Catheter ablation of atrial fibrillation: cardiac imaging guidance as an adjunct to the electrophysiological guided approach

Markman, Timothy M.; Khoshknab, Mirmilad; Nazarian, Saman

doi:10.1093/europace/euaa249

Cited by 4 publications

(5 citation statements)

References 54 publications

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“…In this study, all consecutive patients suffering from symptomatic AF who had received preprocedural cardiac CT for its ability to comprehensively evaluate pulmonary veins and left atrium, identify small variant anatomy, and rule out any suspicion of cardiac thrombus ( 18 ), and echocardiography examinations before the first-time catheter ablation between January 2018 and June 2021 at The First Affiliated Hospital of Chengdu Medical College were retrospectively recruited. The postmenopausal women and men matched for age, BMI, and type of AF were included.…”

Section: Methodsmentioning

confidence: 99%

Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes

Zhu

Zhuo

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThere are significant differences in the prevalence and prognosis of atrial fibrillation (AF) between sexes. Epicardial adipose tissue (EAT) has been found as a risk factor for AF. This study aimed to evaluate whether sex-based EAT differences were correlated with AF recurrence and major adverse cardiovascular events (MACE).MethodsIn this study, postmenopausal women and age, BMI, and type of AF matched men who had received first catheter ablation were included. EAT volume was quantified based on the pre-ablation cardiac computed tomography (CT) images. Clinical, CT, and echocardiographic variables were compared by sex groups. The predictors of AF recurrence and MACE were determined through Cox proportional hazards regression.ResultsWomen were found with significantly lower total EAT volumes (P < 0.001) but higher periatrial/total (P/T) EAT ratios (P = 0.009). The median follow-up duration was 444.5 days. As revealed by the result of the Kaplan-Meier survival analysis, the women were found to have a significantly higher prevalence of AF recurrence (log rank, P = 0.011) but comparable MACE (log rank, P = 0.507) than men. Multivariate analysis demonstrated that female gender (HR: 1.88 [95% CI: 1.03, 4.15], P = 0.032), persistent AF (HR: 2.46 [95% CI: 1.19, 5.05], P = 0.015), left atrial (LA) dimension (HR: 1.47 [95% CI: 1.02, 2.13], P = 0.041), and P/T EAT ratio (HR: 1.73 [95% CI: 1.12, 2.67], P = 0.013) were found as the independent predictors of AF recurrence. Sex-based subgroup multivariable analysis showed that the P/T EAT ratio was an independent predictor of AF recurrence in both men (HR: 1.13 [95% CI: 1.01, 1.46], P = 0.047) and women (HR: 1.37 [95% CI: 1.11, 1.67], P = 0.028). While age (HR: 1.81 [95% CI: 1.18, 2.77], P = 0.007), BMI (HR: 1.44 [95% CI: 1.02, 2.03], P = 0.038), and periatrial EAT volume (HR: 1.31 [95% CI: 1.01, 1.91], P = 0.046) were found to be independent of MACE.ConclusionWomen had a higher P/T EAT ratio and AF post-ablation recurrence but similar MACE as compared with men. Female gender and P/T EAT ratio were found to be independent predictors of AF recurrence, whereas age and periatrial EAT volume were found to be independent predictors of MACE.

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Section: Methodsmentioning

confidence: 99%

Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes

Zhu

Zhuo

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…Postablation scar on CMR demonstrates increased IIR and decreased left atrial wall thickness compared with patients with atrial fibrillation and no prior ablation [30]. Targeting regions of chronic fibrosis using LGE can allow for more complete inactivation of arrhythmogenic substrate, decreasing the likelihood of arrhythmia recurrence and improving procedural outcomes [17,31]. Furthermore, the likelihood of favourable response to treatment increases when applying specific ablation techniques to different scar characteristic noted on CMR.…”

Section: Substrate Identificationmentioning

confidence: 99%

“…Although the size of a low-voltage region on EAM is associated with the extent of LGE on CMR, the correlation is moderate and ranges between 0.57 and 0.6 [22]. One potential reason why EAM and CMR are only moderately correlated may be from masking of abnormal substrate by nearby healthy tissue [17]. In fact, LGE on CMR can detect areas of abnormal substrate, which may not manifest as decreased voltage with EAM [22], and is associated with electrogram fractionation in the absence of voltage abnormalities [23 ▪ ].…”

Section: Atrialmentioning

confidence: 99%

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Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation

Morris

Carlson

Bhagat³

2022

Current Opinion in Cardiology

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Purpose of reviewIncreasing evidence supports the use of advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in the work-up of patients with arrythmias being considered for ablation.Recent findingsAdvances in imaging technology and postprocessing are facilitating the use of advanced imaging before, during and after ablation in patients with both atrial and ventricular arrhythmias.In atrial arrythmias, quantitative assessment of left atrial wall thickness on CCT and quantification of late gadolinium enhancement (LGE) on CMR identify patients more likely to develop recurrent atrial arrythmias following ablation. In addition, in patients with recurrent arrythmia post ablation, LGE CMR can potentially identify targets for repeat ablation.In ventricular arrythmias, qualitative assessment of LGE can aide in determining the optimal ablation approach and predicts likelihood of ventricular arrythmias inducibility. Quantitative assessment of LGE can identify conduction channels that can be targeted for ablation. On CCT, quantitative assessment of left ventricular wall thickness can demonstrate myocardial ridges associated with re-entrant circuits for ablation.SummaryThis review focuses on the utility of CCT and CMR in identifying key anatomical components and arrhythmogenic substrate contributing to both atrial and ventricular arrhythmias in patients being considered for ablation. Advanced imaging has the potential to improve procedural outcomes, decrease complications and shorten procedural time.

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“…These findings, along with the widespread use of imaging technologies to better guide the management approach of AF patients [18], motivated several researchers to examine the role of EAT in arrhythmia recurrence following catheter ablation. Nevertheless, their findings have been equivocal [19,20].…”

Section: Introductionmentioning

confidence: 99%

Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis

Anagnostopoulos,

Kousta,

Kossyvakis

et al. 2023

JCM

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(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship between EAT and post-ablation recurrence.(2) Purpose: to investigate the relationship between total and peri-left atrium (peri-LA) EAT with post-ablation AF recurrence. (3) Methods: major electronic databases were searched for articles assessing the relationship between EAT, quantified using computed tomography, and the recurrence of AF following catheter ablation procedures. (4) Results: Twelve studies (2179 patients) assessed total EAT and another twelve (2879 patients) peri-LA EAT. Almost 60% of the included patients had paroxysmal AF and recurrence was documented in 34%. Those who maintained sinus rhythm had a significantly lower volume of peri-LA EAT (SMD: −0.37, 95%; CI: −0.58–0.16, I2: 68%). On the contrary, no significant difference was documented for total EAT (SMD: −0.32, 95%; CI: −0.65–0.01; I2: 92%). No differences were revealed between radiofrequency and cryoenergy pulmonary venous isolation. No publication bias was identified. (5) Conclusions: Only peri-LA EAT seems to be predictive of post-ablation AF recurrence. These findings may reflect different pathophysiological roles of EAT depending on its location. Whether peri-LA EAT can be used as a predictor and target to prevent recurrence is a matter of further research.

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Catheter ablation of atrial fibrillation: cardiac imaging guidance as an adjunct to the electrophysiological guided approach

Cited by 4 publications

References 54 publications

Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes

Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes

Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation

Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis

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