Figure - available from: Journal of Interventional Cardiac Electrophysiology
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Antral isolation of the right pulmonary veins. Funnel-shaped ostia and veins that do not converge into a carina often preclude antral isolation of the right veins. All images are from the same patient. The multiple lines represent balloon contours at different views. Same color represents balloon contour during the same ablation lesion, the different colors represent balloon position during different lesions. Panels a and c show voltage map after occlusive lesions. The lower cutoff voltage for scar is 0.02 mV; therefore, red areas represent complete signal obliteration. The balloon contour during nonocclusive lesions is represented with colored lines in panels b and d. Nonocclusive lesions allowed the extension of isolation posteriorly and septally (b). The cryoballoon cannot be visualized at its entirety during applications on the right veins; however projecting the contour of the balloon that is seen can provide valuable information on the balloon location and orientation (d). Balloon contours correlate with level of isolation by voltage map. On panel d, the drawn contours of the balloon during applications on the left pulmonary veins are presented distally to the level of isolation
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Objective
Ablation for atrial fibrillation (AF) requires electrical isolation of the pulmonary veins (PV) by wide-area circumferential PV antral isolation (PVAI). Cryoballoon ablation delivers cryoenergy circumferentially after occlusion of the PV by the cryoballoon; thus, it is likely that the level of isolation, determined by adequate balloon-tis...
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Background: Pulmonary vein isolation (PVI) is a common therapeutic approach for symptomatic atrial fibrillation (AF). Among various techniques, cryo-balloon (CB) PVI is widely adopted, but, to date, established CB systems have had fixed balloon sizes. A novel size-adjustable CB, allowing balloon size adjustments during ablation, lacks sufficient da...
Aims
Cryoballoon pulmonary vein isolation (PVI) is a safe and effective treatment for atrial fibrillation (AF). Current limitations include incomplete vein occlusion due to balloon rigidity and inconsistent electrogram recording, which impairs identification of isolation. We aimed to evaluate the acute safety and performance of a novel cryoballoon...
Citations
Background and aims:
Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation.
Methods:
In 28 patients undergoing AF ablation, baseline patient information were recorded and 3D shells of LA body and anatomical structures (LAA/LSPV/LIPV/RSPV/RIPV) were reconstructed using the DL algorithm. The selected ultrasound frames were gated to end-expiration and max LA volume. Ostial diameters of these structures and carina-to-carina distance between left and right pulmonary veins were measured and compared with CT measurements. Anatomical accuracy of the DL algorithm was evaluated by three independent electrophysiologists using a 3-anchor scale for LA anatomical structures and a 5-anchor scale for LA body. Ablation related characteristics were summarized.
Results:
The algorithm generated 3D reconstruction of LA anatomies and 2D contours overlaid on ultrasound input frames. Average calculation time for LA reconstruction was 65s. Mean ostial diameters and carina-to-carina distance were all comparable to CT without statistical significance. Ostial diameters and carina-to-carina distance also showed moderate to high correlation (r=0.52-0.75) except for RIPV (r=0.20). Qualitative ratings showed good agreement without between-rater differences. Average procedure time was 143.7±43.7min, with average RF time 31.6±10.2min. All patients achieved ablation success and no immediate complications were observed.
Conclusion:
DL algorithm integration with ICE demonstrated considerable accuracy compared to CT and qualitative physician assessment. The feasibility of ICE with this algorithm can potentially further streamline AF ablation workflow.
Background:
Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA).
Methods:
The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices.
Results:
A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = - 0.66; 95% CI (- 1.01, - 0.32) and SMD = - 0.56; 95% CI (- 0.73, - 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35-0.67, and SMD = 0.35; 95% CI 0.20-0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79-2.02). Moderate statistical heterogeneity and small case-control studies are the main limitations of our meta-analysis.
Conclusions:
Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence.
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.
