AIMS: Mitral isthmus (MI) ablation is technically challenging, requiring long endocardial ablation times and frequently coronary sinus (CS) ablation. The circumflex artery lies in the epicardium in close proximity to the CS and the mitral annulus and may potentially be injured during radiofrequency ablation. METHODS AND RESULTS: Fifty-four patients underwent catheter ablation procedures that included MI ablation for treatment of atrial fibrillation. Irrigated ablation catheters were used with the following settings: endocardial surface (max power: 40/50 W at the annular end; max temperature: 48°C); CS (max power: 25/30 W; max temperature: 48°C). Coronary angiography was performed pre- and post-ablation and analysed by two cardiologists with quantitative coronary angiography. Mitral isthmus block was achieved in 89% of patients (60% required CS ablation). Fifteen patients (28%) had angiographic changes following ablation: eight had mid-circumflex narrowing only, one had circumflex and obtuse marginal (OM) artery narrowing, one had OM narrowing only, and five had distal circumflex occlusion/narrowing. Five patients had significant narrowing (50-84%), which resolved with intracoronary glycerine trinitrate. Fourteen (93%) of the patients with circumflex 'injury' had CS ablation and a longer mean CS ablation time (5.0 ± 3.0 vs. 2.6 ± 3.3 min, P = 0.03). Patients with distal circumflex occlusion had significantly smaller vessel diameter (1.0 ± 0.1 vs. 2.1 ± 0.2 mm, P = 0.03). A shorter distance between the circumflex and the CS was also associated with circumflex 'injury' (3.2 ± 1.9 vs. 5.6 ± 3.2 mm, P = 0.04). There were no electrocardiographic or echocardiographic abnormalities and no angina symptoms during follow-up. CONCLUSION: Acute sub-clinical circumflex 'injury' following MI ablation is not uncommon. Ablation within the CS, proximity of the circumflex and the CS, and a small distal circumflex were risk factors for 'injury'.
AIMS: Mitral isthmus (MI) ablation is technically challenging, requiring long endocardial ablation times and frequently coronary sinus (CS) ablation. The circumflex artery lies in the epicardium in close proximity to the CS and the mitral annulus and may potentially be injured during radiofrequency ablation. METHODS AND RESULTS: Fifty-four patients underwent catheter ablation procedures that included MI ablation for treatment of atrial fibrillation. Irrigated ablation catheters were used with the following settings: endocardial surface (max power: 40/50 W at the annular end; max temperature: 48°C); CS (max power: 25/30 W; max temperature: 48°C). Coronary angiography was performed pre- and post-ablation and analysed by two cardiologists with quantitative coronary angiography. Mitral isthmus block was achieved in 89% of patients (60% required CS ablation). Fifteen patients (28%) had angiographic changes following ablation: eight had mid-circumflex narrowing only, one had circumflex and obtuse marginal (OM) artery narrowing, one had OM narrowing only, and five had distal circumflex occlusion/narrowing. Five patients had significant narrowing (50-84%), which resolved with intracoronary glycerine trinitrate. Fourteen (93%) of the patients with circumflex 'injury' had CS ablation and a longer mean CS ablation time (5.0 ± 3.0 vs. 2.6 ± 3.3 min, P = 0.03). Patients with distal circumflex occlusion had significantly smaller vessel diameter (1.0 ± 0.1 vs. 2.1 ± 0.2 mm, P = 0.03). A shorter distance between the circumflex and the CS was also associated with circumflex 'injury' (3.2 ± 1.9 vs. 5.6 ± 3.2 mm, P = 0.04). There were no electrocardiographic or echocardiographic abnormalities and no angina symptoms during follow-up. CONCLUSION: Acute sub-clinical circumflex 'injury' following MI ablation is not uncommon. Ablation within the CS, proximity of the circumflex and the CS, and a small distal circumflex were risk factors for 'injury'.
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Interv Card Electrophysiol Date: 2017-10 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Arrhythm Date: 2017-09-15
Authors: Andreas Rillig; Boris Schmidt; Britta Feige; Erik Wissner; Andreas Metzner; Anita Arya; Shibu Mathew; Hisaki Makimoto; Peter Wohlmuth; Feifan Ouyang; Karl-Heinz Kuck; Roland Richard Tilz Journal: Clin Res Cardiol Date: 2013-07-30 Impact factor: 5.460