esophageal position. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Marta Nuñez-Garcia
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Shuman Jia
- INRIA Epione research team, Sophia Antipolis, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Clementine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,INRIA Epione research team, Sophia Antipolis, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
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21
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Sasaki T, Nakamura K, Minami K, Take Y, Nakatani Y, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Naito S. Local impedance measurements during contact force‐guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation. J Arrhythm 2022; 38:245-252. [PMID: 35387143 PMCID: PMC8977576 DOI: 10.1002/joa3.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background An ablation catheter capable of contact force (CF) and local impedance (LI) monitoring (IntellaNav StablePoint, Boston Scientific) has been recently launched. We evaluated the relationship between the CF and LI values during radiofrequency catheter ablation (RFCA) along the cavotricuspid isthmus (CTI). Methods Fifty consecutive subjects who underwent a CTI‐RFCA using IntellaNav StablePoint catheters were retrospectively studied. The initial CF and LI at the start of the RF applications and mean CF and minimum LI during the RF applications were measured. The absolute and percentage LI drops were calculated as the difference between the initial and minimum LIs and 100 × absolute LI drop/initial LI, respectively. Results We analyzed 602 first‐pass RF applications. A weak correlation was observed between the initial CF and LI (r = 0.13) and between the mean CF and LI drops (r = 0.22). The initial LI and absolute and percentage LI drops were greater at effective ablation sites than ineffective ablation sites (median, 151 vs. 138 Ω, 22 vs. 14 Ω, and 14.4% vs. 9.9%; p < .001), but the initial and mean CF did not differ. At optimal cutoffs of 21 Ω and 10.8% for the absolute and percentage LI drops according to the receiver‐operating characteristic analysis, the sensitivity, and specificity for predicting an effective ablation were 57.4% and 88.9% and 80.0%, and 61.1%, respectively. Conclusions The effective sites during the CF‐guided CTI‐RFCA had greater initial LI and LI drops than the ineffective sites. Absolute and percentage LI drops of 21 Ω and 10.8% may be appropriate targets for an effective ablation.
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Affiliation(s)
- Takehito Sasaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kentaro Minami
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yutaka Take
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yosuke Nakatani
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yuko Miki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Koji Goto
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kenichi Kaseno
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Eiji Yamashita
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Keiko Koyama
- Division of Radiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Shigeto Naito
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
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22
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Takagi T, Derval N, Pambrun T, Nakatani Y, André C, Ramirez FD, Nakashima T, Krisai P, Kamakura T, Pineau X, Tixier R, Chauvel R, Cheniti G, Duchateau J, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Optimized Computed Tomography Acquisition Protocol for Ethanol Infusion Into the Vein of Marshall. JACC Clin Electrophysiol 2022; 8:168-178. [PMID: 35210073 DOI: 10.1016/j.jacep.2021.09.020] [Citation(s) in RCA: 2] [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: 06/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization. BACKGROUND Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation. METHODS Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data. RESULTS VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 ± 7 mm. Mean VOM diameter was 1.6 ± 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and postero-superiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without-CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization. CONCLUSIONS The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization.
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Affiliation(s)
- Takamitsu Takagi
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France.
| | - Nicolas Derval
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Xavier Pineau
- Département de Cardiovascular Imaging, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Romain Tixier
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
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Pambrun T, Derval N, Duchateau J, Ramirez FD, Chauvel R, Tixier R, Marchand H, Bouyer B, Welte N, André C, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Krisai P, Ascione C, Balbo C, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Frontera A, Meo M, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Sinus node exit, crista terminalis conduction, interatrial connection and wavefront collision: key features of human atrial activation in sinus rhythm. Heart Rhythm 2022; 19:701-709. [PMID: 35033665 DOI: 10.1016/j.hrthm.2022.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/06/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics. OBJECTIVE To describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage. METHODS Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage > 0.5 mV during high-density 3D-mapping were studied. RESULTS Sinus node exits varied between patients along a lateral oblique arc extending from the anterior aspect of the superior vena cava (SVC) to the mid-posterior wall of the right atrium (RA). Conduction slowing or block at one of the smooth components that faces the crista terminalis was observed in 54% of cases, including complete block at the SVC musculature and the systemic venous sinus in 6% of cases. Depending on these two key features of RA activation, interatrial conduction was mediated by the Bachmann bundle (64%) and posterior bundles (54%), with an overlap of the resulting LA breakthrough location. Wavefront collision was consistently observed at three sites: the septal aspect of the cavotricuspid isthmus; and the lower aspects of the dome and of the mitral isthmus. CONCLUSION During sinus rhythm, atrial activation occurs via distinct sequences mediated by a complex interaction of anatomic factors.
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Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - F Daniel Ramirez
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Nicolas Welte
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takashi Nakashima
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Yosuke Nakatani
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Félix Bourier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takeshi Kitamura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Antonio Frontera
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Marianna Meo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
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Ramirez FD, Winterfield JR, Shi X, Chou D, Robinson D, Angel N, Shah P, Sorrell T, Ghafoori E, Vanderper A, Mariappan L, Soré B, Peyrat JM, Loyer V, Nakatani Y, Cochet H, Jaïs P. Non-contact whole-chamber charge density mapping of the left ventricle: preclinical evaluation in a sheep model. Heart Rhythm 2022; 19:828-836. [PMID: 35032670 DOI: 10.1016/j.hrthm.2022.01.009] [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: 06/02/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conventional contact-based electroanatomic mapping is poorly suited for rapid or dynamic ventricular arrhythmias. Whole-chamber charge density (CD) mapping could efficiently characterize complex ventricular tachyarrhythmias and yield insights into their underlying mechanisms. OBJECTIVE This study sought to evaluate the feasibility and accuracy of non-contact whole-chamber left ventricular (LV) CD mapping, and to characterize CD activation patterns during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF). METHODS Ischemic scar as defined by CD amplitude thresholds was compared to late gadolinium enhancement criteria on magnetic resonance imaging using an iterative closest point algorithm. Electrograms recorded at sites of tissue contact were compared to the nearest non-contact CD-derived electrograms to calculate signal morphology cross-correlations and time differences. Regions of consistently slow conduction were examined relative to areas of scar and to localized irregular activation (LIA) during VF. RESULTS Areas under receiver operating characteristic curves (AUCs) of CD-defined dense and total LV scar were 0.92 ± 0.03 and 0.87 ± 0.06, with accuracies of 0.86±0.03 and 0.80±0.05, respectively. Morphology cross-correlation between 8,677 contact and corresponding non-contact electrograms was 0.93±0.10, with a mean time difference of 2.5±5.6 msec. Areas of consistently slow conduction tended to occur at scar borders and exhibited spatial agreement with LIA during VF (AUC 0.90±0.02). CONCLUSION Non-contact LV CD mapping can accurately delineate ischemic scar. CD-derived ventricular electrograms correlate strongly with conventional contact-based electrograms. Regions with consistently slow conduction are often at scar borders and tend to harbor LIA during VF.
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Affiliation(s)
- F Daniel Ramirez
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Jeffrey R Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Dave Robinson
- Acutus Medical, Carlsbad, California; inHEART, Bordeaux-Pessac, France
| | | | | | | | | | | | | | | | | | - Virginie Loyer
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Heart Modelling Institute (LIRYC), Bordeaux-Pessac, France; Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France; inHEART, Bordeaux-Pessac, France.
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25
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Krisai P, Cheniti G, Kamakura T, Takagi T, André C, Ramirez FD, Nakatani Y, Nakashima T, Tixier R, Chauvel R, Pillois X, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Catheter Ablation for Atrial Fibrillation in Hyperthyroid Patients. Circ Arrhythm Electrophysiol 2021; 14:e010200. [PMID: 34693719 DOI: 10.1161/circep.121.010200] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philipp Krisai
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Xavier Pillois
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
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Nakamura K, Sasaki T, Minami K, Take Y, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Yoshimura S, Nakatani Y, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Funabashi N, Naito S. Symptomatic and asymptomatic intracerebral hemorrhages detected by magnetic resonance imaging after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2021; 64:443-454. [PMID: 34432185 DOI: 10.1007/s10840-021-01051-6] [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: 06/02/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Symptomatic intracerebral hemorrhages (ICHs) are a rare complication after atrial fibrillation (AF) catheter ablation, while the incidence of asymptomatic ICHs detected by magnetic resonance (MR) imaging remains unclear. This study aimed to investigate the incidence, characteristics, and predictors of new-onset ICHs on MR imaging after AF ablation. METHODS We retrospectively studied 1257 consecutive AF ablation procedures in 1201 patients who underwent MR imaging on the day after the procedure. Repeat MR imaging within 3 months post-ablation was available in 352 procedures. RESULTS Old ICHs on the initial MR imaging were observed in 28 procedures (2.2%). Post-ablation new ICHs were observed in 14 procedures (4.0%), including one symptomatic (0.3%) and 13 (3.7%) asymptomatic ICHs. One patient had a new ICH on the initial MR imaging, while the remaining 13 had such on the repeat MR imaging. A univariate analysis revealed that a previous ischemic stroke or transient ischemic attack (TIA) and the CHA2DS2-VASc score were positive predictors of new ICHs (odds ratios, 5.502 and 1.435; P = 0.004 and 0.044). The lesion diameter did not significantly differ between the old and new ICHs (median, 6.1 mm vs. 8.0 mm, P = 0.281), while the predominant location differed (lobar areas, 22.6% vs. 53.3%; cerebellum, 22.6% vs. 20.0%; others, 54.8% vs. 26.7%; P = 0.026). CONCLUSIONS A few asymptomatic ICHs may occur after AF ablation. Most of the post-ablation new ICHs occurred a few days or later after the procedure. A previous ischemic stroke/TIA and the CHA2DS2-VASc score may be risk factors for post-ablation ICHs.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Keiko Koyama
- Division of Radiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
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Yokoyama S, Fujita Y, Matsumura S, Yoshimura T, Kinoshita I, Watanabe T, Tabata H, Tsuji T, Ozawa S, Tamaki T, Nakatani Y, Oka M. Cribriform carcinoma in the lymph nodes is associated with distant metastasis, recurrence, and survival among patients with node-positive colorectal cancer. Br J Surg 2021; 108:e111-e112. [PMID: 33793704 DOI: 10.1093/bjs/znaa123] [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] [Received: 10/12/2020] [Accepted: 11/15/2020] [Indexed: 11/13/2022]
Abstract
Cribriform lymph node pattern is an independent risk factor for metachronous or synchronous distant metastasis in patients with stage III and IV node-positive colorectal cancer. Multivariable analysis in patients with stage III disease indicated that the cribriform pattern of carcinoma in the lymph nodes was an independent risk factor for recurrence and survival. Kaplan–Meier analysis demonstrated that the group with stage III cribriform-type lymph node carcinoma had shorter recurrence-free and overall survival times than the stage III group with the tubular type (P < 0.001).
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Affiliation(s)
- S Yokoyama
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - Y Fujita
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - S Matsumura
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Yoshimura
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - I Kinoshita
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Watanabe
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - H Tabata
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Tsuji
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - S Ozawa
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Tamaki
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - Y Nakatani
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - M Oka
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
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Baba N, Miura N, Kuwamura S, Ueno S, Nakatani Y, Ichimoto K. Shift-and-add image processing incorporated with the unsharp masking method. Appl Opt 2021; 60:6725-6729. [PMID: 34613148 DOI: 10.1364/ao.428770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
Shift-and-add (SAA) is a simple image processing procedure. SAA was devised to reconstruct a diffraction-limited image from atmospherically degraded stellar images. Recently SAA has been applied to biological imaging. There are several variants of SAA. Here proposed is an SAA procedure incorporated with unsharp masking (USM). The SAA procedure proposed here encompasses an extended version of USM. The proposed SAA method retains the simplicity and easiness, and the basic features of SAA. The effectiveness of the proposed method is examined by restoring atmospherically degraded solar images. It is shown that the USM SAA reconstructed image exhibits high contrast and reveals fine structures blurred by atmospheric turbulence. It is also shown that the USM SAA performs better with a data frame selection scheme.
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Vlachos K, Efremidis M, Derval N, Martin CA, Takigawa M, Bazoukis G, Frontera A, Gkalapis C, Duchateau J, Nakashima T, Letsas KP, Mililis P, Pambrun T, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Kitamura T, Cheniti G, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation. Europace 2021; 23:1052-1062. [PMID: 33564832 DOI: 10.1093/europace/euaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS An incomplete understanding of the mechanism of atrial tachycardia (AT) is a major determinant of ablation failure. We systematically evaluated the mechanisms of AT using ultra-high-resolution mapping in a large cohort of patients. METHODS AND RESULTS We included 107 consecutive patients (mean age: 65.7 ± 9.2 years, males: 81 patients) with documented endocardial gap-related AT after left atrial ablation for persistent atrial fibrillation (AF). We analysed the mechanism of 134 AT (94 macro-re-entries and 40 localized re-entries) using high-resolution activation mapping in combination with high-density voltage and entrainment mapping. Voltage in the conducting channels may be extremely low, even <0.1 mV (0.14 ± 0.095 mV, 51 of 134 AT, 41%), and almost always <0.5 mV (0.03-0.5 mV, 133 of 134 AT, 99.3%). The use of multipolar Orion, HDGrid, and Pentaray catheters improved our accuracy in delineating ultra-low-voltage areas critical for maintenance of the circuit of endocardial gap-related AT. Conventional ablation catheters often do not detect any signal (noise level) even using adequate contact force, and only multipolar catheters of small electrodes and shorter interelectrode space can detect clear fractionated low-amplitude and high frequency signals, critical for re-entry maintenance. We performed a diagnosis in 112 out of 134 AT (83.6%) using only activation mapping and in 134 out of 134 AT (100%) using the combination of activation and entrainment mapping. CONCLUSION High-resolution activation mapping in combination with high-density voltage and entrainment mapping is the ideal strategy to delineate the critical part of the circuit in endocardial gap-related re-entrant AT after AF ablation.
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Affiliation(s)
- Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France.,Department of Electrophysiology-Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Charis Gkalapis
- Department of Electrophysiology-Cardiology, Klinikum Vest, Recklinghausen, Germany.,Department of Cardiology, Akademisches Lehrkrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
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Ramirez FD, Pambrun T, Duchateau J, Nédellec C, Nakashima T, Nakatani Y, Krisai P, Vlachos KG, André C, Goujeau C, Kamakura T, Takagi T, Cheniti G, Chauvel R, Tixier R, Welte N, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. B-PO03-074 COMPARATIVE ANALYSIS OF THE MARSHALL-PLAN AND DRIVER-GUIDED ABLATION WITH ARRHYTHMIA TERMINATION AS PROCEDURAL ENDPOINT IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krisai P, Cheniti G, Kamakura T, Takagi T, Andre C, Daniel Ramirez F, Nakatani Y, Nakashima T, Tixier R, Xavier Pillois RC, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haissaguerre M, Jais P. B-PO03-084 CATHETER ABLATION FOR ATRIAL FIBRILLATION IN HYPERTHYROID PATIENTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.558] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Surget E, Cheniti G, Nakatani Y, Nakashima T, Takagi T, Kamakura T, Krisai P, André C, Welte N, Chauvel R, Tixier R, Duchateau J, Pambrun T, Derval N, Jais P, Sacher F, Hocini M, Haissaguerre M. B-PO04-171 SUBTLE ABNORMALITIES OF REPOLARIZATION IN PATIENTS WITH IDIOPATHIC VF. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.863] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Krisai P, Pambrun T, Takagi T, Kamakura T, Nakatani Y, Nakashima T, Andre C, Cheniti G, Chauvel R, Duchateau J, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. B-PO05-105 VEIN OF MARSHALL ETHANOL INJECTION IN ATRIAL FIBRILLATION PATIENTS WITH LEFT VENTRICULAR CARDIAC RESYNCHRONIZATION THERAPY LEADS IN THE CORONARY SINUS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nakatani Y, Nakashima T, Duchateau J, Vlachos K, Krisai P, Takagi T, Kamakura T, André C, Goujeau C, Daniel Ramirez F, Chauvel R, Tixier R, Takigawa M, Kitamura T, Cheniti G, Denis A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Derval N, Pambrun T. Characteristics of macroreentrant atrial tachycardias using an anatomical bypass: Pseudo-focal atrial tachycardia case series. J Cardiovasc Electrophysiol 2021; 32:2451-2461. [PMID: 34314087 DOI: 10.1111/jce.15186] [Citation(s) in RCA: 4] [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: 06/04/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human atria comprise distinct layers. One layer can bypass another, and lead to a downstream centrifugal propagation at their interface. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of "pseudo-focal" atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. METHODS AND RESULTS We retrospectively analyzed left atrial ATs showing centrifugal propagation with postpacing intervals (PPIs) after entrainment pacing suggestive of a macroreentrant mechanism. A total of 22 patients had pseudo-focal ATs consisting of 15 perimitral and 7 roof-dependent flutters. A low-voltage area was consistently found at the collision site and colocalized with distinct anatomical structures like the: (1) coronary sinus-great cardiac vein bundle (27%), (2) vein of Marshall bundle (18%), (3) Bachmann bundle (27%), (4) septopulmonary bundle (18%), and (5) fossa ovalis (9%). The mean missing tachycardia cycle length (TCL) was 65 ± 31 ms (22%) on the endocardial activation map. PPI was 0 [0-15] ms and 0 [0-21] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 21 pseudo-focal ATs (95%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [20/21 (95%) vs. 1/5 (20%); p < .001]. CONCLUSION Perimitral and roof-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified anatomical structures. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site.
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Affiliation(s)
- Yosuke Nakatani
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Clémentine André
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Cyril Goujeau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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Kamakura T, Derval N, Duchateau J, Denis A, Nakashima T, Takagi T, Ramirez FD, André C, Krisai P, Nakatani Y, Tixier R, Chauvel R, Cheniti G, Kusano K, Cochet H, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Vein of Marshall Ethanol Infusion: Feasibility, Pitfalls, and Complications in Over 700 Patients. Circ Arrhythm Electrophysiol 2021; 14:e010001. [PMID: 34280029 PMCID: PMC8376276 DOI: 10.1161/circep.121.010001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Vein of Marshall (VOM) ethanol infusion is a relatively new therapeutic option for atrial tachyarrhythmias. We aimed to evaluate the feasibility, pitfalls, and complications associated with this procedure in a large cohort of patients.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.).,Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (T.K., K.K.)
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Arnaud Denis
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | | | | | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (T.K., K.K.)
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
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Yamaguchi Y, Sakamoto T, Nakatani Y, Mizumaki K. Cardiac vagus nerve denervation by pulmonary vein isolation was effective for swallowing-induced atrial tachycardia. Ann Noninvasive Electrocardiol 2021; 27:e12875. [PMID: 34268837 PMCID: PMC8739605 DOI: 10.1111/anec.12875] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022] Open
Abstract
Swallowing‐induced atrial tachycardia (SIAT) is a relatively rare arrhythmia. A 56‐year‐old woman was admitted to treat atrial tachycardia that occurs by not only eating and drinking but also yawning. Both the right and left upper pulmonary veins were suspected as the earliest activation site of the tachycardia and the abnormal activation of ectopies themselves were suppressed after pulmonary vein isolation (PVI). In a 24‐hour Holter electrocardiogram, the HF component of the analysis of heart rate variability was suppressed both at 1 day and at 2 years after ablation. In this case, cardiac vagal nerve denervation by PVI was effective for SIAT.
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Affiliation(s)
| | | | - Yosuke Nakatani
- The Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama, Toyama, Japan
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Surget E, Cheniti G, Ramirez FD, Leenhardt A, Nogami A, Gandjbakhch E, Extramiana F, Hidden-Lucet F, Pillois X, Benoist D, Krisai P, Nakatani Y, Nakashima T, Takagi T, Kamakura T, André C, Welte N, Chauvel R, Tixier R, Duchateau J, Pambrun T, Derval N, Jaïs P, Sacher F, Bernus O, Hocini M, Haïssaguerre M. Sex differences in the origin of Purkinje ectopy-initiated idiopathic ventricular fibrillation. Heart Rhythm 2021; 18:1647-1654. [PMID: 34260987 DOI: 10.1016/j.hrthm.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/07/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Purkinje ectopics (PurkEs) are major triggers of idiopathic ventricular fibrillation (VF). Identifying clinical factors associated with specific PurkE characteristics could yield insights into the mechanisms of Purkinje-mediated arrhythmogenicity. OBJECTIVE The purpose of this study was to examine the associations of clinical, environmental, and genetic factors with PurkE origin in patients with PurkE-initiated idiopathic VF. METHODS Consecutive patients with PurkE-initiated idiopathic VF from 4 arrhythmia referral centers were included. We evaluated demographic characteristics, medical history, clinical circumstances associated with index VF events, and electrophysiological characteristics of PurkEs. An electrophysiology study was performed in most patients to confirm the Purkinje origin. RESULTS Eighty-three patients were included (mean age 38 ± 14 years; 44 [53%] women), of whom 32 had a history of syncope. Forty-four patients had VF at rest. PurkEs originated from the right ventricle (RV) in 41 patients (49%), from the left ventricle (LV) in 36 (44%), and from both ventricles in 6 (7%). Seasonal and circadian distributions of VF episodes were similar according to PurkE origin. The clinical characteristics of patients with RV vs LV PurkE origins were similar, except for sex. RV PurkEs were more frequent in men than in women (76% vs 24%), whereas LV and biventricular PurkEs were more frequent in women (81% vs 19% and 83% vs 17%, respectively) (P < .0001). CONCLUSION PurkEs triggering idiopathic VF originate dominantly from the RV in men and from the LV or both ventricles in women, adding to other sex-related arrhythmias such as Brugada syndrome or long QT syndrome. Sex-based factors influencing Purkinje arrhythmogenicity warrant investigation.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - F Daniel Ramirez
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Antoine Leenhardt
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, Paris, France
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Estelle Gandjbakhch
- Département de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrice Extramiana
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, Paris, France
| | - Françoise Hidden-Lucet
- Département de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philipp Krisai
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Yosuke Nakatani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Takashi Nakashima
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Takamitsu Takagi
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Tsukasa Kamakura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Clémentine André
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Nicolas Welte
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Rémi Chauvel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Tixier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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Nakatani Y, Maury P, Rollin A, Ramirez FD, Goujeau C, Nakashima T, André C, Carapezzi A, Krisai P, Takagi T, Kamakura T, Vlachos K, Cheniti G, Tixier R, Voglimacci-Stefanopoli Q, Welte N, Chauvel R, Duchateau J, Pambrun T, Derval N, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. Accuracy of automatic abnormal potential annotation for substrate identification in scar-related ventricular tachycardia. J Cardiovasc Electrophysiol 2021; 32:2216-2224. [PMID: 34223662 DOI: 10.1111/jce.15148] [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: 02/23/2021] [Revised: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Ultrahigh-density mapping for ventricular tachycardia (VT) is increasingly used. However, manual annotation of local abnormal ventricular activities (LAVAs) is challenging in this setting. Therefore, we assessed the accuracy of the automatic annotation of LAVAs with the Lumipoint algorithm of the Rhythmia system (Boston Scientific). METHODS AND RESULTS One hundred consecutive patients undergoing catheter ablation of scar-related VT were studied. Areas with LAVAs and ablation sites were manually annotated during the procedure and compared with automatically annotated areas using the Lumipoint features for detecting late potentials (LP), fragmented potentials (FP), and double potentials (DP). The accuracy of each automatic annotation feature was assessed by re-evaluating local potentials within automatically annotated areas. Automatically annotated areas matched with manually annotated areas in 64 cases (64%), identified an area with LAVAs missed during manual annotation in 15 cases (15%), and did not highlight areas identified with manual annotation in 18 cases (18%). Automatic FP annotation accurately detected LAVAs regardless of the cardiac rhythm or scar location; automatic LP annotation accurately detected LAVAs in sinus rhythm, but was affected by the scar location during ventricular pacing; automatic DP annotation was not affected by the mapping rhythm, but its accuracy was suboptimal when the scar was located on the right ventricle or epicardium. CONCLUSION The Lumipoint algorithm was as/more accurate than manual annotation in 79% of patients. FP annotation detected LAVAs most accurately regardless of mapping rhythm and scar location. The accuracy of LP and DP annotations varied depending on mapping rhythm or scar location.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Philippe Maury
- Unité Inserm U 1048, University Hospital Rangueil, Toulouse, France
| | - Anne Rollin
- Unité Inserm U 1048, University Hospital Rangueil, Toulouse, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | | | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | | | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University Hospital (CHU), University of Bordeaux, Bordeaux, France
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Nakatani Y, Sridi-Cheniti S, Cheniti G, Ramirez FD, Goujeau C, André C, Nakashima T, Eggert C, Schneider C, Viswanathan R, Krisai P, Takagi T, Kamakura T, Vlachos K, Derval N, Duchateau J, Pambrun T, Chauvel R, Reddy VY, Montaudon M, Laurent F, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation. Europace 2021; 23:1767-1776. [PMID: 34240134 PMCID: PMC8576285 DOI: 10.1093/europace/euab155] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 10/04/2020] [Accepted: 05/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation. Methods and results Cardiac magnetic resonance was performed pre-ablation, acutely (<3 h), and 3 months post-ablation in 41 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 18) or thermal ablation (n = 23, 16 radiofrequency ablations, 7 cryoablations). Late gadolinium enhancement (LGE), T2-weighted, and cine images were analysed. In the acute stage, LGE volume was 60% larger after PFA vs. thermal ablation (P < 0.001), and oedema on T2 imaging was 20% smaller (P = 0.002). Tissue changes were more homogeneous after PFA than after thermal ablation, with no sign of microvascular damage or intramural haemorrhage. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after thermal ablation. The maximum strain on PV antra, the LA expansion index, and LA active emptying fraction declined acutely after both PFA and thermal ablation but recovered at the chronic stage only with PFA. Conclusion Pulsed field ablation induces large acute LGE without microvascular damage or intramural haemorrhage. Most LGE lesions disappear in the chronic stage, suggesting a specific reparative process involving less chronic fibrosis. This process may contribute to a preserved tissue compliance and LA reservoir and booster pump functions.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Clementine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | | | | | | | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Vivek Y Reddy
- Department of Cardiac Arrhythmia, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
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Pambrun T, Derval N, Duchateau J, Denis A, Chauvel R, Tixier R, Welte N, André C, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Ramirez FD, Krisai P, Goujeau C, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Frontera A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Epicardial course of the musculature related to the great cardiac vein: Anatomical considerations and clinical implications for mitral isthmus block after vein of Marshall ethanol infusion. Heart Rhythm 2021; 18:1951-1958. [PMID: 34217842 DOI: 10.1016/j.hrthm.2021.06.1202] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/25/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mitral isthmus gaps have been ascribed to an epicardial musculature anatomically related to the great cardiac vein (GCV) and the vein of Marshall (VOM). Their lumen offers an access for radiofrequency application or ethanol infusion, respectively. OBJECTIVE The purpose of this study was to evaluate the frequency of mitral isthmus gaps accessible via the GCV lumen, to assess their location around the GCV circumference, and to propose an efficient ablation strategy when present. METHODS One hundred consecutive patients underwent VOM ethanol infusion (step 1) and endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein (step 2). In cases of mitral isthmus gap, endovascular ablation of the GCV anchored wall facing the left atrium was systematically performed (step 3), while the opposite GCV free wall was targeted in case of block failure only (step 4). RESULTS After VOM ethanol infusion and endocardial ablation, mitral isthmus block occurred in 51 patients (51%). Pacing maneuvers and activation sequences demonstrated an epicardial gap via the VOM in 2 patients (2%) and via the GCV in 47 patients (47%). In the latter case, block was achieved at the GCV anchored wall in 42 patients (89%) and the GCV free wall in 5 patients (11%). Global success rate of mitral isthmus block was 98%. No tamponade occurred. CONCLUSION With the advent of VOM ethanol infusion, residual mitral isthmus gaps are mostly eliminated within the first centimeter of the GCV. Thorough mapping of the entire circumference of the GCV wall can help identify these epicardial gaps.
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Affiliation(s)
- Thomas Pambrun
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France.
| | - Nicolas Derval
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Arnaud Denis
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Rémi Chauvel
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Romain Tixier
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Cyril Goujeau
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Félix Bourier
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Antonio Frontera
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
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Kamakura T, Cochet H, Juhoor M, Nakatani Y, Ramirez FD, André C, Nakashima T, Krisai P, Takagi T, Tixier R, Chauvel R, Cheniti G, Duchateau J, Pambrun T, Derval N, Kusano K, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Role of endocardial ablation in eliminating an epicardial arrhythmogenic substrate in patients with Brugada syndrome. Heart Rhythm 2021; 18:1673-1681. [PMID: 34182174 DOI: 10.1016/j.hrthm.2021.06.1188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/01/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Epicardial ablation is occasionally limited by coronary artery (CA) injuries or epicardial fat (EF). OBJECTIVE The purpose of this study was to evaluate the anatomic obstacles that prevent ablation of epicardial abnormal potentials (EAPs) in patients with Brugada syndrome (BrS) and to investigate the feasibility of EAP elimination by endocardial right ventricular (RV) ablation. METHODS This study included 16 BrS patients with previous ventricular fibrillation (VF), including 10 with an electrical storm. Data from multidetector computed tomography were assessed, and the proximity of the CA and EF was correlated with EAPs. RESULTS EAPs were present in the epicardial RV outflow tract and RV inferior wall in all patients and 12 patients (75%), respectively. These EAPs were present within 5 mm of the main body and branches of the right CA in 14 patients (87.5%). However, only 1.4% ± 2.9% of the EAP area was covered with thick EF (≥8 mm). Partial EAP elimination by endocardial RV ablation was feasible in all 10 patients, with 53.3% successful endocardial RV radiofrequency applications for eliminating EAPs. After the procedure, VF remained inducible in 37.5% of the patients. During the 25.1 ± 29.1 months of follow-up, no patients experienced an electrical storm, and VF burden significantly decreased (median VF episodes before and after ablation: 7 and 0, respectively). CONCLUSION EAPs are near the CA in most BrS patients, thereby requiring caution during epicardial ablation, whereas EF is less of an issue. Endocardial ablation is feasible to eliminate some EAPs and may be combined with epicardial ablation.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Mehdi Juhoor
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.
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42
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Cochet H, Nakatani Y, Sridi-Cheniti S, Cheniti G, Ramirez FD, Nakashima T, Eggert C, Schneider C, Viswanathan R, Derval N, Duchateau J, Pambrun T, Chauvel R, Reddy VY, Montaudon M, Laurent F, Sacher F, Hocini M, Haïssaguerre M, Jais P. Pulsed field ablation selectively spares the oesophagus during pulmonary vein isolation for atrial fibrillation. Europace 2021; 23:1391-1399. [PMID: 33961027 PMCID: PMC8427383 DOI: 10.1093/europace/euab090] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 02/05/2021] [Accepted: 03/26/2021] [Indexed: 01/04/2023] Open
Abstract
Aims Extra-atrial injury can cause complications after catheter ablation for atrial fibrillation (AF). Pulsed field ablation (PFA) has generated preclinical data suggesting that it selectively targets the myocardium. We sought to characterize extra-atrial injuries after pulmonary vein isolation (PVI) between PFA and thermal ablation methods. Methods and results Cardiac magnetic resonance (CMR) imaging was performed before, acutely (<3 h) and 3 months post-ablation in 41 paroxysmal AF patients undergoing PVI with PFA (N = 18, Farapulse) or thermal methods (N = 23, 16 radiofrequency, 7 cryoballoon). Oesophageal and aortic injuries were assessed by using late gadolinium-enhanced (LGE) imaging. Phrenic nerve injuries were assessed from diaphragmatic motion on intra-procedural fluoroscopy. Baseline CMR showed no abnormality on the oesophagus or aorta. During ablation procedures, no patient showed phrenic palsy. Acutely, thermal methods induced high rates of oesophageal lesions (43%), all observed in patients showing direct contact between the oesophagus and the ablation sites. In contrast, oesophageal lesions were observed in no patient ablated with PFA (0%, P < 0.001 vs. thermal methods), despite similar rates of direct contact between the oesophagus and the ablation sites (P = 0.41). Acute lesions were detected on CMR on the descending aorta in 10/23 (43%) after thermal ablation, and in 6/18 (33%) after PFA (P = 0.52). CMR at 3 months showed a complete resolution of oesophageal and aortic LGE in all patients. No patient showed clinical complications. Conclusion PFA does not induce any signs of oesophageal injury on CMR after PVI. Due to its tissue selectivity, PFA may improve safety for catheter ablation of AF.
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Affiliation(s)
- Hubert Cochet
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Charles Eggert
- Farapulse, CA, Farapulse, Los Altos, 3715 Haven Ave Control, Menlo Park, CA 94025, USA
| | - Christopher Schneider
- Farapulse, CA, Farapulse, Los Altos, 3715 Haven Ave Control, Menlo Park, CA 94025, USA
| | - Raju Viswanathan
- Farapulse, CA, Farapulse, Los Altos, 3715 Haven Ave Control, Menlo Park, CA 94025, USA
| | - Nicolas Derval
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Josselin Duchateau
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Thomas Pambrun
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Remi Chauvel
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Vivek Y Reddy
- Department of Cardiac Arhhythmias, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Michel Montaudon
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - François Laurent
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Frederic Sacher
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Mélèze Hocini
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Pierre Jais
- IHU LIRYC-CHU Bordeaux, Univ. Bordeaux, Inserm U1045, Avenue du Haut Lévêque, 33604 Pessac, France.,Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
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43
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Nakashima T, Cheniti G, Takagi T, Vlachos K, Goujeau C, André C, Krisai P, Ramirez FD, Pintican G, Kamakura T, Nakatani Y, Surget E, Roux JR, Meillet V, Carapezzi A, Tixier R, Chauvel R, Pambrun T, Duchateau J, Derval N, Pillois X, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. Local abnormal ventricular activity detection in scar-related VT: Microelectrode versus conventional bipolar electrode. Pacing Clin Electrophysiol 2021; 44:1075-1084. [PMID: 33932234 DOI: 10.1111/pace.14253] [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] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conventional bipolar electrodes (CBE) may be suboptimal to detect local abnormal ventricular activities (LAVAs). Microelectrodes (ME) may improve the detection of LAVAs. This study sought to elucidate the detectability of LAVAs using ME compared with CBE in patients with scar-related ventricular tachycardia (VT). METHODS We included consecutive patients with structural heart disease who underwent radiofrequency catheter ablation for scar-related VT using either of the following catheters equipped with ME: QDOTTM or IntellaTip MIFITM. Detection field of LAVA potentials were classified as three types: Type 1 (both CBE and ME detected LAVA), Type 2 (CBE did not detect LAVA while ME did), and Type 3 (CBE detected LAVA while ME did not). RESULTS In 16 patients (68 ± 16 years; 14 males), 260 LAVAs electrograms (QDOT = 72; MIFI = 188) were analyzed. Type 1, type 2, and type 3 detections were 70.8% (QDOT, 69.4%; MIFI, 71.3%), 20.0% (QDOT, 23.6%; MIFI, 18.6%) and 9.2% (QDOT, 6.9%; MIFI, 10.1%), respectively. The LAVAs amplitudes detected by ME were higher than those detected by CBE in both catheters (QDOT: ME 0.79 ± 0.50 mV vs. CBE 0.41 ± 0.42 mV, p = .001; MIFI: ME 0.73 ± 0.64 mV vs. CBE 0.38 ± 0.36 mV, p < .001). CONCLUSIONS ME allow to identify 20% of LAVAs missed by CBE. ME showed higher amplitude LAVAs than CBE. However, 9.2% of LAVAs can still be missed by ME.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,Department of Cardiac Pacing and Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gabriela Pintican
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Elodie Surget
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | | | | | | | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Xavier Pillois
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
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44
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Nakashima T, Nakatani Y, Ramirez FD, Cheniti G, Jaïs P, Sacher F. Varying physiologic ventricular resynchronization with changes in atrial rhythm in a patient with a right-sided accessory pathway and right bundle branch block. J Electrocardiol 2021; 66:122-124. [PMID: 33906060 DOI: 10.1016/j.jelectrocard.2021.04.012] [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: 01/26/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
We describe varying physiologic ventricular resynchronization owing to differences in atrial rhythm in a patient with the right-sided accessory pathway and pre-existing right bundle branch block.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France.
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), 33600 Pessac- Bordeaux, France
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45
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Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [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] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
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Chauvel R, Derval N, Duchateau J, Denis A, Tixier R, Welte N, André C, Ramirez FD, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Krisai P, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Persistent atrial fibrillation ablation in cardiac laminopathy: Electrophysiological findings and clinical outcomes. Heart Rhythm 2021; 18:1115-1121. [PMID: 33812085 DOI: 10.1016/j.hrthm.2021.03.040] [Citation(s) in RCA: 4] [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: 02/25/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about persistent atrial fibrillation (AF) ablation in patients with cardiac laminopathy (CLMNA). OBJECTIVES We aimed to characterize atrial electrophysiological properties and to assess the long-term outcomes of persistent AF ablation in patients with CLMNA. METHODS All patients with CLMNA referred in our center for persistent AF ablation were retrospectively included. Left atrial (LA) volume, left atrial appendage (LAA) cycle length, interatrial conduction delay, and LA voltage amplitude were analyzed during the ablation procedure. Sinus rhythm maintenance and LA contractile function were assessed during long-term follow-up. RESULTS From 2011 to 2020, 8 patients were included. The mean age was 47 ± 14 years, and 3 patients (38%) were women. The LA volume was 205.8 ± 43.7 mL; the LAA AF cycle length was 250.7 ± 85.6 ms; and the interatrial conduction delay was 296.5 ± 110.1 ms. Large low-voltage areas (>50% of the LA surface; <0.5 mV electrogram) were recorded in all 8 patients. Two patients had inadvertent LAA disconnection during ablation. All A waves recorded by pulsed Doppler in sinus rhythm were <30 cm/s before and after AF ablation. Early arrhythmia recurrence was recorded in 7 patients (87%) (time to recurrence 4 ± 4 months; 1.5 procedures per patient). After a mean follow-up of 4.4 ± 3.2 years, 4 patients underwent implantable cardioverter-defibrillator therapy for life-threatening ventricular arrhythmia and 3 patients finally underwent heart transplantation. CONCLUSION Patients with persistent AF afflicted by CLMNA exhibit severe LA impairment because of large low-voltage areas, prolonged conduction velocity, and reduced contractile function. Ablation procedures have a limited effect with a high recurrence rate.
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Affiliation(s)
- Rémi Chauvel
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Welte
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Takashi Nakashima
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Philipp Krisai
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Félix Bourier
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Takeshi Kitamura
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Unité d'électrophysiologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France.
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Takagi T, Pambrun T, Nakashima T, Vlachos K, André C, Krisai P, Ramirez FD, Kamakura T, Nakatani Y, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Significance of manifest localized staining during ethanol infusion into the vein of Marshall. Heart Rhythm 2021; 18:1057-1063. [PMID: 33741483 DOI: 10.1016/j.hrthm.2021.03.023] [Citation(s) in RCA: 4] [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: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Localized staining due to venule injury is attributable to ethanol infusion into the vein of Marshall (Et-VOM). OBJECTIVE The purpose of this study was to investigate adverse outcomes of localized staining during Et-VOM in patients undergoing ablation for atrial fibrillation. METHODS Two hundred four patients (age 64 ± 10 years; 153 male) were sorted based on the aspect of localized staining. Staining of atrial myocardium that spread uniformly along the VOM vascular tree following selective VOM venography was considered normal, in contrast to predominantly localized staining that spread concentrically from a focal point due to vascular injury. Outcomes between the 2 groups were compared. RESULTS Localized staining was observed in 27% of patients. No patients developed clinically significant pericardial effusions during Et-VOM; however, 7 patients developed pericardial effusions on the first postprocedural day (3.6% in patients with vs 3.4% in patients without localized staining). No significant difference was found in achievement of acute mitral isthmus (MI) block (96% vs 98%) and size of the endocardial low-voltage area (8.5 ± 4.1 cm2 vs 9.3 ± 5.3 cm2) in patients with and without localized staining, respectively. Long-term follow-up was not impacted by localized staining. Freedom from recurrent atrial tachyarrhythmias (66% vs 76%) and durability of MI block (57% vs 54%) were not significantly different with and without localized staining. There were no cases of rehospitalization for pericarditis, chronic pericardial effusion, or heart failure. CONCLUSION In our study, localized staining was frequent but was not associated with clinically relevant impact or disadvantages.
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Affiliation(s)
- Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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Krisai P, Pambrun T, Nakatani Y, Nakashima T, Takagi T, Kamakura T, André C, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Haïssaguerre M, Cochet H, Jaïs P, Derval N, Hocini M. How to perform ethanol ablation of the vein of Marshall for treatment of atrial fibrillation. Heart Rhythm 2021; 18:1083-1087. [PMID: 33601037 DOI: 10.1016/j.hrthm.2021.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Philipp Krisai
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France.
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
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49
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Nakatani Y, Krisai P, Nakashima T, Tixier R, Welte N, Duchateau J, Pambrun T. Atrioventricular block with coronary sinus potential dissociation after lateral mitral isthmus block: What is the mechanism? J Cardiovasc Electrophysiol 2021; 32:874-877. [PMID: 33428314 DOI: 10.1111/jce.14877] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/19/2020] [Accepted: 01/03/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
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50
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Kamakura T, Sacher F, Katayama K, Ueda N, Nakajima K, Wada M, Yamagata K, Ishibashi K, Inoue Y, Miyamoto K, Nagase S, Noda T, Aiba T, Nakatani Y, Ramirez FD, André C, Nakashima T, Krisai P, Takagi T, Tixier R, Chauvel R, Cheniti G, Duchateau J, Pambrun T, Derval N, Hocini M, Jais P, Haïssaguerre M, Kamakura S, Kusano K. High-risk atrioventricular block in Brugada syndrome patients with a history of syncope. J Cardiovasc Electrophysiol 2021; 32:772-781. [PMID: 33428312 DOI: 10.1111/jce.14876] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/25/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Determining the etiology of syncope is challenging in Brugada syndrome (BrS) patients. Implantable cardioverter defibrillator placement is recommended in BrS patients who are presumed to have arrhythmic syncope. However, arrhythmic syncope in BrS patients can occur in the setting of atrioventricular block (AVB), which should be managed by cardiac pacing. The clinical characteristics of BrS patients with high-risk AVB remain unknown. METHODS This study included 223 BrS patients with a history of syncope from two centers. The clinical characteristics of patients with high-risk AVB (Mobitz type II second-degree AVB, high-degree AVB, or third-degree AVB) were investigated. RESULTS During the 99 ± 78 months of follow-up, we identified six BrS patients (2.7%) with high-risk AVB. Three of the six patients (50%) with AVB presented with syncope associated with prodromes or specific triggers. Four patients (67%) were found to have paroxysmal third-degree AVB during the initial evaluation for BrS and syncope, while two patients developed third-degree AVB during the follow-up period. The incidence of first-degree AVB was significantly higher in AVB patients than in non-AVB patients (83% vs. 15%; p = .0005). There was no significant difference in the incidence of ventricular fibrillation between AVB and non-AVB patients (AVB [17%], non-AVB [12%]; p = .56). CONCLUSION High-risk AVB can occur in BrS patients with various clinical presentations. Although rare, the incidence is worth considering, especially in BrS patients with first-degree AVB.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | | | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuko Inoue
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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