T Gaspar

Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study

OBJECTIVEnWe explored whether the use of a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation.nnnMETHODSnEighty patients (44 men (55%); mean age 63 ± 10 years) who underwent catheter ablation due to paroxysmal AF were recruited consecutively in the present study. Patients were randomized (1:1) into 2 arms for AF ablation: one using a conventional 3-dimensional electroanatomical mapping (EAM) system and the other using the F-EAM system.nnnRESULTSnFluoroscopy time (10:42 [interquartile range {IQR} 8:45-12:46] minutes:seconds vs 1:45 [IQR 1:05-2:22] minutes:seconds; P < .001) and radiation doses (2440 [IQR 1593-3091] cGy·cm(2) vs 652 [IQR 326-1489] cGy·cm(2); P < .001) in the EAM group were significantly greater than those in the F-EAM group. The majority of reduction of radiation exposure was achieved after transseptal puncture, which was near-zero fluoroscopic exposure. In total, approximately 84% of fluoroscopy time and 73% of radiation doses have been reduced during the AF ablation procedure using the F-EAM system compared to using the conventional EAM system. However, procedure time did not differ significantly (1:39 [IQR 1:18-2:10] hours:minutes vs 1:37 [IQR 1:17-1:50] hours:minutes; P = .362). During follow-up (5.9 ± 1.3 months), 61 patients (76.3%) had no recurrence of atrial arrhythmias. The recurrence rate between the 2 groups did not differ.nnnCONCLUSIONnAF catheter ablation using the F-EAM system was safe and resulted in a significant reduction of radiation exposure to patients and staff without complicating the workflow of the procedure. A near-zero fluoroscopic catheter ablation procedure could be performed without compromising acute/mid-term efficacy and safety.

Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: Incidence, characteristics, and risk factors

BACKGROUNDnThromboembolic complications remain one of the most severe adverse events associated with catheter ablation of atrial fibrillation (AF), but data on such events are limited.nnnOBJECTIVEnThe purpose of this study was to evaluate the incidence, characteristics, and risk factors of thromboembolic complications after AF ablation.nnnMETHODSnCerebral thromboembolic complications occurring within 1 month of 3360 consecutive AF radiofrequency catheter ablations were assessed. Stroke was defined as a neurologic deficit lasting more than 24 hours or with imaging study showing new infarction. Transient ischemic attack (TIA) was defined as a deficit lasting less than 24 hours and without documented infarction.nnnRESULTSnThere were 17 peri-interventional cerebral thromboembolic events (0.5%). Nine cases (53%) were diagnosed as strokes and 8 (47%) as TIAs. Sixty percent of the events occurred within 48 hours after the ablation; the rest occurred within 1 week. In univariate analysis, peri-interventional thromboembolism was associated with peripheral vascular disease (P = .010), impaired left ventricular ejection fraction (P = .040), periprocedural bridging with heparin (P = .007), and previous stroke (P = .026). Multivariable analysis demonstrated that peripheral vascular disease (odds ratio [OR] 8.81, confidence interval [CI] 1.61-48.31, P = .012) and previous stroke (OR 6.13, CI 1.18-31.91, P = .031) were independent predictors. In a different model, the CHA2DS2-VASc score was associated with thromboembolism (OR 1.35, CI 1.00-1.80, P = .049).nnnCONCLUSIONnCerebral thromboembolic complications after AF radiofrequency catheter ablation are rare. They mostly occur within 48 hours after the procedure and remain without lasting neurologic deficits in the majority of cases. Such complications are associated with peripheral vascular disease, previous stroke, and the CHA2DS2-VASc score.

Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation

AimsnTo describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients.nnnMethods and resultsnConsecutive patients who underwent a bipolar voltage map guided AF ablation, were enrolled. Voltage maps were conducted for each patient using 3-dimensional electroanatomical mapping system and LVZ were defined as areas of bipolar voltage <u20090.5 mV. A total of 539 patients (309 male, age 65u2009±u200910 years) were included. Low voltage zones was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (Pu2009<u20090.001). The area of LVZ was larger in patients with persistent as compare to paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1u2009cm2 (IQR 3.6-28.5), Pu2009=u20090.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1.05-1.10, Pu2009<u20090.001), female gender (OR 2.18, 95%CI 1.38-3.43, Pu2009=u20090.001), sinoatrial node dysfunction (OR 3.90, 95%CI 1.24-12.21, Pu2009=u20090.020), larger surface area of left atrium pr. cm2 (OR 1.01, 95%CI 1.00-1.02, Pu2009=u20090.016), and persistent AF (OR 5.03, 95%CI 3.20-7.90, P<0.001) were associated with presence of LVZ.nnnConclusionnIn a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ was associated with higher age, female gender, larger LA surface area, and sinoatrial node dysfunction.

Koronarsinus-Mapping der optimalen linksventrikulären Elektrodenposition

ZusammenfassungDie kardiale Resynchronisationstherapie (CRT) ist ein etablierter Pfeiler der Behandlung von Patienten mit chronischer Herzinsuffizienz. Rund 30u202f% der Patienten sprechen nicht ausreichend auf diese Therapieform an. Eine mögliche Ursache hierfür ist ein nicht optimaler Stimulationsort am linken Ventrikel. In dieser Übersichtsarbeit werden Möglichkeiten der Darstellung der Koronarvenenanatomie bzw. deren Rolle bei der Bestimmung der elektrischen und mechanischen Dyssynchronie zur Optimierung des Therapieerfolgs der CRT erläutert. Zudem wird auf die klinische Implikation und die Perspektiven eines dezidierten Mappings der Koronarvene eingegangen. Abschließend erfolgt ein kurzer Ausblick auf aktuelle und zukünftige Technologien zur Verbesserung dieser Therapieform.AbstractCardiac resynchronization therapy (CRT) is an established pillar of treatment for patients with chronic heart failure. However, 30% of patients do not respond adequately to this type of therapy. One possible reason for this is axa0nonoptimal left ventricular stimulation site. This review focuses on possibilities of visualization of the coronary vein anatomy and its role in the determination of the electrical and mechanical dyssynchrony to optimize the therapeutic success of the resynchronization therapy. In addition, the clinical implication and the perspectives of axa0dedicated mapping of the coronary vein are discussed. Finally, axa0brief outlook on current and future technologies for improving this form of therapy is given.Cardiac resynchronization therapy (CRT) is an established pillar of treatment for patients with chronic heart failure. However, 30% of patients do not respond adequately to this type of therapy. One possible reason for this is axa0nonoptimal left ventricular stimulation site. This review focuses on possibilities of visualization of the coronary vein anatomy and its role in the determination of the electrical and mechanical dyssynchrony to optimize the therapeutic success of the resynchronization therapy. In addition, the clinical implication and the perspectives of axa0dedicated mapping of the coronary vein are discussed. Finally, axa0brief outlook on current and future technologies for improving this form of therapy is given.