scholarly journals Protection of the Esophagus During Catheter Ablation of Atrial Fibrillation

2020 ◽  
Author(s):  
Mahmoud Houmsse ◽  
Emile Daoud
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Potential Risk ◽  
High Frequency ◽  
Esophageal Injury ◽  
Ablation Procedure ◽  
High Occurrence ◽  
Af Ablation ◽  
Important Concern

Esophageal injury still occurs with high frequency during ablation of atrial fibrillation (AF). The purpose of this study is to provide a review of methods to protect the esophagus from injury during AF ablation. Despite advances in imaging and ablation, the potential risk of esophageal injury during AF ablation remains an important concern with a high occurrence of esophageal injury (≈15%). There have been numerous studies evaluating varied techniques for esophageal protection including active cooling and displacement of the esophagus. These techniques are reviewed in this manuscript as well as the role of esophageal protection in managing patients undergoing AF ablation procedure.

scholarly journals The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

2021 ◽  
Author(s):  
Ioan-Alexandru Minciuna ◽  
Mihai Puiu ◽  
Gabriel Cismaru ◽  
Radu Roșu ◽  
Raluca Tomoaia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Learning Curve ◽  
Radiation Exposure ◽  
Intracardiac Echocardiography ◽  
Procedure Time ◽  
Af Ablation ◽  
Total Procedure Time ◽  
The Mean

Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

Abstract 19466: Preliminary Experience Using Multiplexed Imaging of the Sympathetic Autonomic Nervous System - Impact on Outcome of Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sabine Ernst ◽  
Francesca Menichetti ◽  
Rafael Baavour ◽  
Nathaniel Roth ◽  
Jamshed Bomanji ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
High Frequency ◽  
De Novo ◽  
Imaging Study ◽  
High Frequency Stimulation ◽  
High Uptake ◽  
Af Ablation ◽  
Uptake Sites ◽  
Frequency Stimulation

Introduction: Catheter ablation of ganglionated plexi (GP) as an add on to pulmonary vein (PV) isolation has been reported to significantly improve outcome of atrial fibrillation (AF) ablation. In order to facilitate localization of these GPs, a novel imaging study is proposed, assessing the uptake of iodine-123 metaiodobenzylguanidine (mIBG, an analog of norepinephrine)in combination with 3D surface reconstruction from contrast computed tomography (cCT) or cardiac magnetic resonance (CMR). Methods: A total of 8 patients (5 male, median age 58 yrs) underwent mIBG SPECT using a dedicated cardiac camera (D-SPECT, SUMO, Spectrum Dynamics). This data was merged with 3D CMR or cCT and finally imported into CARTO (Biosense Webster). Using the individual mediastinum uptake as a normalizing factor, high uptake sites in the epicardial fat pads around the left atrium (LA) were identified. Five patients had paroxysmal AF whilst 3 present in persistent (n=2) or longstanding persistent (n=1) AF. Only 3 patients were treated de-novo, with the remaining failing in median 2 previous ablation procedures. Invasively, high uptake sites were mapped using high frequency stimulation (HFS) to confirm GP locations, which were subsequently ablated. PV (re) isolation and CFAE ablation was performed as needed. Results: Both the mIBG and CT or CMR scans were performed without complications. Focal mIBG uptake sites corresponded to anatomical GP sites, but individual variations of additional GPs were observed. Using HFS stimulation, GP sites were confirmed, but exact localization was highly depending on accurate image registration. Median follow-up of 9.2 months with all PAF and persistent AF patients in SR (1 AT redo), while the long-standing AF relapsed. Conclusion: The combination of mIBG SPECT and 3D anatomical imaging (SUMO protocol) provides a novel type of “road map” for localizing GPs during AF ablation. GPs were variable in number and location and were invasively confirmed using high frequency stimulation. Addition of GP ablation to standard AF ablation strategies seems beneficial in patients with paroxysmal or persistent AF. Further studies in larger patient cohorts are needed to confirm these initial observations.

scholarly journals Short coupling with high burden of atrial ectopy in twenty-four hour holter recording predicts recurrence of atrial arrhythmia after atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Okajima ◽  
H Imai ◽  
Y Murase ◽  
N Kano ◽  
Y Ogawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Arrhythmia ◽  
Controlled Study ◽  
Ablation Procedure ◽  
High Burden ◽  
Af Ablation ◽  
Atrial Ectopy ◽  
Holter Recordings

Abstract Background Atrial arrhythmia recurrence is experienced in up to 20% of patients after initially receiving a catheter ablation for atrial fibrillation (AF). Therefore, it is important to define predictors of atrial arrhythmia recurrence. Atrial ectopy (AE) with short coupling interval (S-AE) has been reported to be a trigger of AF. On the other hand, high burden of AE has been reported to be a useful predictor of atrial arrhythmia recurrences after AF ablation. Thus, the combination of the incidence of S-AE and AE burden during a 24-hour Holter recording could be a useful predictor of atrial arrhythmia recurrence after AF ablation. Purpose To investigate this hypothesis, we performed a retrospective case-controlled study. Methods We enrolled 180 patients who underwent their first catheter ablation procedure for AF and performed a 24-hour Holter recording between 90 to 365 days after their ablation procedure. Patients who performed an additional ablation procedure before the Holter recording were excluded. Finally, we analyzed 173 patients (age: 65±10 years, female: 28.3%, non-paroxysmal: 27.7%). The Holter recordings were analyzed by the same experienced technicians. We defined AE as a narrow QRS complex occurring &gt;25% than prior R-R interval, and S-AE as AE occurring &gt;55% earlier than expected. The relationship between the characteristics of AE during the Holter recording and atrial arrhythmia recurrences was investigated. Results The Holter recordings were performed at a median of 103 (IQR: 98–138) days after ablation. The median number of AE were 144 (IQR: 54–699) beats per day, and S-AE was recorded in 49 patients (28.3%). Forty-two patients (24.3%) had a recurrence of atrial arrhythmia during a median 488-day follow up period. Patients with S-AE had a recurrence of atrial arrhythmia more frequently than those without S-AE (44.9% vs 16.1%, p&lt;0.001). We found the cut-off point of AE burden as 241 beats per day by the receiver operating characteristic curve with 74% sensitivity and 70% specificity to predict atrial arrhythmia recurrence. We divided the patients into four groups according to the presence or absence of S-AE and high AE burden. In the Kaplan-Meier analysis, patients with S-AE and high AE burden had the highest atrial arrhythmia recurrence rate (Log-rank test: p&lt;0.001). In the Cox multivariate analysis, S-AE with high AE burden was an independent predictor of atrial arrhythmia recurrence (HR: 4.27, 95% CI: 2.32–7.85, p&lt;0.001). Conclusion For AF patients who underwent their first catheter ablation, S-AE (&gt;55% earlier than expected) with high AE burden (&gt;241 beats per day) during the 24-hour Holter recording predicted recurrences of atrial arrhythmia. These results can help to develop follow-up strategies after AF ablation. Funding Acknowledgement Type of funding source: None

scholarly journals Perioperative coronary artery spasms in patients undergoing catheter ablation of atrial fibrillation

2021 ◽  
Author(s):  
Masato Hachisuka ◽  
Yuhi Fujimoto ◽  
Eiichiro Oka ◽  
Hiroshi Hayashi ◽  
Teppei Yamamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Catheter Ablation ◽  
Case Reports ◽  
Rare Complication ◽  
Smoking Habit ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Number Of Patients ◽  
Life Threatening

Abstract Purpose Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). Although coronary artery spasms (CAS) during or after ablation procedures have been described as a rare complication in some case reports, the incidence and characteristics of this complication have not been fully elucidated. The present observational study aimed to clarify the CAS in a large number of patients experiencing AF ablation. Methods A total of 2913 consecutive patients (male: 78%, mean 66 ± 10 years) who underwent catheter ablation of AF were enrolled. Results Nine patients (0.31%, mean 66 ± 10 years, 7 males) had transient ST-T elevation (STE). Eight out of the 9 patients had STE in the inferior leads. STE occurred after the transseptal puncture in 7 patients, after the sheath was pulled out of the left atrium in 1, and 2 h after the ablation procedure in 1. Six patients had definite angiographic CAS without any sign of an air embolization on the emergent coronary angiography. In the3 other patients, the STE improved either directly after an infusion of nitroglycerin or spontaneously before the CAG. The patients with CAS had a higher frequency of a smoking habit (89% vs. 53%; P = .04), smaller left atrial diameter (36 ± 6 vs. 40 ± 7; P = .07), and lower CHADS2 score (0.6 ± 0.5 vs. 1.3 ± 1.1; P = .004) than those without. Conclusions Although the incidence was rare (0.31%), CAS should be kept in mind as a potentially life-threatening complication throughout an AF ablation procedure especially performed under conscious sedation.

scholarly journals Role of Intracardiac Defibrillation During the Ablation Procedure as a Predictor of Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Vol 62 (1) ◽  
pp. 87-94
Author(s):  
Shintaro Yao ◽  
Hideki Koike ◽  
Tadashi Fujino ◽  
Ryo Wada ◽  
Katsuya Akitsu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Fibrillation Recurrence ◽  
Ablation Procedure

scholarly journals Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

2020 ◽  
Vol 33 (4) ◽  
pp. 210-218
Author(s):  
Anibal Pires Borges ◽  
Guilherme Ferreira Gazzoni ◽  
José Plutarco Gutierrez Yanez ◽  
Karina de Andrade ◽  
Celine de Oliveira Boff ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrence Rate ◽  
Esophageal Perforation ◽  
Thermal Injury ◽  
Rare Complication ◽  
Esophageal Injury ◽  
Upper Gastrointestinal Endoscopy ◽  
Af Ablation ◽  
Af Recurrence

Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature.

Abstract 5663: Intracardiac Echocardiography From Within the Left Atrium Improves the Accuracy of Image Integration During Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sheldon M Singh ◽  
E. Kevin Heist ◽  
David M Donaldson ◽  
Theofanie Mela ◽  
Jeremy N Ruskin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Intracardiac Echocardiography ◽  
Surface Registration ◽  
List Type ◽  
Image Integration ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Integration Error

Background: Intracardiac echocardiography (ICE) can be integrated with pre-procedural CT or MR imaging to direct catheter ablation of atrial fibrillation (AF). Prior work has described ICE imaging of the left atrium (LA) with the ICE probe in the RA, but it is feasible to image the LA from an ICE probe placed directly into the LA via a trans-septal puncture performed for the mapping/ablation procedure. The purpose of this study was to determine whether direct LA imaging with ICE results in improved image integration during AF ablation compared with LA imaging indirectly from the RA. Methods: Twenty-five consecutive patients undergoing an AF ablation procedure with the CARTO-Sound system were studied. A 10 French phased array catheter with an embedded CARTO navigation sensor was employed to provide 2D echocardiogram images of the LA - 13 patients underwent imaging from the RA alone and 12 patients from the LA. The accuracy of the image integration was assessed by the average integration error after surface registration and the requirement to take supplementary electroanatomic mapping points to obtain acceptable image integration. Results: Twenty-five patients (56% paroxysmal AF, average LA size = 42±8 mm, average EF = 63±10 %) were examined. There was no difference in the time or number of ultrasound contours required to create a LA anatomic map with ICE imaging from the RA versus the LA (24±17min vs. 24±25min, P=1.0, 24±16 contours vs. 29±18 contours, P=0.5). The average integration error for all patients was 2.19±0.59mm. Direct LA imaging was associated with improved integration error compared to indirect LA imaging from the RA (1.85±0.33mm versus 2.51±0.62mm, P=0.004). Image integration using RA acquired LA images had a tendency to be less accurate resulting in the primary operator acquiring additional registration points to supplement the registration process (patients requiring additional registration points for registration: 3/12 for LA imaging versus 9/13 for RA imaging of the LA, P=0.05). Conclusion: Direct ICE imaging from within the LA is feasible and associated with improved accuracy of image integration during AF ablation.

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.

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