Cryoballoon left atrial roof ablation for persistent atrial fibrillation ∼Analysis with high‐resolution mapping system∼

Author(s):  
Shinsuke Miyazaki ◽  
Kanae Hasegawa ◽  
Moe Mukai ◽  
Daisetsu Aoyama ◽  
Minoru Nodera ◽  
...  
EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1039-1047 ◽  
Author(s):  
Seigo Yamashita ◽  
Masateru Takigawa ◽  
Arnaud Denis ◽  
Nicolas Derval ◽  
Yuichiro Sakamoto ◽  
...  

Aims The circuit of pulmonary vein-gap re-entrant atrial tachycardia (PV-gap RAT) after atrial fibrillation ablation is sometimes difficult to identify by conventional mapping. We analysed the detailed circuit and electrophysiological features of PV-gap RATs using a novel high-resolution mapping system. Methods and results This multicentre study investigated 27 (7%) PV-gap RATs in 26 patients among 378 atrial tachycardias (ATs) mapped with Rhythmia™ system in 281 patients. The tachycardia cycle length (TCL) was 258 ± 52 ms with P-wave duration of 116 ± 28 ms. Three types of PV-gap RAT circuits were identified: (A) two gaps in one pulmonary vein (PV) (unilateral circuit) (n = 17); (B) two gaps in the ipsilateral superior and inferior PVs (unilateral circuit) (n = 6); and (C) two gaps in one PV with a large circuit around contralateral PVs (bilateral circuit) (n = 4). Rhythmia™ mapping demonstrated two distinctive entrance and exit gaps of 7.6 ± 2.5 and 7.9 ± 4.1 mm in width, respectively, the local signals of which showed slow conduction (0.14 ± 0.18 and 0.11 ± 0.10m/s) with fragmentation (duration 86 ± 27 and 78 ± 23 ms) and low-voltage (0.17 ± 0.13 and 0.17 ± 0.21 mV). Twenty-two ATs were terminated (mechanical bump in one) and five were changed by the first radiofrequency application at the entrance or exit gap. Moreover, the conduction time inside the PVs (entrance-to-exit) was 138 ± 60 ms (54 ± 22% of TCL); in all cases, this resulted in demonstrating P-wave with an isoelectric line in all leads. Conclusion This is the first report to demonstrate the detailed mechanisms of PV-gap re-entry that showed evident entrance and exit gaps using a high-resolution mapping system. The circuits were variable and Rhythmia™-guided ablation targeting the PV-gap can be curative.


EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii29-iii30
Author(s):  
S. Honarbakhsh ◽  
W. Ullah ◽  
E. Keating ◽  
G. Dhillon ◽  
M. Finlay ◽  
...  

2019 ◽  
Vol 55 (3) ◽  
pp. 287-295
Author(s):  
Arian Sultan ◽  
Barbara Bellmann ◽  
Jakob Lüker ◽  
Tobias Plenge ◽  
Jan-Hendrik van den Bruck ◽  
...  

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii297-iii297
Author(s):  
R. Shi ◽  
K. Viswanathan ◽  
L. Mantziari ◽  
C. Butcher ◽  
E. Lim ◽  
...  

Circulation ◽  
1993 ◽  
Vol 88 (2) ◽  
pp. 736-749 ◽  
Author(s):  
C Kirchhof ◽  
F Chorro ◽  
G J Scheffer ◽  
J Brugada ◽  
K Konings ◽  
...  

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Lisette van der Does ◽  
Ameetha Yaksh ◽  
Charles Kik ◽  
Paul Knops ◽  
Frans Oei ◽  
...  

Introduction: Multi-site, high-resolution mapping can be used to identify either the trigger or substrate perpetuating atrial fibrillation (AF). The goal of this study was to assess the feasibility and safety of a new high-resolution epicardial mapping approach. Hypothesis: Epicardial atrial mapping of the entire atria can be safely performed as a routine procedure during cardiac surgery. Methods: Epicardial mapping of the entire right atrium, left atrium and Bachmann’s Bundle was performed in 291 patients (218 male, age:66±11yrs) undergoing elective surgery during sinus rhythm (SR) and (induced) AF using high-resolution mapping arrays with inter-electrode distances of 1-2mm. Electrophysiological parameters were quantified and designated to anatomical quadrants of 1cm2. Results: AF was non-inducible in 36 patients. Hemodynamic parameters (mean arterial pressure, right atrial pressure, BIS score, ST-T segment alterations) before and during SR mapping were comparable (P<0.22). During AF, only mean arterial pressure (71±11 versus 67±10mmHg (P<0.004)) and right atrial pressure (10±4 versus 11±4mmHg (P<0.0001)) decreased. Total mapping time during SR or AF was respectively 3±1min. and 4±2min. Beat-to-beat variation of SR cycle length and peak-to-peak amplitude of unipolar potentials were respectively 0.04±14.42ms and -0.01±0.53mV, reflecting stability of the mapping array. Complications were not observed. Conclusions: Our novel intra-operative epicardial atrial mapping approach can be safely applied during both SR and AF. This mapping approach is the first technique allowing quantification of the arrhythmogenic substrate in the individual patient thereby taking the first step towards personalizing treatment of AF.


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