The role of pulmonary veins vs. autonomic ganglia in different experimental substrates of canine atrial fibrillation

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

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Role of Triggering Pulmonary Veins in the Maintenance of Sustained Paroxysmal Atrial Fibrillation

Pacing and Clinical Electrophysiology ◽

10.1111/pace.12121 ◽

2013 ◽

Vol 36 (7) ◽

pp. 845-854 ◽

Cited By ~ 5

Author(s):

VASSIL B. TRAYKOV ◽

RÓBERT PAP ◽

ZOLTÁN GINGL ◽

SZAMI CHADAIDE ◽

HARIS M. HAQQANI ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins

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Imaging of pulmonary veins during catheter ablation for atrial fibrillation: the role of multi-slice computed tomography

EP Europace ◽

10.1093/europace/eun230 ◽

2008 ◽

Vol 10 (Supplement 3) ◽

pp. iii14-iii21 ◽

Cited By ~ 12

Author(s):

H. Niinuma ◽

R. T. George ◽

A. Arbab-Zadeh ◽

J. A.C. Lima ◽

C. A. Henrikson

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Veins

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Prospective Randomized Clinical Trial of Wide Area Circumferential Pulmonary Vein Ablation versus Segmental Pulmonary Vein Ablation for Pulmonary Vein Isolation as a Treatment for Short-Duration Paroxysmal Atrial Fibrillation

10.22541/au.161196037.76727054/v1 ◽

2021 ◽

Author(s):

Sapan Bhuta ◽

Gustaf Sverin ◽

Hiro Kawata ◽

Malek Bashti ◽

Jessica Hunter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Wide Area ◽

Pulmonary Vein Ablation ◽

Total Procedure Time

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

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Evaluation of Left Atrial Anatomy and Function using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Medical Visualization ◽

10.24835/1607-0763-2017-5-39-55 ◽

2017 ◽

pp. 39-55 ◽

Cited By ~ 2

Author(s):

V. I. Gurina ◽

E. V. Kondrat’ev ◽

A. Sh. Revishvily ◽

M. Z. Alimurzaeva

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Veins ◽

Systemic Review ◽

Free Access ◽

Contrast Enhanced ◽

Review Reports ◽

And Function

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Сatheter ablation (CA) of arrhythmogenic foci is supposed to be an established treatment option for symptomatic patients with AF, refractory to antiarrhythmic therapy. Pre-procedural imaging is indispensable for the assessment of left atrium, pulmonary veins and adjacent anatomy, and facilitates selection of the ablation strategy to achieve an optimal result and minimize the risk of complications.Purpose: to evaluate the role of contrast-enhanced MDCT in patients with AF; also to present the prospects for further development of this method according to the systemic review of world research data.Materials and methods. 140 free access articles requested as “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial appendage” from 01.2009 until 01.2017 were analyzed in PubMed, as well as a number of Russianlanguage articles in eLibrary.Results.This literature review reports and systematizes available data on epidemiology and mechanisms of AF, represents current classification. In addition were analyzed advantages of MDCT over other methods of visualization while planning the CA and follow-up.Conclusion.MDCT is precise, effective and accessible option, which satisfies visualization requirements during the preparation for CA. Moreover, using MDCT in combination with electro-mapping systems increases safety and effectiveness of the procedure. In postoperative period MDCT can be used for complications diagnostic and results assessment.

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Coronary Sinus Ablation Is a Key Player Substrate in Recurrence of Persistent Atrial Fibrillation

Cardiology ◽

10.1159/000501819 ◽

2019 ◽

Vol 143 (3-4) ◽

pp. 107-113 ◽

Cited By ~ 2

Author(s):

Naseer Ahmed ◽

Shahida Perveen ◽

Adeela Mehmood ◽

Gulab Fatima Rani ◽

Giulio Molon

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Coronary Sinus ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Arrhythmogenic Substrate ◽

Electrophysiological Procedures ◽

Very High ◽

Insight Into

Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.

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Long-standing Persistent Atrial Fibrillation Ablation: the Role of the Inter- and Intra-atrial Bundles

Journal of Cardiac Arrhythmias ◽

10.24207/jca.v33i2.3368 ◽

2020 ◽

Vol 33 (2) ◽

pp. 73-81

Author(s):

Russell Mitchell ◽

Cesar Augusto Bonilla Isaza

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Outcomes ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Conduction System ◽

Atrial Fibrillation Ablation ◽

Anatomical Location

Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent and long standing persistent atrial fibrillation. In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.

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A Divergence-Based Approach for the Identification of Atrial Fibrillation Focal Drivers From Multipolar Mapping: A Computational Study

Frontiers in Physiology ◽

10.3389/fphys.2021.749430 ◽

2021 ◽

Vol 12 ◽

Author(s):

Michela Masè ◽

Alessandro Cristoforetti ◽

Maurizio Del Greco ◽

Flavia Ravelli

Keyword(s):

Atrial Fibrillation ◽

Vector Fields ◽

Computational Study ◽

Pulmonary Veins ◽

Proof Of Concept ◽

Activation Time ◽

Mapping Data ◽

Activation Patterns ◽

Novel Approach

The expanding role of catheter ablation of atrial fibrillation (AF) has stimulated the development of novel mapping strategies to guide the procedure. We introduce a novel approach to characterize wave propagation and identify AF focal drivers from multipolar mapping data. The method reconstructs continuous activation patterns in the mapping area by a radial basis function (RBF) interpolation of multisite activation time series. Velocity vector fields are analytically determined, and the vector field divergence is used as a marker of focal drivers. The method was validated in a tissue patch cellular automaton model and in an anatomically realistic left atrial (LA) model with Courtemanche–Ramirez–Nattel ionic dynamics. Divergence analysis was effective in identifying focal drivers in a complex simulated AF pattern. Localization was reliable even with consistent reduction (47%) in the number of mapping points and in the presence of activation time misdetections (noise <10% of the cycle length). Proof-of-concept application of the method to human AF mapping data showed that divergence analysis consistently detected focal activation in the pulmonary veins and LA appendage area. These results suggest the potential of divergence analysis in combination with multipolar mapping to identify AF critical sites. Further studies on large clinical datasets may help to assess the clinical feasibility and benefit of divergence analysis for the optimization of ablation treatment.

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The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review

ISRN Cardiology ◽

10.5402/2012/490674 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Bo He ◽

Benjamin J. Scherlag ◽

Hiroshi Nakagawa ◽

Ralph Lazzara ◽

Sunny S. Po

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Evidence ◽

Critical Role ◽

Pulmonary Veins ◽

Atrial Remodeling ◽

Success Rates ◽

Minimally Invasive Surgical ◽

Wolff Parkinson White Syndrome

The procedure of catheter ablation for the treatment of drug resistant atrial fibrillation (AF) has evolved but still relies on lesion sets intended to isolate areas of focal firing, mainly the myocardial sleeves of the pulmonary veins (PVs), from the rest of the atria. However the success rates for this procedure have varied inversely with the type of AF. At best success rates have been 20 to 30% below that of other catheter ablation procedures for Wolff-Parkinson-White syndrome, atrioventricular junctional re-entrant tachycardia and atrial flutter. Basic and clinical evidence has emerged suggesting a critical role of the ganglionated plexi (GP) at the PV-atrial junctions in the initiation and maintenance of the focal form of AF. At present the highest success rates have been obtained with the combination of PV isolation and GP ablation both as catheter ablation or minimally invasive surgical procedures. Various lines of evidence from earlier and more recent reports provide that both neurally based and myocardially based forms of AF can separately dominate or coexist within the context of atrial remodeling. Future studies are focusing on non-pharmacological, non-ablative approaches for the prevention and treatment of AF in order to avoid the substantive complications of both these regimens.

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