Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review
Introduction Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to presen...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 2021-02, Vol.44 (2), p.293-305 |
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| creator | Zhao, Xin Su, Xin Long, De‐Yong Sang, Cai‐Hua Bai, Rong Tang, Ri‐Bo Liu, Nian Jiang, Chen‐Xi Li, Song‐Nan Guo, Xue‐Yuan Wang, Wei Xin, Du Dong, Jian‐Zeng Yu, Rong‐Hui Ma, Chang‐Sheng |
| description | Introduction
Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID.
Methods
A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure.
Results
All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients).
Conclusion
With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered. |
| doi_str_mv | 10.1111/pace.14144 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2473749805</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2473749805</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4234-36e4615e74c312d3e9892cdebd50b5d974b4d5d487421d1e9f5c0b02e5feb5ca3</originalsourceid><addsrcrecordid>eNp9kc9O3DAQxq2Kqiy0lz5AZYkLQoTa8XjjcEMR_ySk9tCeI8eeFKMk3trOAk_Aa2PYLQcOncuMZn76ZkYfIV85O-E5vq-0wRMOHOADWXAJrFBc1jtkwThUhRKq3iV7Md4xxpYM5CeyK4SoylLxBXlqdLrFhIHqbtDJ-Yn6nuoUnB5o77rghm3bTTS6NMdcrDHEXFh8SMEbHazTp7S51cOA0x88pm5cBb9GS3MyaOeQe35Oxo8Yj6meLB1cXqlTntCAa4f3n8nHXg8Rv2zzPvl9cf6ruSpuflxeN2c3hYFSQCGWCEsusQIjeGkF1qoujcXOStZJW1fQgZUWVAUltxzrXhrWsRJlj500WuyTw41uPu3vjDG1o4sG85MT-jm2JVSigloxmdGDd-idn8OUr8uUUhxqJlmmjjaUCT7GgH27Cm7U4bHlrH2xp32xp321J8PftpJzN6J9Q__5kQG-Ae7dgI__kWp_njXnG9Fn7f2cfQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2488149050</pqid></control><display><type>article</type><title>Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Zhao, Xin ; Su, Xin ; Long, De‐Yong ; Sang, Cai‐Hua ; Bai, Rong ; Tang, Ri‐Bo ; Liu, Nian ; Jiang, Chen‐Xi ; Li, Song‐Nan ; Guo, Xue‐Yuan ; Wang, Wei ; Xin, Du ; Dong, Jian‐Zeng ; Yu, Rong‐Hui ; Ma, Chang‐Sheng</creator><creatorcontrib>Zhao, Xin ; Su, Xin ; Long, De‐Yong ; Sang, Cai‐Hua ; Bai, Rong ; Tang, Ri‐Bo ; Liu, Nian ; Jiang, Chen‐Xi ; Li, Song‐Nan ; Guo, Xue‐Yuan ; Wang, Wei ; Xin, Du ; Dong, Jian‐Zeng ; Yu, Rong‐Hui ; Ma, Chang‐Sheng</creatorcontrib><description>Introduction
Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID.
Methods
A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure.
Results
All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients).
Conclusion
With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.14144</identifier><identifier>PMID: 33372281</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Abnormalities, Multiple ; Aged ; atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - surgery ; Cardiac arrhythmia ; Cardiac Surgical Procedures - methods ; Catheter Ablation ; Catheters ; Computed tomography ; Dextrocardia - complications ; Echocardiography ; Female ; Fibrillation ; Heart ; Humans ; Inversion ; Literature reviews ; Male ; Middle Aged ; Pacemakers ; Radiofrequency ablation ; Retrospective Studies ; sick sinus syndrome ; Situs Inversus - complications ; situs inversus dextrocardia ; Treatment Outcome</subject><ispartof>Pacing and clinical electrophysiology, 2021-02, Vol.44 (2), p.293-305</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><rights>2021 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4234-36e4615e74c312d3e9892cdebd50b5d974b4d5d487421d1e9f5c0b02e5feb5ca3</citedby><cites>FETCH-LOGICAL-c4234-36e4615e74c312d3e9892cdebd50b5d974b4d5d487421d1e9f5c0b02e5feb5ca3</cites><orcidid>0000-0003-4604-5346 ; 0000-0001-7299-7805 ; 0000-0002-3106-7318</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%2Fpace.14144$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpace.14144$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33372281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Xin</creatorcontrib><creatorcontrib>Su, Xin</creatorcontrib><creatorcontrib>Long, De‐Yong</creatorcontrib><creatorcontrib>Sang, Cai‐Hua</creatorcontrib><creatorcontrib>Bai, Rong</creatorcontrib><creatorcontrib>Tang, Ri‐Bo</creatorcontrib><creatorcontrib>Liu, Nian</creatorcontrib><creatorcontrib>Jiang, Chen‐Xi</creatorcontrib><creatorcontrib>Li, Song‐Nan</creatorcontrib><creatorcontrib>Guo, Xue‐Yuan</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><creatorcontrib>Xin, Du</creatorcontrib><creatorcontrib>Dong, Jian‐Zeng</creatorcontrib><creatorcontrib>Yu, Rong‐Hui</creatorcontrib><creatorcontrib>Ma, Chang‐Sheng</creatorcontrib><title>Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Introduction
Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID.
Methods
A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure.
Results
All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients).
Conclusion
With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.</description><subject>Ablation</subject><subject>Abnormalities, Multiple</subject><subject>Aged</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>Computed tomography</subject><subject>Dextrocardia - complications</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart</subject><subject>Humans</subject><subject>Inversion</subject><subject>Literature reviews</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pacemakers</subject><subject>Radiofrequency ablation</subject><subject>Retrospective Studies</subject><subject>sick sinus syndrome</subject><subject>Situs Inversus - complications</subject><subject>situs inversus dextrocardia</subject><subject>Treatment Outcome</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9O3DAQxq2Kqiy0lz5AZYkLQoTa8XjjcEMR_ySk9tCeI8eeFKMk3trOAk_Aa2PYLQcOncuMZn76ZkYfIV85O-E5vq-0wRMOHOADWXAJrFBc1jtkwThUhRKq3iV7Md4xxpYM5CeyK4SoylLxBXlqdLrFhIHqbtDJ-Yn6nuoUnB5o77rghm3bTTS6NMdcrDHEXFh8SMEbHazTp7S51cOA0x88pm5cBb9GS3MyaOeQe35Oxo8Yj6meLB1cXqlTntCAa4f3n8nHXg8Rv2zzPvl9cf6ruSpuflxeN2c3hYFSQCGWCEsusQIjeGkF1qoujcXOStZJW1fQgZUWVAUltxzrXhrWsRJlj500WuyTw41uPu3vjDG1o4sG85MT-jm2JVSigloxmdGDd-idn8OUr8uUUhxqJlmmjjaUCT7GgH27Cm7U4bHlrH2xp32xp321J8PftpJzN6J9Q__5kQG-Ae7dgI__kWp_njXnG9Fn7f2cfQ</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Zhao, Xin</creator><creator>Su, Xin</creator><creator>Long, De‐Yong</creator><creator>Sang, Cai‐Hua</creator><creator>Bai, Rong</creator><creator>Tang, Ri‐Bo</creator><creator>Liu, Nian</creator><creator>Jiang, Chen‐Xi</creator><creator>Li, Song‐Nan</creator><creator>Guo, Xue‐Yuan</creator><creator>Wang, Wei</creator><creator>Xin, Du</creator><creator>Dong, Jian‐Zeng</creator><creator>Yu, Rong‐Hui</creator><creator>Ma, Chang‐Sheng</creator><general>Wiley Subscription Services, Inc</general><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>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4604-5346</orcidid><orcidid>https://orcid.org/0000-0001-7299-7805</orcidid><orcidid>https://orcid.org/0000-0002-3106-7318</orcidid></search><sort><creationdate>202102</creationdate><title>Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review</title><author>Zhao, Xin ; Su, Xin ; Long, De‐Yong ; Sang, Cai‐Hua ; Bai, Rong ; Tang, Ri‐Bo ; Liu, Nian ; Jiang, Chen‐Xi ; Li, Song‐Nan ; Guo, Xue‐Yuan ; Wang, Wei ; Xin, Du ; Dong, Jian‐Zeng ; Yu, Rong‐Hui ; Ma, Chang‐Sheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4234-36e4615e74c312d3e9892cdebd50b5d974b4d5d487421d1e9f5c0b02e5feb5ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Ablation</topic><topic>Abnormalities, Multiple</topic><topic>Aged</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Catheter Ablation</topic><topic>Catheters</topic><topic>Computed tomography</topic><topic>Dextrocardia - complications</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart</topic><topic>Humans</topic><topic>Inversion</topic><topic>Literature reviews</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pacemakers</topic><topic>Radiofrequency ablation</topic><topic>Retrospective Studies</topic><topic>sick sinus syndrome</topic><topic>Situs Inversus - complications</topic><topic>situs inversus dextrocardia</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Xin</creatorcontrib><creatorcontrib>Su, Xin</creatorcontrib><creatorcontrib>Long, De‐Yong</creatorcontrib><creatorcontrib>Sang, Cai‐Hua</creatorcontrib><creatorcontrib>Bai, Rong</creatorcontrib><creatorcontrib>Tang, Ri‐Bo</creatorcontrib><creatorcontrib>Liu, Nian</creatorcontrib><creatorcontrib>Jiang, Chen‐Xi</creatorcontrib><creatorcontrib>Li, Song‐Nan</creatorcontrib><creatorcontrib>Guo, Xue‐Yuan</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><creatorcontrib>Xin, Du</creatorcontrib><creatorcontrib>Dong, Jian‐Zeng</creatorcontrib><creatorcontrib>Yu, Rong‐Hui</creatorcontrib><creatorcontrib>Ma, Chang‐Sheng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Xin</au><au>Su, Xin</au><au>Long, De‐Yong</au><au>Sang, Cai‐Hua</au><au>Bai, Rong</au><au>Tang, Ri‐Bo</au><au>Liu, Nian</au><au>Jiang, Chen‐Xi</au><au>Li, Song‐Nan</au><au>Guo, Xue‐Yuan</au><au>Wang, Wei</au><au>Xin, Du</au><au>Dong, Jian‐Zeng</au><au>Yu, Rong‐Hui</au><au>Ma, Chang‐Sheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2021-02</date><risdate>2021</risdate><volume>44</volume><issue>2</issue><spage>293</spage><epage>305</epage><pages>293-305</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Introduction
Catheter ablation for atrial fibrillation (AF‐CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF‐CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF‐CA in patients with AF and SID.
Methods
A total of 10 patients with AF‐SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three‐dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x‐ray imaging data are necessary to optimize the transseptal puncture and ablation procedure.
Results
All patients successfully underwent 13 AF‐CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF‐CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow‐up period (6‐72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients).
Conclusion
With the improved strategy, AF‐CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long‐term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33372281</pmid><doi>10.1111/pace.14144</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-4604-5346</orcidid><orcidid>https://orcid.org/0000-0001-7299-7805</orcidid><orcidid>https://orcid.org/0000-0002-3106-7318</orcidid></addata></record> |
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| subjects | Ablation Abnormalities, Multiple Aged atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - surgery Cardiac arrhythmia Cardiac Surgical Procedures - methods Catheter Ablation Catheters Computed tomography Dextrocardia - complications Echocardiography Female Fibrillation Heart Humans Inversion Literature reviews Male Middle Aged Pacemakers Radiofrequency ablation Retrospective Studies sick sinus syndrome Situs Inversus - complications situs inversus dextrocardia Treatment Outcome |
| title | Catheter ablation of atrial fibrillation in situs inversus dextrocardia: Challenge, improved procedure, outcomes, and literature review |
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