Left Atrial Appendage Electrical Isolation Reduces Atrial Fibrillation Recurrences

HomeCirculation: Arrhythmia and ElectrophysiologyVol. 14, No. 1Left Atrial Appendage Electrical Isolation Reduces Fibrillation Recurrences Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsFree ArticlePDF/EPUBLeft RecurrencesA Simulation Study Ali Gharaviri, PhD Simone Pezzuto, Mark Potse, Sander Verheule, Giulio Conte, MD, Rolf Krause, Ulrich Schotten, Angelo AuricchioMD, GharaviriAli Gharaviri https://orcid.org/0000-0003-1803-8237 Center for Computational Medicine in Cardiology, Institute of Science, Università della Svizzera italiana, Lugano, Switzerland (A.G., S.P., G.C., R.K., A.A.). Search more papers by this author , PezzutoSimone Pezzuto https://orcid.org/0000-0002-7432-0424 PotseMark Potse https://orcid.org/0000-0003-4166-2687 Carmen team, Inria Bordeaux Sud-Ouest, Talence, France (M.P.). Université de Bordeaux, IMB, UMR 5251, VerheuleSander Verheule https://orcid.org/0000-0001-5196-5425 Department Physiology, Maastricht University, the Netherlands (S.V., U.S.). ConteGiulio Conte https://orcid.org/0000-0003-2248-3456 Fondazione Cardiocentro Ticino, (G.C., KrauseRolf Krause https://orcid.org/0000-0001-5408-5271 SchottenUlrich Schotten Correspondence to: PhD, PO Box 616, 6200 MD Maastricht, Netherlands. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1532-3315 AuricchioAngelo Auricchio https://orcid.org/0000-0003-2116-6993 Originally published24 Dec 2020https://doi.org/10.1161/CIRCEP.120.009230Circulation: Electrophysiology. 2021;14:e009230Pulmonary vein (PV) isolation (PVI) improves freedom from atrial tachyarrhythmia recurrences patients with paroxysmal persistent fibrillation (AF).1 However, PVI has a limited success rate AF ablation techniques adjunctive isolating non-PV triggers remain an area debate these patients.1 Recently, there been growing interest electrical anatomical role left appendage (LAA) triggering sustaining AF, particularly or after repeated procedures.2 Whether originating LAA substrate modification caused (LAAI) is underlying mechanism recurrence prevention still unknown.The data that support findings study are available corresponding upon reasonable request. We investigated effect LAAI structurally detailed model human atria, extensively described previously3 (material Data Supplement). The entails wall thickness heterogeneities, endocardial trabeculated network, subepicardial layer realistic fiber orientations. material properties atria were set produce approximately normal P-wave during sinus rhythm (Table I Supplement).In total, 20 different pacing locations selected both based on reported possible sources extra-PV ectopic focal activity AF4 (Figure).Download figureDownload PowerPointFigure. initiation rates dynamics.A, Catheter patterns points (pacing located outside ablated areas indicated black stars location within was yellow). B, flutter likelihood control catheter simulations degrees fibrosis. C, Number waves per cycle. Wave life span wave generation (the slope fitted line) (D) (E) pulmonary (PVI), (F) PVI+left sever BOX indicates posterior wall.In each simulation, initiated applying incremental duration 2 seconds at site. cycle length started 280 ms gradually reduced 124 ms. compared between (no ablation) (CA) CA included 4 groups: PVI, plus linear lesions encircling (BOX), circumferential (PVI+LAAI), BOX+LAAI. Virtual consisted tissue volumes modeled nonconductive elements. outcome stimulation protocol analyzed terms type self-sustained stimulations. If no observed, considered unsuccessful. Otherwise, distinction made Supplement), latter being unsuccessful.The spatial distribution fibrosis uneven, patches islands presenting higher degree (Figure Supplement).3 Simulations performed without fibrosis, moderate severe which 0%, 50%, 70% elements fibrotic.3In 300 performed. Each simulation group 60 (20 degree).In simulations, increase led significant likelihood. In (which may represent AF), reduction likelihood, either preventing converting into (Figure). contrast, patients), we observed top BOX, comparable as only absence presence adding further least one-third.An and, therefore, conduction pattern complexity, quantified number CAs complexity. complexity BOX.In our group, averaged 149 ms, value previously AF. prolongation II concomitant could significantly length.The single geometry intersubject variability have effects results. in-depth anatomy beyond scope study.We its As presented, lowered consistent clinical studies mentioning lowering patients.2 Finally, demonstrate mechanisms not due LAA, but rather related result LAAI.Nonstandard Abbreviations AcronymsAFatrial fibrillationBOXleft wallCAcatheter ablationLAAleft appendageLAAIleft isolationPVpulmonary veinPVIpulmonary isolationSources FundingThis work supported Swiss National Supercomputing Centre (CSCS project ID s778), grants Dr Heart Foundation (CVON2014-09, RACE V), EU (ERACoSysMED H2020 ERA-NET). (SNF; Ambizione grant PZ00P3_180055/1).Disclosures consultant Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Microport CRM, Philips, Radcliffe Publisher. He received speaker fee Medtronic, Microport. participates trials sponsored Philips. intellectual CRM. consultancy fees honoraria Johnson & Johnson, Roche Diagnostics, Bayer Healthcare. co-founder shareholder YourRhythmics BV. holds property other authors report conflicts.FootnotesThe Supplement https://www.ahajournals.org/doi/suppl/10.1161/CIRCEP.120.009230.For Sources Funding Disclosures, see page 106.Correspondence protected]nlReference1. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya et al.; STAR Investigators. Approaches fibrillation.N Engl J Med. 2015; 372:1812–1822. doi: 10.1056/NEJMoa1408288CrossrefMedlineGoogle Scholar2. Di Biase Burkhardt JD, Mohanty P, S, Sanchez JE, Trivedi Güne? M, Göko?lan Y, Gianni Horton RP, al.. Left longstanding undergoing ablation: BELIEF trial.J Am Coll Cardiol. 2016; 68:1929–1940. 10.1016/j.jacc.2016.07.770CrossrefMedlineGoogle Scholar3. Bidar E, Zeemering Maessen JG, U. Epicardial explains increased endo-epicardial dissociation epicardial breakthroughs fibrillation.Front Physiol. 2020; 11:68. 10.3389/fphys.2020.00068CrossrefMedlineGoogle Scholar4. Chang HY, Lo LW, Lin YJ, SL, Hu YF, Li CH, Chao TF, Chung FP, Ha TL, Singhal Long-term nonpulmonary ectopy.J Cardiovasc Electrophysiol. 2013; 24:250–258. 10.1111/jce.12036CrossrefMedlineGoogle Scholar Previous Back Next FiguresReferencesRelatedDetails January 2021Vol Issue 1Article InformationMetrics Download: 189 © 2020 American Association, Inc.https://doi.org/10.1161/CIRCEP.120.009230PMID: 33356357 publishedDecember 24, Keywordsleft appendagefibrosispulmonary isolationcatheter ablationatrial fibrillationPDF download SubjectsBasic Science ResearchElectrophysiologyAtrial FibrillationComputational Biology