scholarly journals Characterization of Electrograms from Multipolar Diagnostic Catheters during Atrial Fibrillation

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Prasanth Ganesan ◽  
Elizabeth M. Cherry ◽  
Arkady M. Pertsov ◽  
Behnaz Ghoraani
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Simulation Study ◽  
Cycle Length ◽  
Human Subject ◽  
Conduction Delay ◽  
Ablation Procedure ◽  
Endocardial Surface ◽  
Diagnostic Catheter

Atrial fibrillation (AF) is the most common arrhythmia in USA with more than 2.3 million people affected annually. Catheter ablation procedure is a method for treatment of AF, which involves 3D electroanatomic mapping of the patient's left atrium (LA) by maneuvering a conventional multipolar diagnostic catheter (MPDC) along the LA endocardial surface after which pulmonary vein (PV) isolation is performed, thus eliminating the AF triggers originating from the PVs. However, it remains unclear how to effectively utilize the information provided by the MPDC to locate the AF-sustaining sites, known as sustained rotor-like activities (RotAs). In this study, we use computer modeling to investigate the variations in the characteristics of the MPDC electrograms, namely, total conduction delay (TCD) and average cycle length (CL), as the MPDC moves towards a RotA source. Subsequently, a study with a human subject was performed in order to verify the predictions of the simulation study. The conclusions from this study may be used to iteratively direct an MPDC towards RotA sources thus allowing the RotAs to be localized for customized and improved AF ablation.

scholarly journals Dabigatran in the ischemic patient undergoing atrial fibrillation ablation

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 154-157
Author(s):  
Roberto Spoladore
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Poor Response ◽  
Rf Ablation ◽  
Ablation Procedure ◽  
Total Period ◽  
Hemorrhagic Events

Trans-catheter ablation of atrial fibrillation (AF) is a common treatment for symptomatic AF. Among the major complications of AF ablation are stroke, transient ischemic attacks and peri-procedural cardiac tamponade. Various clinical trials have shown that uninterrupted treatment with vitamin K antagonists (VKA) is associated with a lower incidence of embolic events compared to discontinuation of therapy; until recently, in the absence of equally solid evidence, this practice was not extended to the new oral anticoagulants (NOAC) not VKA due to the fear of hemorrhagic complications potentially associated with the use of an "irreversible" anticoagulant. The case of a patient suffering from numerous comorbidities is reported here. In light of the poor response to anti-arrhythmics, a TC-RF ablation was performed, with suspension of dabigatran administration only on the day of the procedure (for a total period <24 hours). Although the fear of the risk of bleeding potentially associated with the trans-catheter ablation procedure may still induce clinicians to stop anticoagulant therapy, even the decision to discontinue anticoagulant therapy with dabigatran on the day of surgery alone is challenged by recent evidence in the literature supporting the efficacy of dabigatran in reducing the incidence of hemorrhagic events during and after ablation, including the results of the RE-CIRCUIT study (Cardiology)

Abstract 4104: Organization of Atrial Signals is Critical Prior to Cardioversion of Atrial Fibrillation with Intravenous Flecainide: Insight from Spectral Analysis of Intracardiac Electrograms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jiun Tuan ◽  
Suman Kundu ◽  
Mohamed Jeilan ◽  
Faizel Osman ◽  
Rajkumar Mantravadi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Spectral Analysis ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Dominant Frequency ◽  
Relative Increase ◽  
Significant Difference ◽  
Before And After ◽  
Atrial Activation ◽  
Relative Change

Introduction & Hypothesis: Studies in catheter ablation of atrial fibrillation (AF) show that an increase in cycle length (CL) and higher organization index (OI) is associated with termination of AF. We hypothesize that similar changes can be seen in chemical cardioversion with Flecainide Methods: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. OI and dominant frequency (DF) were obtained by Fast Fourier Transform of coronary sinus electrograms over 10s in AF, before and after flecainide infusion. Mean CL was also calculated. Results: 28 patients were identified (18 paroxysmal AF and 10 persistent AF). 8 cardioverted to sinus rhythm (SR) with flecainide. In all patients, mean CL increased from 211 ± 44 ms to 321 ± 85 ms (p <0.001). Mean DF decreased from 5.2 ± 1.03 Hz to 3.6 ± 1.04 Hz (p <0.001). Mean OI was 0.33 ± 0.13 before and 0.32 ± 0.11 after flecainide (p = 0.90). Comparing patients who cardioverted to SR with those who did not, OI post-flecainide was 0.41 ± 0.12 vs 0.29 ± 0.10 (p=0.013) and relative change in OI was 29 ± 33% vs −3.9 ± 27% (p=0.016) respectively. No significant difference was noted in the change in CL and DF in the 2 groups. Logistic regression showed that a greater relative increase in OI (p=0.04), a higher OI post-flecainide (p=0.03) and SR at start of procedure (p=0.03) are independently associated with cardioversion to SR with flecainide. Conclusion: Increase in OI, independent of changes to the CL and DF, appears critical to AF termination with flecainide. The increase in OI may reflect an increase in size and reduction in the number of re-entrant circuits, which together with slowing of atrial activation, result in return to SR.

Gastroparesis: An under-recognized complication after atrial fibrillation catheter ablation procedure

2015 ◽  
Vol 145 (12) ◽  
pp. 552-553
Author(s):  
Naiara Calvo ◽  
Manuel García de Yébenes-Castro ◽  
Hugo Arguedas ◽  
Ignacio García-Bolao
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ablation Procedure

scholarly journals P1934Fibrillation cycle length predicts recurrence after catheter ablation in patients with persistent atrial fibrillation

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
H Fukaya ◽  
J Kishihara ◽  
J Oikawa ◽  
Y Arakawa ◽  
R Nishinarita ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Persistent Atrial Fibrillation

P1375Catheter ablation of atrial fibrillation: three-dimensional transesophageal echocardiography versus magnetic resonance imaging for pulmonary vein imaging (periprocedural results and long-term follow-u

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Image Quality ◽  
Pulmonary Vein ◽  
Cardiac Mri ◽  
Left Atrial ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Ablation Procedure

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Three-dimensional transesophageal echocardiography (TEE) is a promising new technique for cardiac imaging. Therefore, we have evaluated the usefulness of 3-D TEE for analysing the left atrial anatomy prior to an ablation procedure in comparison to magnetic resonance imaging (MRI). Methods In 120 patients, 3-D TEE and cardiac MRI were performed immediately prior to an ablation procedure (paroxysmal AF: 50 patients, persistent AF: 70 patients). The image quality provided by 3-D TEE and by cardiac MRI was compared in all patients. Two different ablation strategies were used. In patients with paroxysmal AF, the cryoablation technique was used. In the other patients, a circumferential pulmonary vein ablation was performed using a three-dimensional mapping system. Results A 3-D TEE and a cardiac MRI could be performed successfully in all patients prior to the ablation procedure. Several variations of the PV anatomy could be visualized precisely by 3-D TEE and cardiac MRI (e.g. accessory PVs, common PV ostia, varying diameter of the left atrial appendage and its distance to the left superior PV). The image quality was good in the majority of patients even if AF with rapid ventricular response was present during the examination. The image quality provided by 3-D TEE was acceptable in 116/120 patients (96.7 %). The TEE findings correlated well with the PV angiographies performed using cardiac MRI. There was a good correlation with regard to the diameter of the PV ostia assessed by these two imaging techniques. All ablation procedures could be performed successfully (mean number of completely isolated PVs: 3.9  (cryo group), 4.0 (radiofrequency catheter ablation group)). At 42-month follow-up, 70.0 % of all patients were free from an arrhythmia recurrence (cryo group: 76.0 %, Carto group: 65.7 %). There were no major complications. Conclusions AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging. The image quality was acceptable in the vast majority of patients.

Abstract 17454: The Effect of Catheter Ablation on Coronary Sinus Cycle Length in Persistent Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ghaith Zaatari ◽  
Jorge Bohorquez ◽  
Raul Mitrani ◽  
Jason Ng ◽  
Justin Ng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Coronary Sinus ◽  
Cycle Length ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Quality Signals ◽  
Before And After ◽  
Ventricular Activation ◽  
Ablation Success

Background: While pulmonary vein isolation (PVI) for treatment of persistent atrial fibrillation (PeAF) is successful in approximately 50%, acute termination of PeAF is rarely observed. Prolongation of cycle length (CL) by 10% is often utilized as an indicator of successful catheter ablation (CA). Objective: To evaluate coronary sinus (CS) cycle length (CL) before and after CA for PeAF. Methods: CA for PeAF was performed in 31 patients (24males, age 63±9 yrs, CHA2DS2-VASc 2.3±1.7, LVEF 49±10%) with PVI, with 4 (13%) also having posterior wall isolation. A multielectrode catheter was placed in the CS and maintained throughout the procedure. CS electrograms were recorded for 10 seconds prior to CA and after completion of CA. No patient reverted to sinus rhythm during CA. CS CL was determined using customized software for activation detection and verified visually, excluding ventricular activation and low quality signals (n=3). The shortest CL among the recording electrodes was used for analysis. Results: CS CL pre- and post-CA were 182.4±23.0 and 191.6± 29.9 ms (p= 0.04) with change from baseline of 5.4±12.7%. The figure shows the histogram for change in CS CL from baseline. Only 7/28 (25%) of patients had CS CL prolongation >10%. Of ten patients who were free of AF off anti-arrhythmic drugs at 1 year, CS CL increased 4.0±6.1%; 2/10 had CS CL prolongation >10%. Of 6 patients with recurrent AF, CS CL increased 13.8±20.7%; 4/6 had CS CL prolongation >10%. Conclusion: Our data demonstrate that CS CL prolongation >10% is not a useful marker of outcomes in patients undergoing catheter ablation for PeAF. This highlights the need to identify other indicators of acute ablation success.

Abstract 16896: Electrogram Morphology Recurrence to Characterize Drivers of Persistent Atrial Fibrillation: Findings at Initial versus Redo Catheter Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ghaith Zaatari ◽  
Jorge Bohorquez ◽  
Raul Mitrani ◽  
Jason Ng ◽  
Justin Ng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Cross Correlation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Success Rates ◽  
Mapping Tool ◽  
Group 2 ◽  
Group 1

Background: Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (PeAF) quantifies consistency of activation at each site and is expected to be high and rapid near drivers of PeAF. Objective: To compare EMR in the left (LA) and right atrium (RA) in patients undergoing first- vs second-time PeAF catheter ablation (CA). Methods: Multisite bipolar EGM mapping of the LA (265±153 sites) and RA (224±148 sites) prior to CA for PeAF was performed in 40 patients (29 males, age 63±9 yrs, CHA2DS2-VASc 2.4±1.5, LVEF 48±12%) undergoing first (Group 1, n=31) or second-time (Group 2, n=9) CA. After cross-correlation of each automatically detected EGM with every other EGM in the recording, the most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CL R ) were computed (figure). The minimum CL R sites were identified. Results: In group 1, shortest CL R was in the LA in 26 patients (84%) and RA in 5 patients (16%). In the LA, there were 1 (n=23), 2 (n=2), or 3 (n=1) areas of shortest CL R , most commonly in the pulmonary veins (PV; n=19). In the RA, there was only 1 area of shortest CL R . Minimum CL R was 174.1±25.4 ms (LA-179.6±37.4 vs RA-207.9±34.5, p=0.0004), with Rec% 95±10%. In group 2, shortest CL R was in the LA in 5 patients and RA in 5 patients (56%)– one had both LA and RA. In the LA/RA, there were 1 (n=3/4) or 2 (n=2/1) areas of shortest CL R . The most common LA site was non-PV (6/7, 85.7%). The minimum CL R was 182.1±26.2ms (LA-190.8±36.2 vs RA-196.0±30.5, p=0.6), with Rec% 96±5%. Conclusion: In 61% of patients undergoing initial CA for PeAF, EMR identified LA drivers in the PVs which may explain why PV isolation has been reported to have 50-60% success rates in PeAF. In patients undergoing a 2 nd ablation for PeAF, EMR identified predominantly nonPV drivers with even distribution of shortest CL R between RA and LA and diminished CL R gradient between the LA and RA. EMR may be a useful mapping tool to characterize potential drivers of PeAF.

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