Author's Accepted Manuscript
Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome Shiro Nakahara MD, Yuichi Hori MD, Sayuki Kobayashi MD, Yoshihiko Sakai MD, Isao Taguchi MD, Kan Takayanagi MD, Koichi Nagashima MD, Kazumasa Sonoda MD, Rikitake Kogawa MD, Naoko Sasaki MD, Ichiro Watanabe MD, Yasuo Okumura MD
PII: DOI: Reference:
S1547-5271(14)00502-5 http://dx.doi.org/10.1016/j.hrthm.2014.04.040 HRTHM5761
To appear in:
Heart Rhythm
www.elsevier.com/locate/buildenv
Cite this article as: Shiro Nakahara MD, Yuichi Hori MD, Sayuki Kobayashi MD, Yoshihiko Sakai MD, Isao Taguchi MD, Kan Takayanagi MD, Koichi Nagashima MD, Kazumasa Sonoda MD, Rikitake Kogawa MD, Naoko Sasaki MD, Ichiro Watanabe MD, Yasuo Okumura MD, Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2014.04.040 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome
Shiro Nakahara MD†, Yuichi Hori MD†, Sayuki Kobayashi MD†, Yoshihiko Sakai MD†, Isao Taguchi MD†, Kan Takayanagi MD†, Koichi Nagashima MD*, Kazumasa Sonoda MD*, Rikitake Kogawa MD*, Naoko Sasaki MD*, Ichiro Watanabe MD*, Yasuo Okumura MD*
†Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan * Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
Short Title: EAT-Based Ablation of AF
Address for Correspondence: Shiro Nakahara, MD PhD FACC Department of Cardiology, Dokkyo University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan 343-8555 Tel: 81-489-65-1111 Fax: 81-489-60-1708 E-mail: [email protected]
Disclosures and Finding Sources: None Conflict of interest: None Total words: 4,217
1
Abstract BACKGROUND Increased epicardial adipose tissue (EAT) volume is associated with atrial fibrillation (AF). However, the efficacy of EAT-based left atrial (LA) ablation for persistent AF (PsAF) is unclear. OBJECTIVE To assess whether EAT-based LA ablation is effective for PsAF. METHODS In 60 PsAF patients (group I), 3D reconstructed computed tomography images depicting EAT were merged with NavX-based dominant-frequency (DF) and complex fractionated electrogram (CFE) maps obtained during AF. Pulmonary vein antrum isolation (PVAI) was followed by map-guided EAT-based ablation. Results were compared to results in a historical control group (group II, case-matched patients who underwent generalized stepwise ablation including linear plus CFE-targeted ablation). RESULTS In 70% (n=42) of group I patients, the LA-EAT was located at the PV antra; anterior and inferior surface, roof, septum, mitral annulus; and left atrial appendage. EAT was at or near (< 3mm) 71% (390/550) of high-DF (>-8Hz) sites. In 41 patients with persistent AF despite EAT-targeted ablation, the CFE burden decreased significantly (from 96% to 13%; P8 Hz).
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Figure 2: Electroanatomical maps of the left atrium from the representative case in Figure 1 but seen from the anteroposterior (left-panels) and posteroanterior (right-panels) views of the pre-linear (upper-panels) and post-linear (lower panels) left atrial ablation mean cycle length complex fractionated electrogram (CFE) maps. Sites with a mean CFE cycle length of ≤120 ms are color-coded red/white, and sites with a mean CFE cycle length of >120 ms are color-coded purple. There is a marked reduction in the CFE burden between the 2 maps in the pulmonary vein and non-pulmonary vein areas.
21
Figure 3A: Graph of the EAT distribution per LA region. B: Graph of the overlap between the EAT sites and the high-DF (>8 Hz) sites (green) and continuous CFE (40-50ms) sites (red). Abbreviations are as in Figures-1and 2.
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Figure 4: Effect of EAT-based ablation on the CFE mean in the coronary sinus (CS) (A) and DF in the CS (B). The CFE mean and DF recorded in the CS are shown before ablation, after PVAI, and after EAT-based ablation. There was a significant increase in the CFE mean (P
Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome Shiro Nakahara MD, Yuichi Hori MD, Sayuki Kobayashi MD, Yoshihiko Sakai MD, Isao Taguchi MD, Kan Takayanagi MD, Koichi Nagashima MD, Kazumasa Sonoda MD, Rikitake Kogawa MD, Naoko Sasaki MD, Ichiro Watanabe MD, Yasuo Okumura MD
PII: DOI: Reference:
S1547-5271(14)00502-5 http://dx.doi.org/10.1016/j.hrthm.2014.04.040 HRTHM5761
To appear in:
Heart Rhythm
www.elsevier.com/locate/buildenv
Cite this article as: Shiro Nakahara MD, Yuichi Hori MD, Sayuki Kobayashi MD, Yoshihiko Sakai MD, Isao Taguchi MD, Kan Takayanagi MD, Koichi Nagashima MD, Kazumasa Sonoda MD, Rikitake Kogawa MD, Naoko Sasaki MD, Ichiro Watanabe MD, Yasuo Okumura MD, Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2014.04.040 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and the ablation outcome
Shiro Nakahara MD†, Yuichi Hori MD†, Sayuki Kobayashi MD†, Yoshihiko Sakai MD†, Isao Taguchi MD†, Kan Takayanagi MD†, Koichi Nagashima MD*, Kazumasa Sonoda MD*, Rikitake Kogawa MD*, Naoko Sasaki MD*, Ichiro Watanabe MD*, Yasuo Okumura MD*
†Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan * Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
Short Title: EAT-Based Ablation of AF
Address for Correspondence: Shiro Nakahara, MD PhD FACC Department of Cardiology, Dokkyo University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan 343-8555 Tel: 81-489-65-1111 Fax: 81-489-60-1708 E-mail: [email protected]
Disclosures and Finding Sources: None Conflict of interest: None Total words: 4,217
1
Abstract BACKGROUND Increased epicardial adipose tissue (EAT) volume is associated with atrial fibrillation (AF). However, the efficacy of EAT-based left atrial (LA) ablation for persistent AF (PsAF) is unclear. OBJECTIVE To assess whether EAT-based LA ablation is effective for PsAF. METHODS In 60 PsAF patients (group I), 3D reconstructed computed tomography images depicting EAT were merged with NavX-based dominant-frequency (DF) and complex fractionated electrogram (CFE) maps obtained during AF. Pulmonary vein antrum isolation (PVAI) was followed by map-guided EAT-based ablation. Results were compared to results in a historical control group (group II, case-matched patients who underwent generalized stepwise ablation including linear plus CFE-targeted ablation). RESULTS In 70% (n=42) of group I patients, the LA-EAT was located at the PV antra; anterior and inferior surface, roof, septum, mitral annulus; and left atrial appendage. EAT was at or near (< 3mm) 71% (390/550) of high-DF (>-8Hz) sites. In 41 patients with persistent AF despite EAT-targeted ablation, the CFE burden decreased significantly (from 96% to 13%; P8 Hz).
20
Figure 2: Electroanatomical maps of the left atrium from the representative case in Figure 1 but seen from the anteroposterior (left-panels) and posteroanterior (right-panels) views of the pre-linear (upper-panels) and post-linear (lower panels) left atrial ablation mean cycle length complex fractionated electrogram (CFE) maps. Sites with a mean CFE cycle length of ≤120 ms are color-coded red/white, and sites with a mean CFE cycle length of >120 ms are color-coded purple. There is a marked reduction in the CFE burden between the 2 maps in the pulmonary vein and non-pulmonary vein areas.
21
Figure 3A: Graph of the EAT distribution per LA region. B: Graph of the overlap between the EAT sites and the high-DF (>8 Hz) sites (green) and continuous CFE (40-50ms) sites (red). Abbreviations are as in Figures-1and 2.
22
Figure 4: Effect of EAT-based ablation on the CFE mean in the coronary sinus (CS) (A) and DF in the CS (B). The CFE mean and DF recorded in the CS are shown before ablation, after PVAI, and after EAT-based ablation. There was a significant increase in the CFE mean (P
![[Catheter ablation of persistent atrial fibrillation : pulmonary vein isolation, ablation of fractionated electrograms, stepwise approach or rotor ablation?].](/assets/img/hold.png)
