Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
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TY - JOUR
T1 - Electrophysiological findings during atrial fibrillation reablation
T2 - Extending from pulmonary vein reconnection to sequential bipolar voltage map information
AU - Huo, Yan
AU - Kronborg, Mads Brix
AU - Richter, Utz
AU - Guo, Jianping
AU - Ulbrich, Stefan
AU - Zedda, Angela M.
AU - Kirstein, Bettina
AU - Mayer, Julia
AU - Pu, Liying
AU - Piorkowski, Judith
AU - Wagner, Michael
AU - Gaspar, Thomas
AU - Piorkowski, Christopher
PY - 2020/4
Y1 - 2020/4
N2 - Background: Left atrial substrate modification targeting low voltage zones (LVZ) is an ablation strategy that—in addition to pulmonary vein (PV) isolation—tries to eliminate arrhythmogenic mechanisms harbored in such tissue. Electrophysiological findings at reablation include (a) PV reconnection, (b) reconnection over previous substrate ablation, and (c) de-novo LVZ. Objective: To study, prevalence and contribution of these arrhythmogenic electrophysiological entities in patients with atrial fibrillation (AF) recurrences. Methods: Consecutive patients with highly symptomatic AF undergoing index and reablation were included (n = 113). In all patients' PV reconnection, reconnection over previous substrate ablation and spontaneous de-novo LVZ were quantitatively assessed and integrated into an individual reablation strategy. Follow-up was based on continuous device monitoring. Results: At re-do procedure, 45 out of 113 (39.8%) patients showed PV reconnection as the only electrophysiological abnormality. Reconduction over previous lines was the only electrophysiological abnormality in 8 out of 113 (7.1%) patients. Spontaneous de-novo LVZ was the only electrophysiological abnormality in 12 out of 113 (10.6%) patients. Combined findings of PV reconnection, line reconduction, and/or spontaneous de-novo LVZ were seen in 40 out of 113 (35.4%) patients. No detectable electrophysiological abnormality was observed in 8 out of 113 (7.1%) patients. In univariate analysis, none of the tested electrophysiological characteristics independently predicted the outcome after re-do. Conclusions: In patients undergoing reablation, we could show that reconduction over previous substrate ablation as well as the development of new low voltage areas are frequent findings besides classical PV reconnection—without a clear leading cause for recurrences. These findings impact reablation strategies as well as the strategic focus during index procedures.
AB - Background: Left atrial substrate modification targeting low voltage zones (LVZ) is an ablation strategy that—in addition to pulmonary vein (PV) isolation—tries to eliminate arrhythmogenic mechanisms harbored in such tissue. Electrophysiological findings at reablation include (a) PV reconnection, (b) reconnection over previous substrate ablation, and (c) de-novo LVZ. Objective: To study, prevalence and contribution of these arrhythmogenic electrophysiological entities in patients with atrial fibrillation (AF) recurrences. Methods: Consecutive patients with highly symptomatic AF undergoing index and reablation were included (n = 113). In all patients' PV reconnection, reconnection over previous substrate ablation and spontaneous de-novo LVZ were quantitatively assessed and integrated into an individual reablation strategy. Follow-up was based on continuous device monitoring. Results: At re-do procedure, 45 out of 113 (39.8%) patients showed PV reconnection as the only electrophysiological abnormality. Reconduction over previous lines was the only electrophysiological abnormality in 8 out of 113 (7.1%) patients. Spontaneous de-novo LVZ was the only electrophysiological abnormality in 12 out of 113 (10.6%) patients. Combined findings of PV reconnection, line reconduction, and/or spontaneous de-novo LVZ were seen in 40 out of 113 (35.4%) patients. No detectable electrophysiological abnormality was observed in 8 out of 113 (7.1%) patients. In univariate analysis, none of the tested electrophysiological characteristics independently predicted the outcome after re-do. Conclusions: In patients undergoing reablation, we could show that reconduction over previous substrate ablation as well as the development of new low voltage areas are frequent findings besides classical PV reconnection—without a clear leading cause for recurrences. These findings impact reablation strategies as well as the strategic focus during index procedures.
KW - atrial fibrillation
KW - bipolar voltage
KW - disease progression
KW - low voltage zone
KW - substrate modification
UR - http://www.scopus.com/inward/record.url?scp=85079905973&partnerID=8YFLogxK
U2 - 10.1111/jce.14387
DO - 10.1111/jce.14387
M3 - Journal article
C2 - 32037614
AN - SCOPUS:85079905973
VL - 31
SP - 885
EP - 894
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 4
ER -