Initial experience with fractionation mapping–guided ablation strategy in patients with long-standing persistent atrial fibrillation

Aksu, Tolga; Güler, Tümer Erdem; Bozyel, Serdar; Yalın, Kıvanç; Lakkireddy, Dhanunjaya; Gopinathannair, Rakesh

doi:10.1007/s10840-020-00834-7

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Aksu et al. recently reported that fractionation map based on width, refractory period, and sensitivity instead of cycle length of AF could detect critical AF substrate such as LAA, and may provide an adjunctive benefit in guiding ablations in LSPAF 25,26 . The relationship between this new mapping algorithm and DF is not clear and may deserve further study.…”

Section: Discussionmentioning

confidence: 99%

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

Zaman

Shi

et al. 2021

Pacing Clinical Electrophis

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Objectives To study how left atrial appendage electrical isolation (LAAEI) impacts atrial dominant frequency (DF) in patients with long‐standing persistent atrial fibrillation (LSPAF). Background LAAEI is associated with a high probability of freedom from atrial fibrillation (AF) and spectral analysis may identify high‐frequency sources. How LAAEI impacts the AF dynamics and the subgroup of LSPAF patients in whom LAAEI would be most beneficial, is unclear. Methods Twenty patients with LSPAF were included in the study. Fast Fourier transforms (FFT) were performed on atrial electrograms recorded from 13 sites in the LA and RA. The highest peak frequency was defined as DF. Results There was no significant difference in DF between atrial sites except for at the superior vena cava which had the lowest DF at baseline. Stepwise ablation consisting of circumferential pulmonary vein isolation and a linear ablation set of mitral isthmus and roof significantly reduced the DF within the coronary sinus (CS) (5.93 ± 0.98 Hz vs. 5.09 ± 0.72 Hz, p < .05) and the LA posterior wall (LApos) (6.26 ± 0.92 Hz vs. 5.43 ± 0.98 Hz, p < .01). LAAEI preferentially further decreased the DF at the LApos (p < .01), but not at the CS. In cases where there was < 13.6% reduction in the DF of the LApos following the stepwise ablation, the addition of LAAEI was associated with an increased restoration of sinus rhythm (55%, p < .05). Conclusion LAAEI in addition to stepwise ablation results in further reduction of the DF in the LApos, which is associated with acute termination of AF and favorable ablation outcome.

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Section: Discussionmentioning

confidence: 99%

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

Zaman

Shi

et al. 2021

Pacing Clinical Electrophis

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“…However, in this technique, mapping parameters like width, refractory time, roving sensitivity, and fractionation threshold should be standardized because based on these parameters, the algorithm assigns each EGM a fractionation score. Although use of the fractionation software during AF to detect critical AF substrate 7,14 or to define localization of GPs 8 is studied by our group, the technique should need some validation against GP sites identified by high frequency stimulation or potentially by nuclear imaging in further randomized controlled studies. Therefore, in the present study, ablation points were selected based on previously validated visual method rather than fractionation mapping.…”

Section: Discussionmentioning

confidence: 99%

Fractionation mapping software to map ganglionated plexus sites during sinus rhythm

Aksu

Yalın

Gopinathannair

2020

Cardiovasc electrophysiol

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Ablation of ganglionated plexuses (GPs) is a relatively new technique in patients with vasovagal syncope. Due to individual variation of GP settlement, reproducible GP detection methods are needed to during electrophysiologic study. In the present case, fractionation mapping software of Ensite system was tested to detect localization of GPs and first compared with previously validated fractionated electrograms based strategy.

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“…More recently, our group demonstrated that RF catheter ablation guided by the identification of complex fractionated left atrial electrograms during sinus rhythm using 3D electroanatomical mapping correlated highly with the distribution of successful GP ablation sites without need for HFS, resulting in significant simplification of procedural workflow to add adjunctive GP ablation to PVI. 62,[79][80][81][82] Briefly, after 3D mapping both atria, fragmented bipolar endocardial atrial electrograms are evaluated for the number of deflections at filter settings of 200-500 Hz by using the ablation catheter. The electrograms demonstrating greater or equal to 3-4 deflections in regions which are anatomically consistent with GP sites are tagged as ablation targets.…”

Section: Endocardial Mapping Of Ganglionated Pleximentioning

confidence: 99%

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Aksu

Skeete

Huang

2023

Arrhythm Electrophysiol Rev

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As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS – ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation – constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.

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Initial experience with fractionation mapping–guided ablation strategy in patients with long-standing persistent atrial fibrillation

Cited by 9 publications

References 16 publications

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF

Fractionation mapping software to map ganglionated plexus sites during sinus rhythm

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

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