Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation

Marrouche, Nassir F.; Wazni, Oussama; McGann, Christopher; Greene, Tom; Dean, J. Michael; Dagher, Lilas; Kholmovski, Eugene; Mansour, Moussa; Marchlinski, Francis; Wilber, David J.; Hindricks, Gerhard; Mahnkopf, Christian; Wells, Darryl; Jaı̈s, Pierre; Sanders, Prashanthan; Brachmann, Johannes; Bax, Jeroen J.; Boer, Leonie Morrison-de; Deneke, Thomas; Calkins, Hugh; Sohns, Christian; Akoum, Nazem

doi:10.1001/jama.2022.8831

Cited by 209 publications

(152 citation statements)

References 46 publications

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“…Additionally, the results are often contaminated due to poor AEGs quality, inadequate bipolar interelectrode distance, and far-field effects (remote electrical activity) [ 27 , 28 , 29 , 30 , 31 ]. Therefore, recent clinical trials showed that the rate of freedom from AF in patients who underwent pulmonary vein isolation (PVI) plus targeted ablation of specific AEG characteristics, e.g., CFAEs, DF, low-voltage, and MRI-guided fibrosis, is not superior to those who underwent PVI alone [ 17 , 32 , 33 , 34 ]. For the approach using the identification of activation patterns, both activation sequence and phase analyses have been used in the time domain [ 11 , 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for Targeted Ablation

Lee

Khrestian

Sahadevan

et al. 2022

JCM

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Background: Phase analysis has been used to identify and localize atrial fibrillation (AF) sources for targeted ablation. We previously demonstrated that repetitive wannabe reentry (incomplete reentry) often generated an apparent stable rotor using phase analysis. The misinterpretation caused by phase analysis using atrial electrograms (AEGs) may result from detecting inaccurate time points at phase inversion (π to −π) in the instantaneous phase waveform converted from AEG. The purpose of this study was to evaluate the accuracy of phase analysis to detect atrial activations recorded from the high-density mapping of AF in patients with persistent and long-standing persistent (LSP) AF. Methods and Results: During open heart surgery, we recorded activation from both atria simultaneously using 512 electrodes in 7 patients with persistent and LSP AF. The phase analysis was compared to manual measurements during 4 s of data. For the accuracy of activation sequence maps, a successful recording site was defined as having ≤4 mismatched activation times during the 4 s. In all AF episodes, the accuracy of the phase analysis was only 82% of the total number of activation times due to either activation time differences (14.7%), under-sensing (2.7%), or over-sensing (0.6%). Only 67.9% of the total recording sites met the requirement of a successful recording site by phase analysis. In unsuccessful recording sites, AEG characteristics were relatively irregular cycle length (CL), complex AEG, and double potential AEG. Conclusion: The phase analysis was less accurate in recording sites with a relatively irregular CL, complex AEG, or double potential AEG. As a result, phase analysis may lead to the misinterpretation of atrial activation patterns during AF. A visual review of the original AEG is needed to confirm the detected AF sources of phase analysis before performing targeted ablation.

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Section: Discussionmentioning

confidence: 99%

An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for Targeted Ablation

Lee

Khrestian

Sahadevan

et al. 2022

JCM

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“…Patients with LVAs showed lower AF−recurrence−free survival rates (88%) than those without LVA (57%, P < 0.0001; C, 53%, P < 0.0001), and so, the presence of LVA strongly predicted AF recurrence ( 356 ). Similarly, recently presented ( 357 ) results of the DECAAFII trial suggest that fibrosis-guided ablation was not superior to conventional PVI in reducing atrial arrhythmia recurrence but significantly increased adverse events.…”

Section: Treatmentmentioning

confidence: 91%

The Atrium in Atrial Fibrillation – A Clinical Review on How to Manage Atrial Fibrotic Substrates

Cunha

Laranjo

Heijman

et al. 2022

Front. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.

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“…Interestingly, thoracoscopic ablation was not proven superior in the group of patients with persistent AF compared to CA regarding freedom from atrial tachyarrhythmia, with the latter being more cost-effective, improving patient symptoms, and providing more quality-adjusted life-years [ 119 ]. Lately, magnetic resonance imaging-guided atrial fibrosis ablation, together with PVI, was attempted in patients with persistent AF [ 120 ]. The study, however, did not achieve a greater arrhythmia-free interval, and the evaluated procedure was accompanied with more adverse events [ 120 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

“…Lately, magnetic resonance imaging-guided atrial fibrosis ablation, together with PVI, was attempted in patients with persistent AF [ 120 ]. The study, however, did not achieve a greater arrhythmia-free interval, and the evaluated procedure was accompanied with more adverse events [ 120 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation

Cited by 209 publications

References 46 publications

An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for Targeted Ablation

An Evaluation of Phase Analysis to Interpret Atrial Activation Patterns during Persistent Atrial Fibrillation for Targeted Ablation

The Atrium in Atrial Fibrillation – A Clinical Review on How to Manage Atrial Fibrotic Substrates

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

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