Clinical Outcome of Electrophysiologically Guided Ablation for Nonparoxysmal Atrial Fibrillation Using a Novel Real-Time 3-Dimensional Mapping Technique

Pappone, Carlo; Ciconte, Giuseppe; Vicedomini, Gabriele; Mangual, Jan; Li, Wenwen; Conti, Manuel; Giannelli, Luigi; Lipartiti, Felicia; McSpadden, Luke C.; Ryu, Kyungmoo; Guazzi, Marco; Menicanti, Lorenzo; Santinelli, Vincenzo

doi:10.1161/circep.117.005904

Cited by 25 publications

(24 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This approach was further tested in a prospective, single-centre, randomized trial in 2018. 58 Bipolar endocardial electrograms were acquired with a multipolar catheter at sequential locations in the left atrium. The regions showing repetitive-regular activities (RR, distinct peak–peak activations, consistent electrogram morphology, flat isoelectric line) with a mean cycle length ≤220 ms and a standard deviation ≤30 ms were considered ablation targets (RR a data in Figures 3 and 4 ).…”

Section: Description and Classification Of Mechanism-based Approaches For Af Mapping And Ablationmentioning

confidence: 99%

Novel approaches to mechanism-based atrial fibrillation ablation

Quintanilla

Shpun²,

Jalife

et al. 2021

Cardiovascular Research

View full text Add to dashboard Cite

Modern cardiac electrophysiology has reported significant advances in the understanding of mechanisms underlying complex wave propagation patterns during atrial fibrillation (AF), although disagreements remain. One school of thought adheres to the long-held postulate that AF is the result of randomly propagating wavelets that wonder throughout the atria. Another school supports the notion that AF is deterministic in that it depends on a small number of high-frequency rotors generating three-dimensional scroll waves that propagate throughout the atria. The spiralling waves are thought to interact with anatomic and functional obstacles, leading to fragmentation and new wavelet formation associated with the irregular activation patterns documented on AF tracings. The deterministic hypothesis is consistent with demonstrable hierarchical gradients of activation frequency and AF termination on ablation at specific (non-random) atrial regions. During the last decade, data from realistic animal models and pilot clinical series have triggered a new era of novel methodologies to identify and ablate AF drivers outside the pulmonary veins. New generation electroanatomical mapping systems and multielectrode mapping catheters, complimented by powerful mathematical analyses, have generated the necessary platforms and tools for moving these approaches into clinical procedures. Recent clinical data using such platforms have provided encouraging evidence supporting the feasibility of targeting and effectively ablating driver regions in addition to pulmonary vein isolation in persistent AF. Here, we review state-of-the-art technologies and provide a comprehensive historical perspective, characterization, classification, and expected outcomes of current mechanistically based methods for AF ablation. We discuss also the challenges and expected future directions that scientists and clinicians will face in their efforts to understand AF dynamics and successfully implement any novel method into regular clinical practice.

show abstract

Section: Description and Classification Of Mechanism-based Approaches For Af Mapping And Ablationmentioning

confidence: 99%

Novel approaches to mechanism-based atrial fibrillation ablation

Quintanilla

Shpun²,

Jalife

et al. 2021

Cardiovascular Research

View full text Add to dashboard Cite

show abstract

“…On this line, Pappone et al have proposed a new method based on cycle length analysis, variability of electrograms and conduction velocity vectors to identify the direction of wavefront propagation, the speed of the repetitive-regular activations and the fractionation index, which is measured by an automatic algorithm to show the regions exhibiting fragmented electrograms ( Table 1 , Figure 2D ). [ 66 ] The regions showing repetitive and regular activations with a mean cycle length ≤220 ms and a cycle length standard deviation between 0 and 30 ms were considered as ablation targets. These regions showed distinct peak–peak activations, small variation in activation cycle length, consistent electrogram morphology, flat isoelectric interval between consecutive activations and consistent activation sequences on the multielectrode mapping catheter over time.…”

Section: Experimental Bases and Clinical Tools To Identify Drivers Of Afmentioning

confidence: 99%

“…The methodology excluded irregular activations (>30 ms variability), fractionation (60–120 ms cycle length) and regions with voltage <0.05 mV from the analysis to identify AF sources ( Table 2 ). [ 66 ]…”

Section: Experimental Bases and Clinical Tools To Identify Drivers Of Afmentioning

confidence: 99%

See 1 more Smart Citation

Mapping Technologies for Catheter Ablation of Atrial Fibrillation Beyond Pulmonary Vein Isolation

et al. 2021

View full text Add to dashboard Cite

Catheter ablation remains the most effective and relatively minimally invasive therapy for rhythm control in patients with AF. Ablation has consistently shown a reduction of arrhythmia-related symptoms and significant improvement in patients’ quality of life compared with medical treatment. The ablation strategy relies on a well-established anatomical approach of effective pulmonary vein isolation. Additional anatomical targets have been reported with the aim of increasing procedure success in complex substrates. However, larger ablated areas with uncertainty of targeting relevant regions for AF initiation or maintenance are not exempt from the potential risk of complications and pro-arrhythmia. Recent developments in mapping tools and computational methods for advanced signal processing during AF have reported novel strategies to identify atrial regions associated with AF maintenance. These novel tools – although mainly limited to research series – represent a significant step forward towards the understanding of complex patterns of propagation during AF and the potential achievement of patient-tailored AF ablation strategies for the near future.

show abstract

“…In another study, a novel real-time three-dimensional mapping technique was used to identify repetitive-regular activities (RRas). 133 Patients were randomised into a group undergoing ablation of RRa followed by modified circumferential PV ablation, and another group assigned to modified circumferential PV ablation alone.…”

Section: Ablation Of Non-pulmonary Vein Triggersmentioning

confidence: 99%

Mechanisms of Atrial Fibrillation and Their Impact on Strategies for Catheter Ablation

Guettler¹,

Nicol²,

Schmitt³

et al. 2018

European Journal of Arrhythmia &Amp; Electrophysiology

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained arrhythmia, and is ubiquitous in clinical practice. The underlying mechanisms of initiation and maintenance of AF are complex and not completely understood. This knowledge, however, is fundamental for the development of treatment strategies for AF. Within the last 20 years, catheter ablation has played an increasing role as a rhythm control therapy. Based on diverse models for the initiation and maintenance of AF, various ablation strategies have been proposed. The cornerstone of AF ablation has been pulmonary vein isolation (PVI). In persistent AF, however, PVI alone is often not sufficient. This may be because of the structural remodelling of the atria leading to dilation and fibrosis amongst other factors. The optimal strategy for substrate modification, however, is still a matter of investigation. Current studies are concentrating on the ablation of fibrotic areas, especially in the left atrium, either detected by delayed enhancement magnetic resonance imaging or by identification of low-voltage areas as a surrogate marker. The second intensely evaluated strategy is the localisation and ablation of rotational activity. Many further randomised controlled trials will likely be needed to determine the optimal ablation strategy for individual patients.

show abstract

Clinical Outcome of Electrophysiologically Guided Ablation for Nonparoxysmal Atrial Fibrillation Using a Novel Real-Time 3-Dimensional Mapping Technique

Cited by 25 publications

References 41 publications

Novel approaches to mechanism-based atrial fibrillation ablation

Novel approaches to mechanism-based atrial fibrillation ablation

Mapping Technologies for Catheter Ablation of Atrial Fibrillation Beyond Pulmonary Vein Isolation

Mechanisms of Atrial Fibrillation and Their Impact on Strategies for Catheter Ablation

Contact Info

Product

Resources

About