scholarly journals Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

2016 ◽  
Vol 2 (6) ◽  
pp. 667-678 ◽  
Author(s):  
Yenn-Jiang Lin ◽  
Men-Tzung Lo ◽  
Shih-Lin Chang ◽  
Li-Wei Lo ◽  
Yu-Feng Hu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Substrate Modification ◽  
Phase Mapping ◽  
Mapping Techniques

scholarly journals Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Ramanathan Parameswaran ◽  
Jonathan M. Kalman ◽  
Alistair Royse ◽  
John Goldblatt ◽  
Marco Larobina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Temporal Heterogeneity ◽  
Activation Patterns ◽  
3 Dimensional ◽  
Transmural Migration ◽  
Endocardial Mapping ◽  
Phase Mapping ◽  
Insight Into ◽  
Activation Mapping

Background: Endocardial-epicardial dissociation and focal breakthroughs in humans with atrial fibrillation (AF) have been recently demonstrated using activation mapping of short 10-second AF segments. In the current study, we used simultaneous endo-epi phase mapping to characterize endo-epi activation patterns on long segments of human persistent AF. Methods: Simultaneous intraoperative mapping of endo- and epicardial lateral right atrium wall was performed in patients with persistent AF using 2 high-density grid catheters (16 electrodes, 3 mm spacing). Filtered unipolar and bipolar electrograms of continuous 2-minute AF recordings and electrodes locations were exported for phase analyses. We defined endocardial-epicardial dissociation as phase difference of ≥20 ms between paired endo-epi electrodes. Wavefronts were classified as rotations, single wavefronts, focal waves, or disorganized activity as per standard criteria. Endo-Epi wavefront patterns were simultaneously compared on dynamic phase maps. Complex fractionated electrograms were defined as bipolar electrograms with ≥5 directional changes occupying at least 70% of sample duration. Results: Fourteen patients with persistent AF undergoing cardiac surgery were included. Endocardial-epicardial dissociation was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganized activity (Endo: 41.3% versus Epi: 46.8%, P =0.0194) and single wavefronts (Endo: 31.3% versus Epi: 28.1%, P =0.129) were the dominant patterns. Transient rotations (Endo: 22% versus Epi: 19.2%, P =0.169; mean duration: 590±140 ms) and nonsustained focal waves (Endo: 1.2% versus Epi: 1.6%, P =0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. Electrogram fractionation was significantly higher in the epicardium than endocardium (61.2% versus 51.6%, P <0.0001). Conclusions: Simultaneous endo-epi phase mapping of prolonged human persistent AF recordings shows significant Endocardial-epicardial dissociation marked temporal heterogeneity, discordant and transitioning wavefronts patterns and complex fractionations. No sustained focal activity was observed. Such complex 3-dimensional interactions provide insight into why endocardial mapping alone may not fully characterize the AF mechanism and why endocardial ablation may not be sufficient. Graphic Abstract: A graphic abstract is available for this article.

scholarly journals Safety of high power and short duration ablation (70 watts over 5–7 seconds) in patients with persistent atrial fibrillation undergoing pulmonary vein isolation and additional substrate modification

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Bartkowiak ◽  
M Kottmaier ◽  
T Reents ◽  
F J Bourier ◽  
M Telishevska ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Ablation Catheter ◽  
Historical Cohort ◽  
Substrate Modification ◽  
Significant Difference ◽  
Atrioesophageal Fistula

Abstract Background In paroxysmal atrial fibrillation (AF), pulmonary vein isolation using HPSD has shown a promising success rate compared to ablation using conventional power settings, as well as a significant reduction in procedural and ablation time. In persistent atrial fibrillation, left atrial substrate modification seems to be a promising additional ablation approach besides pulmonary vein isolation (PVI). However, results after additional substrate ablation are not consistently positive, which may be related to non-transmural lesions and tissue oedema. An extended time of the procedure may also influence safety. Recent publications showed that HPSD ablation provides more sufficient lesions due to acute cell necrosis instead of cell oedema. Purpose The aim of this study is to evaluate the safety of HPSD ablation in patients undergoing ablation of persistent atrial fibrillation with PVI and additional substrate modification. Methods We studied and compared n=300 patients from our register undergoing the first ablation of persistent atrial fibrillation with HPSD settings (n=150) between May 2018 and January 2019 and standard settings (n=150) between July 2017 and January 2018. Patients were followed up for three months to report procedure-related adverse events. In all patients, a modified stepwise approach using PVI followed by electrogram-guided substrate modification and linear-ablation, if necessary, was performed. A HPSD ablation was performed with 70 watts with a maximum duration of 5–7 seconds. Catheter irrigation was set to 20 ml/min using the Flexability™ ablation catheter and the Ampere™ generator. The patients were compared with a historical cohort that underwent PVI using a conventional power protocol with 30–40 watts over 20–40 seconds, using the same ablation catheter. A transthoracic echocardiogram was performed in all patients after the ablation-procedure and on the following day. Duplex sonography or clinical control were performed to assess groin complications. Results Baseline characteristics and procedural data are shown in table 1. No significant difference in the complication rates in both groups was observed by a significant procedure-time reduction in HPSD-Group (2:13h vs 2:31h p&lt;0,001) and overall low risk of the procedure. No deaths, thromboembolic complications or atrioesophageal fistula were registered. Complication rates with statistical relevancy are shown in table 2. Conclusion Complex ablation using PVI and additional substrate modification in persistent atrial fibrillation using HPSD seems to be equally as safe regarding procedure-related outcomes as standard power settings ablation and can significantly reduce the time of the overall procedure. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Two Independent Mapping Techniques Identify Rotational Activity Patterns at Sites of Local Termination During Persistent Atrial Fibrillation

2017 ◽  
Vol 28 (6) ◽  
pp. 615-622 ◽  
Author(s):  
MAHMOOD ALHUSSEINI ◽  
DAVID VIDMAR ◽  
GABRIELA L. MECKLER ◽  
CHRISTOPHER A. KOWALEWSKI ◽  
FATEMAH SHENASA ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Activity Patterns ◽  
Persistent Atrial Fibrillation ◽  
Mapping Techniques

scholarly journals Transient Rotor Activity During Prolonged 3-Dimensional Phase Mapping in Human Persistent Atrial Fibrillation

2018 ◽  
Vol 4 (1) ◽  
pp. 72-83 ◽  
Author(s):  
Bhupesh Pathik ◽  
Jonathan M. Kalman ◽  
Tomos Walters ◽  
Pawel Kuklik ◽  
Jichao Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
3 Dimensional ◽  
Phase Mapping
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