Pulmonary Veins to Left Atrium Cycle Length Gradient Predicts Procedural and Clinical Outcomes of Persistent Atrial Fibrillation Ablation

Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent and long standing persistent atrial fibrillation. In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.

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Evaluation of a new approach for persistent atrial fibrillation: Ablation index-guided pulmonary veins isolation with contiguous lesions

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.176 ◽

2019 ◽

Vol 11 (1) ◽

pp. 80

Author(s):

P. Taghji ◽

Sok-Sithikun Bun ◽

B. Enache ◽

Decebal Gabriel Latcu ◽

N. Saoudi

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

New Approach ◽

Ablation Index

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Impact of baseline atrial fibrillation cycle length on acute and long-term outcome of persistent atrial fibrillation ablation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-014-9927-6 ◽

2014 ◽

Vol 41 (3) ◽

pp. 253-259 ◽

Cited By ~ 3

Author(s):

S. Ammar ◽

G. Hessling ◽

M. Paulik ◽

T. Reents ◽

R. Dillier ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cycle Length ◽

Persistent Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

Term Outcome ◽

Long Term Outcome

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Image-Integration of Intraprocedural Rotational Angiography-Based 3D Reconstructions of Left Atrium and Pulmonary Veins into Electroanatomical Mapping: Accuracy of a Novel Modality in Atrial Fibrillation Ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2009.01615.x ◽

2010 ◽

Vol 21 (3) ◽

pp. 278-283 ◽

Cited By ~ 19

Author(s):

GEORG NÖLKER ◽

STEFAN ASBACH ◽

KLAUS J. GUTLEBEN ◽

HARALD RITTGER ◽

GUIDO RITSCHER ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Veins ◽

Atrial Fibrillation Ablation ◽

Electroanatomical Mapping ◽

Rotational Angiography ◽

Image Integration ◽

Mapping Accuracy ◽

3D Reconstructions

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Abstract 16896: Electrogram Morphology Recurrence to Characterize Drivers of Persistent Atrial Fibrillation: Findings at Initial versus Redo Catheter Ablation

Circulation ◽

10.1161/circ.142.suppl_3.16896 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ghaith Zaatari ◽

Jorge Bohorquez ◽

Raul Mitrani ◽

Jason Ng ◽

Justin Ng ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Cycle Length ◽

Cross Correlation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Success Rates ◽

Mapping Tool ◽

Group 2 ◽

Group 1

Background: Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (PeAF) quantifies consistency of activation at each site and is expected to be high and rapid near drivers of PeAF. Objective: To compare EMR in the left (LA) and right atrium (RA) in patients undergoing first- vs second-time PeAF catheter ablation (CA). Methods: Multisite bipolar EGM mapping of the LA (265±153 sites) and RA (224±148 sites) prior to CA for PeAF was performed in 40 patients (29 males, age 63±9 yrs, CHA2DS2-VASc 2.4±1.5, LVEF 48±12%) undergoing first (Group 1, n=31) or second-time (Group 2, n=9) CA. After cross-correlation of each automatically detected EGM with every other EGM in the recording, the most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CL R ) were computed (figure). The minimum CL R sites were identified. Results: In group 1, shortest CL R was in the LA in 26 patients (84%) and RA in 5 patients (16%). In the LA, there were 1 (n=23), 2 (n=2), or 3 (n=1) areas of shortest CL R , most commonly in the pulmonary veins (PV; n=19). In the RA, there was only 1 area of shortest CL R . Minimum CL R was 174.1±25.4 ms (LA-179.6±37.4 vs RA-207.9±34.5, p=0.0004), with Rec% 95±10%. In group 2, shortest CL R was in the LA in 5 patients and RA in 5 patients (56%)– one had both LA and RA. In the LA/RA, there were 1 (n=3/4) or 2 (n=2/1) areas of shortest CL R . The most common LA site was non-PV (6/7, 85.7%). The minimum CL R was 182.1±26.2ms (LA-190.8±36.2 vs RA-196.0±30.5, p=0.6), with Rec% 96±5%. Conclusion: In 61% of patients undergoing initial CA for PeAF, EMR identified LA drivers in the PVs which may explain why PV isolation has been reported to have 50-60% success rates in PeAF. In patients undergoing a 2 nd ablation for PeAF, EMR identified predominantly nonPV drivers with even distribution of shortest CL R between RA and LA and diminished CL R gradient between the LA and RA. EMR may be a useful mapping tool to characterize potential drivers of PeAF.

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