Rarely mitral isthmus ablation is performed empirically, most commonly during repeat AF ablation when all pulmonary veins are chronically isolated. Once OAT is induced, it is characterized by surface 12-lead electrocardiogram, as well as entrainment and activation mapping.
Mitral isthmus ablation is an established strategy in the treatment of peri-mitral atrial flutter and as an adjunct to pulmonary vein isolation. The objective of this review is to summarize the techniques and specific strategies that allow for increased success and durability of mitral isthmus ablation.
Hypothesis: MI block could be achieved in most patients undergoing repeat LPeAF 2021-04-05 · PV electrical isolation and cavotricuspid and mitral isthmus ablation were performed. Their clinical outcome was compared with that of 100 consecutive patients undergoing ablation for the same indications, treated by PV electrical isolation and cavotricuspid ablation, without mitral isthmus ablation from April to December 2001. Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. 2019-11-01 · Rarely mitral isthmus ablation is performed empirically, most commonly during repeat AF ablation when all pulmonary veins are chronically isolated. Once OAT is induced, it is characterized by surface 12-lead electrocardiogram, as well as entrainment and activation mapping. Mitral isthmus thickness predicted ablation failure with a ROC area of 0.84.
2012-08-01 · Macroreentrant tachycardia involving the mitral annulus—perimitral flutter (PMF)—causes 33%–60% of such flutters.1, 3, 4, 5 Catheter ablation of PMF involves, most commonly, the creation of a linear lesion from the mitral annulus to the left inferior pulmonary vein (LIPV), in the so-called mitral isthmus (MI).6, 7 Achieving a complete ablation (defined by bidirectional conduction block Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation Author links open overlay panel José L. Báez-Escudero MD, FHRS ⁎ Percy Francisco Morales MD ⁎ Amish S. Dave MD, PhD ⁎ Christine M. Sasaridis MHA ⁎ Young-Hoon Kim MD, FACC † Kaoru Okishige MD, FACC, FHRS ‡ Miguel Valderrábano MD, FACC ⁎ The creation of mitral isthmus lesions by catheter ablation is technically challenging and may be associated with significant complications. Factors that make obtaining a complete, transmural, and permanent ablation line across the mitral isthmus difficult may be electrical as well as anatomical because of the variable and complex endocardial geometry of this region. Introduction. Mitral isthmus (MI) linear ablation, between the left pulmonary vein (PV) and the mitral annulus (MA), plays an important role in the treatment of atrial fibrillation (AF). 1, 2 It is widely accepted that the endpoint for MI ablation should be bidirectional conduction block across the ablation line. Daisuke Sato, Hiroki Mani, Yu Makihara, Hiroki Kitajima, Yuji Nishikawa, Seno Keitaro, Yeong-Hwa Chun, Electrogram characteristics of the coronary sinus in cases requiring epicardial ablation within the coronary sinus for creating a conduction block at the left lateral mitral isthmus, Journal of Interventional Cardiac Electrophysiology, 10.1007/s10840-018-0403-6, 53, 1, (53-61), (2018).
Purpose: The purpose of this study is to evaluate the use of a high-resolution mapping system to identify and localize residual endocardial and epicardial conduction after MI linear ablation. Background: Mitral isthmus (MI) ablation was limited due to technical challenges in the index ablation for long-standing persistent atrial fibrillation (LPeAF). The role of adjunctive MI ablation was controversial.
Mitral isthmus ablation is a challenging procedure and creating an incomplete lesion could be counterproductive and even proarrhythmogenic (Matsuo et al., 2010).
Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic behandling eller ablation men hos individer utan symtom är handläggningen kontroversiell. Risken of the cavotricuspid isthmus: a meta-analysis. Background: There are limited data on the use of a remote robotic catheter system (RCS) for mitral isthmus (MI) ablation.
INTRODUCTION: The ligament of Marshall may hinder the creation of mitral isthmus (MI) block or pulmonary vein (PV) isolation (PVI) in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). We aimed to assess the benefit of RF ablation targeting the vein of Marshall (VOM) in failed cases of MI block or PVI.
The use of steerable sheath and high ablation power may improve success rate. Methods: This single‐center Background: Mitral isthmus (MI) ablation for atrial tachyarrhythmias remains challenging. Purpose: The purpose of this study is to evaluate the use of a high-resolution mapping system to identify and localize residual endocardial and epicardial conduction after MI linear ablation. Background: Mitral isthmus (MI) ablation was limited due to technical challenges in the index ablation for long-standing persistent atrial fibrillation (LPeAF). The role of adjunctive MI ablation was controversial. Hypothesis: MI block could be achieved in most patients undergoing repeat LPeAF Mitral isthmus (MI) ablation was limited due to technical challenges in the index ablation for long‐standing persistent atrial fibrillation (LPeAF).
3. Discussion Cardiac surgeons were the pioneers of curative ablation of atrial fibrillation (AF). Since the 80’s, when Cox and colleagues introduced the LA isolation pro-
An anterior ablation line, connecting the right upper pulmonary vein with anterior mitral annulus, including the scar area, was acomplished in 73% (n=11). In 82% of these (n=9), conversion to sinus rhythm (SR) was obtained with the first RF ablation set; effective mitral isthmus block (MIB) was achieved in all except 1 (technical limitations). 2015-08-25
Mitral isthmus ablation forms part of the electrophysiologist’s armoury in the catheter ablation treatment of atrial fibrillation. It is well recognised however, that mitral isthmus ablation is technically challenging and incomplete ablation may be pro-arrhythmic, leading some to question its role. Because of the unstable catheter contact during mitral isthmus ablation, a deflectable long sheath is often used during the procedure.
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Mitral isthmus thickness predicted ablation failure with a ROC area of 0.84. The best threshold to predict MI ablation failure was 8.3 mm with a sensitivity of 67% and a specificity of 97%. Left atrial size was of greater importance in failed cases (2D echo surface: 24.1 ± 2.5 vs. 32.5 ± 6.9 cm2, P = 0.005; electroanatomic volume: 124 ± 32 vs.
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2014-07-01 · Mitral isthmus ablation is an important component of catheter ablation for persistent atrial fibrillation and mitral isthmus dependent flutters. We describe a case where mitral isthmus ablation caused a fistula between the left circumflex artery and the left atrium and symptomatic ischaemia. The fistula was successfully closed with a covered stent.
The response to differential pacing is thought to further distinguish between slow conduction across the ablation line and complete conduction block.3 However, because propagation near the lateral mitral isthmus can also conduct through epicardial bridges, these criteria are not always reliable for assessing line of block in the mitral isthmus with a lateral ablative approach.4 These bridges Daisuke Sato, Hiroki Mani, Yu Makihara, Hiroki Kitajima, Yuji Nishikawa, Seno Keitaro, Yeong-Hwa Chun, Electrogram characteristics of the coronary sinus in cases requiring epicardial ablation within the coronary sinus for creating a conduction block at the left lateral mitral isthmus, Journal of Interventional Cardiac Electrophysiology, 10.1007/s10840-018-0403-6, 53, 1, (53-61), (2018). 2021-02-04 The creation of mitral isthmus lesions by catheter ablation is technically challenging and may be associated with significant complications. Factors that make obtaining a complete, transmural, and permanent ablation line across the mitral isthmus difficult may be electrical as well as anatomical because of the variable and complex endocardial geometry of this region.
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9 Aug 2018 A Department of Cardiovascular Surgery Grand Rounds from the Icahn School of Medicine at Mount Sinai presented by Marc A. Miller, MD.
Mitral isthmus ablation: A hierarchical approach guided by electroanatomic correlation. Pathik B(1), Choudry S(1), Whang W(1), D'Avila A(1), Koruth J(1), Sofi A(1), Miller MA(1), Dukkipati S(1), Reddy VY(2). Author information: (1)Helmsley Centre for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York. Mitral isthmus ablation for atrial fibrillation.