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Master Thesis

Ablation de fibrillation atriale persistante guidée par imagerie électrocardiographique : résultats à 5 ans, stratégie au long cours et impact sur la fonction atriale

Abstract : Atrial fibrillation (AF) is a major public health issue. Control of the rhythm with catheter ablation has considerably increased during the last twenty years and has proved its effectiveness with the pulmonary veins isolation. Nevertheless, the long-term results remain imperfect, especially in the management of persistent AF, which has led to search for other ablation targets and to develop new strategies. In recent years, a non-invasive mapping system has been developed to model cardiac electrical signals by coupling an analysis of 252 electrocardiographic leads to an anatomical CT scan. This system allowed to model rotational or focal electric activities (drivers) of AF and was used for therapeutic purposes by guiding the endocavitary ablation on areas where these drivers are located. In this thesis, we retrospectively study a cohort of patients who have undergone a first ablation of persistent AF guided by the CardioInsight© non-invasive mapping system between April 2012 and October 2014. We first present results of this cohort at 5 years. We study if the strategy of targeting drivers is sustainable over time by analyzing all lesions made by catheter ablation procedures during the follow-up. Then, we evaluate the impact of this ablation strategy on atrial tachycardia recurrence with an analysis of all procedures performed during the follow-up. In particular, we are looking for links between previously ablated areas and kind of atrial tachycardia recurrence. Finally, we evaluate consequences of this strategy on atrial mechanics one year after the first procedure. In particular, we compare our patients to a cohort that has benefited from a new ablation strategy that claims to respect the atrial function.
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https://dumas.ccsd.cnrs.fr/dumas-02498234
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Clément Nédellec. Ablation de fibrillation atriale persistante guidée par imagerie électrocardiographique : résultats à 5 ans, stratégie au long cours et impact sur la fonction atriale. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02498234⟩

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