Temporal elimination of an interatrial epicardial connection by ablation encircling the right-sided pulmonary veins.
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ABSTRACT:
SUBMITTER: Hasebe H
PROVIDER: S-EPMC7653468 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
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Temporal elimination of an interatrial epicardial connection by ablation encircling the right-sided pulmonary veins.
Hasebe Hideyuki H Furuyashiki Yoshitaka Y Yoshida Kentaro K
HeartRhythm case reports 20200818 11
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Project description:A 43-year-old man underwent circumferential pulmonary vein isolation (PVI) for persistent atrial fibrillation. Although first-pass circumferential PV antrum ablation was performed, complete PVI was not obtained. A gap map showed the site of earliest activation was the right-sided PV carina, which was the same site of breakthrough on the left atrium map before ablation. Using a coherent map enabled us easily and clearly to evaluate the breakthrough sites. To identify whether the conduction from the right PV carina connected to adjacent structures, an activation map was obtained during pacing from the right PV carina. This revealed that the site of earliest activation was the posterior right atrium (RA) and implied a direct connection between the right-sided PVs and RA. The first radiofrequency (RF) application in the posterior RA resulted in only temporary isolation of the right-sided PVs with bi-directional block. Therefore, we performed a second set of RF applications to the right PV carina. PVI was obtained immediately after initiating the second set of applications and no further reconnection was observed.Learning objectivePulmonary vein isolation (PVI) is widely accepted as an atrial fibrillation ablation procedure. Previous anatomical studies have revealed the presence of epicardial muscular bundles/fibers connecting the right-sided PVs and right atrium. In some patients, the presence of epicardial connections (ECs) precludes successful first-pass PVI. Identification and elimination of these connections is imperative to achieve complete PVI. The coherent map was useful for evaluating ECs.
| S-EPMC9808440 | biostudies-literature
Project description:BackgroundAblation of the pulmonary vein (PV) carina is occasionally required for PV isolation (PVI). Marshall bundle and epicardial connections between the right-sided PV (RtPV) carina and right atrium (RA) may be one of the mechanisms that necessitates carina ablation.ObjectiveWe sought to clarify anatomical characteristics predictive of the necessity of carina ablation.MethodsForty-five consecutive patients undergoing radiofrequency catheter ablation of atrial fibrillation were prospectively included in this study. Left atrial (LA) and PV size and morphology, and interatrial distance in the posterior aspect, were measured on cardiac computed tomography (CT) images.ResultsFor right-sided PVI, the patients were divided into 2 groups based on the necessity of RtPV carina ablation, Carina-ABL group (n = 21) and Non-Carina-ABL group (n = 24). The distance between the anterior portion of the RtPV carina and RA was shorter in the Carina-ABL group vs in the Non-Carina-ABL group (7.7 ± 1.7 mm/m2 vs 9.5 ± 2.3 mm/m2; P = .005), whereas other anatomical parameters (LA and RA volumes, right inferior PV angle, and ostial diameters of the RtPVs) did not differ between the groups. For left-sided PVI, the ostial diameter and circumference of the left superior PV were smaller in the Carina-ABL group (n = 13) vs the Non-Carina-ABL group (n = 32) (8.6 ± 2.1 mm/m2 vs 7.3 ± 1.5 mm/m2; P = .044, and 34.9 ± 6.0 mm/m2 vs 30.1 ± 5.1 mm/m2; P = .017, respectively).ConclusionsA shorter interatrial distance for right-sided PVI and a smaller PV ostium for left-sided PVI were associated with the necessity of additional carina ablation. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry.
| S-EPMC8183890 | biostudies-literature
Project description:BackgroundThis study thought to elucidate the anatomical features that can predict an epicardial connection (EC) between the right pulmonary vein (RPV) and right atrium.MethodsWe retrospectively analyzed 251 consecutive patients undergoing initial radiofrequency pulmonary vein isolation. We defined EC as present when RPV could not be isolated with circumferential ablation and additional ablation for the conduction gap if needed, and RPV isolation could be achieved by ablation for the earliest activation site >10 mm inside the initial ablation line. Using computed tomography data, we evaluated the RPV bifurcation angle, and the area occupation ratio of the carina region to the RPV antrum (ARC) for predicting EC. In subjects with EC undergoing RPV activation mapping after circumferential ablation, the correlation between conduction delay and bipolar/unipolar potential voltage in the carina region was investigated.ResultsThere were ECs in 45 out of 251 patients (17.9%). The RPV bifurcation angle (47.7° vs. 38.8°, p < .001) and ARC (37.2% vs. 29.7%, p < .001) were significantly greater in the EC (+) group. Multivariate logistic regression analysis revealed that RPV bifurcation angle (odds ratio [OR]: 1.994, p = .002) and ARC (OR: 3.490, p = .013) were independent predictors of EC. In nine patients with EC undergoing carina region mapping, the unipolar potential voltage was correlated with conduction delay in RPV with EC (R = -0.401, p < .001).ConclusionAnatomical features suggesting a wider RPV carina region could predict the presence of EC, and potential with high voltage could be helpful for detecting EC connection sites.
| S-EPMC10692864 | biostudies-literature
Project description: Not available
| S-EPMC7498505 | biostudies-literature
Project description:A 74-year-old man after multiple mitral valve surgeries underwent catheter ablation of a bi-atrial tachycardia (BiAT). Ultra-high resolution activation mapping exhibited a reentrant circuit propagating around the inferior to anterior mitral annulus and right atrial (RA) septum with two interatrial connections. At the transeptal puncture site, continuous fractionated electrograms were recorded during the BiAT, and entrainment pacing revealed a post-pacing interval similar to the tachycardia cycle length, which suggested that the interatrial conduction from the RA to the left atrium (LA) was located just at the transseptal puncture site. A radiofrequency application inside the transseptal puncture hole could successfully eliminate the BiAT. The ablation target for BiATs propagating around the mitral annulus and RA septum is generally the anatomical mitral isthmus (MI). Since the present case had multiple incisions on both the RA and LA septum due to mitral valve surgeries, there was the possibility of the occurrence of a BiAT including the RA and LA septum after performing an MI linear ablation. Therefore, the preferable ablation target for the BiAT in the present case appeared to be the interatrial connection. Ultra-high resolution detailed mapping not only on the atrial endocardium but also in the transseptal puncture hole may be useful for identifying a critical interatrial connection of BiAT circuits.
| S-EPMC10491961 | biostudies-literature
Project description: Not available
| S-EPMC9811108 | biostudies-literature
Project description:IntroductionHow wide the encircling line is made may influence the outcomes of pulmonary vein isolation (PVI). In the present study we hypothesised that the distance between the lines encircling the pulmonary veins may correspond with the extent of wide antral circumferential ablation (WACA). The aim of the study was to assess the impact of the distance and the area between the lines on the posterior wall of the left atrium on first-pass isolation rate and 12-month freedom from atrial arrhythmia in patients undergoing PVI ablation.Methods and resultsOne hundred sixteen patients underwent circumferential ablation index (AI)-guided PVI. The distance between the encircling ablation lines was measured off-line between the uppermost points (right and left) and the lowest points and as the area between the encircling lines on the posterior wall. The first-pass isolation rate and 12-month freedom from atrial arrhythmia were 59% and 73%, respectively. Distance between the encircling lines measured linearly or as the area of the posterior wall, assessed as direct values or indexed to left atrial dimensions, did not differ between patients with and without first-pass isolation or between patients with and without recurrences of atrial arrhythmia.ConclusionsThe distance between the ablation lines did not influence the rate of first-pass isolation and arrhythmia recurrence in the long-term follow-up after PVI procedures incorporating the ablation index protocol.
| S-EPMC10094726 | biostudies-literature
Project description:BackgroundSemantic variant of primary progressive aphasia (svPPA) is a subtype of frontotemporal dementia characterized by asymmetric temporal atrophy.MethodsWe investigated the pattern of medial temporal lobe atrophy in 24 svPPA patients compared to 72 controls using novel approaches to segment the hippocampal and amygdalar subregions on MRIs. Based on semantic knowledge scores, we split the svPPA group into 3 subgroups of early, middle and late disease stage.ResultsEarly stage: all left amygdalar and hippocampal subregions (except the tail) were affected in svPPA (21-35% smaller than controls), together with the following amygdalar nuclei in the right hemisphere: lateral, accessory basal and superficial (15-23%). On the right, only the temporal pole was affected among the cortical regions. Middle stage: the left hippocampal tail became affected (28%), together with the other amygdalar nuclei (22-26%), and CA4 (15%) on the right, with orbitofrontal cortex and subcortical structures involvement on the left, and more posterior temporal lobe on the right. Late stage: the remaining right hippocampal regions (except the tail) (19-24%) became affected, with more posterior left cortical and right extra-temporal anterior cortical involvement.ConclusionsWith advanced subregions segmentation, it is possible to detect early involvement of the right medial temporal lobe in svPPA that is not detectable by measuring the amygdala or hippocampus as a whole.
| S-EPMC6511178 | biostudies-literature
Project description: Not available
| S-EPMC7261229 | biostudies-literature
Project description:IntroductionFemoral venous access is routinely used for radiofrequency catheter ablation (RFA) procedures. Deep vein thrombosis (DVT), which is often sub-clinical, is uncommon following RFCA. Point-of-care ultrasound (POCUS) is a cost-effective way to diagnose DVT. Identification of DVT incidence, especially if sub-clinical, can direct change in practice to reduce DVT and lay ground for cost-effective screening strategies postprocedures. The aim of our study is to determine the incidence of DVT after right-sided radiofrequency cardiac catheter ablation using POCUS.MethodsWe conducted a single-center prospective cross-sectional study in patients undergoing right-sided RFCA. Within 24 h postprocedure, the participants underwent compression venous duplex ultrasonography using POCUS to look for evidence of DVT in cannulated limb. The contralateral limb that was not cannulated was scanned as a control.ResultsA total of 194 patients were scanned post-right-sided RFCA procedures. Average age was 43.5 ± 13.2 years and 131 (67.5%) were women. A total of 148 (76.3%) patients underwent AVNRT ablation. Ten (5.2%) patients developed DVT, of which nine had sub-clinical DVT. Age (>53 years), greater sum of sheaths used (>3) and longer duration of bed rest maintained (up to 4.0 h vs. >4.0 h, p = 0.006) were identified as risk factors.ConclusionMost of the DVTs after right-sided catheter ablation are sub-clinical. Routine scanning for DVT after right-sided catheter ablation as well as reducing number of sheaths and bed rest should be considered.
| S-EPMC11474768 | biostudies-literature