RESUMEN
BACKGROUND: A novel circular pulmonary vein ablation catheter (PVAC) has been introduced for pulmonary vein isolation (PVI). Accurate delineation of left atrium-pulmonary vein (LA-PV) anatomy is important for this technique. The aim of this study was to test whether the 3-dimensional rotational angiography (3D RTA) of the left atrium can facilitate PVI using PVAC technique. METHODS: Twenty patients with paroxysmal atrial fibrillation (AF) were enrolled in this study. The 3D RTA was reconstructed and registered with live fluoroscopy in all the patients. AF ablation was performed with a PVAC catheter in the navigation of registered 3D RTA. RESULTS: The 3DRTA image was successfully reconstructed and registered with live fluoroscopy in all patients (100%). The LA-PV anatomy was delineated clearly in all patients. Navigation of the PVAC inside the registered 3D RTA, ensured accurate placement within the atrium to perform ablation, and the PVAC was correctly placed inside the PV ostium to verify the PVI. All the PVs were isolated. Total procedural time was (87.5 ± 12.1) minutes, and fluoroscopy time was (20.1 ± 6.3) minutes. Follow-up after (7.1 ± 1.5) months showed freedom from AF in 70% (14/20) patients. No PV stenosis was observed. CONCLUSIONS: Intraprocedure reconstructed and registered 3D RTA can clearly delineate the LA-PV anatomy in real-time. The results demonstrate the feasibility and reliability of combining use of 3DRA and PVAC in AF ablation procedures.
Asunto(s)
Angiografía/métodos , Ablación por Catéter/métodos , Atrios Cardíacos/cirugía , Venas Pulmonares/cirugía , Anciano , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: The study was designed to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein (PV) potentials during ablation procedures and without interchanging catheters. METHODS AND RESULTS: A total of 23 consecutive patients with paroxysmal atrial fibrillation (AF) were enrolled. A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium. A 6-pole mapping catheter with a 0.035-inch shaft diameter was introduced into the PV through the central lumen of the cryoballoon catheter. In addition to the function as a recording device, the mapping catheter was also used as a "guide-wire" during the procedure. A total of 84 PVs (84/92, 91.3%) were completely isolated using this novel cryoballoon technique. In 43 of the 84 veins (51.2%), isolation was observed in real time during the cryoablation; in the remaining 41 veins (48.8%), isolation was confirmed immediately post ablation attempt with the mapping catheter. Procedure time was 152.7 +/- 54.9 minutes, and fluoroscopy time was 33.2 +/- 17.3 minutes. At follow-up (7.4 months, range 2-18 months), 17 (73.9%) patients were free from AF. There was 1 occurrence of phrenic nerve palsy during ablation of a right superior PV, which fully resolved after 1 month. CONCLUSION: The use of a cryoballoon catheter equipped with a 6-pole micromapping catheter inserted through its central lumen for the purpose of mapping and ablation during PV isolation procedures is both feasible and effective.
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Cateterismo Periférico/métodos , Criocirugía/métodos , Venas Pulmonares/anatomía & histología , Anciano , Fibrilación Atrial/patología , Fibrilación Atrial/cirugía , Cateterismo Periférico/instrumentación , Estudios de Cohortes , Frío , Ecocardiografía Transesofágica , Electrocardiografía , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Three-dimensional (3D) image of left atrium (LA) can greatly facilitate ablation of atrial fibrillation (AF). Reconstructing method using computed tomography (CT) has certain limitations. The 3D image of LA can be intraprocedurally reconstructed by a rotational angiography technique. METHODS: Forty-six patients undergoing AF ablation were included in this study. Preprocedural CT imaging and intraprocedural reconstructing 3D rotational angiogram (3DRA) of LA were performed in all the patients. Rapid ventricular pacing (RVP, 300 ms) was used to inhibit the drainage of atrium. During RVP, contrast medium was injected into the LA, and rotational angiography was performed. The 3DRA was reconstructed and was registered with the live fluoroscopy. The 3DRA was evaluated in comparison to the CT image. In the navigation of the registered 3DRA, the ablation of AF was performed. RESULTS: Forty-four 3DRAs (95.7%) were successfully reconstructed and registered with the live fluoroscopy. The LA anatomy was delineated in the 3DRA in comparison to a CT image. AF ablation was successfully performed in the 44 patients in the navigation of the registered 3DRA. There were good correlations in the PV ostial diameter and the LA volume as assessed by 3DRA in comparison to a CT image (r>=0.87). The radiation exposure in rotational angiography was substantially less than that in CT scanning (2.7+/-0.9 mSv vs. 24.9+/-3.1 mSv, P<0.001). CONCLUSIONS: It is feasible to reconstruct and register the 3DRA with live fluoroscopy using the RVP method during the ablation of AF.
Asunto(s)
Angiografía/métodos , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Imagenología Tridimensional/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
BACKGROUND: Conventional pulmonary vein (PV) angiography cannot precisely delineate the left atrium (LA)-PV anatomy, which is essential for the ablation of atrial fibrillation (AF). The aim of the study was to test the feasibility of a novel method of rotational angiography for the AF ablation. METHODS AND RESULTS: Forty-one patients were enrolled in this study. CT scanning was performed in all patients before the procedure. Rotational angiography (rotating from right anterior oblique 55 degrees to left anterior oblique 55 degrees ) was performed before AF ablation. Rapid ventricular pacing (RVP, 300 ms) was carried out to reduce cardiac output while contrast medium was injected into the LA via a pigtail catheter. RVP was successfully performed in 36 (87.8%) patients. The ostia of all PVs and the LA appendage were visible in all these 36 cases. There was a good correlation in the PV ostial diameters as assessed by rotational angiography via RVP as compared to CT imaging (r (2) > 0.85). CONCLUSIONS: Rotational angiography by RVP is able to delineate the LA-PV anatomy. There is a good correlation in the PV ostial diameters as assessed by rotational angiography via RVP and CT imaging. Rotational angiography by RVP is feasible during AF ablation.