Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information
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)...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2020-04, Vol.31 (4), p.885-894 |
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| creator | Huo, Yan Kronborg, Mads Brix Richter, Utz Guo, Jianping Ulbrich, Stefan Zedda, Angela M. Kirstein, Bettina Mayer, Julia Pu, Liying Piorkowski, Judith Wagner, Michael Gaspar, Thomas Piorkowski, Christopher |
| description | 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. |
| doi_str_mv | 10.1111/jce.14387 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2353014681</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2353014681</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3887-926f9e095c7ae97baff87e1623d7758a5298607385078e2415fc5de04ccbcdae3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi0EomXhwAsgS1zgkNaO7djhhlZb_qgSFzhHjjNevHLsYCeFfZi-K95N4YCELzMa_eab8XwIvaTkipZ3fTBwRTlT8hG6pIKTStFGPi454aIqZXaBnuV8IISyhoin6ILVhMmG8kt0v_Ng5hSn78fsoo97Z7TH1oXBhX3Gw5JKxHpO7lzuk_Nezy4GnED3a_oO737NcO7ANsURT4sfY9DpiO_AnUgTQyhjTm1zxBl-LBDmk2Lvpuh1wnfRz3oPeNQTdsHGNJ6Vn6MnVvsMLx7iBn272X3dfqxuv3z4tH1_WxmmlKzaurEtkFYYqaGVvbZWSaBNzQYphdKiblVDJFOCSAU1p8IaMQDhxvRm0MA26M2qO6VYdstzN7psoHw1QFxyVzPBCOWNogV9_Q96iEsKZbtCqUZxzstxN-jtSpkUc05guym5sVyko6Q7edYVz7qzZ4V99aC49CMMf8k_JhXgegV-Og_H_yt1n7e7VfI3Xb6kmg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2386844420</pqid></control><display><type>article</type><title>Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Huo, Yan ; Kronborg, Mads Brix ; Richter, Utz ; Guo, Jianping ; Ulbrich, Stefan ; Zedda, Angela M. ; Kirstein, Bettina ; Mayer, Julia ; Pu, Liying ; Piorkowski, Judith ; Wagner, Michael ; Gaspar, Thomas ; Piorkowski, Christopher</creator><creatorcontrib>Huo, Yan ; Kronborg, Mads Brix ; Richter, Utz ; Guo, Jianping ; Ulbrich, Stefan ; Zedda, Angela M. ; Kirstein, Bettina ; Mayer, Julia ; Pu, Liying ; Piorkowski, Judith ; Wagner, Michael ; Gaspar, Thomas ; Piorkowski, Christopher</creatorcontrib><description>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.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14387</identifier><identifier>PMID: 32037614</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Action Potentials ; Aged ; atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; bipolar voltage ; Cardiac arrhythmia ; Catheter Ablation - adverse effects ; disease progression ; Electrophysiologic Techniques, Cardiac ; Female ; Fibrillation ; Heart Rate ; Humans ; low voltage zone ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Veins - physiopathology ; Pulmonary Veins - surgery ; Recurrence ; Reoperation ; Risk Factors ; substrate modification ; Time Factors ; Treatment Outcome ; Voltage</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-04, Vol.31 (4), p.885-894</ispartof><rights>2020 The Authors. published by Wiley Periodicals, Inc.</rights><rights>2020 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals, Inc.</rights><rights>2020 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3887-926f9e095c7ae97baff87e1623d7758a5298607385078e2415fc5de04ccbcdae3</citedby><cites>FETCH-LOGICAL-c3887-926f9e095c7ae97baff87e1623d7758a5298607385078e2415fc5de04ccbcdae3</cites><orcidid>0000-0002-9379-6364</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.14387$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.14387$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32037614$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huo, Yan</creatorcontrib><creatorcontrib>Kronborg, Mads Brix</creatorcontrib><creatorcontrib>Richter, Utz</creatorcontrib><creatorcontrib>Guo, Jianping</creatorcontrib><creatorcontrib>Ulbrich, Stefan</creatorcontrib><creatorcontrib>Zedda, Angela M.</creatorcontrib><creatorcontrib>Kirstein, Bettina</creatorcontrib><creatorcontrib>Mayer, Julia</creatorcontrib><creatorcontrib>Pu, Liying</creatorcontrib><creatorcontrib>Piorkowski, Judith</creatorcontrib><creatorcontrib>Wagner, Michael</creatorcontrib><creatorcontrib>Gaspar, Thomas</creatorcontrib><creatorcontrib>Piorkowski, Christopher</creatorcontrib><title>Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>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.</description><subject>Action Potentials</subject><subject>Aged</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>bipolar voltage</subject><subject>Cardiac arrhythmia</subject><subject>Catheter Ablation - adverse effects</subject><subject>disease progression</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>low voltage zone</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Pulmonary Veins - surgery</subject><subject>Recurrence</subject><subject>Reoperation</subject><subject>Risk Factors</subject><subject>substrate modification</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Voltage</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQxi0EomXhwAsgS1zgkNaO7djhhlZb_qgSFzhHjjNevHLsYCeFfZi-K95N4YCELzMa_eab8XwIvaTkipZ3fTBwRTlT8hG6pIKTStFGPi454aIqZXaBnuV8IISyhoin6ILVhMmG8kt0v_Ng5hSn78fsoo97Z7TH1oXBhX3Gw5JKxHpO7lzuk_Nezy4GnED3a_oO737NcO7ANsURT4sfY9DpiO_AnUgTQyhjTm1zxBl-LBDmk2Lvpuh1wnfRz3oPeNQTdsHGNJ6Vn6MnVvsMLx7iBn272X3dfqxuv3z4tH1_WxmmlKzaurEtkFYYqaGVvbZWSaBNzQYphdKiblVDJFOCSAU1p8IaMQDhxvRm0MA26M2qO6VYdstzN7psoHw1QFxyVzPBCOWNogV9_Q96iEsKZbtCqUZxzstxN-jtSpkUc05guym5sVyko6Q7edYVz7qzZ4V99aC49CMMf8k_JhXgegV-Og_H_yt1n7e7VfI3Xb6kmg</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Huo, Yan</creator><creator>Kronborg, Mads Brix</creator><creator>Richter, Utz</creator><creator>Guo, Jianping</creator><creator>Ulbrich, Stefan</creator><creator>Zedda, Angela M.</creator><creator>Kirstein, Bettina</creator><creator>Mayer, Julia</creator><creator>Pu, Liying</creator><creator>Piorkowski, Judith</creator><creator>Wagner, Michael</creator><creator>Gaspar, Thomas</creator><creator>Piorkowski, Christopher</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9379-6364</orcidid></search><sort><creationdate>202004</creationdate><title>Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information</title><author>Huo, Yan ; Kronborg, Mads Brix ; Richter, Utz ; Guo, Jianping ; Ulbrich, Stefan ; Zedda, Angela M. ; Kirstein, Bettina ; Mayer, Julia ; Pu, Liying ; Piorkowski, Judith ; Wagner, Michael ; Gaspar, Thomas ; Piorkowski, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3887-926f9e095c7ae97baff87e1623d7758a5298607385078e2415fc5de04ccbcdae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Action Potentials</topic><topic>Aged</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>bipolar voltage</topic><topic>Cardiac arrhythmia</topic><topic>Catheter Ablation - adverse effects</topic><topic>disease progression</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>low voltage zone</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Pulmonary Veins - surgery</topic><topic>Recurrence</topic><topic>Reoperation</topic><topic>Risk Factors</topic><topic>substrate modification</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huo, Yan</creatorcontrib><creatorcontrib>Kronborg, Mads Brix</creatorcontrib><creatorcontrib>Richter, Utz</creatorcontrib><creatorcontrib>Guo, Jianping</creatorcontrib><creatorcontrib>Ulbrich, Stefan</creatorcontrib><creatorcontrib>Zedda, Angela M.</creatorcontrib><creatorcontrib>Kirstein, Bettina</creatorcontrib><creatorcontrib>Mayer, Julia</creatorcontrib><creatorcontrib>Pu, Liying</creatorcontrib><creatorcontrib>Piorkowski, Judith</creatorcontrib><creatorcontrib>Wagner, Michael</creatorcontrib><creatorcontrib>Gaspar, Thomas</creatorcontrib><creatorcontrib>Piorkowski, Christopher</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huo, Yan</au><au>Kronborg, Mads Brix</au><au>Richter, Utz</au><au>Guo, Jianping</au><au>Ulbrich, Stefan</au><au>Zedda, Angela M.</au><au>Kirstein, Bettina</au><au>Mayer, Julia</au><au>Pu, Liying</au><au>Piorkowski, Judith</au><au>Wagner, Michael</au><au>Gaspar, Thomas</au><au>Piorkowski, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>31</volume><issue>4</issue><spage>885</spage><epage>894</epage><pages>885-894</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32037614</pmid><doi>10.1111/jce.14387</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9379-6364</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Action Potentials Aged atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery bipolar voltage Cardiac arrhythmia Catheter Ablation - adverse effects disease progression Electrophysiologic Techniques, Cardiac Female Fibrillation Heart Rate Humans low voltage zone Male Middle Aged Predictive Value of Tests Pulmonary Veins - physiopathology Pulmonary Veins - surgery Recurrence Reoperation Risk Factors substrate modification Time Factors Treatment Outcome Voltage |
| title | Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information |
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