Repeat Left Atrial Catheter Ablation

Harrison, James; Sohns, Christian; Linton, Nick; Karim, Rashed; Williams, Steven E.; Rhode, Kawal; Gill, Jaswinder; Cooklin, Michael; Rinaldi, Christopher Aldo; Wright, Matthew; Schaeffter, Tobias; Razavi, Reza; O’Neill, Mark

doi:10.1161/circep.114.002066

Cited by 83 publications

(27 citation statements)

References 30 publications

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“…The density of ablation points is significant when the electro-anatomical maps are recreated with the help of MRI, and gap re-isolation during repeated procedures leads to a significant decrease in the rate of AF recurrence. 14,15 …”

Section: Catheter Ablation In Afmentioning

confidence: 99%

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

Kovács

Mester²,

Bordi³

et al. 2016

Journal of Interdisciplinary Medicine

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Atrial fibrillation (AF) is the most frequent cardiac arrhythmia increasing the risk of stroke and mortality from heart failure. Magnetic resonance imaging was used by several authors for assessment of atrial fibrosis and to predict the rate of recurrence following AF ablation. The aim of this manuscript was to summarize the new data in the literature regarding the role of atrial fibrosis in AF imaging and the role of cardiac fibrosis in predicting AF recurrence after radiofrequency ablation.

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Section: Catheter Ablation In Afmentioning

confidence: 99%

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

Kovács

Mester²,

Bordi³

et al. 2016

Journal of Interdisciplinary Medicine

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“…15 A scenario of incomplete ablation line and electric isolation is therefore possible. Despite its rigorous methodology, the study by Harrison et al 12 is not without limitations. The CMR area assigned to each mapping point taken with a 3.5-mm tip can be argued, but the investigators also assessed 2.5-and 5-mm radius areas without improving correlation between voltage and CMR intensity.…”

mentioning

confidence: 99%

“…This carefully conducted study by Harrison et al 12 highlights the challenges that still exist in the field of atrial ablation imaging. Since Peters et al 13 first demonstrated the feasibility of LA scar imaging, a variety of publications have examined the clinical applicability of LA fibrosis imaging.…”

mentioning

confidence: 99%

“…Despite those improvements, an important number of LA CMR studies are deemed of insufficient diagnostic quality even in highly experienced centers. 13 Both topics investigated by Harrison et al, 12 namely the atrial voltage cut-off for scar and gap imaging, are of high clinical importance for electrophysiologists. The commonly used threshold of 0.05 mV to define LA scar in many studies lacks histopathologic validation.…”

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confidence: 99%

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Closing the Knowledge Gaps

Jiménez

Dickfeld

2015

Circ: Arrhythmia and Electrophysiology

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“…

We read with great interest the article of Harrison et al 1 The authors report that delayed-enhancement cardiac magnetic resonance (DE-CMR) is unable to predict the site of pulmonary vein (PV) reconnection after ablation of atrial fibrillation. They found a weak point-by-point correlation between DE-CMR and peak-to-peak endocardial voltage.

…”

mentioning

confidence: 99%

Letter by Bisbal et al Regarding Article, “Repeat Left Atrial Catheter Ablation: Cardiac Magnetic Resonance Prediction of Endocardial Voltage and Gaps in Ablation Lesion Sets”

Bisbal

Berruezo

Mont

2015

Circ: Arrhythmia and Electrophysiology

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We read with great interest the article of Harrison et al. 1 The authors report that delayed-enhancement cardiac magnetic resonance (DE-CMR) is unable to predict the site of pulmonary vein (PV) reconnection after ablation of atrial fibrillation. They found a weak point-by-point correlation between DE-CMR and peak-to-peak endocardial voltage. The authors are to be commended for their thorough analysis of DE-CMR and voltage data; however, some study limitations should be acknowledged, which we believe preclude the dismissal of DE-CMR evaluation of PV reconnection based on the results of their study.A recently published study by our group demonstrated that ablation at the gaps depicted on the DE-CMR (CMR-gap) led to reisolation of 95.6% of PVs, even when the earliest activation did not match a CMR-gap. 2 This necessarily means that DE-CMR can reliably identify the sites of PV reconnection. The sensitivity/specificity and positive/negative predictive values of detecting PV reconnection with DE-CMR were 100%/57% and 94%/100%, respectively. 3 Several DE-CMR acquisition, image postprocessing, and procedural differences might explain these conflicting results. Compared with our study, Harrison et al collected a significantly lower number of points to create the map, with a mean of 338±210 points per map (range, 51-901), compared with 808±159 points per map in our study (range, 520-1004). Of note, 3 maps (15%) in their study had <100 points. The lower mapping density could have led to insufficient voltage information in the areas of interest to clearly define small breaks in ablation lines. The lack of a contact force mapping catheter, which was used in our study, could potentially result in false low-voltage areas because of poor tip-tissue contact. In addition, DE-CMR was acquired with a greater voxel size (1.25×1.25×4 mm) than has been reported by other groups (1.25×1.25×2.5 mm), 2,4 which would preclude detection of smaller anatomic gaps. Remarkably, 55% of patients in their study had >1 prior ablation. Evidence has been published on the attenuation over time of gadolinium signal-intensity at sites of scar. 5 The use of restrictive signal-intensity thresholds in patients with >1 prior procedures may misclassify, as healthy myocardium, areas of less intense scar created on the first procedure. To overcome this issue, we included only patients undergoing a second procedure.Finally, we disagree with the statement that the DE-CMR acquisition and postprocessing protocol used by Harrison et al is a validated method. In addition to the aforementioned limitations, this technique has not been externally validated, and thus its superiority over other reported methodologies cannot be demonstrated. 2,4 However, voltage mapping also has not been validated as a reliable tool to predict PV reconnection. Considering that the spatial resolution of a point-bypoint map using a 3.5-mm tip catheter is ≈6 mm in diameter and that the voxel size of DE-CMR can be as small as 1.25×1.25×2.5 mm, 2,4 we consider it inappropriate to use voltage m...

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Repeat Left Atrial Catheter Ablation

Cited by 83 publications

References 30 publications

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

Closing the Knowledge Gaps

Letter by Bisbal et al Regarding Article, “Repeat Left Atrial Catheter Ablation: Cardiac Magnetic Resonance Prediction of Endocardial Voltage and Gaps in Ablation Lesion Sets”

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