Nonlinear analysis of right atrial electrograms predicts termination of persistent atrial fibrillation within the left atrium by catheter ablation

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

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Left atrium electrical isolation as a complication of catheter ablation of persistent atrial fibrillation

Acta Cardiologica ◽

10.2143/ac.65.2.2047068 ◽

2010 ◽

Vol 65 (2) ◽

pp. 271-273 ◽

Cited By ~ 2

Author(s):

M. Ning ◽

J.-Z. Dong ◽

C.-S. Ma

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Persistent Atrial Fibrillation ◽

Electrical Isolation

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P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽

10.1093/europace/euaa162.089 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Kettering

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

Pulmonary Vein Ablation ◽

Group A ◽

Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (> 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

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Apparent foreign-body-like structure detected in the left atrium after catheter ablation for persistent atrial fibrillation

Biomedical Papers ◽

10.5507/bp.2018.052 ◽

2019 ◽

Vol 163 (2) ◽

pp. 184-186

Author(s):

Tomas Skala ◽

Ondrej Moravec ◽

Martin Hutyra ◽

Zbynek Tudos ◽

Martin Kocher ◽

...

Keyword(s):

Atrial Fibrillation ◽

Foreign Body ◽

Catheter Ablation ◽

Left Atrium ◽

Persistent Atrial Fibrillation

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Disparity Between Two-Dimensional Echocardiographic and Electroanatomic Left and Right Atrial Volumes in Patients Undergoing Catheter Ablation for Long-Standing Persistent Atrial Fibrillation

Physiological Research ◽

10.33549/physiolres.933314 ◽

2017 ◽

pp. 241-249 ◽

Cited By ~ 1

Author(s):

L. ŠKŇOUŘIL ◽

Š. HAVRÁNEK ◽

V. BULKOVÁ ◽

M. DORDA ◽

T. PALEČEK ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Control Strategies ◽

Persistent Atrial Fibrillation ◽

Right Atrial ◽

Atrial Remodeling ◽

Two Dimensional ◽

2D Echocardiography ◽

Absolute Bias ◽

Left And Right

Left atrial (LA) volume (LAV) is used for the selection of patients with atrial fibrillation (AF) to rhythm control strategies. Calculation of LAV from the LA diameters and areas by two-dimensional (2D) echocardiography may result in significant error. Accuracy of atrial volume assessment has never been studied in patients with long-standing persistent AF (LSPAF) and significant atrial remodeling. This study investigated correlation and agreement between 2D echocardiographic (Simpson method) and electroanatomic (CARTO, Biosense Webster) left and right atrial (RA) volumes (LAVECHO vs. LAVCARTO and RAVECHO vs. RAVCARTO) in patients undergoing catheter ablation for LSPAF. The study enrolled 173 consecutive subjects (females: 21 %, age: 59±9 years). There was only modest correlation between LAVECHO (92±31 ml) and LAVCARTO (178±37 ml) (R=0.57), and RAVECHO (71±29 ml) and RAVCARTO (173±34 ml) (R=0.42), respectively. LAVECHO and RAVECHO underestimated LAVCARTO and RAVCARTO with the absolute bias (±1.96 standard deviation) of -85 (-148; -22) ml and -102 (-169; -35) ml, respectively, and with the relative bias of -48 (-75; -21) % and -59 (-88; -30) %, respectively (all P<0.000001 for their mutual difference). Significant confounders of this difference were not identified. In patients with LSPAF, 2D echocardiography significantly underestimated both LA and RA volumes as compared with electroanatomic reference. This disagreement was independent of clinical, echocardiographic and mapping characteristics.

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P979Persistent atrial fibrillation terminated within the left atrium without recurrence at follow-up demonstrates a gradual intracardiac organization during stepwise ablation

European Heart Journal ◽

10.1093/eurheartj/ehz747.0572 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Pithon ◽

A Luca ◽

A Buttu ◽

J M Vesin ◽

L Roten ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Persistent Atrial Fibrillation ◽

Right Atrial ◽

Linear Ablation ◽

The Right ◽

Dominant Frequencies ◽

Complex Fractionated Atrial Electrograms

Abstract Introduction We previously reported that patients (pts) with recurrence (Rec) after stepwise catheter ablation (step-CA) of persistent atrial fibrillation (pAF) exhibit high bi-atrial intracardiac dominant frequencies (DF) values before ablation, indicative of a severe bi-atrial electro-anatomical remodeling. Purpose Herein, we hypothesized that a gradual decrease in DF values during step-CA is associated with pAF termination and maintenance of sinus rhythm (SR) on the long term. Method In 40 consecutive pts (61±8 yo, sustained AF duration 19±11 months), pulmonary vein isolation (PVI) and left atrium (LA) ablation were performed until pAF termination or cardioversion. 10-sec intracardiac electrograms (EGMs) epochs were recorded before ablation (BL), during PVI and during complex fractionated atrial electrograms (CFAEs) and linear ablation (post_PVI) in the right atrial (RAA) and left atrial (LAA) appendages and in the coronary sinus (CS). DF was defined as the highest peak within the [3–15] Hz EGM spectrum. Rec was defined as any atrial arrhythmia lasting >30 sec during follow-up (FU). Results pAF was terminated within the LA in 70% (28/40, LT) of the pts, while 30% (12/40, NLT) were not. After a mean FU of 34±14 months, all NLT pts had a Rec, while LT pts presented a Rec in 71% (20/28, LT_rec) and remained in SR in 29% (8/28, LT_norec). Figure 1 shows: 1) a gradient in DF values measured in the LAA (panel A), RAA (panel B) and CS (panel C) with the highest values in NLT pts (red), intermediate values in LT_rec pts (yellow) and lowest DF values in LT_norec pts (green); 2) all three groups displayed a gradual intracardiac organization during LA ablation as shown by decreasing DF values (p<0.05, BL vs post_PVI), but the LT_norec pts (green) exhibited the highest relative changes in DF from BL (p<0.05, LT_norec vs NLT, Δ range: −5.31 to −9.69%). Figure 1. Effect of ablation on DF Conclusion Low DF values before ablation and gradual intracardiac organization until pAF termination are associated with maintenance of SR on the long term.

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