Histological assessment of transmurality after repeated radiofrequency ablation of the left atrial wall

Wakasa, Satoru; Kubota, Suguru; Shingu, Yasushige; Kato, Hiroki; Ōoka, Tomonori; Tachibana, Tsuyoshi; Matsui, Yoshiro

doi:10.1007/s11748-013-0363-9

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…The transmurality of RF ablation lesion is known to be lower in thick myocardium [8]. Therefore, the wall thickness of the PV antrum could be a determinant of successful PV isolation.…”

Section: Discussionmentioning

confidence: 99%

“…One of the major hurdles in the creation of transmural lesion by radiofrequency (RF) ablation is myocardial wall thickness. In a study using bipolar RF ablation in excised left atrial specimens, transmural lesion was only created in < 40% of the cases with thickness > 2.0 mm [8]. Mitral isthmus is one of the most common ablation targets for persistent AF and mitral isthmus-dependent atrial flutter.…”

Section: Introductionmentioning

confidence: 99%

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Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map

Joo

Lee

et al. 2021

Int J Arrhythm

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Background The major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV reconnection, and thicker wall could be associated with reconnection. Objectives This study aimed to evaluate the wall thickness of the PV antrum in reconnection sites using a three-dimensional (3D) wall thickness map. Methods A total of 91 patients who underwent a second ablation procedure due to AF recurrence were evaluated. The locations of the PV reconnection sites were confirmed in electroanatomical maps. A 3D atrial wall thickness (AWT) map was created using computed tomography scan data. The AWT values of the ablation lines of the index procedure were graded in each segment of the PV antrum: grade 1, 0.5 < AWT ≤ 1.0 mm; grade 2, 1.0 < AWT ≤ 1.5 mm; grade 3, 1.5 < AWT ≤ 2.0 mm; grade 4, 2.0 < AWT ≤ 2.5 mm; grade 5, AWT > 2.5 mm. Results A total of 281 PV reconnection sites among 1256 segments of the PV antrum in 79 patients were detected. The average AWT grades were 2.7 ± 1.0 and 2.2 ± 1.0 in the reconnected and non-reconnected segments, respectively (P < 0.01). Higher AWT grades were observed in the reconnected superior segments of the left superior PV, carina and inferior segments of the left inferior PV, superior and posterior segments of the right superior PV, and posterior and inferior segments of the right inferior PV. Conclusion The reconnected segments of the PV antrum showed thicker myocardium than the non-reconnected ones in patients with recurrent AF after catheter ablation. A wall thickness map for PV isolation could be considered for customized ablation in order to reduce PV reconnection.

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“…The transmurality of RF ablation lesion is known to be lower in thick myocardium [8]. Therefore, the wall thickness of the PV antrum could be a determinant of successful PV isolation.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map

Joo

Lee

et al. 2021

Int J Arrhythm

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“…In the thoracoscopic procedure, the ablation clamp was used to clamp the antrum of the PVs directly, allowing durable PV isolation with ease. The RF clamp, which can detect changes in tissue impedance, helps evaluate the transmurality of the ablation line [11]. As such, this is considered an objective and stable evaluation technique.…”

Section: Discussionmentioning

confidence: 99%

Immediate electrophysiological characteristics following modified thoracoscopic ablation via unilateral approach for non-valvular atrial fibrillation

Ding

Zeng

et al. 2021

Heart Vessels

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Background Thoracoscopic ablation has emerged as an effective therapy for patients with long-standing persistent Atrial fibrillation (LsPAF). We aimed to investigate the immediate electrophysiological characteristics following modified ablation with 3 circular and 3 linear lesions in the thoracoscopic procedure via a unilateral approach. Methods Between May 2015 and October 2018, 40 patients underwent the one-stage hybrid procedure for LsPAF. Isolation of the pulmonary veins (PV) and left atrium posterior wall (LAPW), excision of the left atrial appendage (LAA), and high-density endocardial mapping and individualized percutaneous catheter ablation for AF termination were performed. Results The modified thoracoscopic procedure may enable successful PV and LAPW isolation and LAA removal. Endocardial electrophysiological examination showed 6 out of 40 (15%) patients with a right PV gap, 3 (7.5%) patients with incomplete roof lesions, and 8 (20%) patients with incomplete Dallas lesions. A total of 44 driving areas were mapped and ablated. Thirty-five patients achieved procedural AF termination. After a mean follow-up period of 26 months, the success rate of a single procedure was 85%. Cox regression analysis demonstrated that the failure of procedural AF termination may be a risk factor in atrial tachyarrhythmia recurrence. Discussion Endocardial electrophysiological examination is a necessary partner to thoracoscopic ablation. Our modified thoracoscopic ablation and driving areas-based ablation contribute to high rates of procedural AF termination, which may lead to reduced recurrence rate. The hybrid procedure may be an effective strategy for the management of LsPAF.

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“…RF energy was applied at least 3 times in every patient in whom a bipolar ablation device was used for PV isolation. 16 The conduction block test for PV isolation was performed in the majority of patients, except those in whom the test is contraindicated. In fact, incomplete PV isolation was detected in 5.9% of patients by the conduction block test despite multiple applications of RF energy, and additional applications of RF ablation were performed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Restoration of sinus rhythm and atrial transport function after the maze procedure: U lesion set versus box lesion set

Nitta

Ishii

Fujii

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Histological assessment of transmurality after repeated radiofrequency ablation of the left atrial wall

Abstract: Triple repetition of RFA was associated with higher transmurality of lesions than double RFA, especially for thicker lesions. Increasing the number of repetitions could improve the success rate of the Cox-Maze procedure using RFA devices.

Cited by 11 publications

References 14 publications

Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map

Left atrial wall thickness and its relationship with reconnection after pulmonary vein isolation in patients with atrial fibrillation evaluated using a three-dimensional wall thickness map

Immediate electrophysiological characteristics following modified thoracoscopic ablation via unilateral approach for non-valvular atrial fibrillation

Restoration of sinus rhythm and atrial transport function after the maze procedure: U lesion set versus box lesion set

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