Benefit of ultra-high-density mapping-guided radiofrequency reablation in pulmonary vein isolation non-responders after initial cryoballoon procedure

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 906-915
Author(s):  
Florian Straube ◽  
Uwe Dorwarth ◽  
Stefan Hartl ◽  
Benedikt Brueck ◽  
Janis Pongratz ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Antiarrhythmic Drugs ◽  
High Density ◽  
Right Atrial ◽  
Atrial Arrhythmias ◽  
Electroanatomical Mapping ◽  
Septal Wall

Abstract Aims Symptomatic atrial arrhythmias despite complete pulmonary vein isolation (PVI) are common. The purpose was to evaluate ultra-high-density multi-electrode electroanatomical mapping-guided radiofrequency ablation (RFA) in PVI non-responders. Methods and results Ultra-high-density multi-electrode electroanatomical mapping-guided RFA in consecutive symptomatic atrial fibrillation (AF) patients after initial cryoballoon PVI was performed. Patients were included if all pulmonary veins (PVs) were still isolated. Radiofrequency targets were atrial tachycardia (AT), extra-PV trigger, and/or substrate. Procedural results and outcome were evaluated. Of 95 patients, 67 (70.5%) with complete PVI were included (70 years, CHA2DS2Vasc 2.9, left atrium 45 mm, persistent AF 45%, AT 45%). The median time to reablation was 26 months. One hundred and seven maps (1.6/patient) and 11.890 ± 9.018 electrograms were acquired in 33 ± 12 min. Twenty-eight percent of the left atrial (LA) wall showed pathological voltage signals, predominantly at the anterior (37%) and septal wall (26%). Atrial tachycardia (49 left, 4 right) were ablated in 35 patients (52%), extra-PV trigger in two patients (3%). One atrioventricular nodal re-entry tachycardia and seven right atrial isthmus ablation (10%) were performed. In 32 patients (48%), no AT was present and substrate-based ablation was performed. Mean LA area ablated was 7 ± 6 cm2 (7%). No major complication occurred. The mean follow-up time was 772 ± 317 days. Freedom from atrial arrhythmia recurrence off antiarrhythmic drugs was 49% at 12 months. Conclusion Pulmonary vein isolation non-responders are older, mainly suffering from complex atrial arrhythmias. Left atrial substrate is predominantly located at the anterior and septal wall. Ultra-high-density multi-electrode electroanatomical mapping-guided RFA is safe and effective. At 1 year, 5 out of 10 patients were in stable sinus rhythm off antiarrhythmic drugs.

The efficacy of class III D,L sotalol in treatment of left atrial tachycardia after pulmonary vein isolation

2009 ◽  
Vol 150 (36) ◽  
pp. 1694-1700 ◽  
Author(s):  
Attila Mihálcz ◽  
Csaba Földesi ◽  
Attila Kardos ◽  
Károly Ladunga ◽  
Tamás Szili-Török
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Class Iii

Pitvarfibrilláció miatt végzett pulmonalis vena izolációját követően a betegek egy részénél iatrogén bal pitvari tachycardia jelentkezik. Cél: A sotalolterápia hatásosságának összehasonlítása az 1C tip. propafenonnal szemben, a postablatiós arrhythmiák kezelésében. Módszer és eredmények: A vizsgálatba 75, pitvarfibrillációban szenvedő beteget (átlagéletkor 55,4 ± 7,14 év) választottunk, akiknél a pulmonalis vénák valódi elektromos izolálását végeztük. A beavatkozás során az elektromos izolációt körkörös multipoláris katéterrel ellenőriztük. Az ablatiót követően folytattuk az antiarrhythmiás terápiát még minimum 6 hétig, de célunk annak leépítése volt. Az utánkövetést 1, majd 3 havonta tervezett, ambuláns vizsgálatok alapján végeztük. A 12. hónap végén 67 betegnél tudtuk a protokoll szerint gyűjtött adatokat elemezni. 21 betegnél jelentkezett 3 hónapot követően tartósan bal pitvari tachycardia (31,3%). 11 beteg propafenon-, 4 beteg amiodaron- és 6 beteg sotalolterápiában részesült. Az első két csoportnál sotalolterápiára váltottunk, míg az utolsó csoportnál propafenonterápiát kezdtünk. A 12. hónap végére a sotalol hatásossága 80%, a propafenon hatásossága 20% volt. Következtetések: Adataink alapján PV-izolációt követően a sotalolterápia nem hatásosabb a bal pitvari tachycardiák megelőzésében, mint a propafenon. A 3 hónapon túl fellépő postablatiós bal pitvari tachycardiák kezelésében a sotalol hatásosabb, mint az IC-csoportba tartozó propafenon.

scholarly journals Left Atrial Tachycardia After Pulmonary Vein Isolation for Atrial Fibrillation

2005 ◽  
Vol 21 (5) ◽  
pp. 536-541
Author(s):  
Kenichi Hashimoto ◽  
Ichiro Watanabe ◽  
Masayoshi Kofune ◽  
Sonoko Ashino ◽  
Yasuo Okumura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Tachycardia

scholarly journals P829Bipolar voltage variability in left atrial ultra-high density 3D maps (Rhythmia) in patients undergoing pulmonary vein isolation

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i153-i153
Author(s):  
K Lackermair ◽  
S Kellner ◽  
L Riesinger ◽  
K Rizas ◽  
M F Sinner ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
High Density

Treatment of Sustained Left Atrial Tachycardia by Ostial Pulmonary Vein Isolation

2004 ◽  
Vol 27 (8) ◽  
pp. 1153-1157
Author(s):  
BENGT HERWEG ◽  
ARZU ILERCIL ◽  
DAVID M. WHITAKER ◽  
LYN HAMILTON ◽  
NADIM G. KHAN ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Tachycardia

Lower rate of left atrial tachycardia after pulmonary vein isolation with PVAC versus irrigated-tip circumferential antral ablation

Heart Rhythm ◽  
2016 ◽  
Vol 13 (8) ◽  
pp. 1596-1601 ◽  
Author(s):  
Kristina Wasmer ◽  
David Krüsemann ◽  
Patrick Leitz ◽  
Fatih Güner ◽  
Christian Pott ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Tachycardia

scholarly journals Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Shohreh Honarbakhsh ◽  
Richard J. Schilling ◽  
Malcolm Finlay ◽  
Emily Keating ◽  
Ross J. Hunter
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cycle Length ◽  
Atrial Tachycardia ◽  
Antiarrhythmic Drugs ◽  
Persistent Atrial Fibrillation ◽  
Unique Identifier ◽  
Long Term Follow Up

Background: A novel stochastic trajectory analysis of ranked signals (STAR) mapping approach to guide atrial fibrillation (AF) ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. Methods: This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF<2 years were included. Following pulmonary vein isolation AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30 seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or cycle length slowing ≥30 ms. Results: Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on pulmonary vein isolation, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.1 per patient) of which 70 were targeted with ablation (2.6±1.2 per patient). An ablation response was seen at 54 AFDs (77.1% of AFDs; 21 AF termination and 33 cycle length slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22 out of 27 (81.5%) patients undergoing STAR-guided ablation were free from AF/atrial tachycardia off antiarrhythmic drugs. Conclusions: STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/atrial tachycardia off antiarrhythmic drugs at long-term follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02950844.

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