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1. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation

Author

Yosuke, Nakatani, Soumaya, Sridi-Cheniti, Ghassen, Cheniti, F Daniel, Ramirez, Cyril, Goujeau, Clementine, André, Takashi, Nakashima, Charles, Eggert, Christopher, Schneider, Raju, Viswanathan, Philipp, Krisai, Takamitsu, Takagi, Tsukasa, Kamakura, Konstantinos, Vlachos, Nicolas, Derval, Josselin, Duchateau, Thomas, Pambrun, Remi, Chauvel, Vivek Y, Reddy, Michel, Montaudon, François, Laurent, Frederic, Sacher, Mélèze, Hocini, Michel, Haïssaguerre, Pierre, Jaïs, Hubert, Cochet, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Icahn School of Medicine at Mount Sinai [New York] (MSSM), Agence Nationale de la Recherche, European Research Council, ANR-11-EQPX-0030,MUSIC,Plateforme multi-modale d'exploration en cardiologie(2011), ANR-10-IAHU-0004,LIRYC,L'Institut de Rythmologie et modélisation Cardiaque(2010), and European Project: 715093,H2020,ERC-2016-STG,ECSTATIC(2017)

Subjects
[SPI]Engineering Sciences [physics], Cardiac magnetic resonance, Pulsed field ablation, Contrast Media, Humans, Gadolinium, Catheter ablation, Heart Atria, Atrial fibrosis, Fibrosis, Magnetic Resonance Imaging, Atrial fibrillation
Abstract

International audience; Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation.Cardiac magnetic resonance was performed pre-ablation, acutely (

Published
2021

2. Impact of Spacing and Orientation on the Scar Threshold With a High-Density Grid Catheter

Author

Steven Kim, Frederic Sacher, Arnaud Denis, Masateru Takigawa, Felix Bourier, Claire A. Martin, Josselin Duchateau, Nicolas Derval, Anna Lam, Nathaniel Thompson, Grégoire Massoullié, Michel Haïssaguerre, Xavier Pillois, Florent Collot, Thomas Pambrun, Jérôme Naulin, Ruairidh Martin, Takeshi Kitamura, Mélèze Hocini, Pierre Jaïs, Bruno Quesson, Hubert Cochet, Ghassen Cheniti, Jatin Relan, Michael Wolf, Antonio Frontera, Mathilde Merle, Konstantinos Vlachos, Julie Magat, IHU lyric, Institut de rythmologie et modélisation cardiaque [Pessac] (IHU Liryc), IHU-LIRYC, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2, Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), quesson, bruno, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], CHU Bordeaux [Bordeaux], Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], Hôpital Haut-Lévêque, Université Sciences et Technologies - Bordeaux 1-CHU Bordeaux [Bordeaux], Laboratoire Bordelais de Recherche en Informatique (LaBRI), and Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Électronique, Informatique et Radiocommunications de Bordeaux (ENSEIRB)

Subjects
Catheters, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Magnetic Resonance Imaging, Cine, 030204 cardiovascular system & hematology, Orientation (graph theory), Cicatrix, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart Conduction System, Physiology (medical), Animals, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Sheep, business.industry, Myocardium, Body Surface Potential Mapping, Equipment Design, Grid, Disease Models, Animal, Catheter, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, Tachycardia, Ventricular, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Biomedical engineering
Abstract

Background:Multipolar catheters are increasingly used for high-density mapping. However, the threshold to define scar areas has not been well described for each configuration. We sought to elucidate the impact of bipolar spacing and orientation on the optimal threshold to match magnetic resonance imaging-defined scar.Method:The HD-Grid catheter uniquely allows for different spatially stable bipolar configurations to be tested. We analyzed the electrograms with settings of HD-16 (3 mm spacing in both along and across bipoles) and HD-32 (1 mm spacing in along bipoles and 3 mm spacing in across bipoles) and determined the optimal cutoff for scar detection in 6 infarcted sheep.Results:From 456 total acquisition sites (mean 76±12 per case), 14 750 points with the HD-16 and 32286 points with the HD-32 configuration for bipolar electrograms were analyzed. For bipolar voltages, the optimal cutoff value to detect the magnetic resonance imaging-defined scar based on the Youden’s Index, and the area under the receiver operating characteristic curve (AUROC) differed depending on the spacing and orientation of bipoles; across 0.84 mV (AUROC, 0.920; 95% CI, 0.911–0.928), along 0.76 mV (AUROC, 0.903; 95% CI, 0.893–0.912), north-east direction 0.95 mV (AUROC, 0.923; 95% CI, 0.913–0.932), and south-east direction, 0.87 mV (AUROC, 0.906; 95% CI, 0.895–0.917) in HD-16; and across 0.83 mV (AUROC, 0.917; 95% CI, 0.911–0.924), along 0.46 mV (AUROC, 0.890; 95% CI, 0.883–0.897), north-east direction 0.89 mV (AUROC, 0.923; 95% CI, 0.917–0.929), and south-east direction 0.83 mV (AUROC, 0.913; 95% CI, 0.906–0.920) in HD-32. Significant differences in AUROC were seen between HD-16 along versus across (P=0.002), HD-16 north-east direction versus south-east direction (P=0.01), HD-32 north-east direction versus south-east direction (PP=0.006). The AUROC was significantly larger (PConclusions:Spacing and orientation of bipoles impacts the accuracy of scar detection. Optimal threshold specific to each bipolar configuration should be determined. Selecting one best voltage point among multiple points projected on the same surface is also critical on the Ensite-system to increase the accuracy of scar-mapping.

Published
2019

3. Use of Novel Electrogram 'Lumipoint' Algorithm to Detect Critical Isthmus and Abnormal Potentials for Ablation in Ventricular Tachycardia

Author

Nicolas Derval, Takeshi Kitamura, Felix Bourier, Antonio Frontera, Anna Lam, Masateru Takigawa, Christian Meyer, Tom Wong, Michel Haïssaguerre, Michael Wolf, Nathaniel Thompson, Josselin Duchâteau, Mélèze Hocini, Ghassen Cheniti, Parag R Gajendragadkar, Pierre Jaïs, Rui Shi, Konstantinos Vlachos, Frédéric Sacher, Thomas Pambrun, Grégoire Massoullié, Claire Martin, Arnaud Denis, Philippe Maury, Ruairidh Martin, Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de Rangueil, and CHU Toulouse [Toulouse]

Subjects
Male, medicine.medical_treatment, Heart Ventricles, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Ventricular tachycardia, Signal, ablation, electrogram analysis, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, mapping, Aged, Retrospective Studies, Ischemic cardiomyopathy, business.industry, Dilated cardiomyopathy, Middle Aged, medicine.disease, Ablation, Rapid acquisition, Catheter Ablation, Tachycardia, Ventricular, Female, ventricular tachycardia, business, Electrophysiologic Techniques, Cardiac, Algorithm, Algorithms
Abstract

Objectives This study reports the use of a novel “Lumipoint” algorithm in ventricular tachycardia (VT) ablation. Background Automatic mapping systems aid rapid acquisition of activation maps. However, they may annotate farfield rather than nearfield signal in low voltage areas, making maps difficult to interpret. The Lumipoint algorithm analyzes the complete electrogram tracing and therefore includes nearfield signals in its analysis. Methods Twenty-two patients with ischemic cardiomyopathy and 5 with dilated cardiomyopathy underwent mapping using the ultra-high density Rhythmia system. Lumipoint algorithms were applied retrospectively. Results In all left ventricular substrate maps, changing the window of interest to the post-QRS phase automatically identified late potentials. In 25 of 27 left ventricular VT activation maps, a minimum spatial window of interest correctly identified the VT isthmus as seen by the manually annotated map, entrainment, and response to ablation. In 6 maps, the algorithm identified the isthmus where the standard automatically annotated map did not. Conclusions The Lumipoint algorithm automatically highlights areas with electrograms having specific characteristics or timings. This can identify late and fractionated potentials and regions that exhibit discontinuous activation, as well as the isthmus of a VT circuit. These features may enhance human interpretation of the electrogram signals during a case, particularly where the circuit lies in partial scar with low amplitude nearfield signals and potentially allow a more targeted ablation strategy.

Published
2019

4. Localized Structural Alterations Underlying a Subset of Unexplained Sudden Cardiac Death

Author

Ruben Coronel, Stéphane Puyo, Michael J. Ackerman, Mélèze Hocini, Grégoire Massoullié, Pierre Jaïs, Louis Labrousse, Masateru Takigawa, Josselin Duchateau, Frederic Sacher, Olivier Piot, Sylvain Ploux, Jean-Jacques Schott, Xavier Pillois, Thomas Pambrun, Nicolas Derval, Estelle Gandjbakhch, Christophe Leclerc, Nicolas Klotz, Rémi Dubois, Edward J. Vigmond, Jean-Sylvain Hermida, Olivier Bernus, Philippe Ritter, Ruairidh Martin, David J. Tester, Arnaud Denis, Philippe Maury, Koonlawee Nademanee, Pierre Bordachar, David Benoist, Corentin Dallet, Michel Haïssaguerre, Richard D. Walton, Jean-Luc Pasquié, Ghassen Cheniti, Solena Le Scouarnec, Mark Potse, Hubert Cochet, IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Université de Bordeaux (UB), CHU Bordeaux [Bordeaux], Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Haut-Lévêque [CHU Bordeaux], unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut du thorax, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Mayo Clinic, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Toulouse [Toulouse], Bibliothèque interuniversitaire de santé (BIUS), Université Paris Descartes - Paris 5 (UPD5), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], White Memorial Medical Center, Cardiology, ACS - Heart failure & arrhythmias, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, and MORNET, Dominique

Subjects
Male, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Action Potentials, 030204 cardiovascular system & hematology, Sudden cardiac death, 0302 clinical medicine, Heart Rate, Risk Factors, Cause of Death, 030212 general & internal medicine, Epicardial mapping, Incidence, Cardiac Pacing, Artificial, Progression-Free Survival, 3. Good health, [SDV] Life Sciences [q-bio], ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Cardiology, Female, Catheter ablation, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Adolescent, Purkinje Fibers, Young Adult, 03 medical and health sciences, Predictive Value of Tests, Physiology (medical), Internal medicine, medicine, Humans, Ventricular fibrillation, Endocardium, business.industry, Original Articles, medicine.disease, Death, Sudden, Cardiac, business
Abstract

Supplemental Digital Content is available in the text., Background: Sudden cardiac death because of ventricular fibrillation (VF) is commonly unexplained in younger victims. Detailed electrophysiological mapping in such patients has not been reported. Methods: We evaluated 24 patients (29±13 years) who survived idiopathic VF. First, we used multielectrode body surface recordings to identify the drivers maintaining VF. Then, we analyzed electrograms in the driver regions using endocardial and epicardial catheter mapping during sinus rhythm. Established electrogram criteria were used to identify the presence of structural alterations. Results: VF occurred spontaneously in 3 patients and was induced in 16, whereas VF was noninducible in 5. VF mapping demonstrated reentrant and focal activities (87% versus 13%, respectively) in all. The activities were dominant in one ventricle in 9 patients, whereas they had biventricular distribution in others. During sinus rhythm areas of abnormal electrograms were identified in 15/24 patients (62.5%) revealing localized structural alterations: in the right ventricle in 11, the left ventricle in 1, and both in 3. They covered a limited surface (13±6 cm2) representing 5±3% of the total surface and were recorded predominantly on the epicardium. Seventy-six percent of these areas were colocated with VF drivers (P

Published
2018

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