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rotor ablation atrial fibrillation

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https://www.readbyqxmd.com/read/29744616/identification-of-active-atrial-fibrillation-sources-and-their-discrimination-from-passive-rotors-using-electrographical-flow-mapping
#1
Barbara Bellmann, Tina Lin, Peter Ruppersberg, Marit Zettwitz, Selma Guttmann, Verena Tscholl, Patrick Nagel, Mattias Roser, Ulf Landmesser, Andreas Rillig
BACKGROUND: The optimal ablation approach for the treatment of persistent atrial fibrillation (AF) is still under debate; however, the identification and elimination of AF sources is thought to play a key role. Currently available technologies for the identification of AF sources are not able to differentiate between active rotors or focal impulse (FI) and passive circular turbulences as generated by the interaction of a wave front with a functional obstacle such as fibrotic tissue. OBJECTIVES: This study introduces electrographic flow (EGF) mapping as a novel technology for the identification and characterization of AF sources in humans...
May 9, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29743170/clinical-implications-of-ablation-of-drivers-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#2
Tina Baykaner, Albert J Rogers, Gabriela L Meckler, Junaid Zaman, Rachita Navara, Miguel Rodrigo, Mahmood Alhusseini, Christopher A B Kowalewski, Mohan N Viswanathan, Sanjiv M Narayan, Paul Clopton, Paul J Wang, Paul A Heidenreich
BACKGROUND: The outcomes from pulmonary vein isolation (PVI) for atrial fibrillation (AF) are suboptimal, but the benefits of additional lesion sets remain unproven. Recent studies propose ablation of AF drivers improves outcomes over PVI, yet with conflicting reports in the literature. We undertook a systematic literature review and meta-analysis to determine outcomes from ablation of AF drivers in addition to PVI or as a stand-alone procedure. METHODS: Database search was done using the terms atrial fibrillation and ablation or catheter ablation and driver or rotor or focal impulse or FIRM (Focal Impulse and Rotor Modulation)...
May 2018: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29722856/long-term-clinical-outcomes-of-magnetically-navigated-rotor-ablation-as-an-adjunct-to-conventional-pulmonary-vein-isolation
#3
Gunjan Shukla, John Zimmerman, Zoya Shir, Roshan Shah, Edmund Hasanaj
Aims: The objective of this study is to evaluate the outcomes of magnetically guided ablation of atrial fibrillation (AF) rotors in conjunction with magnetically guided pulmonary vein isolation (PVI) in a large consecutive series of patients. Methods and results: A total of 110 consecutive patients with drug-refractory AF underwent rotor ablation followed by conventional PVI and ablation of other spontaneous arrhythmias, all of which were performed with remote magnetic navigation (RMN)...
May 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29657593/not-all-rotors-effective-ablation-targets-for-nonparoxysmal-atrial-fibrillation-are-included-in-areas-suggested-by-conventional-indirect-indicators-of-atrial-fibrillation-drivers-extra-mapping-project
#4
Kensuke Sakata, Yusuke Okuyama, Tomoya Ozawa, Ryo Haraguchi, Kazuo Nakazawa, Takeshi Tsuchiya, Minoru Horie, Takashi Ashihara
Background: Effects of nonparoxysmal atrial fibrillation (non-PAF) ablation targeting complex fractionated atrial electrogram (CFAE) areas and/or low voltage areas (LVAs) are still controversial. Methods and Results: A recently developed online real-time phase mapping system (ExTRa Mapping) was used to conduct LVA mapping and simultaneous ExTRa and CFAE mapping in 28 non-PAF patients after pulmonary vein isolation (PVI). Nonpassively activated areas, in the form of meandering rotors and/or multiple wavelets assumed to contain non-PAF drivers, partly overlapped with CFAE/LVAs but not always coincided with them...
April 2018: Journal of Arrhythmia
https://www.readbyqxmd.com/read/29629398/simulation-of-spiral-waves-and-point-sources-in-atrial-fibrillation-with-application-to-rotor-localization
#5
Prasanth Ganesan, Kristina E Shillieto, Behnaz Ghoraani
Cardiac simulations play an important role in studies involving understanding and investigating the mechanisms of cardiac arrhythmias. Today, studies of arrhythmogenesis and maintenance are largely being performed by creating simulations of a particular arrhythmia with high accuracy comparable to the results of clinical experiments. Atrial fibrillation (AF), the most common arrhythmia in the United States and many other parts of the world, is one of the major field where simulation and modeling is largely used...
June 2017: Proceedings
https://www.readbyqxmd.com/read/29545360/long-term-outcome-of-pulmonary-vein-isolation-with-and-without-focal-impulse-and-rotor-modulation-mapping-insights-from-a-meta-analysis
#6
Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Carola Gianni, Domenico G Della Rocca, Luigi Di Biase, Andrea Natale
BACKGROUND: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without focal impulse and rotor modulation (FIRM) ablation in patients with atrial fibrillation. METHODS AND RESULTS: Extensive literature search was performed for studies reporting outcomes of PVI alone and PVI+FIRM procedures. For PVI alone, only randomized trials conducted in the past 3 years reporting single-procedure off-antiarrhythmic drugs success rate at ≥12-month follow-up were included...
March 2018: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29508083/ablation-approaches-for-ventricular-fibrillation
#7
REVIEW
Prabhpreet Singh, Amit Noheria
Invasive electrophysiology (EP) mapping and catheter ablation has increasingly become the standard of care for many cardiac arrhythmias like supraventricular tachycardias, atrial fibrillation, premature ventricular complexes (PVC), and monomorphic ventricular tachycardia. In this review, we discuss the recent progress made in the mapping and ablation of ventricular fibrillation (VF). Ventricular activation during VF is apparently disorganized, making mapping and interpretation difficult. Prolonged mapping during VF would require mechanical circulatory support as VF causes complete hemodynamic collapse...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29505583/factors-affecting-basket-catheter-detection-of-real-and-phantom-rotors-in-the-atria-a-computational-study
#8
Laura Martinez-Mateu, Lucia Romero, Ana Ferrer-Albero, Rafael Sebastian, José F Rodríguez Matas, José Jalife, Omer Berenfeld, Javier Saiz
Anatomically based procedures to ablate atrial fibrillation (AF) are often successful in terminating paroxysmal AF. However, the ability to terminate persistent AF remains disappointing. New mechanistic approaches use multiple-electrode basket catheter mapping to localize and target AF drivers in the form of rotors but significant concerns remain about their accuracy. We aimed to evaluate how electrode-endocardium distance, far-field sources and inter-electrode distance affect the accuracy of localizing rotors...
March 2018: PLoS Computational Biology
https://www.readbyqxmd.com/read/29436112/cost-effectiveness-of-focal-impulse-and-rotor-modulation-guided-ablation-added-to-pulmonary-vein-isolation-for-atrial-fibrillation
#9
Tina Baykaner, Steve Duff, James T Hasegawa, Michael S Mafilios, Mintu P Turakhia
BACKGROUND: Although ablation with focal impulse and rotor modulation (FIRM), as an adjunct to pulmonary vein isolation (PVI), has been shown to decrease atrial fibrillation (AF) recurrence, cost-effectiveness has not been assessed. OBJECTIVE: We aimed to evaluate the cost effectiveness of FIRM-guided ablation when added to PVI in a mixed AF population. METHODS AND RESULTS: We used a Markov model to estimate the costs, quality-adjusted survival, and cost effectiveness of adding FIRM ablation to PVI...
April 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29340595/clinical-impact-of-rotor-ablation-in-atrial-fibrillation-a-systematic-review
#10
Ramanathan Parameswaran, Aleksandr Voskoboinik, Alexandra Gorelik, Geoffrey Lee, Peter M Kistler, Prashanthan Sanders, Jonathan M Kalman
Aims: Rotor mapping and ablation have gained favour over the recent years as an emerging ablation strategy targeting drivers of atrial fibrillation (AF). Their efficacy, however, has been a topic of great debate with variable outcomes across centres. The aim of this study was to systematically review the recent medical literature to determine the medium-term outcomes of rotor ablation in patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF). Methods and results: A systematic search of the contemporary scientific literature (PubMed and EMBASE) was performed in August 2017...
January 11, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29287119/effectiveness-of-atrial-fibrillation-rotor-ablation-is-dependent-on-conduction-velocity-an-in-silico-3-dimensional-modeling-study
#11
COMPARATIVE STUDY
Byounghyun Lim, Minki Hwang, Jun-Seop Song, Ah-Jin Ryu, Boyoung Joung, Eun Bo Shim, Hyungon Ryu, Hui-Nam Pak
BACKGROUND: We previously reported that stable rotors are observed in in-silico human atrial fibrillation (AF) models, and are well represented by a dominant frequency (DF). In the current study, we hypothesized that the outcome of DF ablation is affected by conduction velocity (CV) conditions and examined this hypothesis using in-silico 3D-AF modeling. METHODS: We integrated 3D CT images of left atrium obtained from 10 patients with persistent AF (80% male, 61...
2017: PloS One
https://www.readbyqxmd.com/read/29097406/localized-optogenetic-targeting-of-rotors-in-atrial-cardiomyocyte-monolayers
#12
Iolanda Feola, Linda Volkers, Rupamanjari Majumder, Alexander Teplenin, Martin J Schalij, Alexander V Panfilov, Antoine A F de Vries, Daniël A Pijnappels
BACKGROUND: Recently, a new ablation strategy for atrial fibrillation has emerged, which involves the identification of rotors (ie, local drivers) followed by the localized targeting of their core region by ablation. However, this concept has been subject to debate because the mode of arrhythmia termination remains poorly understood, as dedicated models and research tools are lacking. We took a unique optogenetic approach to induce and locally target a rotor in atrial monolayers. METHODS AND RESULTS: Neonatal rat atrial cardiomyocyte monolayers expressing a depolarizing light-gated ion channel (Ca2+-translocating channelrhodopsin) were subjected to patterned illumination to induce single, stable, and centralized rotors by optical S1-S2 cross-field stimulation...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29035207/novel-quantitative-analytical-approaches-for-rotor-identification-and-associated-implications-for-mapping
#13
Elizabeth M Annoni, Shivaram Poigai Arunachalam, Suraj Kapa, Siva K Mulpuru, Paul A Friedman, Elena G Tolkacheva
GOAL: Clinical studies identifying rotors and confirming these sites for ablation in treating cardiac arrhythmias have had inconsistent results with the currently available analysis techniques. The aim of this study is to evaluate four new signal analysis approaches-multiscale frequency (MSF), Shannon entropy (SE), Kurtosis (Kt), and multiscale entropy (MSE)-in their ability to identify the pivot point of rotors. METHODS: Optical mapping movies of ventricular tachycardia were used to evaluate the performance and robustness of SE, Kt, MSF, and MSE techniques with respect to several clinical limitations: decreased time duration, reduced spatial resolution, and the presence of meandering rotors...
February 2018: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/29016785/obstructive-sleep-apnea-is-associated-with-increased-rotor-burden-in-patients-undergoing-focal-impulse-and-rotor-modification-guided-atrial-fibrillation-ablation
#14
Daniel J Friedman, Peter Liu, Adam S Barnett, Kristen Bova Campbell, Kevin P Jackson, Tristram D Bahnson, James P Daubert, Jonathan P Piccini
Aims: To assess whether obstructive sleep apnea (OSA) was associated with increased rotor burden among atrial fibrillation (AF) patients. Methods and results: We studied 33 consecutive patients who were scheduled for focal impulse and rotor modulation (FIRM) ablation at our institution to describe the mapping, ablation, and outcomes, among patients with and without OSA. Patients underwent biatrial FIRM mapping in AF with ablation of stable rotors in addition to conventional ablation lesion sets...
August 9, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28988690/impact-of-number-of-co-existing-rotors-and-inter-electrode-distance-on-accuracy-of-rotor-localization
#15
Konstantinos N Aronis, Hiroshi Ashikaga
BACKGROUND: Conflicting evidence exists on the efficacy of focal impulse and rotor modulation on atrial fibrillation ablation. A potential explanation is inaccurate rotor localization from multiple rotors coexistence and a relatively large (9-11mm) inter-electrode distance (IED) of the multi-electrode basket catheter. METHODS AND RESULTS: We studied a numerical model of cardiac action potential to reproduce one through seven rotors in a two-dimensional lattice. We estimated rotor location using phase singularity, Shannon entropy and dominant frequency...
January 2018: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28964155/demonstration-of-cardiac-rotor-and-source-mapping-techniques-in-embryonic-chick-monolayers
#16
Min Ju You, Peter Langfield, Lucas Campanari, Matt Dobbs, Alvin Shrier, Leon Glass
Excitable media, such as the heart, display propagating waves with different geometries including target patterns and rotors (spiral waves). Collision of two waves leads to annihilation of both. We present algorithms for data processing and analysis to identify the core of rotors. In this work, we show that as the spatial sampling resolution decreases it becomes increasingly difficult to identify rotors-there are instances of false negatives and false positives. These observations are relevant to current controversies concerning the role of rotors in the initiation, maintenance, and treatment of cardiac arrhythmias, especially atrial fibrillation...
September 2017: Chaos
https://www.readbyqxmd.com/read/28887361/technical-considerations-on-phase-mapping-for-identification-of-atrial-reentrant-activity-in-direct-and-inverse-computed-electrograms
#17
Miguel Rodrigo, Andreu M Climent, Alejandro Liberos, Francisco Fernández-Avilés, Omer Berenfeld, Felipe Atienza, Maria S Guillem
BACKGROUND: Phase mapping has become a broadly used technique to identify atrial reentrant circuits for ablative therapy guidance. This work studies the phase mapping process and how the signal nature and its filtering affect the reentrant pattern characterization in electrogram (EGM), body surface potential mapping, and electrocardiographic imaging signals. METHODS AND RESULTS: EGM, body surface potential mapping, and electrocardiographic imaging phase maps were obtained from 17 simulations of atrial fibrillation, atrial flutter, and focal atrial tachycardia...
September 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28856145/ablation-of-long-standing-persistent-atrial-fibrillation
#18
REVIEW
Behram P Mody, Anoshia Raza, Jason Jacobson, Sei Iwai, Daniel Frenkel, Rhadames Rojas, Wilbert S Aronow
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in the clinical setting affecting nearly 6 million people in United States and the numbers are only expected to rise as the population continues to age. Broadly it is classified into paroxysmal, persistent and longstanding persistent AF. Electrical, structural and autonomic remodeling are some of the diverse pathophysiological mechanisms that contribute to the persistence of AF. Our review article emphasizes particularly on long standing persistent atrial fibrillation (LSPAF) aspect of the disease which poses a great challenge for electrophysiologists...
August 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28827810/role-of-atrial-wall-thickness-in-wave-dynamics-of-atrial-fibrillation
#19
Jun-Seop Song, Jin Wi, Hye-Jeong Lee, Minki Hwang, Byounghyun Lim, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Jeong-Wook Seo, Hui-Nam Pak
BACKGROUND/AIMS: Atrial anatomy and thickness may affect the electrical wave-dynamics of atrial fibrillation (AF). We explored the relationship between left atrial (LA) wall thickness (LAWT) or LA geometry and AF wave-dynamics. METHODS: We included 15 patients with persistent AF (age, 62.3 ± 11.9 years) who underwent AF catheter ablation. We measured the LAWT, LA endocardial curvature, and SD-curvature (surface bumpiness) from preprocedural computed tomography images...
2017: PloS One
https://www.readbyqxmd.com/read/28800192/efficacy-and-safety-of-driver-guided-catheter-ablation-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#20
F Daniel Ramirez, David H Birnie, Girish M Nair, Agnieszka Szczotka, Calum J Redpath, Mouhannad M Sadek, Pablo B Nery
INTRODUCTION: Targeting localized drivers (electrical rotors or focal impulses) during catheter ablation for atrial fibrillation (AF) has been proposed as a strategy to improve procedural success. However, the strength and quality of the evidence to support this approach is unclear. METHODS AND RESULTS: Clinical studies reporting efficacy or safety outcomes of driver-guided ablation for AF were identified in Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Pubmed, and conference abstracts from major scientific meetings...
December 2017: Journal of Cardiovascular Electrophysiology
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