Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation

Abstract Background The major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV reconnection, and thicker wall could be associated with reconnection. Objectives This study aimed to evaluate the wall thickness of the PV antrum in reconnection sites using a three-dimensional (3D) wall thickness map. Methods A total of 91 patients who underwent a second ablation procedure due to AF recurrence were evaluated. The locations of the PV reconnection sites were confirmed in electroanatomical maps. A 3D atrial wall thickness (AWT) map was created using computed tomography scan data. The AWT values of the ablation lines of the index procedure were graded in each segment of the PV antrum: grade 1, 0.5 < AWT ≤ 1.0 mm; grade 2, 1.0 < AWT ≤ 1.5 mm; grade 3, 1.5 < AWT ≤ 2.0 mm; grade 4, 2.0 < AWT ≤ 2.5 mm; grade 5, AWT > 2.5 mm. Results A total of 281 PV reconnection sites among 1256 segments of the PV antrum in 79 patients were detected. The average AWT grades were 2.7 ± 1.0 and 2.2 ± 1.0 in the reconnected and non-reconnected segments, respectively (P < 0.01). Higher AWT grades were observed in the reconnected superior segments of the left superior PV, carina and inferior segments of the left inferior PV, superior and posterior segments of the right superior PV, and posterior and inferior segments of the right inferior PV. Conclusion The reconnected segments of the PV antrum showed thicker myocardium than the non-reconnected ones in patients with recurrent AF after catheter ablation. A wall thickness map for PV isolation could be considered for customized ablation in order to reduce PV reconnection.

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Heterogeneity in the left atrial wall thickness contributes to atrial fibrillation recurrence after catheter ablation

Heart and Vessels ◽

10.1007/s00380-018-1200-y ◽

2018 ◽

Vol 33 (12) ◽

pp. 1549-1558 ◽

Cited By ~ 6

Author(s):

Yosuke Nakatani ◽

Tamotsu Sakamoto ◽

Yoshiaki Yamaguchi ◽

Yasushi Tsujino ◽

Naoya Kataoka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Wall Thickness ◽

Left Atrial ◽

Atrial Fibrillation Recurrence ◽

Atrial Wall ◽

Left Atrial Wall

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Atrial Wall Thickness and Risk of Hemopericardium in Elderly Women After Catheter Ablation for Atrial Fibrillation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.009368 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Jae-Hyuk Lee ◽

Hee Tae Yu ◽

Oh-Seok Kwon ◽

Hee-Jin Han ◽

Tae-Hoon Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Wall Thickness ◽

Elderly Women ◽

Atrial Wall

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Catheter Ablation for Persistent Atrial Fibrillation: a Multicentre Randomised Trial of Pulmonary Vein Isolation (PVI) versus PVI with Posterior Left Atrial Wall Isolation (PWI) - the CAPLA Study

American Heart Journal ◽

10.1016/j.ahj.2021.09.015 ◽

2021 ◽

Author(s):

David Chieng ◽

Hariharan Sugumar ◽

Liang-Han Ling ◽

Louise Segan ◽

Sonia Azzopardi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Randomised Trial ◽

Persistent Atrial Fibrillation ◽

Atrial Wall ◽

Left Atrial Wall

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Image-Based Computational Evaluation of the Effects of Atrial Wall Thickness and Fibrosis on Re-entrant Drivers for Atrial Fibrillation

Frontiers in Physiology ◽

10.3389/fphys.2018.01352 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 14

Author(s):

Aditi Roy ◽

Marta Varela ◽

Oleg Aslanidi

Keyword(s):

Atrial Fibrillation ◽

Wall Thickness ◽

Atrial Wall ◽

Computational Evaluation

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659Left atrial wall thickness evaluation during atrial fibrillation redo procedures

EP Europace ◽

10.1093/europace/euaa162.239 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Teres ◽

D Soto ◽

B Jauregui ◽

D Penela ◽

A Ordonez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Wall Thickness ◽

Atrial Wall ◽

Ablation Procedure ◽

Left Atrial Wall ◽

Local Distance ◽

The Mean ◽

The Right ◽

The Relationship ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Dr Teres was funded by Swiss Heartrhythm Foundation Introduction pulmonary vein (PV) reconnections due to gaps on circumferential ablation lines are responsible for atrial fibrillation recurrences after catheter ablation. We sought to analyze the local left atrial wall thickness (LAWT) of PV line gaps at AF redo ablation during real-time catheter positioning. LAWT was measured on the MDCT 3D reconstruction and fused with the LA anatomy using CARTO-merge. Objective To analyze the relationship between local reconnection gaps and the LAWT during AF redo procedures. Methods Single-Center cohort study that included 41 consecutive patients referred for AF redo procedure. All patients had a MDCT prior to the ablation procedure. LAWT maps were semi-automatically computed from the MDCT as the local distance between the LA endo and epicardium. Each PV line was subdivided into 8 segments and mean LAWT was computed. During the procedure, the local gap was defined as the earliest activation site at the reconnected segment of the circumferential PV line (Figure 1A & 1B). Results 41 patients [31 (75.6%) male, age 60 ± 10 years] were included. Mean LAWT was 1.36 ± 0.20 mm. Mean PV circumferential line WT was higher in left PVs than in the right PVs 1.68 ± 0.57 vs. 1.31 ± 0.39 mm p < 0.001 respectively. Mean WT of the reconnected points was 44% higher than the mean WT of the segment where the reconnection was located. Mean reconnection point WT was at the 87th percentile of the circumferential line in the LPVs and at the 76th percentile in the RPVs. The reconnected point WT was higher in the LPVs than RPVs 2.13 ± 1.14 vs. 1.47 ± 0.48 mm p < 0.001 respectively. The most frequent location for reconnections was the left anterior carina (71%), with a mean WT of 2.24 ± 0.91mm; and the right anterior carina (56%) with a mean WT of 1.57 ± 0.62mm (Figure 2A & 2B). Conclusions Reconnection points were more frequently present in the thicker segments of the PV circumferential line. The most frequently reconnected segment was the anterior carina in both right and left PVs. Atrial wall thickness maps derived from MDCT are useful to guide AF redo procedures. Abstract Figure. 1) Activation & WT map; 2) Segment WT

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