Role of the Posterior Left Atrium and Pulmonary Veins in Human Lone Atrial Fibrillation

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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Nonpharmacologic management of atrial fibrillation: Role of the pulmonary veins and posterior left atrium

Heart Rhythm ◽

10.1016/j.hrthm.2009.07.030 ◽

2009 ◽

Vol 6 (12) ◽

pp. S5-S11 ◽

Cited By ~ 6

Author(s):

Kalyanam Shivkumar ◽

Eric Buch ◽

Noel G. Boyle

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Veins

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Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Journal of Clinical Medicine ◽

10.3390/jcm10143129 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3129

Author(s):

Riyaz A. Kaba ◽

Aziz Momin ◽

John Camm

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Pulmonary Veins ◽

Treatment Strategies ◽

Persistent Atrial Fibrillation ◽

Posterior Wall ◽

Cardiovascular Death ◽

Good Effect ◽

Complex Forms

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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The developing pulmonary veins and left atrium: implications for ablation strategy for atrial fibrillation†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezt098 ◽

2013 ◽

Vol 44 (5) ◽

pp. 792-799 ◽

Cited By ~ 13

Author(s):

Hisham M. F. Sherif

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Veins

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Abstract 4649: A Radiofrequency HOT Balloon Catheter for Isolating the Posterior Left Atrium Including All the Pulmonary Veins in the Treatment of Atrial Fibrillation: Feasibility and Safety of a New Approach

Circulation ◽

10.1161/circ.118.suppl_18.s_924-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hiroshi Sohara ◽

Shutaro Satake ◽

Hiroshi Takeda ◽

Hideki Ueno ◽

Toshimichi Oda

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Phrenic Nerve ◽

Pulmonary Veins ◽

Balloon Catheter ◽

Holter Monitoring ◽

Phrenic Nerve Palsy ◽

Total Procedure Time ◽

Successful Isolation

Atrial fibrillation (AF) is originated from mostly from pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (PLA). The present study was designed to evaluate the usefulness of a radiofrequency HOT balloon catheter (RBC) for isolation of the PLA including all PVs en masse in the patients with AF. In a total of 96 patients (75 men and 21 women; mean age 64±8 years old) with drug-resistant paroxysmal (n=63) and persistent AF(n=33), PLA including all PVs were ablated and isolated using RBC. Dragging the balloon, contiguous lesions at the roof between the superior PVs were first created, then each antrum of all PVs were ablated, and finally, contiguous lesions at the PLA between the both inferior PVs were made, while we performed monitoring esophagus temperature and phrenic nerve pacing. Electro-anatomical bipolar voltage amplitude mapping (CARTO) of the LA-PVs was performed to determine the extent of this electrical isolation after all procedure. Successful isolation of the PLA including all PVs was achieved in all of 96 cases with elimination of all the PLA and PV potentials. The mean total procedure time 133 ± 31 minutes including 32±9 minutes fluoroscopy time. Recurrences of AF were diagnosed by Holter monitoring, mobile electrocardiogram. After first session, eighty- seven (59 paroxysmal, 28 persistent) of 96 patients were free from AF without anti-arrhythmic drugs and the remaining patients could maintain sinus rhythm with anti-arrhythmic drugs except two cases with LA flutter during 11.0±4.1 months follow-up. No major complications such as cerebral embolism, PV stenosis, or phrenic nerve palsy, and LA-esophageal fistula were observed. Complete isolation of the PLA including all PVs using a RBC, is useful for the treatment of both paroxysmal and persistent AF without severe complication.

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P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽

10.1093/europace/euaa162.203 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A P Martin ◽

M Fowler ◽

N Lever

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Pulmonary Veins ◽

Posterior Wall ◽

The Novel ◽

Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated. Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

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