Jiro Inoue1, Allan C Skanes2, Lorne J Gula2, Maria Drangova1,3. 1. Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada. 2. Division of Cardiology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada. 3. Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada.
Abstract
INTRODUCTION: Radiofrequency (RF) ablation in thicker regions of the left atrium (LA) may require increased ablation energy in order to achieve effective transmural lesions. Consequently, many cases of recurrent atrial fibrillation (AF) postablation may be due to thicker-than-normal atrial tissue. The aim of this study was to test the hypotheses that patients with recurrent AF have thicker tissue overall and that electrical reconnection is more likely in regions of thicker tissue. METHODS AND RESULTS: Retrospective analysis was performed on 86 CT images acquired preoperatively from a cohort of 119 patients who had undergone RF ablation for AF. Of these, 33 patients experienced recurrence of AF within 1 year of initial treatment and 29 returned for a repeat ablation. For each patient, LA wall thickness (LAWT) was measured from the images in 12 anatomical regions using custom software. Patients with recurrent AF had larger LAWT compared to successfully treated patients (1.6 ± 0.6 mm vs. 1.5 ± 0.5 mm, P < 0.001) and reconnection was found to be at regions of thicker tissue (1.6 ± 0.6 mm, P = 0.038) compared to nonreconnected regions (1.5 ± 0.5 mm). The superior right posterior wall of the LA was significantly related to both recurrence (P = 0.048) and reconnection (P = 0.014). CONCLUSION: Increased LAWT has a small but significant effect on postablation recurrence and reconnection. Measures of LAWT may facilitate appropriate dosing of RF energy, but other factors will be critical in transmural lesion formation and ablation success.
INTRODUCTION: Radiofrequency (RF) ablation in thicker regions of the left atrium (LA) may require increased ablation energy in order to achieve effective transmural lesions. Consequently, many cases of recurrent atrial fibrillation (AF) postablation may be due to thicker-than-normal atrial tissue. The aim of this study was to test the hypotheses that patients with recurrent AF have thicker tissue overall and that electrical reconnection is more likely in regions of thicker tissue. METHODS AND RESULTS: Retrospective analysis was performed on 86 CT images acquired preoperatively from a cohort of 119 patients who had undergone RF ablation for AF. Of these, 33 patients experienced recurrence of AF within 1 year of initial treatment and 29 returned for a repeat ablation. For each patient, LA wall thickness (LAWT) was measured from the images in 12 anatomical regions using custom software. Patients with recurrent AF had larger LAWT compared to successfully treated patients (1.6 ± 0.6 mm vs. 1.5 ± 0.5 mm, P < 0.001) and reconnection was found to be at regions of thicker tissue (1.6 ± 0.6 mm, P = 0.038) compared to nonreconnected regions (1.5 ± 0.5 mm). The superior right posterior wall of the LA was significantly related to both recurrence (P = 0.048) and reconnection (P = 0.014). CONCLUSION: Increased LAWT has a small but significant effect on postablation recurrence and reconnection. Measures of LAWT may facilitate appropriate dosing of RF energy, but other factors will be critical in transmural lesion formation and ablation success.
Authors: Melinda Boussoussou; Bálint Szilveszter; Borbála Vattay; Márton Kolossváry; Milán Vecsey-Nagy; Zoltán Salló; Gábor Orbán; Perge Péter; Piros Katalin; Nagy Klaudia Vivien; Osztheimer István; Pál Maurovich-Horvat; Béla Merkely; László Gellér; Nándor Szegedi Journal: Int J Cardiovasc Imaging Date: 2022-02-09 Impact factor: 2.357
Authors: Mark J Mulder; Michiel J B Kemme; Amaya M D Hagen; Luuk H G A Hopman; Peter M van de Ven; Herbert A Hauer; Giovanni J M Tahapary; Marco J W Götte; Albert C van Rossum; Cornelis P Allaart Journal: Int J Cardiol Heart Vasc Date: 2020-07-03
Authors: Sophinese Iskander-Rizk; Pieter Kruizinga; Robert Beurskens; Geert Springeling; Frits Mastik; Natasja M S de Groot; Paul Knops; Antonius F W van der Steen; Gijs van Soest Journal: Photoacoustics Date: 2019-11-30
Authors: Francesco De Sensi; Diego Penela; David Soto-Iglesias; Antonio Berruezo; Ugo Limbruno Journal: J Clin Med Date: 2021-05-24 Impact factor: 4.241
Authors: Rashed Karim; Lauren-Emma Blake; Jiro Inoue; Qian Tao; Shuman Jia; R James Housden; Pranav Bhagirath; Jean-Luc Duval; Marta Varela; Jonathan M Behar; Loïc Cadour; Rob J van der Geest; Hubert Cochet; Maria Drangova; Maxime Sermesant; Reza Razavi; Oleg Aslanidi; Ronak Rajani; Kawal Rhode Journal: Med Image Anal Date: 2018-08-24 Impact factor: 8.545