scholarly journals The impact of the presence of left atrial low voltage areas on outcomes from pulmonary vein isolation

2019 ◽  
Vol 35 (2) ◽  
pp. 205-214
Author(s):  
Fiyyaz Ahmed‐Jushuf ◽  
Francis Murgatroyd ◽  
Para Dhillon ◽  
Paul A. Scott
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
The Impact

scholarly journals Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kawai ◽  
K Nagaoka ◽  
S Takase ◽  
K Sakamoto ◽  
H Ikuta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Past History ◽  
Univariate Analysis ◽  
Atrial Tachyarrhythmia ◽  
Chads2 Score ◽  
Atrial Capture ◽  
History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

The Extent of Left Atrial Low-Voltage Areas Included in Pulmonary Vein Isolation Is Associated With Freedom from Recurrent Atrial Arrhythmia

2018 ◽  
Vol 34 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Dong Huang ◽  
Jing-bo Li ◽  
Tarek Zghaib ◽  
Esra Gucuk Ipek ◽  
Muhammad Balouch ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Atrial Arrhythmia

scholarly journals 34The impact of the presence of left atrial low voltage areas on outcomes from pulmonary vein isolation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_1) ◽  
pp. i15-i15
Author(s):  
F Ahmed-Jushuf ◽  
F Murgatroyd ◽  
P Dhillon ◽  
P A Scott
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage

Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 240-249 ◽  
Author(s):  
Björn Müller-Edenborn ◽  
Juan Chen ◽  
Jürgen Allgeier ◽  
Maxim Didenko ◽  
Zoraida Moreno-Weidmann ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Early Stage ◽  
Morphological Changes ◽  
Persistent Atrial Fibrillation ◽  
P Wave ◽  
Wave Amplification ◽  
Grade 3

Abstract Aims  Presence of arrhythmogenic left atrial (LA) low-voltage substrate (LVS) is associated with reduced arthythmia freedom rates following pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). We hypothesized that LA-LVS modifies amplified sinus-P-wave (APW) characteristics, enabling identification of patients at risk for arrhythmia recurrences following PVI. Methods and results  Ninety-five patients with persistent AF underwent high-density (>1200 sites) voltage mapping in sinus rhythm. Left atrial low-voltage substrate (<0.5 and <1.0 mV) was quantified in a 10-segment LA model. Amplified sinus-P-wave-morphology and -duration were evaluated using digitized 12-lead electrocardiograms (40–80 mm/mV, 100–200 mm/s). 12-months arrhythmia freedom following circumferential PVI was assessed in 139 patients with persistent AF. Left atrial low-voltage substrate was most frequently (84%) found at the anteroseptal LA. Characteristic changes of APW were related to the localization and extent of LA-LVS. At an early stage, LA-LVS predominantly located to the LA-anteroseptum and was associated with APW-prolongation (≥150 ms). More extensive LA-LVS involved larger areas of LA-anteroseptum, leading to morphological changes of APW (biphasic positive–negative P-waves in inferior leads). Severe LA-LVS involved the LA-anteroseptum, roof and posterior LA, but spared the inferior LA, lateral LA, and LA appendage. In this advanced stage, widespread LVS at the posterior LA abolished the negative portion of P-wave in the inferior leads. The delayed activation of the lateral LA and LA appendage produced the late positive deflections in the anterolateral leads, resulting in the “late-terminal P”-pattern. Structured analysis of APW-duration and -morphology stratified patients to their individual extent of LA-LVS (Grade 1: mean LA-LVS 4.9 cm2 at <1.0 mV; Grade 2: 28.6 cm2; Grade 3: 42.3 cm2; P < 0.01). The diagnostic value of APW-duration for identification of LA-LVS was significantly superior to standard P-wave-amplification (c-statistic 0.945 vs. 0.647). Arrhythmia freedom following PVI differed significantly between APW-predicted grades of LA-LVS-severity [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.18–4.83; P = 0.015 for Grade 1 vs. Grade 2; HR 1.79, 95% CI 1.00–3.21, P = 0.049 for Grade 2 vs. Grade 3). Arrhythmia freedom 12 months after PVI was 77%, 53%, and 33% in Grades 1, 2 and 3, respectively. Conclusion  Localization and extent of LA-LVS modifies APW-morphology and -duration. Analysis of APW allows accurate prediction of LA-LVS and enables rapid and non-invasive estimation of arrhythmia freedom following PVI.

scholarly journals Ongoing antiarrhythmic drug therapy type does not affect the rate of first-pass pulmonary vein isolation: data from a multicenter registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Gasimova ◽  
E Kropotkin ◽  
E Ivanitsky ◽  
G Kolunin ◽  
A Nechepurenko ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Beta Blockers ◽  
Real Life ◽  
Af Ablation ◽  
First Pass ◽  
The Impact ◽  
Multicenter Registry

Abstract Background It is well-known that antiarrhythmic drugs (AAD) change the electrophysiological properties of the atrium mostly by increasing the atrial refractory period and wavelength for reentry. Frequently, atrial fibrillation (AF) catheter ablation is being performed with AAD interruption. However, the information on the impact of AAD on AF ablation performance is lacking, and AAD interruption is not desirable in highly symptomatic patients with persistent arrhythmia. Purpose We sought to study potential differences in achieving first-pass pulmonary vein isolation (FPI) during AF ablation in patients receiving different classes of ongoing AADs. Methods This was a prospective observational multicenter registry. All centers were invited to participate in the registry voluntarily. Data on demographic, clinical, and procedure characteristics were derived from a web-based system. All catheter ablation procedures were performed according to local practices. A total of 450 patients were enrolled, 408 of them underwent first-time AF ablation. Data on AAD characteristics were available in 350 patients (mean age 61±9 years, 195 (56%) males, 270 (77%) had paroxysmal AF). All patients were divided into three groups: ongoing I class AAD treatment (propafenone, ethacyzin, allapinin, n=76), ongoing II class AAD (beta-blockers, n=60), and ongoing III class AAD (amiodarone, sotalol, n=214). Results Baseline clinical and procedural characteristics between AAD groups are summarized in Table. Patients in the I class AAD group were younger, likely had paroxysmal AF, and a smaller mean left atrial diameter. Procedures in the III class AAD group were performed with a higher median target ablation index on the posterior left atrial wall. But the percentage of first-pass isolation was distributed equally between groups (60%, 68%, 61%, p=0.56). The correlation matrix revealed no significant associations between FPI and clinical and procedural variables (r=0.02–0.09; p>0.05 for all). Conclusion(s) Our real-life multicenter data demonstrate no difference in FPI achievement between patients receiving different AADs. We suggest that highly symptomatic patients may continue pharmacological treatment during AF ablation without compromising acute ablation success. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Higher Education grant (Russian Federation President Grant) Table 1. Clinical and procedural parameter

Sign in / Sign up

Export Citation Format

Share Document