Journal of Interventional Cardiac Electrophysiology最新文献

Background: Electrographic flow (EGF) mapping reconstructs atrial electrical wavefront propagation, potentially revealing sources of atrial fibrillation (AF). Electrographic flow consistency (EGFC) measures the concurrence of wavefront patterns and may provide insights into atrial substrate health. This study aimed to compare EGF patterns during atrial fibrillation (AF) with sinus rhythm (SR) and explore the correlation between EGFC and regional bipolar voltage.

Methods: In this single-center, prospective study, AF patients underwent mapping of the atria using bipolar voltage and EGF mapping. Mapping was performed during both AF and SR using a 16-electrode grid catheter (bipolar mapping) and a 64-pole basket catheter (EGF mapping). EGFC was computed as the average modulus of individual EGF vectors, reflecting flow pattern consistency.

Results: Ten patients were enrolled. EGF identified 11 sources with a mean source activity of 32 ± 9% during AF. Eight out of eleven sources in AF converted to passive "sinks" when mapped in SR. EGFC was significantly lower during AF compared to SR (0.74 ± 0.14 vs 1.0 ± 0.11 AUs, P < 0.01), consistent with EGFC quantifying the more chaotic wavefront propagation during arrhythmia. No spatial correlation between areas of high EGFC during AF and SR was observed. EGFC correlated with bipolar voltage across rhythms and atria (r = 0.647, P < 0.0001).

Conclusion: EGF patterns varied by rhythm with AF showing lower EGFC values. EGFC correlated with bipolar voltage across rhythms and atria, suggesting its potential as an atrial myopathy marker akin to high-density voltage mapping and offering insights into atrial substrate health. Trial registration ClinicalTrials.gov Identifier: NCT06260670.

Background: Pulsed field ablation (PFA) is a novel non-thermal energy source. Recently, we developed a tailored and streamlined pulmonary vein isolation (PVI) approach utilizing a pentaspline PFA catheter via a single access, single catheter approach. This study was aimed at comparing safety, efficacy, and follow-up of this approach with a conventional approach.

Methods and results: Fifty consecutive patients with atrial fibrillation (AF) underwent first-time PVI via PFA under deep sedation. The first 25 patients were treated with a conventional approach utilizing two femoral vein access sheath inclusive utilization of 3D mapping and a coronary sinus catheter (conventional approach, control group). The second 25 patients were treated via a simplified single venous, single transseptal puncture, single catheter approach utilizing a vascular closure system (Fast and Furious PFA approach, FAST group). A total of 194 PVs were identified and isolated with PFA only (100%). The median procedural time was 26 (25, 30) min (FAST) and 65 (59, 72) min (control), respectively (P < 0.0001). The median fluoroscopy time was 5 (4, 7) min (FAST) and 12 (10, 14) min (control), respectively (P < 0.001). Freedom from AF recurrence at 12 months was 77% for the FAST group (vs.

Control: 81%, P = 0.856, and overall: 79%).

Conclusion: The combination of a single venous puncture, single transseptal puncture approach utilizing PFA and vascular closure device resulted in a 100% rate of acute PVI and fast procedure with comparable safety, acute efficacy and 12-month outcome to the conventional approach.

Background: Pulsed-field ablation (PFA), as a nonthermal ablative approach for atrial fibrillation, has attracted much attention in recent years. And there are few comparative studies on PFA versus conventional thermal ablation, including radiofrequency ablation (RFA) and cryoballoon ablation (CBA). The efficacy, safety, and somatic sensation of PFA and thermal ablation need to be further compared.

Methods: A total of 109 patients with paroxysmal atrial fibrillation were divided into three groups (27 in the PFA group, 41 in the CBA group, and 41 in the RFA group), and the operation characteristics, efficacy, safety, and somatic sensation were recorded and analyzed. All patients were followed for 2 years.

Results: All pulmonary veins were successfully isolated except for 1 pulmonary vein that was not successfully isolated during the CBA process (PFA vs. CBA vs. RFA = 100% vs. 99% vs. 100%). The total operation time for PFA is considerably shorter than that for thermal ablation (PFA vs. CBA vs. RFA = 65.28 ± 22.78 min vs. 75.38 ± 18.53 min vs. 96.26 ± 23.23 min, P < 0.001), and the same applies to all the sub-phases. PFA was similarly more dominant in terms of somatosensory perception, mainly in headache (PFA vs. CBA = 1.17 ± 0.48 vs. 2.31 ± 1.06, P < 0.001) and chest pain (PFA vs. RFA = 1.45 ± 0.88 vs. 2.52 ± 1.06, P < 0.001). All these three groups demonstrated good maintenance rates (PFA vs. CBA vs. RFA = 85.00% vs. 80.49% vs. 78.05%, 2 years after operation).

Conclusion: PFA demonstrates its excellent somatic sensation and favorable safety. And it also showed a great immediate success and maintenance rate, which is not inferior to thermal ablation.

Background: The level of atrial remodeling is closely related to the recurrence of atrial fibrillation (AF). Although structural remodeling has been extensively evaluated, methods for assessing atrial electrical remodeling have not been established. The purpose of our study is to investigate the relationship between atrial conduction velocity and the recurrence of atrial fibrillation (AF) following radiofrequency ablation with pulmonary vein isolation.

Methods and results: We prospectively enrolled 155 patients with paroxysmal atrial fibrillation who underwent their first AF ablation at our center. High-density bipolar voltage mapping was conducted during sinus rhythm in all patients. A coherent mapping was constructed to accurately evaluate the total conduction time, distance, and left atrial conduction velocity (LACV) on the anterior, posterior, and septal routes between the earliest and latest activation sites during sinus rhythm. Out of the patients, 24 experienced a recurrence of AF. The LACV was significantly lower in the patients with AF recurrence compared to those without (anterior, 0.81 ± 0.03 vs. 1.07 ± 0.02 m/s, p < 0.01; posterior, 1.06 ± 0.05 vs. 1.32 ± 0.03 m/s, p < 0.01; septal, 0.91 ± 0.05 vs. 1.13 ± 0.02 m/s, p < 0.01). A multivariate logistic analysis, which included age, left atrial diameter (LAD), LA low-voltage area, P-wave duration, and LA conduction velocity, demonstrated that a slow anterior left atrial conduction velocity (LACV) was an independent predictor of AF recurrence with an adjusted odds ratio of 1.64 (95% confidence interval [CI]: 1.24-3.78, p < 0.01). ROC curve analysis confirmed that the anterior LACV was the most accurate predictor of AF recurrence after pulmonary vein isolation (PVI) with a cut-off value of 0.83 m/s, a sensitivity of 93.9%, and a specificity of 70.8%. Anterior LACV was lower in patients with low-voltage areas than in those without low-voltage areas (0.81 ± 0.03 vs. 1.09 ± 0.02 cm/s, p < 0.01).

Conclusion: An anterior LACV < 0.83 m/s was identified as a strong independent predictor of AF recurrence after PVI in patients with paroxysmal AF.

Cardiac imaging (CI), including echocardiography, multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR), is gaining increasing interest to aid atrial fibrillation (AF) ablation procedures, from pre-procedural planning to intra-procedural guidance. Transthoracic echocardiography is widely used for imaging, especially for preprocedural assessment, while transesophageal and intracardiac echocardiography (ICE) are used for intraprocedural guidance during transseptal puncture. Cardiac MDCT, leveraging its high spatial resolution, offers a detailed anatomical visualization of cardiac chambers and adjacent structures; moreover, left atrial wall thickness assessed by MDCT may guide radiofrequency energy titration to enhance procedural safety and efficiency. At the same time, CMR allows for detailed myocardial tissue characterization and the detection of fibrosis. ICE, MDCT, and CMR also permit intra-procedural image integration with electroanatomical maps, allowing to be aware of a greater amount of intra-procedural real-time information regarding the anatomy and the local characteristics of the tissue in contact with the ablation catheter. One of the primary objectives of performing CI-aided AF ablations is to increase procedural safety and to permit more personalized procedures, according to the characteristics of each patient. This review offers a comprehensive overview of the current applications of CI during the different phases of AF ablation and explores the potential future applications of CI in this context.