scholarly journals Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Jürgen Biermann ◽  
Christoph Bode ◽  
Stefan Asbach
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Three Dimensional ◽  
Interatrial Septum ◽  
Intracardiac Echocardiography ◽  
Success Rates ◽  
Adjacent Structures ◽  
Intracardiac Ultrasound ◽  
Dimensional Object

Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

scholarly journals Fluoroless ablation of atrial fibrillation using intracardiac ultrasound integrated with 3D electroanatomical mapping system

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
B Antolic ◽  
M Jan ◽  
M Vrbajnscak ◽  
D Zizek ◽  
N Kajdic
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Three Dimensional ◽  
Intracardiac Echocardiography ◽  
High Rate ◽  
Integration System ◽  
Funding Sources ◽  
Automatic Integration ◽  
First Pass ◽  
Intracardiac Ultrasound

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Intracardiac echocardiography (ICE) is gaining increasingly wider adoption in interventional electrophysiology (EP) and represents an all-round tool for ablation of atrial fibrillation (AF). The key upgrade to the usefulness of ICE is its integration into three-dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). Purpose The aim of this single-centre retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF.  Methods Patients with symptomatic paroxysmal or persistent AF referred for first pulmonary vein isolation (PVI) radiofrequency catheter ablation (RFCA) from September 2017 to August 2020 were included in the study. Those who underwent additional ablations for concomitant arrhythmias were excluded from statistical analysis. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping. PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI.  Results A total of 56 patients underwent RFCA (35.7% females, median age 62.7 years, 53.6% paroxysmal AF). Acute PVI was achieved in all patients (100%). Adverse events were detected in two patients (3.6%). The median procedure duration was 110.5 min (IQR 100.0-133.8). First-pass isolation was achieved in 50/56 LPVs (89.3%) and in 44/56 RPVs (78.6%). In patients where first-pass isolation was no achieved, intravenous carina had to be ablated in 3/6 (50%) of LPVs and 9/12 (75%) of RPVs.  Conclusions Flouroless PVI using ICE/EAM automatic integration system is feasible, safe and acutely effective. We achieved high rate of first-pass isolation.

Abstract 5661: Three-Dimensional Reconstructions of Left Atrium and Pulmonary Veins based on Intraprocedural C-Arm Rotational Angiography in Comparison to Electroanatomical Mapping: Integration of a Novel Modality into Atrial Fibrillation Ablation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Georg Noelker ◽  
Stefan Asbach ◽  
Klaus Juergen Gutleben ◽  
Anil Sinha ◽  
Guido Ritscher ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Three Dimensional ◽  
Work Flow ◽  
Electroanatomical Mapping ◽  
Rotational Angiography ◽  
Preprocedural Imaging ◽  
Intraprocedural Imaging ◽  
3D Anatomy

Preprocedural imaging and its integration into electroanatomical mapping (EAM) is commonly used in atrial fibrillation (AF) ablation. However, intraprocedural imaging based on rotational angiography (DynaCT Cardiac) may be superior in terms of actuality and may lead to an improved work-flow. Feasibility of integrating Dyna CT Cardiac into EAM has not yet been shown. In 23 patients (62±7 years, 16 male) undergoing catheter ablation of paroxysmal (n=10) or persistent (n=13) AF, we intraprocedurally performed rotational angiography enhanced by contrast agent applied to the pulmonary artery with offline segmentation of left atrium (LA) and pulmonary veins (PV). Fig 1 depicts reconstructed LA and PV-anatomy directly importet into CARTOMerge. Distances between the 2 modalities were analyzed. Direct image integration of prereconstructed 3D-anatomy was feasible in all patients. Procedure time was 156 ± 24 minutes including 11 ± 3 minutes for DynaCT Cardiac registration and segmentation. 132 ± 74 mapping points were taken. Mapping points deviated to intraprocedural DynaCT Cardiac 3D-reconstructions by 2.2 ± 0.4 mm (2.3 ± 0.5 mm in patients suffering from paroxysmal atrial fibrillation (AF) vs. 2.1 ± 0.40 mm persistent AF, n.s.). No complications occured. Integration of intraprocedural Dyna CT Cardiac into EAM was feasible and fast. The work-flow seemed to be improved by avoiding additional preprocedural imaging. The novel modality is highly accurate in comparison to EAM.

scholarly journals Fluid–structure interaction in a fully coupled three-dimensional mitral–atrium–pulmonary model

2021 ◽  
Author(s):  
Liuyang Feng ◽  
Hao Gao ◽  
Nan Qi ◽  
Mark Danton ◽  
Nicholas A. Hill ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Three Dimensional ◽  
Left Heart ◽  
Structure Interaction ◽  
Acute Mitral Regurgitation ◽  
Reversal Flow

AbstractThis paper aims to investigate detailed mechanical interactions between the pulmonary haemodynamics and left heart function in pathophysiological situations (e.g. atrial fibrillation and acute mitral regurgitation). This is achieved by developing a complex computational framework for a coupled pulmonary circulation, left atrium and mitral valve model. The left atrium and mitral valve are modelled with physiologically realistic three-dimensional geometries, fibre-reinforced hyperelastic materials and fluid–structure interaction, and the pulmonary vessels are modelled as one-dimensional network ended with structured trees, with specified vessel geometries and wall material properties. This new coupled model reveals some interesting results which could be of diagnostic values. For example, the wave propagation through the pulmonary vasculature can lead to different arrival times for the second systolic flow wave (S2 wave) among the pulmonary veins, forming vortex rings inside the left atrium. In the case of acute mitral regurgitation, the left atrium experiences an increased energy dissipation and pressure elevation. The pulmonary veins can experience increased wave intensities, reversal flow during systole and increased early-diastolic flow wave (D wave), which in turn causes an additional flow wave across the mitral valve (L wave), as well as a reversal flow at the left atrial appendage orifice. In the case of atrial fibrillation, we show that the loss of active contraction is associated with a slower flow inside the left atrial appendage and disappearances of the late-diastole atrial reversal wave (AR wave) and the first systolic wave (S1 wave) in pulmonary veins. The haemodynamic changes along the pulmonary vessel trees on different scales from microscopic vessels to the main pulmonary artery can all be captured in this model. The work promises a potential in quantifying disease progression and medical treatments of various pulmonary diseases such as the pulmonary hypertension due to a left heart dysfunction.

scholarly journals Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan-Jing Wang ◽  
Huan Sun ◽  
Xiao-Fei Fan ◽  
Meng-Chao Zhang ◽  
Ping Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Arteries ◽  
Contact Points ◽  
Pulmonary Vein Ablation ◽  
Adjacent Structures ◽  
Anatomical Correlation ◽  
The Right

Abstract Background The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures. Methods Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured. Results The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001). Conclusions The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.

Clarifying the anatomy of the superior sinus venosus defect

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319334
Author(s):  
Jay Relan ◽  
Saurabh Kumar Gupta ◽  
Rengarajan Rajagopal ◽  
Sivasubramanian Ramakrishnan ◽  
Gurpreet Singh Gulati ◽  
...  
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Interatrial Septum ◽  
Sinus Venosus ◽  
Caval Vein ◽  
Therapeutic Implications ◽  
Superior Caval Vein ◽  
Inferior Pulmonary Vein ◽  
The Right

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.

Sign in / Sign up

Export Citation Format

Share Document