Evaluation of Left Atrial Anatomy and Function using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

2017 ◽  
pp. 39-55 ◽  
Author(s):  
V. I. Gurina ◽  
E. V. Kondrat’ev ◽  
A. Sh. Revishvily ◽  
M. Z. Alimurzaeva
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Systemic Review ◽  
Free Access ◽  
Contrast Enhanced ◽  
Review Reports ◽  
And Function

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Сatheter ablation (CA) of arrhythmogenic foci is supposed to be an established treatment option for symptomatic  patients with AF, refractory to antiarrhythmic therapy. Pre-procedural imaging is indispensable for the assessment of left atrium,  pulmonary veins and adjacent anatomy, and facilitates selection of  the ablation strategy to achieve an optimal result and minimize the risk of complications.Purpose: to evaluate the role of contrast-enhanced MDCT in  patients with AF; also to present the prospects for further  development of this method according to the systemic review of world research data.Materials and methods. 140 free access articles requested as  “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial  appendage” from 01.2009 until 01.2017 were analyzed in PubMed,  as well as a number of Russianlanguage articles in eLibrary.Results.This literature review reports and systematizes available  data on epidemiology and mechanisms of AF, represents current  classification. In addition were analyzed advantages of MDCT over  other methods of visualization while planning the CA and follow-up.Conclusion.MDCT is precise, effective and accessible option, which  satisfies visualization requirements during the preparation for CA.  Moreover, using MDCT in combination with electro-mapping systems  increases safety and effectiveness of the procedure. In postoperative period MDCT can be used for complications diagnostic and results assessment.

Abstract 4649: A Radiofrequency HOT Balloon Catheter for Isolating the Posterior Left Atrium Including All the Pulmonary Veins in the Treatment of Atrial Fibrillation: Feasibility and Safety of a New Approach

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroshi Sohara ◽  
Shutaro Satake ◽  
Hiroshi Takeda ◽  
Hideki Ueno ◽  
Toshimichi Oda
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Phrenic Nerve ◽  
Pulmonary Veins ◽  
Balloon Catheter ◽  
Holter Monitoring ◽  
Phrenic Nerve Palsy ◽  
Total Procedure Time ◽  
Successful Isolation

Atrial fibrillation (AF) is originated from mostly from pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (PLA). The present study was designed to evaluate the usefulness of a radiofrequency HOT balloon catheter (RBC) for isolation of the PLA including all PVs en masse in the patients with AF. In a total of 96 patients (75 men and 21 women; mean age 64±8 years old) with drug-resistant paroxysmal (n=63) and persistent AF(n=33), PLA including all PVs were ablated and isolated using RBC. Dragging the balloon, contiguous lesions at the roof between the superior PVs were first created, then each antrum of all PVs were ablated, and finally, contiguous lesions at the PLA between the both inferior PVs were made, while we performed monitoring esophagus temperature and phrenic nerve pacing. Electro-anatomical bipolar voltage amplitude mapping (CARTO) of the LA-PVs was performed to determine the extent of this electrical isolation after all procedure. Successful isolation of the PLA including all PVs was achieved in all of 96 cases with elimination of all the PLA and PV potentials. The mean total procedure time 133 ± 31 minutes including 32±9 minutes fluoroscopy time. Recurrences of AF were diagnosed by Holter monitoring, mobile electrocardiogram. After first session, eighty- seven (59 paroxysmal, 28 persistent) of 96 patients were free from AF without anti-arrhythmic drugs and the remaining patients could maintain sinus rhythm with anti-arrhythmic drugs except two cases with LA flutter during 11.0±4.1 months follow-up. No major complications such as cerebral embolism, PV stenosis, or phrenic nerve palsy, and LA-esophageal fistula were observed. Complete isolation of the PLA including all PVs using a RBC, is useful for the treatment of both paroxysmal and persistent AF without severe complication.

P563Hemoptysis after cryoablation for atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Kumar ◽  
I Aksoy
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Pulmonary Veins ◽  
Systemic Review ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
The Mean ◽  
Lower Temperature ◽  
Severe Type

Abstract Aim Cryoballoon is a widely used tool for ablation for atrial fibrillation (AF). There are several complications after cryoablation. This paper assesses the incidence rate and severity of hemoptysis after cryo ablation for AF. Methods For current systemic review and meta-analysis, literature has been reviewed from 2008 to 2019 focusing on the incidence of hemoptysis after cryoballoon ablation for atrial fibrillation catheter ablation in PubMed, Cochrane library and EMBASE databases. Results This meta-analysis included 3534 patients from 20 studies; of mean age 54.0 ± 10.9 years. All patients had cryoballoon ablation for paroxysmal or persistent AF refractory to treatment and follow up duration for 8.2 ± 5.9 months with mean procedure duration of 153.4± 65.4 minutes. The mean cryoablation duration was 869.4 ± 148 sec with mean temperature of -59.7 ± 5.1 °C and a total of 109 patients (3.08%) had hemoptysis which was mild in the majority of cases (76.1%), mild to moderate in 20.2% and severe in only 3.7%.  Hemoptysis onset was at 29.0 ± 56.5 day with median of 7 days, range (2 hours to 210 days). In 11 studies hemoptysis occurred early in 51 patients (95% CI for I2 was 0.0% to 0.0, P =0.95, I2 was 0.0%), but in 9 studies, hemoptysis occurred late in 58 patients (95% CI for I2 was 0.0% to 0.0, P =0.96, I2 was 0.0%). Conclusion Mild hemoptysis is experienced by significant number of cryoballoon AF ablation patients and severe type in 3.5 % attributed to significantly lower temperature in inferior pulmonary veins and is more often associated with bigger cryoballoon. Abstract Figure. Overview of the manuscripts selection

scholarly journals Nonpharmacologic management of atrial fibrillation: Role of the pulmonary veins and posterior left atrium

Heart Rhythm ◽  
2009 ◽  
Vol 6 (12) ◽  
pp. S5-S11 ◽  
Author(s):  
Kalyanam Shivkumar ◽  
Eric Buch ◽  
Noel G. Boyle
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Veins

Long-term results of simultaneous hybrid ablation of therapy-resistant atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Baimbetov ◽  
K Bizhanov ◽  
I Yakupova ◽  
B Bairamov ◽  
U Medeubekov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Pulmonary Veins ◽  
Long Term Results ◽  
Hybrid Ablation

Abstract Background A hybrid technique using thoracoscopic epicardial and standard endocardial ablation of atrial fibrillation (AF) is a strategy used to treat AF patients with therapy-resistant symptomatic AF. We conducted comparative study of efficacy and safety of simultaneous hybrid ablation in patients with non-paroxysmal forms of AF and evaluated the factors that determine success and quality of life. Methods The study included 56 consecutive patients who underwent simultaneous hybrid ablation. First, epicardial ablation was performed using thoracoscopic access: to isolate the pulmonary veins and the posterior wall of the left atrium. After this, an endocardial electrophysiological assessment was carried out from the pulmonary veins to the left atrium and additional endocardial ablation was performed, where necessary. The next day, a loop ECG recorder was implanted subcutaneously in the thoracic region. Efficiency was evaluated using implanted loop ECG recorders. The average follow up was 24 months, the studied patients came to the clinic every 3 months to receive diagnostic reports from loop recorders. Recurrence was defined as AF, atrial flutter and other atrial tachycardia, recorded in reports of loop recorders lasting >30 sec during follow up period. Results Continuous follow up was carried out in 56 patients, the average age of which was 57±9 years. Of these, 39 (70%) men, 6 (10%) paroxysmal, 38 (68%) persistent and 12 (22%) long-standing persistent AF. Within 24 months of follow up, 45 (80%) maintened a sinus rhythm. Most recurrenses were atrial flutter (8/11 patients). Success was associated with factors such as left atrial size, patient age and duration of arrhythmia. Patients with paroxysmal AF had the highest success, patients with long-standing persistent AF had the least success. 5 (9%) patients had complications associated with the procedure. Quality of life after ablation improved in patients with sinus rhythm. Conclusion The efficiency of simultaneuous hybrid AF ablation was 80% for 24 months of continuous follow up period associated with the type of AF. Quality of life improved significantly, complications associated with the procedure occurred in 9%. Funding Acknowledgement Type of funding source: None

scholarly journals Role of the Posterior Left Atrium and Pulmonary Veins in Human Lone Atrial Fibrillation

Circulation ◽  
2003 ◽  
Vol 108 (25) ◽  
pp. 3108-3114 ◽  
Author(s):  
Derick M. Todd ◽  
Allan C. Skanes ◽  
Gerard Guiraudon ◽  
Colette Guiraudon ◽  
Andrew D. Krahn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Lone Atrial Fibrillation

Relationship between epicardial fat and left atrium fibrosis in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Nascimento Matos ◽  
A Ferreira ◽  
P Freitas ◽  
G Rodrigues ◽  
J Carmo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Cox Regression ◽  
Non Invasive ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Time To Relapse ◽  
Af Recurrence

Abstract Background Epicardial adipose tissue (EAT) has recently been shown to be associated with the presence, severity, and recurrence of atrial fibrillation (AF). Although the pathophysiological mechanisms underlying this association remain to be established, several hypotheses have been put forward, including direct adipocyte infiltration, oxidative stress, and the secretion of adipokines causing inflammation and fibrosis of atrial tissue. We hypothesized that the volume of EAT and the amount of left atrium (LA) fibrosis assessed by non-invasive imaging would be significantly correlated in patients with AF, and that both would predict time to relapse after pulmonary vein isolation (PVI). Methods Sixty-eight patients with AF being studied for a first PVI procedure underwent both cardiac computerized tomography (CT) and cardiac magnetic resonance (CMR) within less than 48h. EAT was quantified on contrast-enhanced CT images. LA fibrosis was quantified on isotropic 1.5mm 3D delayed enhancement CMR for image intensity ratio values >1.20. Radiofrequency PVI was performed using an irrigated contact force-sensing ablation catheter, guided by electroanatomical mapping. After PVI, patients were followed for AF recurrence, defined as symptomatic or documented AF after a 3-month blanking period. Pearson's correlation coefficient was used for gauging the correlation between EATLM volume and LA fibrosis. The relationship between these two variables and time to AF recurrence was assessed by Cox regression. Results Most of the 68 patients (46 men, mean age 61±12 years) had paroxysmal AF (71%, n=48). The mean body mass index (BMI) was 28.0±4.0 kg/m2. Patients had a median EATLM volume of 2.4 cm3/m2 [interquartile range (IQR) 1.6–3.2 cm3/m2], and a median estimated amount of LA fibrosis of 8.9 g (IQR 5–15 g), corresponding to 8% (IQR 5–11%) of the total LA wall mass. The correlation between EATLM and LA fibrosis was statistically significant but weak (Pearson's R = 0.38, P=0.001) – Figure 1. During a median follow-up of 22 months (IQR 12–31), 31 patients (46%) suffered AF recurrence. Four predictors of relapse were identified in univariate Cox regression: EATLM (HR 2.19, 95% CI 1.65–2.91, P<0.001), LA fibrosis (HR 1.05, 95% CI 1.01–1.09, P=0.033), non-paroxysmal AF (HR 3.36, 95% CI 1.64–6.87, P=0.001), and LA volume (HR 1.03, 95% CI 1.01–1.06, P=0.006). Multivariate analysis yielded two independent predictors of time to AF relapse: EATLM (HR 2.05, 95% CI 1.51–2.79, P<0.001), and non-paroxysmal AF (HR 2.36, 95% CI 1.08–5.16, P=0.031). Conclusion The weak correlation between EAT and LA suggests that LA fibrosis is not the main mechanism by which EAT and AF are linked. EAT was more strongly associated with AF recurrence than LA fibrosis, which supports the existence of other, more important mediators between EAT and this arrhythmia. Correlation between EAT and LA Funding Acknowledgement Type of funding source: None

scholarly journals Role of transoesophageal echocardiography in evaluating the effect of catheter ablation of atrial fibrillation on anatomy and function of the pulmonary veins

EP Europace ◽  
2008 ◽  
Vol 10 (9) ◽  
pp. 1079-1084 ◽  
Author(s):  
B. De Piccoli ◽  
A. Rossillo ◽  
C. Zanella ◽  
A. Bonso ◽  
S. Themistoclakis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Transoesophageal Echocardiography ◽  
And Function

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 Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

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