scholarly journals Is the extent of left atrial fibrosis associated with body mass index in patients undergoing pulmonary vein isolation for atrial fibrillation?

2021 ◽  
Author(s):  
Janko Szavits Nossan ◽  
Igor Šesto ◽  
Krešimir Štambuk ◽  
Tomislav Šipić ◽  
Robert Bernat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Pulmonary Vein ◽  
Body Mass ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis

Assessing the atrial substrate: electrograms from the coronary sinus can predict left atrial fibrosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Mohsen ◽  
J Draheim ◽  
N Grossmann ◽  
C.H Turan ◽  
M Schoett ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Coronary Sinus ◽  
Left Atrial ◽  
Pearson Correlation ◽  
Atrial Fibrosis ◽  
Atrial Ablation ◽  
Left Atrial Fibrosis ◽  
Diagnostic Catheter

Abstract Background Left atrial fibrosis plays a key role regarding the success rate of pulmonary vein isolation for atrial fibrillation. It can be analyzed using LGE-MRI or invasive LA electroanatomical mapping. Assessing LA substrate prior to performing LA ablation procedures might help in optimizing the ablation approach. Method We analysed highdensity-electroanatomical maps of the left atrium derived by Carto 3 from 282 consecutive atrial fibrillation patients scheduled for RF pulmonary vein isolation (PVI). Maps were divided into 5 different anatomical areas and fibrosis was defined as local voltage <0.5mV. The extent of fibrosis was analyzed and compared with signal recordings from different positions of a diagnostic catheter positioned in the coronary sinus (CS) using Pearson correlation analysis. Results PVI was carried out in 282 patients (male 72%, mean age 63±10.8 years). A minimum of 1000 evenly distributed local electrograms were recorded in every patient. Significant LA fibrosis (>5%) was present in 54% of the patients with the maximum incidence of 100% at the anterior and 80% at the posterior wall. Signal amplituds in the proximal CS position significantly correlated with presence of LA fibrosis in the posterior LA (R 0.84, p<0.001), LA roof (R 0.65; p<0.001), left lateral (R 0.54; p<0.001), septal (R 0.47; p<0.001), and even LA anterior wall (R 0.56; p<0.001). Comparable results were found when using distal CS signals or a signal averaged over all individual CS signals. When used as a diagnostic tool, a CS amplitude <1.9mV could predict fibrosis at the posterior left atrial wall with a specificity of 97% and a sensitivity of 67% (PLR 24, AUC 0.91, 95% CI 0.87 - 0.95; p<0.001). A cut-off value of 1.9mV could be used to identify patients with only minimal LA fibrosis (<5%) with specificity of 88% and a sensitivity of 50% (PLR 4.2, AUC 0.81, 95% CI 0.71–0.89; p<0.001. Conclusion Voltage signals in the CS are significantly associated with presence of fibrosis in all left atrial areas. Moreover, CS voltage signals can be used to identify presence of significant left atrial extrapulmonary vein fibrosis and could help guiding left atrial ablation procedures and choice of ablation technique. Funding Acknowledgement Type of funding source: None

scholarly journals Quantification of Left Atrial Fibrosis in Patients After Pulmonary Vein Isolation Using the Second-Generation Cryoballoon

2021 ◽  
Vol 62 (1) ◽  
pp. 65-71
Author(s):  
Laura Rottner ◽  
Christian-Hendrik Heeger ◽  
Christine Lemes ◽  
Peter Wohlmuth ◽  
Tilman Maurer ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Second Generation ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis

scholarly journals Electrograms from the coronary sinus as a predictor for the outcome of a re-do pulmonary vein isolation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Mohsen ◽  
N Grossmann ◽  
J Draheim ◽  
M Horlitz ◽  
F Stoeckigt
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Coronary Sinus ◽  
Left Atrial ◽  
High Sensitivity ◽  
Signal Amplitude ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis ◽  
Diagnostic Catheter ◽  
Af Recurrence

Abstract Background Voltage signals in the coronary sinus (CS) have been associated with the presence of left atrial fibrosis. The aim of the present study was to evaluate the value of CS voltage signals as a predictor for atrial fibrillation (AF)-recurrence-free outcome of pulmonary vein isolationprocedures (PVI) in patients after a first unsuccessful cryo-balloon PVI. Method We collected recordings from a diagnostic catheter positioned in the CS from 282 consecutive atrial fibrillation patients undergoing a re-dopulmonary vein isolation using a 3D mapping system. The patients were followed-up (Holter ECG and telephone calls) for at least one year (median of 14 months). Results Of the 282 patients (male 72%, mean age 63±10.8 years, 61% persistent AF) AF recurrences were documented in 152 pts (54%)with a signal amplitude in the proximal CS position of 2.4 mV ± 1.5 mV. Patients free of AF-recurrence showed significantly higher signal amplitude of 2.9 mV ± 2.1 mV (P<0,05). A CS voltage <0.53mV could predict recurrences of AF with a sensitivity of 94.7% (95% CI 89.3% – 97.8%) and specificity of 8.6% (95% CI 4.6% – 14.8%; PLR 1.04; AUC 0.55). Conclusion Voltage signals in the CS, as a marker for left atrial fibrosis, are associated with the outcome of PVI. A voltage threshold of <0.53mV can predict AF recurrences with a high sensitivity. However, the predictive value for AF recurrences is not high due to the low specificity of this test. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Impact of body mass index on atrial fibrillation ablation using cryoballoon: procedural data and clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Urbanek ◽  
S Chen ◽  
S Bordignon ◽  
N Tsianakas ◽  
F Bologna ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Pulmonary Vein ◽  
Body Mass ◽  
Pulmonary Vein Isolation ◽  
Clinical Success ◽  
Cryoballoon Ablation ◽  
Group 3 ◽  
The Impact

Abstract Background The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported. Purpose To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB. Methods Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) >75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT). Results Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p<0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p<0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%). Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded. Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF. Conclusions Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF. Funding Acknowledgement Type of funding source: None

Atrial Fibrosis and Conduction Slowing in the Left Atrial Appendage of Patients Undergoing Thoracoscopic Surgical Pulmonary Vein Isolation for Atrial Fibrillation

2015 ◽  
Vol 8 (2) ◽  
pp. 288-295 ◽  
Author(s):  
Sébastien P.J. Krul ◽  
Wouter R. Berger ◽  
Nicoline W. Smit ◽  
Shirley C.M. van Amersfoorth ◽  
Antoine H.G. Driessen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Atrial Fibrosis
Sign in / Sign up

Export Citation Format

Share Document