Magnetic resonance imaging-confirmed ablative debulking of the left atrial posterior wall and septum for treatment of persistent atrial fibrillation: rationale and initial experience
Autor: | Eric N. Fish, Nathan S. Burgon, Nathan M. Segerson, Rob S. MacLeod, Yaw A. Adjei-Poku, Nazem Akoum, Swati N. Rao, Edward V. R. DiBella, Akram Shabaan, Eugene G. Kholmovski, Nassir F. Marrouche, Troy J. Badger, Sathya Vijayakumar, Marcos Daccarett |
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Rok vydání: | 2009 |
Předmět: |
Male
medicine.medical_specialty Radiofrequency ablation medicine.medical_treatment Catheter ablation Pilot Projects Pulmonary vein law.invention law Heart Conduction System Physiology (medical) Internal medicine Atrial Fibrillation Heart Septum Medicine Humans Heart Atria Aged medicine.diagnostic_test business.industry Magnetic resonance imaging Atrial fibrillation medicine.disease Debulking Ablation Magnetic Resonance Imaging Heart septum Treatment Outcome Cardiology Catheter Ablation Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Journal of cardiovascular electrophysiology. 21(2) |
ISSN: | 1540-8167 |
Popis: | LA Debulking for Atrial Fibrillation.Introduction: Though pulmonary vein (PV) isolation has been widely adopted for treatment of atrial fibrillation (AF), recurrence rates remain unacceptably high with persistent and longstanding AF. As evidence emerges for non-PV substrate changes in the pathogenesis of AF, more extensive ablation strategies need further study. Methods: We modified our PV antrum isolation procedure to include abatement of posterior and septal wall potentials. We also employed recently described image-processing techniques using delayed-enhancement (DE) MRI to characterize tissue injury patterns 3 months after ablation, to assess whether each PV was encircled with scar, and to assess the impact of these parameters on procedural success. Results: 118 consecutive patients underwent debulking procedure and completed follow-up, of which 86 underwent DE-MRI. The total left atrial (LA) radiofrequency delivery correlated with percent LA scarring by DE-MRI (r = 0.6, P < 0.001). Based on DE patterns, complete encirclement was seen in only 131 of 335 PVs (39.1%). As expected, Cox regression analysis showed a significant relationship between the number of veins encircled by delayed enhancement and clinical success (hazard ratio of 0.62, P = 0.015). Also, progressive quartile increases in postablation posterior and septal wall scarring reduced recurrences rates with a HR of 0.65, P = 0.022 and 0.66, P = 0.026, respectively. Conclusion: Pathologic remodeling in the septal and posterior walls of the LA helps form the pathogenic substrate for AF, and these early results suggest that more aggressive treatment of these regions appears to correlate with improved ablation outcomes. Noninvasive imaging to characterize tissue changes after ablation may prove essential to stratifying recurrence risk. (J Cardiovasc Electrophysiol, Vol. 21, pp. 126-132, February 2010) |
Databáze: | OpenAIRE |
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