AF Highlighted case: March 2018

Case of a 60-year-old female patient with arterial hypertension and prior persistent atrial fibrillation ablation.

Clinical background of the patient:

  • Pulmonary veins and anterior line ablated seven years before the present procedure
  • Atypical flutter diagnosed 8 months previous to the procedure

Intervention Planning

The atrial myocardium was segmented and characterized with the analysis of LGE-MRI using ADAS-AF.

Anterior view

The patient presented a fibrotic substrate around the veins, on the anterior wall and on the roof. The total myocardial area of 124.9 cm² consisted of:

  • 25.76% (32.2 cm²) dense scar tissue (red)
  • 18.47% (23.1 cm²) mild fibrotic tissue (yellow)
  • 55.77% (69.6 cm²) healthy tissue (blue)

Gaps

The anterior wall presented two ablation gaps:

  • One gap in the roof line
  • One gap near the mitral valve

Gallery

Intervention

Thanks to the identification of the AF substrate provided by ADAS-AF the mapping could be focused on the region around the ablation line gaps.

Carto during the intervention

The substrate and anatomical information from ADAS were imported into the navigation system and registered with the electro-anatomical atrial map.

The patient was in flutter during the whole mapping.

When ablating the gap at the roof of the anterior wall, the patient spontaneously reverted to sinus rhythm.

Case Review

The electro-anatomical map was imported into ADAS-AF to contrast the findings with the LGE-MRI data.

ADAS-AF provided statistics about the similarity between image intensity and voltage maps. When ablating the position marked by the dark blue dot, the patient reverted to sinus rhythm. This position is located perfectly in the MRI gap.

Case Courtesy of Dr Lluís Mont, Arrhythmia Section, Hospital Clínic de Barcelona, Spain

Hospital Clínic de Barcelona

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