ABSTRACT
<p><b>BACKGROUND</b>The success and complication rates of atrial fibrillation (AF) ablation may be related to regional differences in left atrial (LA) wall thickness. The purpose of this study was to investigate the transmural LA wall thickness in various regions.</p><p><b>METHODS</b>We measured LA wall thickness in 36 human heart specimens using calipers at three planes including left pulmonary veins (PVs) vestibule plane, right PVs vestibule plane and the middle plane between the two. In each plane, eight points were selected, including superior, middle and inferior levels at anterior and posterior wall, roof and bottom.</p><p><b>RESULTS</b>The anterior and posterior wall thickness displayed gradient from superior to inferior level (anterior wall: (2.73 ± 1.01) mm, (2.08 ± 0.91) mm and (1.54 ± 0.69) mm; posterior wall: (1.74 ± 0.68) mm, (1.48 ± 0.39) mm and (1.27 ± 0.42) mm). At the roof, LA wall thickness was thickest in middle plane ((2.01 ± 1.02) mm) and was thinnest in left PVs vestibule plane ((1.29 ± 0.41) mm). The posterior wall thickness in left PVs vestibule plane was thinner than in the other two planes (P < 0.05 - 0.001), and was thinner in right PVs vestibule plane than in middle plane (P < 0.01 - 0.001). Whereas in anterior wall, the wall thickness in left PVs vestibule plane was thicker than in middle and right PVs vestibule plane.</p><p><b>CONCLUSIONS</b>Significant variations exist for mean LA wall thickness at different regions which are often targeted during circumferential pulmonary venous ablation (CPVA). Appreciating these differences may have significant implications in catheter ablation of AF.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atrial Fibrillation , General Surgery , Catheter Ablation , Heart Atria , General Surgery , In Vitro TechniquesABSTRACT
<p><b>OBJECTIVE</b>The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) and is becoming more widely accepted. This study aims to evaluate the effectiveness of the CARTO and the EnSite-NavX system and to compare between them on procedural parameters and clinical characteristics.</p><p><b>METHODS</b>Seventy-five patients with paroxysmal or persistent symptomatic AF were randomly assigned to CPVA procedure guided by either the EnSite-NavX system (group I, n = 40) or the CARTO system (group II, n = 35). After successful transseptal procedure, a geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferential tissues out of pulmonary veins (PVs) ostia. In cases with persistent AF, linear ablation was applied to modify the substrate of LA. The endpoint of the procedure was complete PVs isolation.</p><p><b>RESULTS</b>Seventy-four cases underwent a successful procedure. The total procedure and fluoroscopic time in group II was significantly shorter than those in group I (150 min +/- 23 min and 18 min +/- 17 min vs 170 min +/- 34 min and 25 min +/- 16 min, P = 0.03 and 0.04, respectively). There was no significant difference in the fluoroscopic and procedure durations for geometry creation between the groups I and II (8 min +/- 4 min and 16 min +/- 11 min vs 5 min +/- 4 min and 14 min +/- 8 min, respectively). The fluoroscopic time for CPVA was 15 min +/- 5 min in group I vs 10 min +/- 6 min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than those in group (86 min +/- 11 min vs 110 min +/- 15 min, P = 0.04). AF was terminated by RF delivery in 14 cases (35%) in group Ivs 5 cases (14%) in group II (P = 0.04). Complete PV isolation was obtained in 26 cases (65%) in group Ivs 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardial tamponade and 1 case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured and no PV stenosis was observed.</p><p><b>CONCLUSIONS</b>The CPVA procedure for atrial fibrillation is effective and safe. Although there is a difference between the CARTO and the EnSite-NavX system, the CPVA procedure guided by either of them yields similar clinical results.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation , General Surgery , Catheter Ablation , Methods , Imaging, Three-Dimensional , Pulmonary Veins , General SurgeryABSTRACT
<p><b>BACKGROUND</b>The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.</p><p><b>METHODS</b>Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group I, n = 40) and by the CARTO system (group II, n = 35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins' (PVs') ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium (LA). The endpoint of the procedure was complete PVs isolation.</p><p><b>RESULTS</b>Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group II were significantly shorter than in group I [(150 +/- 23) min and (18 +/- 17) min versus (170 +/- 34) min and (25 +/- 16) min, P = 0.03 and 0.04, respectively]. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group I and group II [(8 +/- 4) min and (16 +/- 11) min versus (5 +/- 4) min and (14 +/- 8) min, respectively]. The fluoroscopic durations for CPVA were (15 +/- 5) min in group I versus (10 +/- 6) min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than in group I [(18 +/- 11) min versus (25 +/- 10) min, P = 0.04]. AF was terminated by radio frequency delivery in 14 cases (35%) in group I versus 5 cases (14%) in group II (P = 0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group I versus 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured by proper treatment. No PV stenosis was observed.</p><p><b>CONCLUSIONS</b>The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.</p>