Successful modulation of atrial fibrillation drivers anchoring to fibrotic tissue after box isolation using an online real‐time phase mapping system: ExTRa Mapping

Nakamura, Toshihiro; Kiuchi, Kunihiko; Fukuzawa, Koji; Takami, Mitsuru; Akita, Tomomi; Suehiro, Hideya; Takemoto, Makoto; Sakai, Jun; Yatomi, Atsusuke; Sonoda, Yusuke; Takahara, Hiroyuki; Nakasone, Kazutaka; Yamamoto, K.; Hirata, Ken–ichi; Ashihara, Takashi

doi:10.1002/joa3.12232

Cited by 7 publications

(9 citation statements)

References 5 publications

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“…We previously reported successful ExTRa Mapping and LGE‐MRI‐guided ablation as a case report 32 . In that case, RF applications at NPAs on the bottom of the posterior LA outside the box lesion could convert AF to common atrial flutter.…”

Section: Discussionmentioning

confidence: 94%

Late‐gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation

Nakamura

Kiuchi

Fukuzawa

et al. 2021

Cardiovasc electrophysiol

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Background A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy late‐gadolinium enhancement (LGE) areas and play an important role in AF drivers. However, this was not validated in humans. Objective The purpose of this study was to evaluate the LGE properties of AF rotors in patients with persistent AF. Methods A total of 287 segments in 15 patients with persistent AF (long‐standing persistent AF in 9 patients) that underwent AF ablation were assessed. Non‐passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real‐time phase mapping (ExTRa Mapping). The properties of the LGE areas were assessed using the LGE heterogeneity and the density which was evaluated by the entropy (LGE‐entropy) and the volume ratio of the enhancement voxel (LGE‐volume ratio), respectively. Results NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7% and 10% for the LGE‐entropy and LGE‐volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE‐entropy of >5.7 and LGE‐volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments; p = .001). No NPAs were found at segments with an LGE‐volume ratio of >50% regardless of the LGE‐entropy. Of five patients with AF recurrence, NPAs outside the PV antrum were not ablated in three patients and the remaining NPAs were ablated, but their LGE‐entropy and LGE‐volume ratio were low. Conclusion AF rotors are mostly distributed in relatively weak and much more heterogenous LGE areas.

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Section: Discussionmentioning

confidence: 94%

Late‐gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation

Nakamura

Kiuchi

Fukuzawa

et al. 2021

Cardiovasc electrophysiol

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“…Recently, Ashihara et al developed a novel online real‐time phase mapping system: ExTRa Mapping 14 . By using this novel system, we reported a case in which an RF application at the AF rotor area that overlapped with the FLA could convert AF to a common atrial flutter 22 . We hope that this real‐time mapping system and LGE‐MRI assessment could make it possible to perform an intervention of the specific AF substrate.…”

Section: Discussionmentioning

confidence: 90%

Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late‐gadolinium enhancement areas

Kiuchi

Fukuzawa

Takami

et al. 2021

Cardiovasc electrophysiol

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Background A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE‐MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. Methods A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden‐matched pulmonary vein isolation (PVI) group. Results Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow‐up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log‐rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. Conclusions FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.

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“…13 By using this novel system, we reported the case in which RF application at the AF rotor area overlapped with the PLS could convert AF to common atrial flutter. 21 We would like to hope that this real-time mapping system and LGE-MRI assessment could make it possible to intervention on the specific AF substrate.…”

Section: Af Termination and Rhythm Outcomementioning

confidence: 99%

Acute response and rhythm outcome after the patchy late-gadolinium enhancement site catheter ablation in patients with persistent atrial fibrillation

Kiuchi¹,

Fukuzawa²,

Takami³

et al. 2020

Preprint

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Background: Computer simulation model demonstrated that atrial fibrillation (AF) driver attached to the patchy fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study is to investigate whether radiofrequency (RF) application on the patchy LGE site (PLS) could terminate AF or convert to atrial tachycardia (AT) and improve the rhythm outcome. Methods: A total of 31consecutive persistent AF patients with PLS were enrolled (PLS ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). AF direct termination or AT conversion during RF application on the PLS were defined as favorable response. The rhythm outcome was compared between the PLS ablation group and the propensity matched conventional ablation group. Results: Favorable response was found in 15 (48%) of 31 patients (AF termination in 7, AT conversion in 8 patients). AF recurrence at 12 months follow-up was significantly less in the PLS group as compared to the control group (4 (13%) of 31 patients vs. 11 (35%) of 31 patients, log-rank p = 0.019). In patients with favorable response, AT recurred in 1 (7%) of 15 patients but AF. Conclusions: The PLS ablation could terminate AF or convert to AT in half of the patients and improve the rhythm outcome as compared to the conventional ablation. No AF recurrence was documented in patients with a favorable response.

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Successful modulation of atrial fibrillation drivers anchoring to fibrotic tissue after box isolation using an online real‐time phase mapping system: ExTRa Mapping

Cited by 7 publications

References 5 publications

Late‐gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation

Late‐gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation

Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late‐gadolinium enhancement areas

Acute response and rhythm outcome after the patchy late-gadolinium enhancement site catheter ablation in patients with persistent atrial fibrillation

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