scholarly journals Epicardial Adipose Tissue in the Right Atrium Is Associated with Progression of Atrial Fibrillation and Recurrence after Pulmonary Vein Catheter Ablation in Patients with Atrial Fibrillation

2020 ◽  
Vol 32 (1) ◽  
pp. 11-24
Author(s):  
Hiroki TANISAWA ◽  
Yasushi AKUTSU ◽  
Hiroyuki ITO ◽  
Kosuke NOMURA ◽  
Teruo SEKIMOTO ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Right Atrium ◽  
Epicardial Adipose Tissue ◽  
Vein Catheter ◽  
The Right

scholarly journals Technique for detecting an electrical connection between the right atrium and right pulmonary venous carina

2021 ◽  
Author(s):  
Ippei Tsuboi ◽  
Michio Ogano ◽  
Kei Kimura ◽  
Hidekazu Kawanaka ◽  
Masaharu Tajiri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Pulmonary Vein ◽  
Right Atrium ◽  
Clinical Characteristics ◽  
Epicardial Adipose Tissue ◽  
Posterior Wall ◽  
Right Atrial ◽  
The Right ◽  
Activation Mapping

Introduction: There is increasing evidence of the epicardial connection between the right-sided pulmonary vein (PV) carina and right atrium interrupts right-sided PV isolation after circumferential PV ablation in patients with atrial fibrillation. In such cases, carina ablation is often required. This study aimed to assess the utility of the right atrial posterior wall (RAPW) pacing in the detection of the right-sided epicardial connection (EC), evaluate the requirement for additional carina ablation after circumferential pulmonary vein (PV) ablation depending on the presence of EC, and investigate the clinical characteristics including the amount of epicardial adipose tissue (EAT) in patients with ECs. Methods and Results: Forty-one patients scheduled for PV isolation were enrolled. Before ablation, activation mapping of the LA was prospectively performed during pacing from the RAPW. EC was observed in 12 patients (EC group, 29%), whereas no EC was observed in the remaining 29 patients (non-EC group, 71%). For PV isolation, carina ablation was required in addition to circumferential ablation in 7 patients (58%) in the EC group, compared to 2 patients (7%) in the non-EC group (p < 0.003). Periatrial and intercaval EAT volumes were significantly lower (12.8 ± 6.2 vs. 23.1 ± 13.9 ml/m , p < 0.02, and 1.1 ± 0.8 vs. 2.2 ± 1.6 ml/m , p< 0.02, respectively) and the patients were younger (66.5 ± 6.6 vs. 72.4 ± 8.3 years, p < 0.03) in the EC group than in the non-EC group. Conclusions: RAPW pacing revealed EC between the RA and right PV carina in nearly a quarter of the patients.

scholarly journals Quantification of epicardial adipose tissue in patients undergoing hybrid ablation for atrial fibrillation

2019 ◽  
Vol 56 (1) ◽  
pp. 79-86
Author(s):  
Mindy Vroomen ◽  
Jules R Olsthoorn ◽  
Bart Maesen ◽  
Vladimir L’Espoir ◽  
Mark La Meir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Right Atrium ◽  
Left Atrial ◽  
Epicardial Adipose Tissue ◽  
Conduction Block ◽  
Myocardial Tissue ◽  
Tissue Volume ◽  
Af Ablation

Abstract OBJECTIVES Epicardial adipose tissue volume (EAT-V) has been linked to atrial fibrillation (AF) recurrences after catheter ablation. We retrospectively studied the association between atrial EAT-V and outcome after hybrid AF ablation (epicardial surgical and endocardial catheter ablation). METHODS On preoperative cardiac computed tomography angiography scans, the left atrium and right atrium were manually delineated using the open source ImageJ. With custom-made automated software, the number of pixels in the regions of interest on each slice was calculated. On the basis of the Hounsfield units, pixel size and slice thickness, EAT-V was computed and normalized in relation to the body surface area (BSA) and the myocardial tissue volume. RESULTS Eighty-five patients were included. Left atrial and right atrial EAT-V normalized to BSA were not significantly different between paroxysmal and persistent AF [0.84 (0.51–1.50) vs 0.81 (0.57–1.18), 1.74 (1.02–2.56) vs 1.55 (1.26–2.18), all P = 0.9], neither between the acute conduction block and no acute conduction block in the epicardial box lesion [0.92 (0.55–1.39) vs 0.72 (0.55–1.24), P = 0.5, right atrium not applicable], nor between the sinus rhythm and arrhythmia recurrence after 12 months [0.88 (0.55–1.48) vs 0.63 (0.47–1.10), 1.61 (1.11–2.50) vs 1.55 (1.20–2.20), all P > 0.1]. Left atrial EAT-V normalized to myocardial tissue volume was not different between the groups. CONCLUSIONS This study could neither confirm that EAT-V was predictive of recurrence of supraventricular arrhythmias in patients undergoing a hybrid AF ablation, nor that EAT-V was different between patients with paroxysmal AF and persistent and long-standing persistent AF. This suggests that EAT-V might not affect the outcome in surgical ablation procedures and therefore should not influence preoperative or intraoperative decision-making.

scholarly journals Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxystic Atrial Fibrillation Catheter Ablation?

2021 ◽  
Vol 10 (14) ◽  
pp. 3037
Author(s):  
Néfissa Hammache ◽  
Hugo Pegorer-Sfes ◽  
Karim Benali ◽  
Isabelle Magnin Poull ◽  
Arnaud Olivier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Epicardial Adipose Tissue ◽  
University Hospital ◽  
One Year ◽  
Af Recurrence

Background: In patients undergoing paroxysmal atrial fibrillation (PAF) ablation, pulmonary vein isolation (PVI) alone fails in maintaining sinus rhythm in up to one third of patients after a first catheter ablation. Epicardial adipose tissue (EAT), as an endocrine-active organ, could play a role in the recurrence of AF after catheter ablation. Objective: To evaluate the predictive value of clinical, echocardiographic, biological parameters and epicardial fat density measured by computed tomography scan (CT-scan) on AF recurrence in PAF patients who underwent a first pulmonary vein isolation procedure using radiofrequency (RF). Methods: This monocentric retrospective study included all patients undergoing first-time RF PAF ablation at the Nancy University Hospital between March 2015 and December 2018 with one-year follow-up. Results: 389 patients were included, of whom 128 (32.9%) had AF recurrence at one-year follow-up. Neither total-EAT volume (88.6 ± 37.2 cm3 vs. 91.4 ± 40.5 cm3, p = 0.519), nor total-EAT radiodensity (−98.8 ± 4.1 HU vs. −98.8 ± 3.8 HU, p = 0.892) and left atrium-EAT radiodensity (−93.7 ± 4.3 HU vs. −93.4 ± 6.0 HU, p = 0.556) were significantly associated with AF recurrence after PAF ablation. In multivariate analysis, previous cavo-tricuspid isthmus (CTI) ablation, ablation procedure duration, BNP and triglyceride levels remained independently associated with AF recurrence after catheter ablation at 12-months follow-up. Conclusion: Contrary to persistent AF, EAT parameters are not associated with AF recurrence after paroxysmal AF ablation. Thus, the role of the metabolic atrial substrate in PAF pathophysiology appears less obvious than in persistent AF.

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

2019 ◽  
Vol 30 (11) ◽  
pp. 2209-2216 ◽  
Author(s):  
Jinhee Ahn ◽  
Seung Yong Shin ◽  
Jaemin Shim ◽  
Young‐Hoon Kim ◽  
Sang‐Jin Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Epicardial Adipose Tissue ◽  
Embolic Stroke

scholarly journals Association Between Epicardial Adipose Tissue Volumes on 3-Dimensional Reconstructed CT Images and Recurrence of Atrial Fibrillation After Catheter Ablation

2011 ◽  
Vol 75 (11) ◽  
pp. 2559-2565 ◽  
Author(s):  
Koichi Nagashima ◽  
Yasuo Okumura ◽  
Ichiro Watanabe ◽  
Toshiko Nakai ◽  
Kimie Ohkubo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Epicardial Adipose Tissue ◽  
Ct Images ◽  
3 Dimensional

scholarly journals Catheter ablation of atrial fibrillation without pulmonary vein isolation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Futyma ◽  
L Zarebski ◽  
A Wrzos ◽  
M Futyma ◽  
P Kulakowski
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Superior Vena ◽  
Vena Cava ◽  
Funding Sources ◽  
The Right ◽  
Ganglionated Plexus

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation (CA) of atrial fibrillation (AF), however, long-term efficacy of PVI is frequently below expectations. PVI is invasive, expensive and may be associated with devastating complications. It has been postulated that vagally-mediated AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation by means of radiofrequency CA (RFCA) of the right anterior ganglionated plexus (RAGP), however, data in literature and guidelines are lacking. Purpose To examine the efficacy of RFCA targeting RAGP without PVI in management of vagal AF. Methods We included consecutive 9 male patients with vagal AF who underwent RFCA of RAGP without PVI. RAGP was targeted anatomically from the right atrium (RA) at the postero-septal area below superior vena cava (SVC) and from the left atrium (LA) if needed. The aim was to achieve &gt;30% increase in heart rate (HR) . The follow up consisted of regular visits and Holter ECG conducted every 3 months. Results A total number of 9 patients (age 52 ± 13) with vagally-mediated AF underwent RFCA of RAGP (mean RAGP RF time 147 ± 85, max power 34 ± 8W). The mean procedure time was 60 ± 29min. HR increase &gt;30% was achieved in 8 (89%) patients (pre-RF vs post-RF: 58 ± 8bpm vs 87 ± 12bpm, p = 0.00002) . Transseptal  to reach RAGP also from the LA was needed in 2 (22%) patients. There were no major complications during the procedures. The follow up lasted 6 ± 2 months. Antiarrhythmic drugs were discontinued in 8 (89%) patients. There was 1 (11%) AF recurrence in the patient in whom targeted HR acceleration during RFCA was not achieved. B-blockers were administered in  6 (67%) patients due to increased HR and such treatment was well tolerated by all. Conclusions Catheter ablation of RAGP without performing PVI is feasible and can be effective in majority of patients with vagally-mediated AF. Increased HR after such cardioneuroablation can be well controlled using b-blockers and is usually associated with mild symptoms. The role of cardioneuroablation for treatment of vagally-mediated AF needs to be determined in prospective trials. Abstract Figure. Cardioneuroablation in vagal AF

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