Evaluation of catheter ablation of periatrial ganglionic plexi in patients with atrial fibrillation.

Recent data suggests that the cardiac autonomic nervous system has an important role in the initiation and maintenance of atrial fibrillation (AF). This study investigated (1) the feasibility of identifying and targeting these autonomic ganglia using endocardial radiofrequency stimulation and ablation, respectively; (2) the efficacy of endocardial ablation to completely eliminate the vagal response elicited from epicardial stimulation; and (3) the effect of autonomic ablation on the acute inducibility of AF. The study included 18 patients referred for catheter ablation of suspected vagal-mediated AF.

Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation?

Background: Unlike the initial balloon ablation catheters that were designed to deliver ablation lesions within the pulmonary veins (PVs), the current balloon prototypes are fashioned to deliver lesions at the PV ostia.

Objective: Using electroanatomical mapping, this study evaluates the actual location of ablation lesions generated by cryo-based, laser-based, or ultrasound-based balloon catheters.

Methods: In a total of 14 patients with paroxysmal atrial fibrillation, PV isolation was performed using either a cryoballoon catheter (8 patients), laser catheter (4 patients) or ultrasound balloon catheter (2 patients).

View-synchronized robotic image-guided therapy for atrial fibrillation ablation: experimental validation and clinical feasibility.

Background: A robotic catheter navigation system has been developed that provides a significant degree of freedom of catheter movement. This study examines the feasibility of synchronizing this robotic navigation system with electroanatomic mapping and 3-dimensional computed tomography imaging to perform view-synchronized left atrial (LA) ablation.

Methods And Results: This study consisted of a porcine experimental validation phase (9 animals) and a clinical feasibility phase (9 atrial fibrillation patients).

Integration of cardiac CT/MR imaging with three-dimensional electroanatomical mapping to guide catheter manipulation in the left atrium: implications for catheter ablation of atrial fibrillation.

Introduction: Preprocedural cardiac imaging (CT/MRI) and intraprocedural electroanatomical mapping (EAM) are commonly used during left atrial (LA) catheter ablation of atrial fibrillation (AF). In the optimal scenario, the imaging datasets would be directly integrated with the EAM system to guide catheter mapping based on the accurate individual cardiac anatomy.

Methods And Results: Strategies to align the EAM and imaging data were assessed by simulations using a life-size model of the LA and aorta.

Three-dimensional analysis of pulmonary venous ostial and antral anatomy: implications for balloon catheter-based pulmonary vein isolation.

Background: Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through-slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA-PVs were generated and analyzed to define ostial architecture and size.

Relationship of the esophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation.

Background: A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures.

Objectives: The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA).

The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention.

Background: Image-guided intervention using pre-acquired CT/MR 3-dimensional images is an emerging strategy for atrial fibrillation (AF) ablation but may be limited by its use of static images to depict dynamic physiology. The effect of biologic factors such as respiration on the left atrial-pulmonary venous (LA-PV) anatomy is not well understood but is likely to have important implications. Conventional CT/MR imaging is performed during an inspiratory breath-hold, while electroanatomical mapping (EAM) during "quiet" breathing approximates an expiratory breath-hold.

Integration of cardiac magnetic resonance imaging with three-dimensional electroanatomic mapping to guide left ventricular catheter manipulation: feasibility in a porcine model of healed myocardial infarction.

Objectives: In a series of in vitro and in vivo experiments, we evaluated the feasibility of integrating three-dimensional (3D) magnetic resonance imaging (MRI) and electroanatomic mapping (EAM) data to guide real-time left ventricular (LV) catheter manipulation.

Background: Substrate-based catheter ablation of post-myocardial infarction ventricular tachycardia requires delineation of the scarred myocardium, typically using an EAM system. Cardiac MRI might facilitate this procedure by localizing this myocardial scar.