The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation

2020 ◽  
Vol 16 (2) ◽  
pp. 135-144 ◽  
Author(s):  
Zsuzsanna Kis ◽  
Astrid Amanda Hendriks ◽  
Taulant Muka ◽  
Wichor M. Bramer ◽  
Istvan Kovacs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Imaging Modality ◽  
Final Analysis ◽  
Atrial Fibrosis ◽  
Atrial Wall ◽  
Af Ablation ◽  
Left Atrial Wall ◽  
Cmr Imaging

Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

scholarly journals 233 Concomitant Surgical Atrial Fibrillation Ablation Follow-Up Against Best-Practice Standards at A Tertiary Cardiac Surgery Centre in Brighton

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Singh ◽  
A Hussain ◽  
G Kugan ◽  
Michael Lewis
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Best Practice ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Final Analysis ◽  
Outcome Data ◽  
Af Ablation ◽  
Practice Standards

Abstract Introduction Best-practice as per JCTVS 2006 meta-analysis recommends following patients who undergo concomitant surgical Atrial Fibrillation (AF) ablation at 3-months, 1, 2 and 3 years to ensure AF resolution. A dedicated nurse-led arrythmia clinic managed these patients at Royal Sussex County Hospital (RSCH), Brighton but was relinquished. Follow-up was incorporated into routine cardiothoracic/cardiology clinics. This audit compares current practice at RSCH against best-practice (JCTVS). Method Patients who underwent surgical AF ablation between 2016-2017 at RSCH notes were interrogated for demographic, clinical and outcome data. Survival, freedom from AF at 3-years and post-operative anticoagulation/rate-control medications at follow-up data were extracted. Results Sixty-two patients underwent surgical AF ablation; 21 were followed up locally at RSCH and included in the final analysis. 53% had post-surgical AF resolution. At 3-years, 48% were free from AF; all patients survived. Only 38% patients had 4 follow-up appointments as per best-practice standards. 62% and 66% continued anticoagulation and rate-control medications, respectively. Conclusions Best-practice standards were poorly met. Patients inappropriately followed-up could incur severe AF-related complications including longer hospital stay, treatment and poorer quality of life. A nurse-led arrhythmia clinic can prevent AF-related hospital admissions and sequalae by ensuring cost-effective review, optimal anticoagulation, and rate/rhythm control.

The role of chronic atrial stretch and atrial fibrillation on posterior left atrial wall conduction

Heart Rhythm ◽  
2009 ◽  
Vol 6 (8) ◽  
pp. 1109-1117 ◽  
Author(s):  
Kurt C. Roberts-Thomson ◽  
Irene Stevenson ◽  
Peter M. Kistler ◽  
Haris M. Haqqani ◽  
Steven J. Spence ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Wall ◽  
Left Atrial Wall

scholarly journals Role of Magnetic Resonance Imaging of Atrial Fibrosis in Atrial Fibrillation Ablation

2013 ◽  
Vol 2 (2) ◽  
pp. 124 ◽  
Author(s):  
David D Spragg ◽  
Irfan Khurram ◽  
Saman Nazarian ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Atrial Fibrosis ◽  
Complex Interplay ◽  
Af Ablation ◽  
Atrial Electrophysiology ◽  
Arrhythmogenic Substrate ◽  
Derived Data

Atrial fibrillation (AF) likely involves a complex interplay between triggering activity, usually from pulmonary vein foci, and maintenance of the arrhythmia by an arrhythmogenic substrate. Both components of AF, triggers and substrate have been linked to atrial fibrosis and attendant changes in atrial electrophysiology. Recently, there has been a growing use of imaging modalities, particularly cardiac magnetic resonance (CMR), to quantify the burden of atrial fibrosis and scar in patients either undergoing AF ablation, or who have recently had the procedure. How to use the CMR derived data is still an open area of investigation. The aim of this article is to summarise what is known as atrial fibrosis, as assessed by traditional catheter-based techniques and newer imaging approaches, and to report on novel efforts from our group to advance the use of CMR in AF ablation patients.

scholarly journals Personalized atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness. the ablate by-law single center study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Teres ◽  
D Penela ◽  
D Soto-Iglesias ◽  
B Jauregui ◽  
A Ordonez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Wall Thickness ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Procedure Time ◽  
Atrial Wall ◽  
Af Ablation ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
First Pass

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Teres is funded by the research fellowship grant from the Swiss Heart Rhythm Foundation, Dr Carreno was funded was funded by a Scholarship from Sociedad Española de Cardiología (SEC). Introduction Left atrial wall thickness (LAWT) is a determinant of transmural lesion formation during atrial fibrillation (AF) ablation. The utility of ablation index (AI) to dose radiofrequency (RF) 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. Objective To determine if adapting AI to atrial wall thickness (AWT) is feasible, effective and safe during AF ablation. Methods Consecutive patients referred for a first PAF ablation. LAWT 3D-maps were obtained from multidetector computed tomography (MDCT) and integrated into the CARTO navigation system. LAWT maps were semi-automatically computed from the MDCT as the local distance between the LA endo and epicardium and categorized into 1mm-layers and AI was titrated to the LAWT, as follows: Thickness < 1 mm (red): 300; 1-2 mm (yellow): 350; 2-3 mm (green): 400; 3-4 mm (blue): 450; > 4 mm (purple): 450 (Figure). The ablation line was designed in a personalized fashion to avoid thicker regions. All ablation procedures were performed under general anesthesia with a high frequency low-volume ventilation. Primary endpoints were acute efficacy and safety, and freedom from AF recurrences. Follow-up (FU) was scheduled at 1, 3, 6, and every 6 months thereafter. Results 90 patients [60 (67 %) male, age 58 ± 13 years] were included. Mean LAWT was 1.25 ± 0.62 mm. Mean AI was 366 ± 26 on the right pulmonary veins (RPVs) with a first-pass isolation in 84 (93%) patients and 380 ± 42 on the left pulmonary veins (LPVs) with first-pass in 87 (97%). Procedure time was 59 min [49-66]; RF time 14 min [12,5-16]; fluoroscopy time 0.7 min [0.5-1.4]. No major complication occurred. Eighty-six out of 90 (95.5%) patients were free of recurrence after a mean FU of 11 ± 4 months. Conclusions  Personalized AF ablation, adapting the AI to LAWT allowed decreasing RF delivery, fluoroscopy and procedure time while obtaining a high rate of first-pass isolation. Lesion durability as estimated by freedom from AF recurrences was as high as in more demanding ablation protocols. Abstract Figure. Personalized protocol and results

scholarly journals Role of imaging in assessment of atrial fibrosis in patients with atrial fibrillation: state-of-the-art review

2013 ◽  
Vol 15 (1) ◽  
pp. 1-5 ◽  
Author(s):  
L. Longobardo ◽  
M. C. Todaro ◽  
C. Zito ◽  
M. C. Piccione ◽  
G. Di Bella ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
State Of The Art ◽  
Atrial Fibrosis

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 < 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 < 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

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.

scholarly journals Role of multidetector computed tomography in evaluation of abdominal trauma in Sothern Rajasthan, India

2019 ◽  
Vol 7 (6) ◽  
pp. 2350
Author(s):  
Puran . ◽  
Narendra Kumar Kardam
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Abdominal Trauma ◽  
Imaging Modality ◽  
Abdominal Injury ◽  
Male Predominance ◽  
Ct Findings ◽  
Highly Sensitive

Background: Abdominal injury constitutes a significant portion of all blunt and penetrating body injuries. Computed   tomography is an important and fast technique which gives rapid information on the type of abdominal injury and helps in management of the patient accordingly. The aim of the present study was to evaluate the usefulness of Multidetector Computed Tomography (MDCT) in detection of intra-abdominal injury in patients with blunt abdominal trauma and to provide information that could accurately determine choice of management (non- operative versus operative). And to correlate the computed tomography (CT) findings with either clinical observation, follow up CT scan (if required) or surgical findings (wherever applicable).Methods: A total of 50 patients with abdominal trauma who underwent computed tomography (CT) examination were included. CT findings were compared with surgical findings in operated cases, and in the rest CT findings were compared by clinical outcome.Results: Among the 50 cases studied, all 50 had positive CT findings of abdominal trauma, out of which 24 patients underwent surgery and the remaining were managed conservatively. The age group of the patients was ranging from 8 to 66 years with male predominance. In this study the commonest organs affected were liver and spleen accounting for 48% and 44% respectively.Conclusions: Computed tomography is an important and highly sensitive imaging modality for diagnosis of organ injuries in patients with abdominal trauma and accordingly deciding the management of patient.

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