Abstract 12471: Optimal Prediction of Atrial Fibrillation Recurrence After Ablation: A Computational Anatomy Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marta Varela ◽  
Felipe Bisbal ◽  
Ernesto Zacur ◽  
Esther Guiu ◽  
Antonio Berruezo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Complete Characterization ◽  
Statistical Shape Model ◽  
Patient Specific ◽  
Shape Variation ◽  
Global Features ◽  
Linear Discriminant ◽  
Af Ablation ◽  
Statistical Shape

Background: Left atrial structural remodelling, assessed by left atrial (LA) sphericity or antero-posterior diameter, has been shown to predict recurrence after atrial fibrillation (AF) ablation. The study aimed to perform a computational shape analysis of the LA to quantitatively characterise the LA shape remodelling process and identify metrics that optimally predict recurrence. Methods: Pre-procedural bright-blood MRIs of the LA of patients undergoing AF ablation were segmented. Patient-specific smooth 3D meshes were fitted to the segmentations. A statistical shape model of the LA was created and the global features underpinning the observed shape variation extracted as principal components (PCs). PCs were optimally combined to create non-empirical atlas-based metrics using linear discriminant analysis. Meshes depicting mean and extreme recurrent and non-recurrent LA shapes were also synthetized. The capability of different metrics to predict recurrence was evaluated using the area under the ROC curve (AUC) of a leave 1 out cross validation test. Results: In total, 111 patients were included. At 12 months follow-up, LA sphericity was the best predictor of recurrence (AUC: 0.66) over novel atlas-based metrics (AUC: 0.65). At 24 months, atlas-based metrics were the best predictors of recurrence (AUC: 0.66), outperforming a combination of sphericity and volume (AUC: 0.64), sphericity alone (AUC: 0.63) and any other traditional metric. Conclusions: Novel atlas-based metrics improve the prediction of recurrence at 2 years post-AF ablation. They allow a more complete characterization of the LA shape remodelling process, for example by allowing the synthesis of recurrent and non-recurrent LA shapes, which may contribute to patient stratification for AF ablation.

scholarly journals The Association of Pre-Existing Left Atrial Fibrosis with Clinical Variables in Patients Referred for Catheter Ablation of Atrial Fibrillation

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15036 ◽  
Author(s):  
Jane Dewire ◽  
Irfan M. Khurram ◽  
Farhad Pashakhanloo ◽  
David Spragg ◽  
Joseph E. Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Af Ablation ◽  
Group 4 ◽  
Significant Difference ◽  
History Of ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Left Atrial Fibrosis

Introduction Atrial fibrillation (AF) recurrence after ablation is associated with left atrial (LA) fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI). We sought to determine pre-ablation, clinical characteristics that associate with the extent of LA fibrosis in patients undergoing catheter ablation for AF. Methods and Results Consecutive patients presenting for catheter ablation of AF were enrolled and underwent LGE-MRI prior to initial AF ablation. The extent of fibrosis as a percentage of total LA myocardium was calculated in all patients prior to ablation. The cohort was divided into quartiles based on the percentage of fibrosis. Of 60 patients enrolled in the cohort, 13 had <5% fibrosis (Group 1), 15 had 5-7% fibrosis (Group 2), 17 had 8-13% fibrosis (Group 3), and 15 had 14-36% fibrosis (Group 4). The extent of LA fibrosis was positively associated with time in continuous AF, and the presence of persistent or longstanding persistent AF. However, no statistically significant difference was observed in the presence of comorbid conditions, age, BMI, LA volume, or family history of AF among the four groups. After adjusting for diabetes and hypertension in a multivariable linear regression model, paroxysmal AF remained independently and negatively associated with the extent of fibrosis (-4.0 ± 1.8, P = 0.034). Conclusion The extent of LA fibrosis in patients undergoing AF ablation is associated with AF type and time in continuous AF. Our results suggest that the presence and duration of AF are primary determinants of increased atrial LGE.

scholarly journals Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium

2021 ◽  
Author(s):  
Jolien Neefs ◽  
Robin Wesselink ◽  
Nicoline W. E. van den Berg ◽  
Jonas S. S. G. de Jong ◽  
Femke R. Piersma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Antiarrhythmic Drugs ◽  
Primary Outcome ◽  
Volume Index ◽  
Substantial Part ◽  
Atrial Tachyarrhythmia ◽  
Af Ablation ◽  
Male Patients

Abstract Purpose Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA. Methods Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m2. Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up. Results At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4–62.8] ml/m2), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m2). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8–49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8–47.4 in a combined group of GLA and/or female sex(log rank p = 0.02). Conclusion Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.

Multiple peripheral embolisation following left atrial MAZE procedure for atrial fibrillation (AF) ablation

2008 ◽  
Vol 19 (1) ◽  
pp. 71-72
Author(s):  
Sagar Saha ◽  
Martin Lowe ◽  
Clare Dollery
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Maze Procedure ◽  
Af Ablation

STROKE RATES ASSOCIATED WITH METHODS OF SURGICAL LEFT ATRIAL APPENDAGE EXCLUSION (LAAE) DURING CONCOMITANT ATRIAL FIBRILLATION (AF) ABLATION

2019 ◽  
Vol 73 (9) ◽  
pp. 391
Author(s):  
Marc W. Gerdisch ◽  
Patrick McCarthy ◽  
Glenn Barnhart ◽  
Jonathan Philpott ◽  
Mubashir Mumtaz
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Af Ablation

Probabilistic Study of a Lumbar Motion Segment: Sensitivity of Kinematics to Material and Anatomical Variability

2011 ◽  
Author(s):  
Kelli S. Barnes ◽  
Jeffrey R. Armstrong ◽  
Amit Agarwala ◽  
Anthony J. Petrella
Keyword(s):  
Statistical Shape Model ◽  
Single Subject ◽  
Shape Variation ◽  
Shape Model ◽  
Probabilistic Simulation ◽  
Motion Segment ◽  
Biomechanical Simulation ◽  
Statistical Shape ◽  
Probabilistic Study ◽  
Lumbar Motion

Finite element modeling of the lumbar spine has advanced significantly in the last decade [1] and become a relatively well established method for examining fundamental biomechanics as well as new spinal implants and procedures. However, most of these models only represent a single subject and do not account for normal subject-to-subject variation. This limitation can be addressed using a probabilistic simulation in which virtual specimens are used to represent a broad population of subjects. The greatest challenge to implementing probabilistic techniques in biomechanical simulation is parameterization of anatomy to capture normal variation across subjects. In the present study, shape variation was captured using a statistical shape model (SSM) and implemented in a probabilistic framework to evaluate biomechanics of a single motion segment. The Monte Carlo (MC) method is a common probabilistic simulation technique that is robust even for non-monotonic or highly non-linear systems. The purpose of this study was to perform a probabilistic study of a lumbar motion segment using MC simulation to determine the sensitivity of spinal rotations to changes in geometry and soft tissue material properties.

scholarly journals The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine

Cardiology ◽  
2016 ◽  
Vol 135 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Peng Liu ◽  
Rijing Liu ◽  
Yan Zhang ◽  
Yingfeng Liu ◽  
Xiaoming Tang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
3D Printing ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
3D Models ◽  
Atrial Appendage ◽  
Patient Specific ◽  
The Real ◽  
Echocardiographic Image

Aims and Objectives: The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Background: Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Methods: Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to ‘Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. Results: We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the presence of a peridevice leak. Conclusions: 3D printing of the LAA using real-time 3D transesophageal echocardiographic data has a perfect and rapid application in LAA occlusion to assist with physician planning and decision making.

scholarly journals Transition from Transesophageal Echocardiography to Cardiac Computed Tomography for the Evaluation of Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation and Incidence of Cerebrovascular Events During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Tauseef Akhtar ◽  
Ryan Wallace ◽  
Usama Daimee ◽  
Erica Hart ◽  
Armin Arbab-Zadeh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Ct Imaging ◽  
Atrial Appendage ◽  
Af Ablation ◽  
Cerebrovascular Events

Background Transesophageal echocardiography (TEE) is variably performed before atrial fibrillation (AF) ablation to evaluate left atrial appendage (LAA) thrombus. We describe our experience with transitioning to the pre-ablation cardiac computed tomography (CT) approach for the assessment of LAA thrombus during the COVID-19 pandemic. Methods We studied consecutive patients undergoing AF ablation at our center. The study cohort was divided into pre- vs. post-COVID groups. The pre-COVID cohort included ablations performed during 1 year before the COVID-19 pandemic; pre-ablation TEE was used routinely to evaluate LAA thrombus in high-risk patients. Post-COVID cohort included ablations performed during the 1 year after the COVID-19 pandemic; pre-ablation CT was performed in all patients, with TEE performed only in patients with LAA thrombus by CT imaging. The demographics, clinical history, imaging, and ablation characteristics, and peri-procedural cerebrovascular events (CVE) were recorded. Results A total of 637 patients (pre-COVID n=424, post-COVID n=213) were studied. The mean age was 65.6  10.1 years in the total cohort, and the majority were men. There was a significant increase in pre-ablation CT imaging from pre to post-COVID cohort (74.8 vs. 93.9%, p=<0.01), with a significant reduction in TEEs (34.6 vs. 3.7%, p=<0.01). One patient in the post-COVID cohort developed CVE following negative pre-ablation CT. However, the incidence of peri-procedural CVE between both cohorts remained statistically unchanged (0 vs. 0.4%, p=0.33). Conclusion Implementation of pre ablation CT-only imaging strategy with selective use of TEE for LAA thrombus evaluation is not associated with increased CVE risk during the COVID- 19 pandemic.

Relationship Between Lateral Patellar Stability and Tibial Tubercle Location for Varying Patellofemoral Geometries

2019 ◽  
Vol 141 (12) ◽  
Author(s):  
Allison L. Clouthier ◽  
Daniel Borschneck ◽  
Darryl G. Thelen ◽  
Kevin J. Deluzio ◽  
Michael J. Rainbow
Keyword(s):  
Patellar Instability ◽  
Groove Depth ◽  
Statistical Shape Model ◽  
Patient Specific ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Statistical Shape ◽  
Tendon Insertion ◽  
The Impact ◽  
Patellar Stability

Abstract The geometry of the patellofemoral joint affects function and pathology. However, the impact of trochlear groove depth on treatments for patellar instability and pain is not clear. Tibial tubercle osteotomy is a common surgical intervention for patellar instability where the tibial insertion of the patellar tendon (PT) is translated to align the extensor mechanism and stabilize the joint. The aim of this work was to investigate the interaction between trochlear groove depth and PT insertion and their effect on patellar stability. Patellofemoral geometry was modified based on a statistical shape model to create knees with a range of trochlear groove depths. A Monte Carlo approach was used and 750 instances of a musculoskeletal model were generated with varying geometry and anterior and medial transfer of the PT. Stability was assessed by applying a lateral perturbation force to the patella during simulation of overground walking. In knees with deep trochlear grooves, a medialized PT increased stability. However, in knees with shallow trochlear grooves, stability was maximized for tendon insertion ∼1 mm medial to its neutral location. This PT insertion also corresponded to the best alignment of the patella in the trochlear groove in these knees, indicating that good alignment may be important to maximizing stability. Anterior PT transfer had minimal effect on stability for all geometries. A better understanding of the effects of articular geometry and tubercle location on stability may aid clinicians in patient-specific surgical planning.

scholarly journals The Predictive Value of PRECISE-DAPT Score for the Thrombogenic Milieu in Left Atrium and Left Atrial Appendix in the Patients with Atrial Fibrillation Planned AF Ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.C Konte ◽  
E.H Cetin ◽  
M.B Ozbay ◽  
N.M Yaman ◽  
O Ozeke ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Independent Predictor ◽  
Critical Role ◽  
Multivariate Logistic Regression Analysis ◽  
Roc Curves ◽  
Risk Indicators ◽  
Thromboembolic Risk ◽  
Af Ablation

Abstract Introduction and aim Atrial fibrillation (AF) is the most common arrhythmia in the clinical practice. In AF patients, the assessment of thromboembolic risk and the initiation of anticoagulant therapy to appropriate patients play critical role in management of these patients. Current guidelines recommend to use CHA2DS2VASC score in evaluation of thromboembolic risk. However, the effectiveness of this score has been questioned recently. This situation requires new risk indicators. Although PRECISE-DAPT score was initially constituted to determine the duration of dual antiplatelet therapy in patients with PCI, current studies have reported that this score may also predict thrombotic events. In this study, we aimed to evaluate the effectiveness of PRECISE-DAPT score to predict thrombogenic milieu by comparing with CHA2DS2VASC score in non valvular AF patients whom referred TEE before AF ablation procedure. Method 428 patients were included in the study. The presence of grade 2–3 SEC and thrombus in left atrium and/or left atrial appendage were accepted as thrombogenic milieu. The patients were divided into two groups according to the presence of thrombogenic milieu. In addition, we constituted three groups as grade 0–1 SEC group, grade 2–3 SEC group and thrombus group to evaluate the parameters in detail. Results Grade 2–3 SEC was found in 36 patients and thrombus was detected in 24 patients. 60 patients was included to the thrombogenic positive (artı) group while 368 patients was included to thrombogenic milieu (−) group. PRECISE-DAPT and CHA2DS2VASC scores were higher in thrombogenic positive (artı) group In multivariate logistic regression analysis, PRECISE-DAPT score was found to be an independent predictor of thrombogenic milieu (OR: 1.145, CI:1.083–1.211, p&lt;0,001). The comparison of ROC curves was shown that PRECISE DAPT score was higher area under curve than CHA2DS2VASC score, 0,753 and 0,649 respectively. Conclusion In our study, in patients performed TEE before AF ablation, PRECISE-DAPT score was found to be an independent predictor for thrombogenic milieu presented as high grade SEC and thrombus, there by thromboembolic risk. PRECISE-DAPT score seems to be more effective than CHA2DS2VASC score. In AF patients, PRECISE-DAPT score may provide additional benefit in assessment of thromboembolic risk, thus enabling a more individual and accurate anticoagulation decision in these patients. Funding Acknowledgement Type of funding source: None

The three-dimensional shape symmetry of the lunate and its implications

2021 ◽  
pp. 175319342110040
Author(s):  
Nazlı Tümer ◽  
Olivier Hiemstra ◽  
Yvonne Schreurs ◽  
Gerald A. Kraan ◽  
Johan van der Stok ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Three Dimensional ◽  
Dorsal Side ◽  
Statistical Shape Model ◽  
Patient Specific ◽  
Shape Model ◽  
Patient Specific Implants ◽  
Statistical Shape ◽  
Dimensional Shape ◽  
Three Dimensional Shape

We studied the three-dimensional (3-D) shape variations and symmetry of the lunate to evaluate whether a contralateral shape-based approach to design patient-specific implants for treatment of Kienböck’s disease is accurate. A 3-D statistical shape model of the lunate was built using the computed tomography scans of 54 lunate pairs and shape symmetry was evaluated based on an intraclass correlation analysis. The lunate shape was not bilaterally symmetrical in (1) the angle scaphoid surface – radius-ulna surface, (2) the dorsal side and the length of the side adjacent to the triquetrum, (3) the orientation of the volar surface, (4) the width of the side adjacent to the scaphoid, (5) the skewness in the coronal plane and (6) the curvature of bone articulating with the hamate and capitate. These findings suggest that using the contralateral lunate to design patient-specific lunate implants may not be as accurate as it is intended.

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