scholarly journals Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Seil Oh ◽  
Yoon Ha Joo ◽  
Euijae Lee ◽  
So-Ryoung Lee ◽  
Myung-Jin Cha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Wall Thickness ◽  
Three Dimensional ◽  
Atrial Wall ◽  
Grade 5 ◽  
Left Atrial Wall ◽  
Scan Data ◽  
Grade 3 ◽  
The Right

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.

659Left atrial wall thickness evaluation during atrial fibrillation redo procedures

EP Europace ◽  
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 &lt; 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 &lt; 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

Left atrial wall thickness of the pulmonary vein reconnection sites during atrial fibrillation redo procedures

2021 ◽  
Author(s):  
Cheryl Teres ◽  
David Soto‐Iglesias ◽  
Diego Penela ◽  
Beatriz Jáuregui ◽  
Augusto Ordoñez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
Pulmonary Vein Reconnection

scholarly journals Association between left atrial wall thickness and residual potential after pulmonary vein antral isolation in patients with atrial fibrillation receiving Ablation Index-guided ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.R Lee ◽  
E.J Lee ◽  
M.J Cha ◽  
E.K Choi ◽  
S Oh
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
Significant Difference ◽  
First Pass ◽  
Residual Potential

Abstract Background For the improvement of efficacy in radiofrequency catheter ablation (RFCA) of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF), fixed target Ablation Index (AI) value has been recommended regardless of individual and regional differences of left atrial wall thickness (LAWT). Objective To evaluate the association between LAWT and residual potential (RP) after first pass encirclement of PVI in AF patients receiving AI-guided PVI. Method A total of 116 patients (29% persistent AF) undergone AF RFCA using AI-guided PVI were included. Using SmartTouch catheter or SmartTouch SF catheter (Biosense Webster Inc., CA, US), point-by-point ablation was delivered at 30–40W on the anterior/roof segments and 25–30W on the posterior/inferior/carina segments. AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments. After first encirclement of PVI was performed, RP was evaluated. LAWT was evaluated by 3-dimensional wall thickness map using computed tomographic images. LAWT values of ablation regions were graded by LAWT in each segment of PV antrum (Figure). Results Among a total of 1564 PV segments, RP was observed in 106 segments (6.8%). Left superior, inferior PV ridges and right superior PV roof segments were the most, second, and third thickest area among 14 PV segments (mean LAWT grade 5.09±1.08, 3.34±1.70, and 2.32±1.11, respectively). Mean LAWT grade was lower in segments with RP than those in without RP (2.74±1.80 vs. 2.07±1.28, p&lt;0.001, Figure). In segments applied AI 450 (anterior/roof), segments with RP showed significantly thicker LAWT than those without RP (mean LAWT grade 3.65±2.01 vs. 2.57±1.56, p&lt;0.001). In posterior/inferior/carina segments applied AI 350, there was no significant difference in mean LAWT between segments with and without RP (1.80±0.77 vs. 1.75±0.83, p=0.744). Conclusion Delivering same AI during PVI, thicker LAWT was associated with higher incidence of RP after first pass encirclement of PV in anterior/roof area. Tailored AI should be considered by LAWT to improve acute outcome of PVI. LAWP RP Funding Acknowledgement Type of funding source: None

scholarly journals Correlation of left atrial wall thickness and atrial remodeling in atrial fibrillation

Medicine ◽  
2019 ◽  
Vol 98 (15) ◽  
pp. e15170 ◽  
Author(s):  
Kun Zuo ◽  
Kuibao Li ◽  
Min Liu ◽  
Jing Li ◽  
Xiaoqing Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Remodeling ◽  
Atrial Wall ◽  
Left Atrial Wall

1244Feasibility, safety and efficacy of tailoring ablation index to left atrial wall thickness (lawt) during atrial fibrillation ablation. The Ablate By-LAW Study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Teres ◽  
B Jauregui ◽  
D Soto-Iglesias ◽  
A Ordonez ◽  
A Chauca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Fibrillation Ablation ◽  
High Rate ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
First Pass ◽  
Catheter Stability

Abstract Funding Acknowledgements Dr Teres was funded by Swiss Heartrhythm Foundation Introduction Circumferential pulmonary vein isolation (PVI) has become a mainstay in the treatment of atrial fibrillation (AF). The utility of ablation index (AI) to dose radiofrequency delivery for the reduction of AF recurrences has already been proven with a target AI ≥ 400 at the posterior wall and ≥550 at the anterior Wall. Nevertheless, the left atrial wall is a thin, heterogeneous structure with an important inter and intra-patient variability of LAWT. Objective To determine if adapting AI to atrial wall thickness (AWT) is feasible, effective and safe during AF ablation. Methods Single-Center study that included 80 consecutive patients referred for a first paroxysmal AF ablation that was performed with a single catheter approach with the intention to reduce vascular access complication rate. 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. All procedures were performed under general anesthesia with a high-rate low-volume ventilation protocol for obtaining higher catheter stability. The transeptal puncture was TEE-guided. During the procedure, the WT map was fused with the LA anatomy using CARTO-merge. LAWT was categorized into 1mm-layers and the AI was titrated to the local atrial WT as follows: Thickness &lt; 1 mm (red): 300; 1-2 mm (yellow): 350; 2-3 mm (green): 400; 3-4 mm (blue): 450; &gt; 4 mm (purple): 450 (Figure). Maximal inter-lesion distance was set at 6 mm. VisiTag settings were: catheter position stability: minimum time 3 s, maximum range 4 mm; force over time: 25%, minimum force 3 g; lesion tag size: 3 mm. Respiration training was not possible due to the high catheter stability.  The circumferential ablation line was designed in a personalized fashion to avoid thicker regions. Results 80 patients [41 (51,2 %) male, age 60± 11 years] were included. Mean LVEF was 59 ± 5 %, Mean LA diameter 39,1 ± 5,8 mm, Mean LAWT was 1.36 ± 0.63 mm. Mean AI was 352 ± 36 on the RPVs and 356 ± 36 on the LPVs. Procedure time was 60,0 min (IQR 51-70). Fluoroscopy time was 58,5 s (35-97,5). First pass isolation was obtained in 72 (90%) of the RPVs and 75 (93,8%) of the LPVs. Conclusions the present study, assessing a novel, personalized protocol for radiofrequency titration during atrial fibrillation ablation, shows a high rate of first pass isolation with a lower need for RF energy delivery and lower procedure requirements, as compared to previous PV ablation protocols. Further studies are needed to evaluate the long-term results of this approach. Abstract Figure. LAWT-map Visitag points with tailored AI

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

EP Europace ◽  
2015 ◽  
Vol 18 (3) ◽  
pp. 376-383 ◽  
Author(s):  
Martin Bishop ◽  
Ronak Rajani ◽  
Gernot Plank ◽  
Nicholas Gaddum ◽  
Gerry Carr-White ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Wall Thickness ◽  
Three Dimensional ◽  
Atrial Wall
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