Image in Cardiology
Ablation of stable complex fractionated atrial electrogram defined by dynamic overlaid mapping in persistent atrial fibrillation
Mapas de sobreposição dinâmica na fibrilhação auricular persistente: ablação de um eletrograma complexo fracionado estável
Pedro Adragão
, Pedro Carmo, Diogo Cavaco, João Carmo, Francisco Costa, Francisco Morgado
Autor para correspondência
Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal
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White arrows indicate the intimal flap; (F and G) IVUS and OCT, respectively, after stent implantation, showing correct expansion and apposition; (H and I) IVUS and OCT, respectively, displaying the hematoma at the origin of a patent septal branch (star); (J) three-dimensional (3-D) OCT reconstruction at the same level as (I); (K) 3-D reconstruction after implantation of the first stent. The cross shows the hematoma and the luminal compromise; (L and M) final 3-D result. IVUS: intravascular ultrasound; OCT: optical coherence tomography.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iván J. Núñez-Gil, Mauro Echavarría-Pinto, Gisela Feltes, Antonio Fernández-Ortiz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Iván J." "apellidos" => "Núñez-Gil" ] 1 => array:2 [ "nombre" => "Mauro" "apellidos" => "Echavarría-Pinto" ] 2 => array:2 [ "nombre" => "Gisela" "apellidos" => "Feltes" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Fernández-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301336?idApp=UINPBA00004E" "url" => "/08702551/0000003600000004/v1_201704060057/S0870255117301336/v1_201704060057/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Ablation of stable complex fractionated atrial electrogram defined by dynamic overlaid mapping in persistent atrial fibrillation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "316" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Adragão, Pedro Carmo, Diogo Cavaco, João Carmo, Francisco Costa, Francisco Morgado" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Pedro" "apellidos" => "Adragão" "email" => array:1 [ 0 => "padragao@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Carmo" ] 2 => array:2 [ "nombre" => "Diogo" "apellidos" => "Cavaco" ] 3 => array:2 [ "nombre" => "João" "apellidos" => "Carmo" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "Costa" ] 5 => array:2 [ "nombre" => "Francisco" "apellidos" => "Morgado" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Santa Cruz Hospital, CHLO, Carnaxide, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Mapas de sobreposição dinâmica na fibrilhação auricular persistente: ablação de um eletrograma complexo fracionado estável" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1875 "Ancho" => 2500 "Tamanyo" => 178717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior view of the left atrium showing a stable complex fragmented atrial electrogram (CFAE) defined by dynamic overlaid mapping. Anatomy defined by the Ensite NavX™ system; electrograms recorded by basket catheter (Constellation, Boston Scientific); ablation performed by ablation catheter (yellow) located over the area of a stable CFAE (white arrow). CFAE: complex fractionated atrial electrogram; CS: coronary sinus; LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We describe the case of a 64-year-old woman with persistent atrial fibrillation (more than one year's duration) referred for ablation. Three-dimensional electroanatomical mapping of the left atrium was performed using the Ensite NavX™ system (St. Jude Medical, Minneapolis, MN) and a Constellation™ 64-pole basket diagnostic catheter (Boston Scientific, Natick, MA). A stable complex fragmented atrial electrogram (CFAE) was identified in 5-min time-frame windows using novel proprietary software (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). A localized radiofrequency application over the CFAE near the left pulmonary vein ostia modified electrical activity in the posterior wall of the left atrium, increasing cycle length until interruption (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2–4</a>). This case highlights the importance of finding areas that are critical in maintaining electrical fibrillatory activity. A precise ablation target was identified (stable CFAE).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0010" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-02-21" "fechaAceptado" => "2017-03-01" "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1875 "Ancho" => 2500 "Tamanyo" => 178717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior view of the left atrium showing a stable complex fragmented atrial electrogram (CFAE) defined by dynamic overlaid mapping. Anatomy defined by the Ensite NavX™ system; electrograms recorded by basket catheter (Constellation, Boston Scientific); ablation performed by ablation catheter (yellow) located over the area of a stable CFAE (white arrow). CFAE: complex fractionated atrial electrogram; CS: coronary sinus; LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1876 "Ancho" => 3333 "Tamanyo" => 792633 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Above, anatomical mapping of the left atrium with the Constellation catheter and the ablation catheter. Below, coronary sinus electrograms and electrograms from the splines of the diagnostic catheter. The posterior wall is represented from splines C to F. Immediately after initiation of radiofrequency application, an increase in cycle length in the posterior wall is noted (scale 50 mm/s). LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; RF: radiofrequency; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1877 "Ancho" => 3333 "Tamanyo" => 706942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the first radiofrequency application, a marked slowing in the posterior wall is seen. LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1876 "Ancho" => 3333 "Tamanyo" => 804156 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">During the second radiofrequency application to eliminate the stable CFAE (enlarged lesion), interruption of the electrical activity of the posterior wall is seen (scale 25 mm/s to confirm continued electrical activity suppression). LIPV: left inferior pulmonary vein; LSPV: left superior pulmonary vein; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003600000004/v1_201704060057/S0870255117301567/v1_201704060057/en/main.assets" "Apartado" => array:4 [ "identificador" => "29264" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000004/v1_201704060057/S0870255117301567/v1_201704060057/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301567?idApp=UINPBA00004E" ]
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