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Kircher S, Arya A, Altmann D, Rolf S, Bollmann A, Sommer P, Dagres N, Richter S, Breithardt OA, Dinov B, Husser D, Eitel C, Gaspar T, Piorkowski C, Hindricks G. Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study. Europace 2017; 20:1766-1775. [DOI: 10.1093/europace/eux310] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon Kircher
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - David Altmann
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Ole-A Breithardt
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Charlotte Eitel
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
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Marai I, Suleiman M, Blich M, Lessick J, Abadi S, Boulos M. Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation. World J Cardiol 2016; 8:317-322. [PMID: 27152144 PMCID: PMC4840165 DOI: 10.4330/wjc.v8.i4.317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/02/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of using computed tomography (CT) and contact force (CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation (AF) ablation.
METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation (PVI) for AF during 2012 and 2013 guided by CT image integration (Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping (EAM) system (CT group) using standard irrigated radiofrequency catheter (ThermoCool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor (Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter (ThermoCool) using only EAM (Carto) system (EAM group). Linear lesions were performed according to the discretion of operator.
RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group (81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant (73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up (100% vs 73%; respectively; P = 0.07). Major complications (pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.
CONCLUSION: These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.
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Marai I, Boulos M, Lessick J, Abadi S, Blich M, Suleiman M. Outflow tract ventricular arrhythmia originating from the aortic cusps: our approach for challenging ablation. J Interv Card Electrophysiol 2015; 45:57-62. [PMID: 26573056 DOI: 10.1007/s10840-015-0076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation of outflow flow ventricular arrhythmia (VA) originating from aortic cusps can be challenging. The aim of this study was to describe our approach for this ablation. METHODS All patients with outflow VA suspected to originate from aortic cusps according to ECG or after failed ablation from right ventricular outflow tract (RVOT) underwent cardiac CT and radiofrequency ablation. CT image of aortic cusps and coronary arteries was integrated into electroanatomic mapping system by point (left main ostium)-based registration. Ablation was performed at the earliest activation site. RESULTS Ten patients were included in this case cohort. The ablation catheter was easily maneuvered above and below the aortic valve after registration. Two patients who had previous failed ablation of RVOT focus had successful ablation at right coronary cusp (RCC) and at left coronary cusp (LCC). A patient who had previous failed ablations of RVOT and LCC focuses had successful ablation at RCC-LCC junction. A patient who had previous failed ablation at LCC had successful ablation at RCC-LCC junction. Three patients had successful ablation at RCC-LCC junction, and one patient at LCC. One patient had successful ablation at anterior interventricular vein-great cardiac vein junction. One patient had successful ablation at non-coronary cusp. During follow-up (12-30 months), one patient had recurrence of VA controlled by flecainide. The remaining patients were free of VA without medications. CONCLUSIONS Catheter ablation of VA originating from aortic cusps is safe and effective. CT image integration into electroanatomic mapping system can be helpful in this challenging ablation.
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Affiliation(s)
- Ibrahim Marai
- Division of Pacing and Electrophysiology, Department of Cardiology, Rambam Medical Center, Technion - Israel Institute of Technology, 31096, Haifa, Israel.
| | - Monther Boulos
- Division of Pacing and Electrophysiology, Department of Cardiology, Rambam Medical Center, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Jonathan Lessick
- Division of Pacing and Electrophysiology, Department of Cardiology, Rambam Medical Center, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Sobhi Abadi
- Department of Diagnostic Imaging, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Miry Blich
- Division of Pacing and Electrophysiology, Department of Cardiology, Rambam Medical Center, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Mahmoud Suleiman
- Division of Pacing and Electrophysiology, Department of Cardiology, Rambam Medical Center, Technion - Israel Institute of Technology, 31096, Haifa, Israel
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Kiuchi K, Yoshida A, Takei A, Fukuzawa K, Itoh M, Imamura K, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Hirata KI, Kanda G, Okajima K, Shimane A, Yamada S, Taniguchi Y, Yasaka Y, Kawai H. Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation. J Arrhythm 2015; 31:286-92. [PMID: 26550084 DOI: 10.1016/j.joa.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA. METHODS Sixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7 mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated. RESULTS After the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02-1.12, p=0.001; odds ratio: 0.41, CI: 0.21-0.77, p=0.006). CONCLUSION Enlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence.
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Akihiro Yoshida
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Asumi Takei
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Mitsuaki Itoh
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Kimitake Imamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ryudo Fujiwara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Atsushi Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Tomoyuki Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Soichiro Yamashita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
| | - Gaku Kanda
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Katsunori Okajima
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Akira Shimane
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Shinichiro Yamada
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yasuyo Taniguchi
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
| | - Hiroya Kawai
- Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
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Huo Y, Holmqvist F, Carlson J, Gaspar T, Hindricks G, Piorkowski C, Bollmann A, Platonov PG. Variability of P-wave morphology predicts the outcome of circumferential pulmonary vein isolation in patients with recurrent atrial fibrillation. J Electrocardiol 2014; 48:218-25. [PMID: 25555742 DOI: 10.1016/j.jelectrocard.2014.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Severe atrial structural remodeling may reflect irreversible damage of the atrial tissue in patients with atrial fibrillation (AF) and is associated with changes of P-wave duration and morphology. Our aim was to study whether variability of P-wave morphology (PMV) is associated with outcome in patients with AF after circumferential PV isolation (CPVI). METHODS AND RESULTS 70 consecutive patients (aged 60±9years, 46 men) undergoing CPVI due to symptomatic AF were studied. After cessation of antiarrhythmic therapy, standard 12-lead ECG during sinus rhythm was recorded for 10min at baseline and transformed to orthogonal leads. Beat-to-beat P-wave morphology was subsequently defined using a pre-defined classification algorithm. The most commonly observed P-wave morphology in a patient was defined as the dominant morphology. PMV was defined as the percentage of P waves with non-dominant morphology in the 10-min sample. At the end of follow-up, 53 of 70 patients had no arrhythmia recurrence. PMV was greater in patients without recurrence (19.5±17.1% vs. 8.2±6.7%, p<0.001). In the multivariate logistic regression model, PMV≥20% (upper tertile) was the only independent predictor of ablation success (OR=11.4, 95% CI 1.4-92.1, p=0.023). A PMV≥20% demonstrated a sensitivity of 41.5%, a specificity of 94.1%, a PPV of 96.7%, and an NPV of 34.0% for free of AF after CPVI. CONCLUSIONS We report a significant association between increased PMV and 6-month CPVI success. PMV may help to identify patients with very high likelihood of freedom of AF 6-months after CPVI.
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Affiliation(s)
- Yan Huo
- Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden; Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany.
| | - Fredrik Holmqvist
- Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden
| | - Jonas Carlson
- Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center-University Leipzig, Leipzig, Germany
| | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center-University Leipzig, Leipzig, Germany
| | - Pyotr G Platonov
- Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden
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Sommer P, Rolf S, Piorkowski C, Gaspar T, Huo Y, Piedra C, Richter S, Bollmann A, Arya A, Hindricks G. Nonfluoroscopic Catheter Visualization in Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2014; 7:869-74. [DOI: 10.1161/circep.114.001542] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philipp Sommer
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Sascha Rolf
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Christopher Piorkowski
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Thomas Gaspar
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Yan Huo
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Carlos Piedra
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Sergio Richter
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Andreas Bollmann
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Arash Arya
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
| | - Gerhard Hindricks
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany (P.S., S. Rolf, C. Piedra, S. Richter, A.B., A.A., G.H.); and Heart Center, University of Dresden, Dresden, Germany (C. Piorkowski, T.G., Y.H.)
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Rolf S, Kircher S, Arya A, Eitel C, Sommer P, Richter S, Gaspar T, Bollmann A, Altmann D, Piedra C, Hindricks G, Piorkowski C. Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol 2014; 7:825-33. [PMID: 25151631 DOI: 10.1161/circep.113.001251] [Citation(s) in RCA: 418] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. METHODS AND RESULTS In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LVAs and 70% for patients with LVAs and tailored substrate modification (P=0.3). Success rate in a comparison group of 26 LVA patients without further substrate modification was 27%. CONCLUSIONS LVAs can be found at preferred sites in 10% of patients with paroxysmal AF and in 35% of patients with persistent AF. This is the first clinical report describing a consistent voltage-based approach for substrate modification in addition to circumferential pulmonary vein isolation irrespective of AF type. Application of this limited individualized approach may have the potential to compensate for the impaired 12-month outcome of patients with endocardial structural defects.
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Affiliation(s)
- Sascha Rolf
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
| | - Simon Kircher
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Arash Arya
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Charlotte Eitel
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Philipp Sommer
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Sergio Richter
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Thomas Gaspar
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Andreas Bollmann
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - David Altmann
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Carlos Piedra
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Gerhard Hindricks
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
| | - Christopher Piorkowski
- From the Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.)
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HUO YAN, SCHOENBAUER ROBERT, RICHTER SERGIO, ROLF SASCHA, SOMMER PHILIPP, ARYA ARASH, RASTAN ARDAWAN, DOLL NICOLAS, MOHR FRIEDRICHWILHELM, HINDRICKS GERHARD, PIORKOWSKI CHRISTOPHER, GASPAR THOMAS. Atrial Arrhythmias Following Surgical AF Ablation: Electrophysiological Findings, Ablation Strategies, and Clinical Outcome. J Cardiovasc Electrophysiol 2014; 25:725-38. [DOI: 10.1111/jce.12406] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- YAN HUO
- Department of Electrophysiology; Dresden University-Heart Center; Dresden Germany
| | - ROBERT SCHOENBAUER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - SERGIO RICHTER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - SASCHA ROLF
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - PHILIPP SOMMER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - ARASH ARYA
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - ARDAWAN RASTAN
- Department of Cardiac Surgery; Rotenburg a. d. Fulda; Germany
| | - NICOLAS DOLL
- Department of Cardiac Surgery; Sana Hospital; Stuttgart Germany
| | | | - GERHARD HINDRICKS
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | | | - THOMAS GASPAR
- Department of Electrophysiology; Dresden University-Heart Center; Dresden Germany
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9
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Eitel C, Hindricks G, Dagres N, Sommer P, Piorkowski C. EnSite Velocity™ cardiac mapping system: a new platform for 3D mapping of cardiac arrhythmias. Expert Rev Med Devices 2014; 7:185-92. [DOI: 10.1586/erd.10.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Eitel C, Rolf S, Zachäus M, John S, Sommer P, Bollmann A, Arya A, Piorkowski C, Hindricks G, Halm U. Successful Nonsurgical Treatment of Esophagopericardial Fistulas After Atrial Fibrillation Catheter Ablation. Circ Arrhythm Electrophysiol 2013; 6:675-81. [DOI: 10.1161/circep.113.000384] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charlotte Eitel
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Sascha Rolf
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Markus Zachäus
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Silke John
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Philipp Sommer
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Andreas Bollmann
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Arash Arya
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Gerhard Hindricks
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Ulrich Halm
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
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11
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Filgueiras-Rama D, Estrada A, Shachar J, Castrejón S, Doiny D, Ortega M, Gang E, Merino JL. Remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures. J Vis Exp 2013. [PMID: 23628883 PMCID: PMC3665328 DOI: 10.3791/3658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate.
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12
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Use of electrical coupling information in AF catheter ablation: A prospective randomized pilot study. Heart Rhythm 2013; 10:176-81. [DOI: 10.1016/j.hrthm.2012.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Indexed: 11/23/2022]
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13
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Kiuchi K, Kircher S, Watanabe N, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Sommer P. Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique. Circ Arrhythm Electrophysiol 2012; 5:667-75. [DOI: 10.1161/circep.111.969923] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We sought to determine the relationship between the size of the left atrial isolated surface area (ISA) after pulmonary vein antrum isolation for paroxysmal atrial fibrillation (AF) and rhythm outcome during a 12-month follow-up.
Methods and Results—
One hundred one consecutive patients with paroxysmal AF (mean age, 59±11 years; median [range] AF history, 36 [24–96] months; mean left atrial size, 42±6 mm) were enrolled. The ISA was defined as the ratio of the total isolated antral surface area excluding the pulmonary veins to the sum of the total isolated antral surface area and the left atrial posterior wall surface area, while considering the individual characteristics of antral anatomy. All surface areas were assessed using the NavX system. Patients were divided into 4 groups according to ISA (group I: <50%; group II: 50 to <60%; group III: 60 to <70%; group IV: ≥70%). The average ISA for all patients was 59.2±11.6%. Subgroup analysis showed that ISA was 42.8±4.2% in group I (n=23), 54.2±3.0% in group II (n=23), 64.3±3.0% in group III (n=33), and 73.9±3.6% in group IV (n=22). After a 12-month follow-up period, 70% of patients in group I, 78% in group II, 97% in group III, and 100% in group IV were free from AF and atrial macroreentrant tachycardia. There was a significant difference between groups I and III, I and IV, II and III, and II and IV but not groups I and II and groups III and IV (log-rank test
P
=0.024, 0.016, 0.037, 0.044, 0.584, and 0.500, respectively). Receiver operating characteristic curve analysis yielded an optimal cutoff value of 55% for ISA.
Conclusions—
After 12 months, a larger ISA was associated with a significantly lower AF and macroreentrant tachycardia recurrence rate. ISA≥55% may thus serve as a predictor for long-term success after pulmonary vein antrum isolation.
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Affiliation(s)
- Kunihiko Kiuchi
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Simon Kircher
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Norikazu Watanabe
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Thomas Gaspar
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Sascha Rolf
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Arash Arya
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Christopher Piorkowski
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Gerhard Hindricks
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
| | - Philipp Sommer
- From the Department of Electrophysiology, University of Leipzig Heart Center, Leipzig, Germany
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14
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Role of the coronary sinus ostium musculature in reentrant formation. Herzschrittmacherther Elektrophysiol 2012; 23:121-7. [PMID: 22566079 DOI: 10.1007/s00399-012-0174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Radiofrequency ablation of focal atrial tachycardias (AT) is a validated technique with high success rates. However, electrophysiological (EP) characteristics and ablation strategy of localized reentrant AT originating from the coronary sinus ostium (CSo) have not been reported in detail so far. METHODS From January 2009 to July 2010, 1,453 patients underwent clinically motivated EP studies. Four patients were diagnosed with localized reentrant AT originating from the CSo. P wave morphology and consistency of tachycardia cycle length were studied. Subsequently, if reentry was suggested as an underlying mechanism for AT, color-coded 3-dimensional (3D) entrainment mapping was performed to localize the reentrant circuit or differentiate a localized reentrant AT from macroreentant AT, and also confirm reentry as an underlying mechanism of AT by evaluating consistency of return cycles after entrainment at multiple sites in both atria. Finally, activation mapping was performed to localize the earliest activation site. RESULTS The P wave morphologies and isoelectric line between the P waves suggested most likely an AT originating from the CSo with a centrifugal activation pattern, which was confirmed by activation mapping. Consistency of return cycles and continuously fragmented local electrograms at successful ablation sites suggested reentry as an underlying AT mechanism. Color-coded 3D entrainment mapping in all 4 patients located the reentrant circuit in the CSo. There were also two specific features observed. One was fragmented and/or double potentials recorded in the CSo with prominent prolonged electrogram duration compared to those during sinus rhythm. The other is a significant conduction delay within the CS. The myocardium of the CSo was suggested as a part of the critical isthmus within the reentrant circuit, while the rest of atria distal to the CSo and myocardial coat of the distal CS were not involved in the tachycardia circuit, which was confirmed by entrainment mapping. CONCLUSION Although CSo myocardium has been implicated to be a part of atrioventricular nodal reentrant tachycardia, to the best of our knowledge, this is the first report showing the localized reentrant AT confined to the CSo. Three of our patients (75%) had concomitant atrial fibrillation (AF). Further studies should be warranted to clarify the role of AT from the CS in triggering AF.
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Liu J, Rettmann ME, Holmes DR, Duan H, Robb RA. A piecewise patch-to-model matching method for image-guided cardiac catheter ablation. Comput Med Imaging Graph 2011; 35:324-32. [PMID: 21376532 PMCID: PMC3075351 DOI: 10.1016/j.compmedimag.2011.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 01/05/2011] [Accepted: 02/01/2011] [Indexed: 11/24/2022]
Abstract
Accurate and fast fusion and display of real-time images of anatomy and associated data is critical for effective use in image guided procedures, including image guided cardiac catheter ablation. We have developed a piecewise patch-to-model matching method, a modification of the contractive projection point technique, for accurate and rapid matching between an intra-operative cardiac surface patch and a pre-operative cardiac surface model. Our method addresses the problems of fusing multi-modality images and using non-rigid deformation between a surface patch and a surface model. A projection lookup table, K-nearest neighborhood search, and a final iteration of point-to-projection are used to reliably find the surface correspondence. Experimental results demonstrate that the method is fast, accurate and robust for real-time matching of intra-operative surface patches to pre-operative 3D surface models of the left atrium.
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Affiliation(s)
- Jiquan Liu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang 310027, China
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
- Key Laboratory for Biomedical Engineering, Ministry of Education, China
| | - Maryam E. Rettmann
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
| | - David R. Holmes
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
| | - Huilong Duan
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang 310027, China
- Key Laboratory for Biomedical Engineering, Ministry of Education, China
| | - Richard A. Robb
- Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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16
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Sharma K, Brinker JA, Henrikson CA. Computed Tomography Imaging in Atrial Fibrillation Ablation. J Atr Fibrillation 2011; 4:319. [PMID: 28496689 PMCID: PMC5152998 DOI: 10.4022/jafib.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/18/2010] [Accepted: 01/14/2011] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia in adults and catheter ablation has increasingly become the therapy of choice for symptomatic, recurrent, drug refractory AF. The purpose of this review is to evaluate the utility of computed tomography (CT) imaging in guiding radiofrequency catheter ablation (RFCA), as well as highlight the additional radiographic and functional anatomic data provided by CT in comparison to alternative radiographic modalities.
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Affiliation(s)
- Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey A Brinker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles A Henrikson
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, Kircher S, Wetzel U, Parwani AS, Boldt LH, Mende M, Bollmann A, Husser D, Dagres N, Esato M, Arya A, Haverkamp W, Hindricks G. Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol 2011; 4:157-65. [PMID: 21248246 DOI: 10.1161/circep.110.957761] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Steerable sheath technology is designed to facilitate catheter access, stability, and tissue contact in target sites of atrial fibrillation (AF) catheter ablation. We hypothesized that rhythm control after interventional AF treatment is more successful using a steerable as compared with a nonsteerable sheath access. METHODS AND RESULTS One hundred thirty patients with paroxysmal or persistent drug-refractory AF undergoing their first ablation procedure were prospectively included in a randomized fashion in 2 centers. Ablation was performed by 10 operators with different levels of clinical experience. Treatment outcome was measured with serial 7-day Holter ECGs and additional symptom-based arrhythmia documentation. Single procedure success (freedom from AF and/or atrial macroreentrant tachycardia) was significantly higher in patients ablated with a steerable sheath (78% versus 55% after 3 months, P=0.005; 76% versus 53% after 6 months, P=0.008). Rate of pulmonary vein isolation, procedure duration, and radiofrequency application time did not differ significantly, whereas fluoroscopy time was lower in the steerable sheath group (33±14 minutes versus 45±17 minutes, P<0.001). Complication rates showed no significant difference (3.2% versus 5%, P=0.608). On multivariable analysis, steerable sheath usage remained the only powerful predictor for rhythm outcome after 6 months of follow-up (hazard ratio, 2.837 [1.197 to 6.723]). CONCLUSIONS AF catheter ablation using a manually controlled, steerable sheath for catheter navigation resulted in a significantly higher clinical success rate, with comparable complication rates and with a reduction in periprocedural fluoroscopy time. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00469638.
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18
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Schoenbauer R, Huo Y, Hindricks G, Piorkowski C. Two completely separated arrhythmias in one single heart chamber. Europace 2010; 13:589-90. [PMID: 21177275 DOI: 10.1093/europace/euq445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 61-year-old male patient underwent an electrophysiological study and ablation for symptomatic atypical atrial flutter which was most likely related to previous intraoperative cryoablation for treatment of paroxysmal atrial fibrillation during open heart surgery. During the procedure, a tachycardia was induced in the electrically isolated left inferior pulmonary vein (PV). With the routine induction protocol, perimitral flutter was induced, whereas, independently, the PV tachycardia was still maintained. After ablation of the mitral isthmus, no tachycardias were inducible anymore.
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Affiliation(s)
- Robert Schoenbauer
- Department of Cardiac Electrophysiology, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Deutschland, Germany.
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19
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Chromosome 4q25 variants and atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol 2010; 55:747-53. [PMID: 20170812 DOI: 10.1016/j.jacc.2009.11.041] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/20/2009] [Accepted: 11/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study tested the hypothesis that chromosome 4q25 single-nucleotide polymorphisms (SNPs) associate with atrial fibrillation (AF) recurrence after catheter ablation. BACKGROUND Recent genome-wide association studies identified 2 SNPs on chromosome 4q25 associated with AF. Although the mechanisms underlying this increased risk are unknown, the closest gene, PITX2, is critical for myocardium development in the pulmonary veins. METHODS A total of 195 consecutive patients (mean age 56 +/- 12 years, 73% male) with drug-refractory paroxysmal (78%) or persistent (22%) AF who underwent AF catheter ablation were included. Two SNPs, rs2200733 and rs10033464, were genotyped using real-time polymerase chain reaction and fluorescence resonance energy transfer. Serial 7-day Holter electrocardiographic recordings were acquired to detect AF recurrences. RESULTS Early recurrence of atrial fibrillation (ERAF) (within the first 7 days) was observed in 37%, whereas late recurrence of atrial fibrillation (LRAF) (between 3 and 6 months) occurred in 21% of the patients. None of the clinical or echocardiographic baseline characteristics were associated with ERAF or LRAF. In contrast, the presence of any variant allele increased the risk for both ERAF (odds ratio [OR]: 1.994, 95% confidence interval [CI]: 1.036 to 3.837, p = 0.039) and LRAF (OR: 4.182, 95% CI: 1.318 to 12.664, p = 0.011). In patients with ERAF, 45% had LRAF, as opposed to 8% in patients without ERAF (OR: 9.274, 95% CI: 3.793 to 22.678, p < 0.001). CONCLUSIONS Polymorphisms on chromosome 4q25 modulate the risk for AF recurrence after catheter ablation. This finding points to a potential role for stratification of AF ablation therapy or peri-interventional management by genotype.
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Abstract
OBJECTIVES Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal damage because of the close proximity between the posterior wall of the left atrium and the esophagus. The aim of this prospective study was to determine the incidence, endoscopic characterization, and endoluminal temperature dependency of esophageal thermal lesions after catheter ablation. METHODS In all, 185 consecutive patients with symptomatic atrial fibrillation or left atrial macro-re-entrant tachycardia who underwent left atrial radiofrequency catheter ablation were scheduled for upper gastrointestinal endoscopy. During the ablation procedure, a non-fluoroscopic three-dimensional system for catheter orientation, computed tomography (CT) image integration, and activation mapping was used. The esophagus was intubated with a temperature probe for visualization within the three-dimensional image and for real-time intraluminal temperature monitoring. RESULTS A total of 27 (14.6%) asymptomatic ulcer-like or hemorrhagic esophageal thermal lesions with a diameter of 2-16 mm were observed. Esophageal lesions did not occur below an intraluminal esophageal temperature of 41 degrees C. The maximal temperature in the esophagus was significantly higher in patients with thermal lesions than in patients without lesions (42.6+/-1.7 degrees C vs. 41.4+/-1.7 degrees C, P=0.003). For every 1 degrees C increase in endoluminal temperature, the odds of an esophageal lesion increased by a factor of 1.36 (95% confidence interval (CI) 1.07-1.74, P=0.012). No progression of the lesions was observed during follow-up endoscopies. CONCLUSIONS Localized esophageal ulcer-like lesion is a frequent event after left atrial catheter ablation and can be found in patients whose intraluminal temperature has reached at least 41 degrees C.
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Sommer P, Piorkowski C, Arya A, Hindricks G. Successful integration of a computed tomography-based left atrial three-dimensional model in an electroanatomically reconstructed right atrium for ablation of biatrial tachycardia. Heart Rhythm 2010; 8:152-3. [PMID: 20156609 DOI: 10.1016/j.hrthm.2009.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Sommer
- Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany.
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PIORKOWSKI CHRISTOPHER, SIH HARIS, SOMMER PHILIPP, MILLER STEPHANP, GASPAR THOMAS, TEPLITSKY LIANE, HINDRICKS GERHARD. First in Human Validation of Impedance-Based Catheter Tip-to-Tissue Contact Assessment in the Left Atrium. J Cardiovasc Electrophysiol 2009; 20:1366-73. [DOI: 10.1111/j.1540-8167.2009.01552.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arya A, Hindricks G, Sommer P, Huo Y, Bollmann A, Gaspar T, Bode K, Husser D, Kottkamp H, Piorkowski C. Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace 2009; 12:173-80. [PMID: 19889688 DOI: 10.1093/europace/eup331] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. METHODS AND RESULTS In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. CONCLUSION In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.
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Affiliation(s)
- Arash Arya
- Department of Electrophysiology, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Eitel C, Hindricks G, Sommer P, Gaspar T, Kircher S, Wetzel U, Dagres N, Esato M, Bollmann A, Husser D, Hilbert S, Zaker-Shahrak R, Arya A, Piorkowski C. Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach. Heart Rhythm 2009; 7:157-64. [PMID: 20036199 DOI: 10.1016/j.hrthm.2009.10.003] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 10/04/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation has become a cornerstone for ablation of atrial fibrillation (AF). Circular mapping catheter (CMC)-guided techniques for detection of lesion gaps are challenging. OBJECTIVE The present study describes a new concept of circumferential PV ablation aiming at bidirectional conduction block based on simultaneous pacing and ablation through the tip of a single mapping/ablation catheter. METHODS A total of 147 patients with AF received circumferential PV ablation. In persistent AF, a posterior "box" lesion and a mitral isthmus line were added. All procedures were performed in sinus rhythm. Gaps within the left atrial (LA) ablation lines were detected and closed using voltage and pace mapping through the mapping/ablation catheter. Bidirectional conduction block was the procedural end point. Subsequently, the end point was validated by an independent electrophysiologist using a CMC. RESULTS Procedural and radiation time measured 188 +/- 55 and 37 +/- 15 min. Bidirectional PV conduction block (lack of PV potentials and lack of LA capture) was found in 140 of 147 (95%) patients with single mapping/ablation catheter and in 138 of 147 (94%) patients with CMC. Early PV reconduction was seen in 22 of 147 (15%) patients. After 12 months follow-up, 84% of the patients were free from AF and/or atrial macro-re-entrant tachycardia. The rate of reablations was 10% and 24% for patients with paroxysmal and persistent AF, respectively. CONCLUSION Pacing and ablation from the tip of the mapping/ablation catheter is feasible to detect and close gaps within long atrial ablation lines to consistently achieve bidirectional conduction block.
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Affiliation(s)
- Charlotte Eitel
- Department of Electrophysiology, University of Leipzig Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany
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Abecasis J, Dourado R, Ferreira A, Saraiva C, Cavaco D, Santos KR, Morgado FB, Adragão P, Silva A. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace 2009; 11:1289-94. [PMID: 19632980 DOI: 10.1093/europace/eup198] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS Catheter ablation (CA) of atrial fibrillation (AF) might be a definitive curative therapy for selected groups of patients (pts). However, current ablation protocols are not standardized and predictors of CA success and sinus rhythm maintenance are not clearly defined. To evaluate whether left atrium (LA) volume quantification provided by multi-detector computed tomography (MDCT) might predict the success of pulmonary vein (PV) isolation procedure. METHODS AND RESULTS We evaluated 99 pts, 66 male, mean age 54.4 +/- 10.1 years, referred for CA because of drug resistant AF. All pts were submitted to 64-slice MDCT scan for electroanatomic mapping integration, pulmonary veins anatomy delineation, LA thrombi exclusion, and LA volume estimation. Complete isolation of all the PVs was always performed with eventual cavo-tricuspid isthmus ablation. For a mean follow-up period (Fup) of 16.7 +/- 6.6 months, clinical success was assessed after a 3-month blanking period. Anti-arrhythmic drug therapy was discontinued or modified at the clinician's criteria. At the end of the Fup, 29 pts suspended anti-arrhythmic drug therapy and 26% were of oral anticoagulation. Univariate analysis showed that the probability of AF relapse after CA was higher in pts with non-paroxysmal forms of AF. The probability of relapse was significantly higher in pts with LA volumes greater than 100 mL when assessed by MDCT. We found that the LA volume of 145 mL was a good cut-off value for AF recurrence prediction. Patients with LA volumes greater than 145 mL had significantly higher recurrence rates of arrhythmia, even when adjusted for the effect of age, gender, body mass index, hypertension, and type of AF. CONCLUSION Left atrium volume estimated by MDCT may be useful to identify pts in whom successful AF ablation can be achieved with simpler ablation procedures, restricted to PV isolation.
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Affiliation(s)
- João Abecasis
- Cardiologia, Centro Hospitalar de Lisboa Ocidental, Rua Professor Reynaldo dos Santos 2795-523 Carnaxide, Portugal
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Esato M, Hindricks G, Sommer P, Arya A, Gaspar T, Bode K, Bollmann A, Wetzel U, Hilbert S, Kircher S, Eitel C, Piorkowski C. Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia. Heart Rhythm 2009; 6:349-58. [PMID: 19251210 DOI: 10.1016/j.hrthm.2008.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 12/03/2008] [Indexed: 11/28/2022]
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