Common pulmonary vein on the recurrence of atrial tachyarrhythmia after pulmonary vein isolation

2019 ◽  
Vol 42 (7) ◽  
pp. 882-889
Author(s):  
Wei‐Chieh Lee ◽  
Yi‐Wei Lee ◽  
Hsiu‐Yu Fang ◽  
Huang‐Chung Chen ◽  
Yung‐Lung Chen ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Atrial Tachyarrhythmia ◽  
Common Pulmonary Vein

scholarly journals Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kawai ◽  
K Nagaoka ◽  
S Takase ◽  
K Sakamoto ◽  
H Ikuta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Past History ◽  
Univariate Analysis ◽  
Atrial Tachyarrhythmia ◽  
Chads2 Score ◽  
Atrial Capture ◽  
History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

Common ostium of the left pulmonary veins – to freeze or not to freeze – that was the question?

2017 ◽  
Vol 4 (45) ◽  
pp. 33-34
Author(s):  
Michał Orczykowski
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Clinical Results ◽  
Common Pulmonary Vein

Second-generation cryoballoon (CB2) - based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Nevertheless, the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV) are still a matter of debate. Commented paper by Heeger ChH, et al. analyzes this issue with some practical conclusions.

scholarly journals Laser balloon ablation in patients with a left common pulmonary vein.

2021 ◽  
Author(s):  
Shinichi Tachibana ◽  
Kaoru Okishige ◽  
Koji Sudo ◽  
Takatoshi Shigeta ◽  
Yuichiro Sagawa ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
De Novo ◽  
Average Diameter ◽  
Visually Guided ◽  
Atrial Tachyarrhythmia ◽  
Therapeutic Tool ◽  
Maximal Average ◽  
Balloon Ablation ◽  
Common Pulmonary Vein ◽  
Laser Balloon Ablation

Background: Pulmonary vein isolation (PVI) with a balloon-based visually guided laser ablation (VGLA) is regarded as a useful therapeutic tool for treating atrial fibrillation (AF). The clinical efficacy of a VGLA has never been fully investigated in patients with a left common pulmonary vein (LCPV). Objective: We investigated the procedural safety as well as clinical usefulness of VGLA in patients with an LCPV. Methods: This study consisted of 130 consecutive patients who underwent VGLA of de novo non-valvular paroxysmal AF. Results: Eleven patients (8.5%) had an LCPV (ostium maximal average diameter: 27.5 ± 4.9 mm, ostium minimal average diameter: 17.7 ± 3.5 mm). Nine out of 11 (81.8%) LCPVs were successfully occluded and isolated at the ostium with a VGLA guided PVI. The ablation procedure time was significantly shorter in the patients with than without an LCPV (61.5 ± 15.4 vs. 86.9 ± 32.9 min, p = 0.01). There was no difference regarding the atrial tachyarrhythmia recurrence between those with and without an LCPV (p = 0.18). A total of fifteen patients underwent a redo procedure, but reconnections were not observed in any of the LCPV patients. Conclusion: The VGLA guided PVI was a useful therapeutic tool even in patients with an LCPV. The presence of an LCPV was not associated with any atrial tachyarrhythmia recurrence.

scholarly journals A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ju Youn Kim ◽  
Younghoon Kim ◽  
Gil-Hwan Oh ◽  
Sun Hwa Kim ◽  
Young Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Large Scale ◽  
Three Dimensional ◽  
Area Under The Curve ◽  
Test Accuracy ◽  
Atrial Tachyarrhythmia ◽  
Patient Demographics

Abstract Background and Objectives The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. Materials and methods This study was a retrospective cohort study that enrolled consecutive patients who underwent catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recurrence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. Results We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolutional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). Conclusion In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly; therefore, further large-scale study is needed.

scholarly journals Pulmonary vein isolation in patients with a left common pulmonary vein: Comparison between second-generation cryoballoon and radiofrequency ablation

2019 ◽  
Vol 73 (4) ◽  
pp. 292-298 ◽  
Author(s):  
Masao Yamaguchi ◽  
Shinsuke Miyazaki ◽  
Takatsugu Kajiyama ◽  
Masahiro Hada ◽  
Hiroaki Nakamura ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Common Pulmonary Vein
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