Left atrial wall thickness of the pulmonary vein reconnection sites during atrial fibrillation redo procedures

Abstract

Background Left atrial wall thickness (LAWT) has been related to pulmonary vein (PV) reconnections after atrial fibrillation (AF) ablation. The aim was to integrate 3D‐LAWT maps in the navigation system and analyze the relationship with local reconnection sites during AF‐redo procedures. Methods Consecutive patients referred for AF‐redo ablation were included. Procedure was performed using a single catheter technique. LAWT maps obtained from multidetector computerized tomography (MDCT) were imported into the navigation system. LAWT of the circumferential PV line, the reconnected segment and the reconnected point, were analyzed. Results Sixty patients [44 (73%) male, age 61 ± 10 years] were included. All reconnected veins were isolated using a single catheter technique with 55 min (IQR 47–67) procedure time and 75 s (IQR 50–120) fluoroscopy time. Mean LAWT of the circumferential PV line was 1.46 ± 0.22 mm. The reconnected segment was thicker than the rest of segments of the circumferential PV line (2.05 + 0.86 vs. 1.47 + 0.76, p < .001 for the LPVs; 1.55 + 0.57 vs. 1.27 + 0.57, p < .001 for the RPVs). Mean reconnection point wall thickness (WT) was at the 82nd percentile of the circumferential line in the LPVs and at the 82nd percentile in the RPVs. Conclusion A single catheter technique is feasible and efficient for AF‐redo procedures. Integrating the 3D‐LAWT map into the navigation system allows a direct periprocedural estimation of the WT at any point of the LA. Reconnection points were more frequently present in thicker segments of the PV line. The use of 3D‐LAWT maps can facilitate reconnection point identification during AF‐redo ablation.

Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

“…Acute PVI was confirmed after first pass with the standard local single catheter method demonstrating entry block with the absence of PV potentials inside the vein with the ablation catheter placed sequentially in each segment inside the circumferential PV line, and exit block by proving absence of conduction when pacing from inside the circumferential PV line, at each segment sequentially. 8 …”

“…The endo and epicardial left atrial wall layers were segmented following a previously described method. 8 The esophageal surface layer was defined by manual delineation in 7±3 slices followed by an interpolation in the missing slices. Then, the esophageal position and the distance between the esophagus and the epicardial left atrial posterior wall and pulmonary veins was automatically measured and projected into the endocardial shell as a color-coded isodistance fingerprinted map, where red color depicts the closest area with an atrio-esophageal distance < 1mm, yellow 1.1-2 mm, green 2.1-3 mm, blue 3.1-4 mm, and purple >4 mm.…”

“…MDCT was performed within 48h preceding the intervention. Image segmentation included not only the esophageal anatomy and the atrioesophageal fingerprint, but also the left atrial wall thickness information 8 . Time for UNIVU acquisition was 1.5±1 min and for esophageal FAM acquisition was 3±1.5 min.…”

Optimal Ablation Settings Predicting Durable Scar Detected Using LGE-MRI after Modified Left Atrial Anterior Line Ablation

“…Nevertheless, arrhythmia recurrences after catheter ablation are still a clinical reality. Individualized ablation concepts integrating relevant parameters such as the wall thickness could help create durable scar lesions and predict favorable long-term outcomes [15]. As the LA wall has a variable thickness, a general stringent setting would result in over-or undertherapy, leading to a higher risk of complications or ineffective ablation [16,17].…”

Imaging Techniques for the Study of Fibrosis in Atrial Fibrillation Ablation: From Molecular Mechanisms to Therapeutical Perspectives

“…Berruezo and colleagues proposed a new approach for guiding pulmonary vein isolation by the LAWT. They recently report the feasibility of incorporating 3D LAWT maps into the navigation system, allowing a direct estimation of the WT at any point of the left atrium during the procedure [ 58 ]. They tailor radiofrequency energy, also delivering an ablation line design depending on the LAWT ( Figure 4 ).…”