scholarly journals DISTINCT PROGNOSTIC IMPLICATIONS OF ATRIAL ANATOMICAL REMODELING AFTER RADIOFREQUENCY ABLATION BETWEEN PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION: 3D IMAGING STUDY USING MULTIDETECTOR COMPUTED TOMOGRAPHY

2013 ◽  
Vol 61 (10) ◽  
pp. E366
Author(s):  
Jeonggeun Moon ◽  
Hye-Jeong Lee ◽  
Young Jin Kim ◽  
Jaemin Shim ◽  
Hui-Nam Pak ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Multidetector Computed Tomography ◽  
3D Imaging ◽  
Imaging Study ◽  
Persistent Atrial Fibrillation ◽  
Prognostic Implications

Abstract 18957: Modulation of Ganglionated Plexi as an Addition to Pv Isolation in Persistent Atrial Fibrillation Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sabine Ernst ◽  
Richard Underwood ◽  
Sonya Babu-Narayan ◽  
Simona Ben-Haim
Keyword(s):  
Atrial Fibrillation ◽  
3D Imaging ◽  
Imaging Study ◽  
Persistent Atrial Fibrillation ◽  
High Frequency Stimulation ◽  
Af Ablation ◽  
Road Map ◽  
Ganglionated Plexi ◽  
Individual Variations ◽  
Frequency Stimulation

Introduction: Catheter ablation of ganglionated plexi (GP) as an add on to pulmonary vein (PV) isolation has been reported to significantly improve outcome of atrial fibrillation (AF) ablation. In order to facilitate localization of these GPs, a novel imaging study is proposed that investigates the uptake of iodine-123 metaiodobenzylguanidine (mIBG, an analogon for norepinephrine) on the atrial level. This information is combined with 3D surface reconstruction from contrast computed tomography (cCT) or cardiac magnetic resonance (CMR). Methods: A total of 7 patients (5 male, mean age 64.3 yrs) with AF underwent mIBG nuclear studies using a dedicated solid state cardiac camera (D-SPECT, Spectrum Dynamics). Four patient had 4 persistent AF (3 prev. abl.) with less than 1 year of sustained AF, whereas 3 patient were in longstanding persistent AF (all prev. abl). The acquired data was merged with the 3D imaging and subsequently imported into the 3D electroanatomical mapping system (CARTO, Biosense Webster). During invasive AF ablations these sites were mapped to perform high frequency stimulation (HFS) to confirm GP locations. Results: In all pts, both the mIBG and CT scans were performed without any complications. Locations of high mIBG uptake corresponded to anatomical GP sites (LA & RA) in the majority of patients, but individual variations were observed. PV isolation was added in all but 1 pt (who had previous ablation) plus CFAE ablation if necessary. Follow-up of in median of 10.4 months demonstrated SR in all persistent AF patients (1 redo for atrial reentry). In patients with longstanding persistent AF: 2 pts are in SR (both AF at 1 week and 1 pt in AT at 6 weeks), while 1 pt remained in AF. Conclusion: The combination of mIBG and 3D imaging provides a novel type of “road map” for localizing GPs during AF ablation. As an add-on to PV (re-) isolation, this strategy was found to be beneficial for patients with persistent and longstanding persistent AF. Interestingly, pts with longstanding persistent AF (and multiple previous ablations) all recurred early in F/U but showed reversal to AT and finally SR at later stages. Further studies in larger patient cohorts need to confirm these initial observations.

Simultaneous Catheter and Epicardial Ablations Enable a Comprehensive Atrial Fibrillation Procedure

2011 ◽  
Vol 6 (4) ◽  
pp. 243-247 ◽  
Author(s):  
Andy C. Kiser ◽  
Mark D. Landers ◽  
Ker Boyce ◽  
Matjaž šinkovec ◽  
Andrej Pernat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Chronic Atrial Fibrillation ◽  
Lesion Pattern ◽  
Atrial Size ◽  
Cardiac Surgeon ◽  
Successful Collaboration

Objective Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues. Methods Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a “box” lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation. Results Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m2; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm. Conclusions Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.

Incidental Extracardiac Findings in Cardiac Computed Tomography Performed before Radiofrequency Ablation of Atrial Fibrillation

2011 ◽  
Vol 34 (12) ◽  
pp. 1665-1670 ◽  
Author(s):  
RAPHAËL PEDRO MARTINS ◽  
LUCIAN MURESAN ◽  
JEAN-MARC SELLAL ◽  
DAMIEN MANDRY ◽  
DENIS RÉGENT ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Cardiac Computed Tomography

scholarly journals Epicardial Unipolar Lead Loss of Ventricular Capture during Radiofrequency Ablation of Atrial Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Daniel J. Chu ◽  
Wilson W. Lam
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Case History ◽  
Pulse Generator ◽  
Persistent Atrial Fibrillation ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Cellular Changes ◽  
Unipolar Lead

Introduction. Abnormal pacemaker behavior can occur during radiofrequency ablation. The behaviors are varied and include loss of capture. The mechanisms in this context have not been well described in the literature. We describe a case of epicardial unipolar lead loss of ventricular capture during pulmonary vein isolation. Case History. A 48-year-old man with an epicardial dual chamber pacemaker and persistent atrial fibrillation presented for radiofrequency ablation (RFA) of his abnormal rhythm. During RFA, intermittent loss of ventricular capture was witnessed. Review of the device settings prior to and after the procedure showed an increase in ventricular threshold after the procedure. Loss of capture was shown to be dependent on location and RF energy delivered. It was independent of QTc and independent of local cellular changes that would increase threshold. Conclusion. We hypothesize the mechanism of loss of ventricular capture in this patient with an epicardial pacemaker with unipolar leads is related to intermittent shunt of voltage from the pulse generator to the grounding pad rather than the unipolar lead.

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