Pulmonary Veins to Left Atrium Cycle Length Gradient Predicts Procedural and Clinical Outcomes of Persistent Atrial Fibrillation Ablation

Pascale, Patrizio; Roten, Laurent; Scherr, Douglas S.; Komatsu, Yuki; Ramoul, Khaled; Daly, Matthew; Denis, Arnaud; Derval, Nicolas; Sacher, Frédéric; Hocini, Mélèze; Jaı̈s, Pierre; Haı̈ssaguerre, Michel

doi:10.1161/circep.113.001264

Cited by 22 publications

(30 citation statements)

References 26 publications

(31 reference statements)

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In these studies, both increased single procedural success 3,5,8,10,[13][14][15][16]19,21 and overall clinical success with multiple procedures 2,6,7,[11][12][13][15][16][17]20,21 were reported when compared with patients who did not achieve AF termination. In a study by Rostock et al, 22 which evaluated the long-term predictors of single-and multiple-procedure outcomes for 395 patients who had undergone persistent AF ablation, AF termination during the index procedure significantly predicted single-procedure success and also a favorable outcome after the final procedure.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

“…3,10,36 Furthermore, such a strategy allows stratification of the extent of ablation, where one-size-may-not-fit-all, especially in the setting of persistent AF. Pascale et al 20 demonstrated that a lower PV (fastest activity) to lA cycle length gradient predicted procedural AF termination after PVI or limited adjunctive substrate ablation, and that these patients had significantly better long-term outcomes. In an another study, lin et al 38 showed that procedural AF termination could be used to stratify persistent AF patients who respond well to PVI alone versus limited or extensive substrate modification.…”

Section: Individualized Approach and Patient Stratificationmentioning

confidence: 99%

See 1 more Smart Citation

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

Lim

Derval

Komatsu³

et al. 2015

Circ: Arrhythmia and Electrophysiology

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A lthough effective results are attained with paroxysmal atrial fibrillation (AF) ablation based on pulmonary vein isolation (PVI), catheter ablation of persistent AF remains a challenging task. Current ablation approaches in persistent AF ablation are markedly diverse, and there is a considerable variation in the reported clinical outcomes.1 Moreover, the lack of a distinct procedural end point makes comparison between the studies difficult. Response by Latchamsetty and Oral on p 971Recently, significant advances have been made with the development of novel technologies, such as computational mapping and panoramic noninvasive mapping to map drivers (rotors and focal discharges) during AF. The advent of these newer technologies and strategies for persistent AF ablation further raise the question as to whether AF termination should be the procedural end point, and whether it confers additional long-term clinical benefit.In this article, we review the current evidence on AF termination and long-term clinical outcome, procedural AF termination as a predictor of freedom from recurrent atrial arrhythmias, AF termination rates with various ablation strategies, and potential underlying mechanisms conferring clinical benefit and future directions. AF Termination and Clinical Outcome Search StrategyThe English scientific literature in the PubMed database was searched using the terms catheter ablation, persistent AF, and termination in any region of the PubMed record until October 2014. Studies that described procedural AF termination rates during ablation together with clinical outcomes after ablation for patients with persistent AF or long-standing persistent AF were included. References from the relevant articles were reviewed to identify further related articles. Definition of AF termination included direct conversion to sinus rhythm (SR) and organization to atrial tachycardia (AT) during ablation.

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Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

Section: Individualized Approach and Patient Stratificationmentioning

confidence: 99%

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

Lim

Derval

Komatsu³

et al. 2015

Circ: Arrhythmia and Electrophysiology

Self Cite

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“…However, how to predict whether PVI is sufficient for a given patient with persistent AF [1] and what to do for the majority of patients in whom it is not effective is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Paroxysmal AF patients have shorter ERP and longer conduction delays compared to control patients. Patients for whom persistent AF is likely to terminate after PVI have a larger ERP gradient compared to those who require further ablation [1,2]. In addition, AF patients show a number of other differences to control patients: conduction delay is increased at the LA/PV junction [2]; and fiber direction may be more disorganised, particularly at the PV ostium [3].…”

Section: Introductionmentioning

confidence: 99%

The Combination of Pulmonary Vein Electrophysiology and Atrial Fibrosis Determines Driver Location

Roney

Bayer

Dubois

et al. 2017

Computing in Cardiology Conference (CinC)

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Patients exhibit a range of pulmonary vein (PV) and fibrosis properties, but their individual and combined effects on arrhythmia inducibility and maintenance mechanisms is unknown. We aim to predict locations of high phase singularity (PS) density using a combination of PV electrophysiology and fibrosis measurements. We used a bilayer computational human atrial model with interstitial fibrosis based on delayed-enhancement MRI (DE-MRI), including high or low levels of fibrosis. PV action potential duration and conduction velocity were varied. Reentry was observed around the left atrial (LA)-PV junction in a subset of patients and reproduced in the model for PV properties with baseline APD, but not for short. For patients for whom rotors were located away from the PVs, increasing model fibrosis from low to high increased the model agreement with clinical PS density 2.3 ± 1.0 fold. For other patients, lower levels of fibrosis with baseline PV properties were more appropriate. These results suggest that modelling both PV electrophysiology and atrial fibrosis is important for determining arrhythmia mechanisms. The combined use of PV and DE-MRI measurements may improve ablation therapy success.

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“…Characteristics such as cycle lengths (AFCLs) of atrial activations (AAs) can help predict persistent AF ablation outcomes [1,2]. Moreover, AFCLs can be used to determine sites with high frequency activities which may help identify critical ablation targets to restore sinus rhythm [3].…”

Section: Introductionmentioning

confidence: 99%

Extracting atrial activations from intracardiac signals during atrial fibrillation using adaptive mathematical morphology

Yazdani

Buttu

Pruvot

et al. 2015

2015 Computing in Cardiology Conference (CinC)

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The detection of intracardiac activities is a major issue in the processing of atrial fibrillation signals. we evaluate a method based on mathematical morphology with an adaptive structuring element in order to extract the atrial activations from intracardiac electrograms. The structuring element is continuously updated for each activation based on the morphological characteristics of the previously detected activations. A dataset of recordings from patients with chronic atrial fibrillation who underwent catheter ablation were used in order to evaluate the performance of the proposed method. Results show high performance compared to a dataset manually annotated by an expert. The detection rate, sensitivity and positive prediction value (PPV) were respectively 99.1% ,99.5%, 99.5%. The proposed method is fast and offers low computational cost, which makes it a suitable approach for realtime/online scenarios. IntroductionIntracardiac activation-time detection algorithms can be used in atrial fibrillation (AF) electrogram analysis as a first step in estimating AF characteristics. Characteristics such as cycle lengths (AFCLs) of atrial activations (AAs) can help predict persistent AF ablation outcomes [1,2]. Moreover, AFCLs can be used to determine sites with high frequency activities which may help identify critical ablation targets to restore sinus rhythm [3].However, the varying amplitude and morphologies of AA during AF makes AA extraction difficult. Through a time consuming task, one can always measure activation intervals manually by using calipers and then averaging several measurements to find the mean AFCL. Alternatively, automatic detection methods can be used to extract AAs even though most are limited due to the use of various thresholds [4]. Spectral analysis can also help to determine AFCL by extracting AF dominant frequency (DF), i.e the frequency that has the maximum power [5]. DF methods try to approximate AA rates by a single sinusoid. Therefore, by nature, these methods are not suitable when AF electrograms present irregularities. A time domain iterative method has been proposed [6] to extract AAs from intracardiac electrograms (ICEGs). The detection threshold level is iteratively adjusted until the mean and the median of AFCL converge on a signal segment.The purpose of this study is to evaluate a new adaptive mathematical morphology (MM) approach that extracts AAs based on their morphological features. The structuring element used in this method is adapted after each AA extraction in order to have a more reliable extraction. Methods Patients and Data AcquisitionStudy Population. The study group for this research consists of three consecutive patients (63 ± 1 years) with chronic AF (sustained AF duration 17 ± 8 months) who underwent catheter ablation.Electrophysiological Study. The following catheters were introduced via the femoral veins: 1) a 3.5 mm cooled-tip catheter for mapping and ablation (Navistar ® Thermocool ® , Biosense Webster ® ); and 2) a circumferential duodecapolar Lasso ® c...

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Pulmonary Veins to Left Atrium Cycle Length Gradient Predicts Procedural and Clinical Outcomes of Persistent Atrial Fibrillation Ablation

Cited by 22 publications

References 26 publications

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

The Combination of Pulmonary Vein Electrophysiology and Atrial Fibrosis Determines Driver Location

Extracting atrial activations from intracardiac signals during atrial fibrillation using adaptive mathematical morphology

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