carina and the RA. It is possible that the closer the LA and RA are in the posterior aspect, the more inside the PV ostia (ie, the PV carina) the attachment of the bridging fiber is. and H.H. Results are shown as mean ± standard deviation, median [interquartile range], or n (%). Further, the performance of indiscriminate carina ablation may just increase the risk for PV stenosis. Scanning was initiated after a threshold of 150 Hounsfield units was reached in the ascending aorta during expiratory breath holding. Finally, this study was primarily designed to investigate epicardial connections involving the right-sided PVs, and therefore, the mechanisms behind the necessity of carina ablation for left-sided PVI were not adequately explored. We use cookies to help provide and enhance our service and tailor content and ads. Check for errors and try again. Further investigation specific to and focusing on the left-sided epicardial connections is needed to clarify this entity. inferior interventricular artery (posterior descending artery). because of epicardial connections present between the right-sided pulmonary venous Electrical isolation of both left pulmonary veins by a single left atrial endocardial radiofrequency energy application: ablation of Marshall bundle bypass. Epicardial connection between the right-sided pulmonary venous carina and the right atrium in patients with atrial fibrillation: A possible mechanism for preclusion of pulmonary vein isolation without carina ablation. The carina usually sits at the level of the sternal angle and the T4/T5 vertebral level in the thoracic plane. Unable to process the form. Two long sheaths (SL0; AF Division, Abbott) were then advanced into the LA. Ablation of the pulmonary venous carina is occasionally required for pulmonary vein Interatrial transseptal electrical conduction: comparison of patients with atrial fibrillation and normal controls. Right atrial parasystole originating from isolated activities in the right inferior pulmonary vein with an epicardial connection. Electrophysiological relation between the superior vena cava and right superior pulmonary vein in patients with paroxysmal atrial fibrillation. Pulmonary vein (PV) isolation (PVI) is a standard strategy determined as a class I recommendation for catheter ablation of atrial fibrillation (AF). Twenty-four (53%) patients were classified into the Non-Carina-ABL group, and 21 (47%) were classified into the Carina-ABL group. Carina Sartor Designs Eireli CNPJ 32.779.912/0001-08 Rua Padre Anchieta, 1923 - sala 1410 Curitiba/PR . Join Facebook to connect with Heart Carina and others you may know. AAD = antiarrhythmic drugs; ABL = ablation; AF = atrial fibrillation; BNP = B-type natriuretic peptide; eGFR = estimated glomerular filtration rate; LA = left atrium; LV = left ventricular; PV = pulmonary vein; TIA = transient ischemic attack. There was no difference in the LA volume index and RA volume index between the Carina-ABL and Non-Carina-ABL groups (35.5 ± 18.7 mL/m. Pulmonary vein isolation as an end point for left atrial circumferential ablation of atrial fibrillation. lesion sets. LA = left atrium; RA= right atrium; RIPV= right inferior pulmonary vein; RSPV = right superior PV. PVI with entrance and exit blocks was confirmed with the Lasso catheter (Biosense Webster, Irvine, CA) and a pacing maneuver performed within the isolation line with an ablation catheter (Non-Carina-ABL group). Finally, interatrial distance was defined as the distance between the mid-point of the anterior tangent and the landing point on the RA. Although the Bachmann bundle (BB) is a common and main interatrial band, local variations in small tongues of muscular fibers were frequently found in autopsy studies. of lone atrial fibrillation. blinded to the study aim, concept, and ablation results measured the following parameters in 3 different orthogonal planes (transverse, sagittal, and coronal views) with multiplanar reformatting function: Assessment of right atrium volume by conventional CT or MR techniques: Which modality resembles in vivo reality?. Morphological evidence of muscular connections between contiguous pulmonary venous orifices: relevance of the interpulmonary isthmus for catheter ablation in atrial fibrillation. The last 2 authors contributed equally to this work. Univariate logistic regression analysis of the measurements on computed tomography imaging. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry. ), who was blinded to the presence or absence of carina breakthrough. carina (n = 1 [3%]), carina and BB (n = 3 [9%]), and carina and FO (n = 2 [6%]). By continuing you agree to the, https://doi.org/10.1016/j.hroo.2020.08.003, Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins, https://doi.org/10.1016/j.hrcr.2020.08.006, View Large DOI: https://doi.org/10.1016/j.hrthm.2018.11.017. If the patients presented to the laboratory in AF, internal cardioversion using a BeeAT catheter was performed. Demonstration of electrical and anatomic connections between Marshall bundles and left atrium in dogs: implications on the generation of P waves on surface electrocardiogram. Atrial structure and fibres: morphologic bases of atrial conduction. "Carina" ultimately derives from Latin, meaning "keel of a boat" 1. Points were acquired using the CARTO ConfiDENSE module (Biosense Webster) in the auto-freeze mode. Bridges joining the LA to the intercaval area on the RA were clearly presented by an anatomical study. Data reconstruction and the measurements of LA and RA volumes were performed on a postprocessing workstation with the use of 2-dimensional viewing modes (SYNAPSE VINCENT; FUJIFILM, Tokyo, Japan). {"url":"/signup-modal-props.json?lang=us\u0026email="}. Ablation of the pulmonary venous carina is occasionally required for pulmonary vein isolation (PVI) despite its nonessential role in ipsilateral PVI from the anatomical (endocardial) viewpoint. Propagation map obtained during sinus rhythm in a patient with Bachmann’s bundle breakthrough alone, corresponding to Figure 4B. Ten patients were selected at random for the assessments of the intraobserver and interobserver reproducibilities by M.B. © 2020 Heart Rhythm Society. Comparison of pulmonary venous and left atrial remodeling in patients with atrial fibrillation with hypertrophic cardiomyopathy versus with hypertensive heart disease. Currently, the only available method to estimate the presence of an epicardial connection before ablation is activation mapping of the LA during sinus rhythm. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. Patients were also classified into the Carina-ABL group (n = 13) and Non-Carina-ABL group (n = 32) based on the necessity of left-sided PV carina ablation (. CT examinations were performed within 7 days before the ablation procedure with a 320-row CT scanner (Somatom Definition Flash; Siemens AG, Erlangen, Germany). The most prominent interatrial bridge is the Bachmann bundle. group (n = 8 [22%]) after excluding 3 patients (8%) because of their complex ablation During sinus rhythm, each PV and the LA, SVC, and RA were mapped with a duodecapolar mapping catheter (PENTARAY; Biosense Webster). NPV = negative predictive value; PPV = positive predictive value; RtPV = right-sided pulmonary vein. The carina is the sagittally-oriented cartilaginous ridge at the bifurcation of the trachea and is an important reference point in chest imaging. Forty-five consecutive patients referred to Ibaraki Prefectural Central Hospital for initial catheter ablation of AF from April 2019 to November 2019 were prospectively included in this study. A mid-point of the anterior tangent between the right superior PV and RIPV was determined. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. Protocol for the measurements of interatrial distance. Patients were also classified into the Carina-ABL group (n = 13) and Non-Carina-ABL group (n = 32) based on the necessity of left-sided PV carina ablation (Supplemental Table 1). atrium (RA) to the left atrium (LA) during sinus rhythm on the necessity of performing LIPV = left inferior pulmonary vein; LSPV = left superior PV; RA = right atrium; RIPV = right inferior PV; RtPV = right-sided PV; RSPV = right superior PV; SVC = superior vena cava. The term was originally used in botany to indicate a projecting ridge on the back of an organ. Results are shown as mean ± SD, median [interquartile range], or n (%). © 2018 Heart Rhythm Society. Near-field or far-field electrograms were discriminated by using their morphologies (sharp or dull) and near-field SVC potentials directly and simultaneously recorded by the BeeAT catheter. Minor- and major-axis diameters of each PV ostium (mm/m. (4) For left-sided PVI, a smaller PV ostium was associated with the necessity of left-sided PV carina ablation. Electrical connection between ipsilateral pulmonary veins: prevalence and implications for ablation and adenosine testing. Join Facebook to connect with Carina Heart and others you may know. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Disclaimer. Patients were Although the Bachmann bundle (BB) is a common and main interatrial (endocardial) viewpoint. Radiofrequency energy was delivered at a power of 20–25 W at the posterior aspect, at 15–20 W at the sites adjacent to the esophagus, and at 25–35 W at the anterior aspect of the PV antrum. Vezi profilurile persoanelor care poartă numele de Heart Carina. Interatrial conduction in patients with paroxysmal atrial fibrillation and in healthy subjects. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry. Theoretically speaking from the endocardial point of view, 1 round of PV ablation with continuous lesion formation achieves PVI, and therefore, operators may be eager to locate conduction gaps and to isolate the veins without performing ablation inside the ablation line. using an electroanatomical mapping system. The ipsilateral PV antrum was circumferentially ablated with a ThermoCool STSF catheter under CARTO guidance (Biosense Webster) using real-time automated display of radiofrequency applications (Visitag; Biosense Webster). Surface electrocardiograms and intracardiac electrograms were continuously monitored and stored on an EP-WorkMate recording system (Abbott, Saint Paul, MN). in the non–carina-ABL group (. Accuracy of left atrial bipolar voltages obtained by ConfiDENSE multielectrode mapping in patients with persistent atrial fibrillation. A common tangent of the PV ostia was drawn (anterior tangent). A shorter interatrial distance for right-sided PVI and a smaller PV ostium for left-sided PVI were associated with the necessity of additional carina ablation. If it was difficult to maintain sinus rhythm after the cardioversion, such patients were excluded from the study. CEP 80730-000 (3) Among anatomical variables that can be measured by cardiac CT imaging, only shorter distance between the anterior portion of the carina and RA was a predictor for the necessity of right-sided PV carina ablation. The carina is the sagittally-oriented cartilaginous ridge at the bifurcation of the trachea and is an important reference point in chest imaging.. The parameters for CT imaging were prospective electrocardiogram-gated acquisitions; tube potential, 120 kVp; and detector configuration, 320 × 0.5 mm. Sensitivity, specificity, and positive and negative predictive values for the necessity of carina ablation (right-sided pulmonary vein isolation), Computed tomography measurements (left-sided pulmonary vein isolation), Anatomy and electrophysiology associated with interatrial epicardial connections, Epicardial connections involving the left-sided PVs, Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0), We use cookies to help provide and enhance our service and tailor content and ads.

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