451
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Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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452
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Hummel JD. Atrial Mapping With Basket Catheters: A Basket Case? JACC Clin Electrophysiol 2016; 2:66-68. [PMID: 29766855 DOI: 10.1016/j.jacep.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- John D Hummel
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
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453
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Ma CS. Atrial Fibrillation Ablation: Indications, New Advances, and Complications. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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454
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Ströker E, de Asmundis C, Saitoh Y, Velagić V, Mugnai G, Irfan G, Hünük B, Tanaka K, Belsack D, Buyl R, Brugada P, Chierchia GB. Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon. Heart Rhythm 2016; 13:342-51. [DOI: 10.1016/j.hrthm.2015.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 10/22/2022]
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455
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Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol 2016; 46:89-96. [PMID: 26810707 DOI: 10.1007/s10840-016-0106-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Novel atrial fibrillation (AF) ablation tools have been designed to facilitate "single-shot" pulmonary vein (PV) isolation using multi-electrode or balloon-based catheters. However, in contrast to point-by-point radiofrequency ablation, these tools may be more dependent on suitable PV anatomy to achieve circumferential PV isolation. METHODS Three hundred and twenty-two patients underwent gadolinium-enhanced cardiac magnetic resonance angiography to delineate PV anatomy prior to initial AF ablation. Long (a) and short (b) axis measurements of the PV orifice were used to calculate the eccentricity index of the PV ostium. RESULTS Long axis dimensions of the left superior PV were 18.2 ± 3.3 mm, left inferior PV 17.7 ± 3.9 mm, right superior PV (RSPV) 20.4 ± 4.3, and right inferior PV 18.7 ± 4.7 mm. The long axis dimension of the RSPV was significantly larger than other PVs (p < 0.001). Forty-two patients (13 %) had at least one PV with a long axis dimension >25 mm and 16 patients (5 %) had at least one PV with a long axis dimension >28 mm. Left-sided PV ostia were significantly more ellipse-shaped than the right-sided PVs, which tended to be more spherical. A significant positive correlation was noted between increasing PV size and increased orifice eccentricity. CONCLUSIONS In this large cohort undergoing initial AF ablation, over 10 % of patients had at least one standard PV with a dimension >25 mm. Additionally, significant differences were noted between left- and right-sided veins with regard to orifice eccentricity. These findings have implications for the design of AF ablation tools and may account for differential isolation rates between PVs noted in some recent studies of novel ablation technologies.
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456
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HE XIN, CHEN YILI, ZHOU YUE, HUANG YIYI, HE JIANGUI. One-Year Clinical Outcome of Pulmonary Vein Isolation Using the Second-Generation Cryoballoon: A Meta-Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:182-9. [PMID: 26592985 DOI: 10.1111/pace.12787] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/28/2015] [Accepted: 11/15/2015] [Indexed: 12/27/2022]
Affiliation(s)
- XIN HE
- Department of Cardiology; The First Affiliated Hospital of Sun Yat-sen University; Yuexiu District Guangzhou Guangdong China
| | - YILI CHEN
- Department of Cardiology; The First Affiliated Hospital of Sun Yat-sen University; Yuexiu District Guangzhou Guangdong China
| | - YUE ZHOU
- Department of Cardiology; The First Affiliated Hospital of Sun Yat-sen University; Yuexiu District Guangzhou Guangdong China
| | - YIYI HUANG
- Emergency Department; The First Affiliated Hospital of Sun Yat-sen University; Yuexiu District Guangzhou Guangdong China
| | - JIANGUI HE
- Department of Cardiology; The First Affiliated Hospital of Sun Yat-sen University; Yuexiu District Guangzhou Guangdong China
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457
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Buch E, Shivkumar K. Catheter Ablation of Atrial Fibrillation: Advent of Second-Generation Technologies. J Am Coll Cardiol 2016; 66:1361-3. [PMID: 26383723 DOI: 10.1016/j.jacc.2015.07.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Eric Buch
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
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458
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Novel perspectives on arrhythmia-induced cardiomyopathy: pathophysiology, clinical manifestations and an update on invasive management strategies. Cardiol Rev 2016; 23:135-41. [PMID: 25133468 DOI: 10.1097/crd.0000000000000040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Arrhythmia-induced cardiomyopathy is a partially or completely reversible form of myocardial dysfunction due to sustained supraventricular and ventricular arrhythmias. Asynchrony, rapid cardiac rates and rhythm irregularities are the main factors involved in the development of the disease. The reversible nature of arrhythmia-induced cardiac dysfunction allows only for a retrospective diagnosis of the disease once cardiac function is restored following heart rate control. A high level of suspicion is needed to make a diagnosis at an early stage and prevent further progression of the disease. Although reversible, arrhythmia-induced cellular and molecular changes may remain, increasing the risk for sudden death even when normal ejection fraction is restored as well as causing rapid deterioration of cardiac function and development of heart failure symptoms if arrhythmia recurs. Appropriate management based on a combination of pharmacologic and nonpharmacologic strategies to achieve rate control and prevent arrhythmia recurrence is pivotal to avoid further cardiac function deterioration and to control symptoms, significantly reducing the risk of heart failure and sudden cardiac death.
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459
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Lo LW, Chen SA. Hope or Hype – Does Cryoballoon Simplify Atrial Fibrillation Ablation Technique or Just Another Costly Toy? –. Circ J 2016; 80:1695-6. [DOI: 10.1253/circj.cj-16-0622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University
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460
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Okumura K, Matsumoto K, Kobayashi Y, Nogami A, Hokanson RB, Kueffer F. Safety and Efficacy of Cryoballoon Ablation for Paroxysmal Atrial Fibrillation in Japan – Results From the Japanese Prospective Post-Market Surveillance Study –. Circ J 2016; 80:1744-9. [DOI: 10.1253/circj.cj-16-0285] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Kazuo Matsumoto
- Division of Arrhythmia Treatment, Department of Cardiology, Saitama International Medical Center, Saitama Medical University
| | | | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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461
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Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
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Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
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462
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Leitz P, Güner F, Wasmer K, Foraita P, Pott C, Dechering DG, Zellerhoff S, Kochhäuser S, Lange PS, Eckardt L, Mönnig G. Data on procedural handling and complications of pulmonary vein isolation using the pulmonary vein ablation catheter GOLD®. Europace 2015; 18:696-701. [DOI: 10.1093/europace/euv355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/28/2015] [Indexed: 01/01/2023] Open
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463
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Gang Y, Gonna H, Domenichini G, Sampson M, Aryan N, Norman M, Behr ER, Zuberi Z, Dhillon P, Gallagher MM. Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial. J Interv Card Electrophysiol 2015; 45:179-87. [DOI: 10.1007/s10840-015-0092-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
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464
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Straube F, Dorwarth U, Hartl S, Bunz B, Wankerl M, Ebersberger U, Hoffmann E. Outcome of paroxysmal atrial fibrillation ablation with the cryoballoon using two different application times: the 4- versus 3-min protocol. J Interv Card Electrophysiol 2015; 45:169-77. [DOI: 10.1007/s10840-015-0084-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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465
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Estenosis de vena pulmonar tras ablación: la distancia entre la clínica y los hallazgos de imagen y la importancia de las palabras en este contexto. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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466
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Saitoh Y, Ströker E, Irfan G, Mugnai G, Ciconte G, Hünük B, Velagić V, Overeinder I, Tanaka K, Brugada P, de Asmundis C, Chierchia GB. Fluoroscopic position of the second-generation cryoballoon during ablation in the right superior pulmonary vein as a predictor of phrenic nerve injury. Europace 2015; 18:1179-86. [DOI: 10.1093/europace/euv362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
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467
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Wissner E, Deiss S, Kuck KH. Balloon-based pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (cryoballoon and laserballoon). Future Cardiol 2015; 11:663-71. [PMID: 26610028 DOI: 10.2217/fca.15.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Electrical isolation of the pulmonary veins still remains one of the major objectives during catheter ablation of atrial fibrillation. In patients with paroxysmal atrial fibrillation, balloon-based technologies hold great promise to simplify the approach to successful pulmonary vein isolation. While the cryoballoon represents the only true 'single-shot' technology, the laserballoon allows real-time endoscopic visualization of the pulmonary vein antrum during energy delivery. Either technology aims at complete electrical isolation, requiring continuous transmural lesion sets encircling the pulmonary veins. Strategies to confirm and to improve upon the efficacy of pulmonary vein isolation are the key to acute and long-term clinical success and will be reviewed in this article.
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Affiliation(s)
- Erik Wissner
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Sebastian Deiss
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
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468
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HUNTER ROSSJ, BAKER VICTORIA, FINLAY MALCOLMC, DUNCAN EDWARDR, LOVELL MATTHEWJ, TAYEBJEE MUZAHIRH, ULLAH WAQAS, SIDDIQUI MSHOAIB, McLEAN AILSA, RICHMOND LAURA, KIRKBY CLAIRE, GINKS MATTHEWR, DHINOJA MEHUL, SPORTON SIMON, EARLEY MARKJ, SCHILLING RICHARDJ. Point-by-Point Radiofrequency Ablation Versus the Cryoballoon or a Novel Combined Approach: A Randomized Trial Comparing 3 Methods of Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation (The Cryo Versus RF Trial). J Cardiovasc Electrophysiol 2015; 26:1307-14. [DOI: 10.1111/jce.12846] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/04/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- ROSS J. HUNTER
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - VICTORIA BAKER
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MALCOLM C. FINLAY
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - EDWARD R. DUNCAN
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MATTHEW J. LOVELL
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MUZAHIR H. TAYEBJEE
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - WAQAS ULLAH
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - M. SHOAIB SIDDIQUI
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - AILSA McLEAN
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - LAURA RICHMOND
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - CLAIRE KIRKBY
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MATTHEW R. GINKS
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MEHUL DHINOJA
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - SIMON SPORTON
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - MARK J. EARLEY
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
| | - RICHARD J. SCHILLING
- Barts Heart Centre, St. Bartholomew's Hospital; Barts Health NHS Trust; London UK
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469
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Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey. BIOMED RESEARCH INTERNATIONAL 2015; 2015:591603. [PMID: 26640789 PMCID: PMC4659951 DOI: 10.1155/2015/591603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/27/2015] [Indexed: 12/17/2022]
Abstract
Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres.
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470
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Gonzalez J, Levinstein M, Brugada P. [Cryoablation: Clinical applications in cardiac electrophysiology from their biophysical bases]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:41-50. [PMID: 26556222 DOI: 10.1016/j.acmx.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022] Open
Abstract
Cryoablation is an energy alternative to radiofrequency for ablation of various arrhythmias, where its unique biophysical properties offer a greater safety profile. Since its first use for the surgical treatment of different arrhythmias until its conceptualization in the current technical transcatheter, cryoablation has proven not to be only a safe source of energy, but also an effective source in the long-term. While the radiofrequency has been the energy most used for isolation of pulmonary veins in atrial fibrillation ablation, technological advances in cryoballon have managed to simplify the procedure without sacrificing its effectiveness. Cryoablation has been widely used for arrhythmias located in high-risk locations, such as the ablation of the atrioventricular nodal reentrant tachycardia and septal accessory pathways, due to its theoretical null risk of complete AV block. This review intends to give the clinical applications of the cryothermy through a thorough understanding of their biophysical basis.
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Affiliation(s)
- Jorge Gonzalez
- Centro Especializado en Terapia Endovascular, Jardines Hospital de Especialidad, Guadalajara, Jalisco, México.
| | | | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Bruselas, Bélgica
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471
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Laish-Farkash A, Katz A, Cohen O, Osherov A, Bruocha S, Khalameizer V. Site localization of painful lesions during radiofrequency ablation of pulmonary veins using circular multi-electrode catheters. J Interv Card Electrophysiol 2015; 45:63-9. [PMID: 26552799 DOI: 10.1007/s10840-015-0065-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous data showed that pain sensation was common during pulmonary vein isolation (PVI) using an 8-mm radiofrequency (RF) ablation catheter. Pain was more common in the left pulmonary veins (PVs). We characterized the location of pain during PVI using circular multi-electrode ablation catheters. METHODS Included are all consecutive patients with atrial fibrillation (AF) who underwent PVI using the phased RF PVAC® catheter (Medtronic) or the irrigated nMARQ™ catheter (Biosense Webster) under conscious sedation between July 2011 and March 2015. Site of pain reaction was marked for each patient. RESULTS A total of 251 patients (141 PVAC®, 110 nMARQ™) were studied; 214 (85 %) had at least one lesion associated with pain. Gender (r = 0.084, p = 0.186), type of AF (r = 0.048, p = 0.452), age (r = 0.078, p = 0.216), and repeat procedure (r = 0.018, p = 0.78) were not correlated with pain. There was no association between site of pain and catheter type; only 33% of the painful PVs were also the largest ones (p = 0.5, kappa = 0.03, R = -0.083). One-year freedom from AF was similar for patients with and without painful PVs (p = 0.6). The distribution of pain was as follows: 126 (59%) left superior PV (LSPV), 28 (13%) left inferior, 28 (13%) all PVs, 12 (5.6%) right superior, 12 (5.6%) right inferior, 18 (8.4%) left common, and 2 (0.9%) right common PV. CONCLUSIONS PVI using multi-electrode catheters more commonly caused pain sensation in LSPV. There was no influence of catheter type or PV size on pain localization. Our findings, which are similar to those using an 8-mm ablation catheter, imply that location of pain is not catheter dependent but rather a reflection of autonomic physiology.
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Affiliation(s)
- Avishag Laish-Farkash
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Amos Katz
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ornit Cohen
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Azriel Osherov
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sharon Bruocha
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimir Khalameizer
- Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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472
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Affiliation(s)
- Jo Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital; Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital; Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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473
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Pulmonary Vein Stenosis After Ablation: The Difference Between Clinical Symptoms and Imaging Findings, and the Importance of Definitions in This Context. ACTA ACUST UNITED AC 2015; 68:1056-8. [PMID: 26546065 DOI: 10.1016/j.rec.2015.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 11/21/2022]
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474
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Stuehlinger M, Hoenig S, Spuller K, Koman C, Stoeger M, Poelzl G, Ulmer H, Pachinger O, Steinwender C. CoolLoop® First: A First In Man Study To Test A Novel Circular Cryoablation System In Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2015; 8:1287. [PMID: 27957211 DOI: 10.4022/jafib.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/15/2015] [Accepted: 08/20/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pulmonary vein (PV) isolation is the mainstay of catheter treatment of paroxysmal atrial fibrillation (AF). The CoolLoop® cryoablation catheter (AFreeze® GmbH; Innsbruck, Austria) was developed to create wide and complete circular lesions around the PVs. In this study we evaluated feasibility and safety of this novel ablation system in humans. METHODS 10 patients (6M/4F; 57.6±7.6y) with paroxysmal AF were included in 2 referral centers. The CoolLoop® catheter was positioned at each PV antrum using a steerable transseptal sheath. Subsequently, 2-6 double-freezes over 5min were performed at each vein and PV-isolation was assessed thereafter using a circular mapping catheter. During cryoablation of the right PVs, pacing was used to monitor phrenic nerve function. RESULTS The CoolLoop® catheter could be successfully positioned at each PV. A mean of 5.6±1.8 cryoablations were performed in the LSPV, 5.2±1.6 in the LIPV, 6.3±2.5 in the RSPV and 5.4±1.6 in the RIPV, respectively. Mean procedure time was 251±60min and mean fluoroscopy time was 44.0±13.2min. 6 / 10 LSPV, 6 / 10 LIPV, 5 / 10 RSPV and 6 / 10 RIPV could be isolated exclusively using the novel cryoablation system. One patient developed groin hematoma and a brief episode of ST-elevation due to air embolism was observed in another subject. No other clinical complications occurred during 3 months of follow up. CONCLUSIONS PV-isolation for paroxysmal atrial fibrillation using the CoolLoop® catheter is feasible and appears safe. Clinical long term efficacy still needs to be evaluated and will be compared with established catheters used for AF ablation.
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Affiliation(s)
- Markus Stuehlinger
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Hoenig
- Department of Internal Medicine 1, Linz General Hospital (AKh Linz), Linz, Austria
| | - Karin Spuller
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Koman
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Stoeger
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Poelzl
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Otmar Pachinger
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Steinwender
- University Clinic of Internal Medicine III / Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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475
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Long-term stroke rates after catheter ablation or antiarrhythmic drug therapy for atrial fibrillation: a meta-analysis of randomized trials. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:507-14. [PMID: 26512242 PMCID: PMC4605946 DOI: 10.11909/j.issn.1671-5411.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. METHODS & RESULTS PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences (RDs) and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients (0.64%) in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients (0.23%) in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy (RD: 0.003, 95% CI: -0.006 to 0.012, P = 0.470), and no evidence of heterogeneity was observed (I (2) = 0, P = 0.981). No potential publication bias was found. There was also no difference in mortality between the two groups (RD: -0.004, 95% CI: -0.014 to 0.006, P = 0.472). CONCLUSIONS This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.
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476
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Tsyganov A, Petru J, Skoda J, Sediva L, Hala P, Weichet J, Janotka M, Chovanec M, Neuzil P, Reddy VY. Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation. J Interv Card Electrophysiol 2015; 44:265-71. [PMID: 26475792 DOI: 10.1007/s10840-015-0068-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE We evaluated the correlation between pulmonary venous (PV) anatomy and acute and long-term success of PV isolation (PVI) with two balloon-based ablation catheter techniques. METHODS One hundred consecutive patients were analyzed in two equal groups treated with either the second-generation cryoballoon (CRYO) catheter or the visually guided laser ablation (VGLA) catheter. All patients underwent multi-detector computed tomography (CT) imaging. The primary and secondary efficacy endpoints were the procedural achievement of proven electrical isolation of all veins and freedom from atrial fibrillation (AF) within a 1-year follow-up period, respectively. RESULTS Variant PV anatomy was observed in 32% of patients in the CRYO group and in 40% of patients in the VGLA group. All PVs were targeted with either the CRYO catheter (n = 199) or the VGLA catheter (n = 206). One hundred ninety-three of 199 PVs (97%) were successfully isolated in the CRYO group and 194 of 206 PVs (94%) in the VGLA group (p = 0.83). Over a 12-month follow-up, AF recurrence was documented in 11/45 (24%) and 7/43 (16%) patients in the CRYO and the VGLA groups, respectively (p = 0.21). In the CRYO group, a larger left inferior PV size was associated with worse long-term outcome (p = 0.001). In the VGLA group, a larger left superior PV size (p = 0.003) and more oval right inferior PV were associated with worse acute success (p = 0.038). There was no absolute cutoff between PV anatomy and clinical success. CONCLUSIONS The variability of PV anatomy did not significantly compromise acute success of PVI or patient outcomes.
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Affiliation(s)
- Alexey Tsyganov
- Na Homolce Hospital, Prague, Czech Republic.
- Petrovsky National Research Centre of Surgery, Moscow, Russia.
| | - Jan Petru
- Na Homolce Hospital, Prague, Czech Republic
| | - Jan Skoda
- Na Homolce Hospital, Prague, Czech Republic
| | | | - Pavel Hala
- Na Homolce Hospital, Prague, Czech Republic
| | | | | | | | | | - Vivek Y Reddy
- The Helmsley Electrophysiology Centre, Mount Sinai School of Medicine, New York, NY, US
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477
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Yamaguchi Y, Sohara H, Takeda H, Nakamura Y, Ihara M, Higuchi S, Satake S. Long-Term Results of Radiofrequency Hot Balloon Ablation in Patients With Paroxysmal Atrial Fibrillation: Safety and Rhythm Outcomes. J Cardiovasc Electrophysiol 2015; 26:1298-306. [PMID: 26331460 DOI: 10.1111/jce.12820] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Isolation of pulmonary veins (PVs) and the posterior left atrium (LA) can be safely performed by radiofrequency hot balloon (RHB)-based box isolation. However, data on long-term effects for the treatment of atrial fibrillation (AF) by the use of this method remain limited. METHODS AND RESULTS We treated 238 patients with paroxysmal AF (194 male; age. 62.6 ± 9.4 years) by RHB ablation. During 6.2-year (75 months) follow-up, 154 (64.7%) patients were free from atrial tachyarrhythmias (ATAs) without antiarrhythmic-drugs (AADs). We performed re-ablation in 69 of 84 patients with ATA recurrence (average 1.3 ± 0.6; median 1, total 91 procedures) using a 3D-mapping system and a conventional catheter. The sites of reconnection were observed at the PV in 61 of 69 (88.4%) patients and at the posterior LA in 58 of 69 (84.1%) patients. Finally, during mean follow-up of 4.6 ± 1.6 years, no-ATA episodes were detected in 201 (84.5%) patients without AADs. Independent predictors of ATA recurrence following a single procedure were heart failure with preserved ejection fraction (HR: 2.67, 95%CI: 1.40-5.10, P = 0.003) and low estimated glomerular filtration rate (HR: 1.81, 95%CI: 1.11-2.93, P = 0.03; cut-off of 62.0 mL/min/1.73 m(2)). During the follow-up period, there were 4 (1.7%) patients with PV stenosis (>70% reduction in PV diameter); however, none of these cases required intervention. Phrenic nerve palsy was detected in 8 patients (3.4%), but resolved during 3 months in all cases. CONCLUSION RHB ablation can be effective during a long-term follow-up for patients with paroxysmal AF. Safety outcomes were within an acceptable range.
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Affiliation(s)
| | - Hiroshi Sohara
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | - Hiroshi Takeda
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | | | - Minoru Ihara
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | | | - Shutaro Satake
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
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478
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Gerede DM, Candemir B, Vurgun VK, Aghdam SM, Acıbuca A, Özcan ÖU, Göksülük H, Kervancıoğlu C, Erol Ç. Prediction of recurrence after cryoballoon ablation therapy in patients with paroxysmal atrial fibrillation. Anatol J Cardiol 2015; 16. [PMID: 26680545 PMCID: PMC5331394 DOI: 10.5152/anatoljcardiol.2015.6309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the factors predicting the maintenance of sinus rhythm in patients with paroxysmal atrial fibrillation (PAF) who underwent cryoablation of the pulmonary veins (PVs). METHODS Fifty-one patients (54.6±10.4 years) with paroxysmal AF who underwent the cryoablation of the PVs were to the prospective trial. The clinical risk factors and echocardiographic parameters [left atrial (LA) diameter, left ventricular ejection fraction and dimensions, left atrial spontaneous echo contrast (LASEC), mitral annulus calcification (MAC), left atrial appendage emptying peak flow velocity (LAAV), and PV flow] were assessed before the cryoablation procedure. Patients with PAF who refused to use any medication because of intolerance or presentation of resistant symptoms, despite the use of at least one antiarrhythmic drug were enrolled to the study, patients with LA/LAA thrombus on echocardiographic examination, severe valvular disease, pericardial fluid, and abnormal thyroid function tests as well as systemic disease were excluded from the study. All parameters were tested for their ability to predict the recurrence of AF during a 1-year follow-up period. RESULTS During the period of follow-up, AF recurred in 16 of 51 patients (31.3%/year). All significant parameters associated with the recurrence of AF were evaluated in multivariate logistic regression analysis. The presence of MAC (p<0.001) as well as LA diameter (p<0.0001), LAAV of <30 cm/s (p<0.0001), PV flow systolic wave velocity (p<0.0001), and LASEC (p<0.0001) were detected as independent predictors of recurrence. In the receiver operating characteristic analysis, LAAV of >30 cm/s had a sensitivity of 85% and a specificity of 95% for predicting success after ablation (AUC=0.813; 95% CI: 0.76-0.92; p<0.0001). CONCLUSION The presence of MAC, increased LA diameter, the existence of LASEC, low LAAV, and low peak PV systolic wave velocity are parameters that can predict the recurrence of AF after cryoablation.
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Affiliation(s)
- Demet Menekşe Gerede
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey.
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479
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Gerstenfeld EP, Duggirala S. Atrial Fibrillation Ablation: Indications, Emerging Techniques, and Follow-Up. Prog Cardiovasc Dis 2015; 58:202-12. [DOI: 10.1016/j.pcad.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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480
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Dukkipati SR, Cuoco F, Kutinsky I, Aryana A, Bahnson TD, Lakkireddy D, Woollett I, Issa ZF, Natale A, Reddy VY. Pulmonary Vein Isolation Using the Visually Guided Laser Balloon. J Am Coll Cardiol 2015; 66:1350-60. [DOI: 10.1016/j.jacc.2015.07.036] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023]
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481
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Bilchick KC, Mealor A, Gonzalez J, Norton P, Zhuo D, Mason P, Ferguson JD, Malhotra R, Michael Mangrum J, Darby AE, DiMarco J, Hagspiel K, Dent J, Kramer CM, Stukenborg GJ, Salerno M. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm 2015; 13:12-9. [PMID: 26341605 DOI: 10.1016/j.hrthm.2015.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed. OBJECTIVE In patients referred for CTA to evaluate pulmonary vein anatomy before the ablation of atrial fibrillation (AF) or left atrial flutter (LAFL), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. METHODS After making delayed imaging of the LAA part of our routine preablation CTA protocol, we integrated early reporting of preablation CTA LAA imaging results into clinical practice as part of a formal protocol in June 2013. We then analyzed the effectiveness of this protocol by evaluating 320 AF/LAFL ablation patients with CTA imaging during the time period 2012-2014. RESULTS In CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus using intracardiac echocardiography or transesophageal echocardiography (TEE) as the reference standard were both 100%. Intracardiac echocardiography during ablation confirmed the absence of thrombus in patients with negative CTA or negative TEE results. No patients with either negative CTA results or equivocal CTA results combined with negative TEE results had strokes or transient ischemic attacks. Overall, the need for TEE procedures decreased from 57.5% to 24.0% during the 3-year period because of the CTA protocol. CONCLUSION Clinical integration of CTA delayed LAA imaging into the care of patients having catheter ablation of AF or LAFL is feasible, safe, and effective. Such a protocol could be used broadly to improve patient care.
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Affiliation(s)
- Kenneth C Bilchick
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
| | - Augustus Mealor
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Jorge Gonzalez
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Patrick Norton
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - David Zhuo
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Pamela Mason
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - John D Ferguson
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Rohit Malhotra
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - J Michael Mangrum
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew E Darby
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - John DiMarco
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Klaus Hagspiel
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - John Dent
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - George J Stukenborg
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Michael Salerno
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
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482
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LO LIWEI, LIN YENNJIANG, CHANG SHIHLIN, HU YUFENG, CHAO TZEFAN, CHUNG FAPO, LIAO JONAN, CHIOU CHEUNWANG, TSAO HSUANMING, CHEN SHIHANN. Predictors and Characteristics of Multiple (More Than 2) Catheter Ablation Procedures for Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 26:1048-56. [DOI: 10.1111/jce.12748] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/13/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- LI-WEI LO
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - YENN-JIANG LIN
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - SHIH-LIN CHANG
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - YU-FENG HU
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - TZE-FAN CHAO
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - FA-PO CHUNG
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - JO-NAN LIAO
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - CHEUN-WANG CHIOU
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
| | - HSUAN-MING TSAO
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
- National Yang-Ming University Hospital; Ilan Taiwan
| | - SHIH-ANN CHEN
- Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute; National Yang-Ming University; Taipei Taiwan
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483
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Aryana A, Bowers MR, O'Neill PG. Outcomes Of Cryoballoon Ablation Of Atrial Fibrillation: A Comprehensive Review. J Atr Fibrillation 2015; 8:1231. [PMID: 27957187 DOI: 10.4022/jafib.1231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022]
Abstract
Over the last decade, cryoballoon ablation has emerged as an effective alternate strategy to point-by-point radiofrequency ablation for treatment of symptomatic atrial fibrillation. There are several reasons for this. First, the acute and long-term safety and efficacy associated with cryoablation appear comparable to that of radiofrequency ablation in patients with both paroxysmal and also persistent atrial fibrillation. Second, cryoablation offers certain advantages over conventional radiofrequency ablation including a gentler learning curve, shorter ablation and procedure times as well as lack of need for costly electroanatomical mapping technologies commonly utilized with radiofrequency ablation. Lastly, with the recent advent of the second-generation cryoballoon, the effectiveness of cryoablation has further improved dramatically. This comprehensive review examines the gradual evolution of the cryoablation tools as well as the rationale and data in support of the currently-available cryoballoon technologies for catheter ablation of atrial fibrillation.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
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484
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Luik A, Radzewitz A, Kieser M, Walter M, Bramlage P, Hörmann P, Schmidt K, Horn N, Brinkmeier-Theofanopoulou M, Kunzmann K, Riexinger T, Schymik G, Merkel M, Schmitt C. Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation: The Prospective, Randomized, Controlled, Noninferiority FreezeAF Study. Circulation 2015; 132:1311-9. [PMID: 26283655 PMCID: PMC4590523 DOI: 10.1161/circulationaha.115.016871] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 08/06/2015] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. There is a lack of data on the comparative efficacy and procedural safety of open irrigated radiofrequency (RF) and cryoballoon catheter (CB) ablation for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
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Affiliation(s)
- Armin Luik
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.).
| | - Andrea Radzewitz
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Meinhard Kieser
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Marlene Walter
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Peter Bramlage
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Patrick Hörmann
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Kerstin Schmidt
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Nicolas Horn
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Maria Brinkmeier-Theofanopoulou
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Kevin Kunzmann
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Tobias Riexinger
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Gerhard Schymik
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Matthias Merkel
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Claus Schmitt
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
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Khurram IM, Catanzaro JN, Zimmerman S, Zipunnikov V, Berger RD, Cheng A, Sinha S, Dewire J, Marine J, Spragg D, Ashikaga H, Halperin H, Calkins H, Nazarian S. MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1317-24. [PMID: 26171648 DOI: 10.1111/pace.12696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 05/26/2015] [Accepted: 06/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF. METHODS Seventeen patients with AF underwent initial pulmonary vein (PV) isolation (PVI) using RF (n = 7), Cryo (n = 5), and Laser (n = 5). LGE-MRI was performed prior to and at 24 hours and 3 months after PVI. RESULTS In a linear mixed-effects model, accounting for intrapatient clustering of data and interpatient differences in baseline scar, LGE extent was significantly increased at 24 hours postablation (+14.6 ± 1.9% of LA myocardium, P < 0.001), and remained stable from 24 hours to 3 months (+0.12 ± 1.9%, P = 0.951). There was no statistically significant difference between the postablation scar extent among ablation modalities when compared to RF (Cryo +4.5 ± 3.0%, P = 0.123; Laser -3.2 ± 3.0%, P = 0.291). The PV antral LGE intensity was increased by 25.1 ± 3.8% (P<0.001) 24 hours after ablation and additionally increased by 8.1 ± 3.8 at 3 months (P = 0.033). CONCLUSIONS Radiofrequency, Cryo, and laser ablation result in increased LGE extent and intensity at 24 hours and 3 months postablation. No statistically significant difference was noted in the extent of fibrosis induced by any modality.
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Affiliation(s)
- Irfan M Khurram
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John N Catanzaro
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan Zimmerman
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, The Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Ronald D Berger
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Cheng
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunil Sinha
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Dewire
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Marine
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Spragg
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry Halperin
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, Maryland
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486
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Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015. [PMID: 26211828 DOI: 10.1016/s0140-6736(15)60026-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation. METHODS We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. FINDINGS Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry. INTERPRETATION Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice. FUNDING Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).
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Affiliation(s)
- Laurent Macle
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Paul Khairy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rukshen Weerasooriya
- University of Western Australia and Hollywood Private Hospital, Perth, WA, Australia
| | - Paul Novak
- Royal Jubilee Hospital, Victoria, BC, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | | | | | | | | | | | | | - Sylvie Levesque
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jason G Andrade
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lena Rivard
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Peter G Guerra
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marc Dubuc
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Bernard Thibault
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Denis Roy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stanley Nattel
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
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Dukkipati SR, Woollett I, McELDERRY HT, Böhmer MC, Doshi SK, Gerstenfeld EP, Horton R, D'Avila A, Haines DE, Valderrabano M, Mangrum JM, Ruskin JN, Natale A, Reddy VY. Pulmonary Vein Isolation Using the Visually Guided Laser Balloon: Results of the U.S. Feasibility Study. J Cardiovasc Electrophysiol 2015; 26:944-949. [PMID: 26080067 DOI: 10.1111/jce.12727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/25/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Visually guided laser balloon (VGLB) ablation is unique in that the operator delivers ablative energy under direct visual guidance. In this multicenter study, we sought to determine the feasibility, efficacy, and safety of performing pulmonary vein isolation (PVI) using this VGLB. METHODS Patients with symptomatic, drug-refractory paroxysmal atrial fibrillation (AF) underwent PVI using the VGLB with the majority of operators conducting their first-ever clinical VGLB cases. The primary effectiveness endpoint was defined as freedom from treatment failure that included: Occurrence of symptomatic AF episodes ≥1 minutes beyond the 90-day blanking, the inability to isolate 1 superior and 2 total PVs, occurrence of left atrial flutter or atrial tachycardia, or left atrial ablation/surgery during follow-up. RESULTS A total of 86 patients (mean age 56 ± 10 years, 67% male) were treated with the VGLB at 10 US centers. Mean fluoroscopy, ablation, and procedure times were 39.8 ± 24.3 minutes, 205.2 ± 61.7 minutes, and 253.5 ± 71.3 minutes, respectively. Acute PVI was achieved in 314/323 (97.2%) of targeted PVs. Of 84 patients completing follow-up, the primary effectiveness endpoint was achieved in 50 (60%) patients. Freedom from symptomatic or asymptomatic AF was 61%. The primary adverse event rate was 16.3% (8.1% pericarditis, phrenic nerve injury 5.8%, and cardiac tamponade 3.5%). There were no cerebrovascular events, atrioesophageal fistulas, or significant PV stenosis. CONCLUSIONS This multicenter study of operators in the early stage of the learning curve demonstrates that PVI can be achieved with the VGLB with a reasonable safety profile and an efficacy similar to radiofrequency ablation.
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Affiliation(s)
- Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ian Woollett
- Sentara Cardiovascular Research Institute, Norfolk, Virginia
| | | | - Marie-Christine Böhmer
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Edward P Gerstenfeld
- University of California San Francisco School of Medicine, San Francisco, California
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Andre D'Avila
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
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488
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Reddy VY, Dukkipati SR, Neuzil P, Natale A, Albenque JP, Kautzner J, Shah D, Michaud G, Wharton M, Harari D, Mahapatra S, Lambert H, Mansour M. Randomized, Controlled Trial of the Safety and Effectiveness of a Contact Force-Sensing Irrigated Catheter for Ablation of Paroxysmal Atrial Fibrillation: Results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) Study. Circulation 2015; 132:907-15. [PMID: 26260733 DOI: 10.1161/circulationaha.114.014092] [Citation(s) in RCA: 294] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/06/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Contact force (CF) is a major determinant of lesion size and transmurality and has the potential to improve efficacy of atrial fibrillation ablation. This study sought to evaluate the safety and effectiveness of a novel irrigated radiofrequency ablation catheter that measures real-time CF in the treatment of patients with paroxysmal atrial fibrillation. METHODS AND RESULTS A total of 300 patients with symptomatic, drug-refractory, paroxysmal atrial fibrillation were enrolled in a prospective, multicenter, randomized, controlled trial and randomized to radiofrequency ablation with either a novel CF-sensing catheter or a non-CF catheter (control). The primary effectiveness end point consisted of acute electrical isolation of all pulmonary veins and freedom from recurrent symptomatic atrial arrhythmia off all antiarrhythmic drugs at 12 months. The primary safety end point included device-related serious adverse events. End points were powered to show noninferiority. All pulmonary veins were isolated in both groups. Effectiveness was achieved in 67.8% and 69.4% of subjects in the CF and control arms, respectively (absolute difference, -1.6%; lower limit of 1-sided 95% confidence interval, -10.7%; P=0.0073 for noninferiority). When the CF arm was stratified into optimal CF (≥90% ablations with ≥10 g) and nonoptimal CF groups, effectiveness was achieved in 75.9% versus 58.1%, respectively (P=0.018). The primary safety end point occurred in 1.97% and 1.40% of CF patients and control subjects, respectively (absolute difference, 0.57%; upper limit of 1-sided 95% confidence interval, 3.61%; P=0.0004 for noninferiority). CONCLUSIONS The CF ablation catheter met the primary safety and effectiveness end points. Additionally, optimal CF was associated with improved effectiveness. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT01278953.
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Affiliation(s)
- Vivek Y Reddy
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.).
| | - Srinivas R Dukkipati
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Petr Neuzil
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Andrea Natale
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Jean-Paul Albenque
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Josef Kautzner
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Dipen Shah
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Gregory Michaud
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Marcus Wharton
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - David Harari
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Srijoy Mahapatra
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Hendrik Lambert
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
| | - Moussa Mansour
- From Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., S.R.D.); Homolka Hospital, Prague, Czech Republic (P.N.); Texas Cardiac Arrhythmia Institute, Austin (A.N.); Clinique Pasteur, Toulouse, France (J.-P.A.); Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (J.K.); University Hospitals of Geneva, Switzerland (D.S.); Brigham and Women's Hospital, Boston, MA (G.M.); Medical University of South Carolina, Charleston (M.W.); St. Jude Medical Inc, St. Paul, MN (D.H., S.M., H.L.); and Massachusetts General Hospital, Boston (M.M.)
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Effect of cryoballoon inflation at the right superior pulmonary vein orifice on phrenic nerve location. Heart Rhythm 2015; 13:28-36. [PMID: 26272525 DOI: 10.1016/j.hrthm.2015.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cryoballoon catheter ablation was developed to simplify ablation for atrial fibrillation (AF). Initial enthusiasm for its widespread use has been dampened by phrenic nerve (PN) injury (PNI). OBJECTIVE The purpose of this study was to assess the effect of cryoballoon inflation at the right superior pulmonary vein (RSPV) orifice on PN location and to elucidate the potential mechanism of PNI. METHODS Twenty patients with paroxysmal atrial fibrillation underwent ablation performed with a second-generation 28-mm cryoballoon catheter. Before ablation, the pacing-determined PN course was delineated along the right atrium. PN location and its relation to the RSPV as well as RSPV surface distortions after balloon inflation were established with a NavX mapping system. RESULTS During RSPV ablation, the inflated balloon surface extended anteriorly 6.3 ± 1.8 mm outside the RSPV. This narrowed the distance between the PN capture points in the RSPV vs PN location from 11.4 ± 5.0 mm to 7.5 ± 5.0 mm (P = .0002) and increased the PN capture area from 1.9 ± 1.3 cm(2) to 3.2 ± 1.8 cm(2) (P = .0004). Furthermore, the PN capture points shifted toward the orifice within the RSPV and after balloon inflation were located significantly closer to the orifice in the 3 patients with transient PNI than in those without PNI. CONCLUSION Cryoballoon inflation at the RSPV orifice alters PV/left atrial surface geometry, reducing the distance between the energy delivery source and the PN and increasing PN area, possibly explaining the mechanism of PNI. PN pacing within the RSPV after balloon inflation may be useful for preventing PNI.
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490
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Stabile G, De Ruvo E, Grimaldi M, Rovaris G, Soldati E, Anselmino M, Solimene F, Iuliano A, Sciarra L, Schillaci V, Bongiorni MG, Gaita F, Calò L. Safety and efficacy of pulmonary vein isolation using a circular, open-irrigated mapping and ablation catheter: A multicenter registry. Heart Rhythm 2015; 12:1782-8. [DOI: 10.1016/j.hrthm.2015.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Indexed: 11/29/2022]
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491
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Roka A, Heist EK, Refaat M, Ruskin J, Mansour M. Novel Technique to Prevent Phrenic Nerve Injury During Pulmonary Vein Isolation Using Preprocedural Imaging. J Cardiovasc Electrophysiol 2015; 26:1057-62. [PMID: 26183238 DOI: 10.1111/jce.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Phrenic nerve (PN) injury is one of the major complications of pulmonary vein isolation (PVI). Pace mapping for PN capture is routinely used to identify areas with high risk for injury along the anterior border of the right pulmonary veins (PVs). Our aim was to evaluate the feasibility of using preprocedural imaging to identify areas where no PN capture is possible along the anterior border of the right PVs, thus avoiding the need for pace mapping during PVI. METHODS AND RESULTS It was hypothesized that PN capture along the anterior border of the right PVs does not occur in the area where the right and left atria overlap. Three-dimensional segmentation of both atria was performed on preprocedural magnetic resonance and computed tomography angiograms in 40 patients before undergoing PVI. The area of overlap between the right and left atria was delineated. Image registration was performed during the procedure. Using pacing, regions with and without PN capture were marked along the anterior border of the right PVs. A total of 361 points were tested for PN stimulation (9 ± 4 points/patient). PN capture occurred in 97 out of the 189 points (51%) in the area with no overlap between the right and left atria. No PN capture occurred in the area of overlap (172 points, P< 0.001). CONCLUSION Delineation of the area of overlap between the right and left atria derived from preprocedural imaging reliably identifies regions where PN pace capture does not occur. Testing for PN stimulation before ablation may not be necessary in these regions.
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Affiliation(s)
- Attila Roka
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - E Kevin Heist
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan Refaat
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy Ruskin
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moussa Mansour
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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492
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ZHOU GONGBU, GUO XIAOGANG, LIU XU, YANG JIANDU, SUN QI, MA JIAN, ZHANG SHU. Pulmonary Vein Isolation Using the First-Generation Cryoballoon Technique in Chinese Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1073-81. [PMID: 26096255 DOI: 10.1111/pace.12675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/05/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- GONG-BU ZHOU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - XIAO-GANG GUO
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - XU LIU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - JIAN-DU YANG
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - QI SUN
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - JIAN MA
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - SHU ZHANG
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
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493
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MRI Reconstructions of Human Phrenic Nerve Anatomy and Computational Modeling of Cryoballoon Ablative Therapy. Ann Biomed Eng 2015; 44:1097-106. [PMID: 26168718 PMCID: PMC4826664 DOI: 10.1007/s10439-015-1379-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/27/2015] [Indexed: 10/29/2022]
Abstract
The primary goal of this computational modeling study was to better quantify the relative distance of the phrenic nerves to areas where cryoballoon ablations may be applied within the left atria. Phrenic nerve injury can be a significant complication of applied ablative therapies for treatment of drug refractory atrial fibrillation. To date, published reports suggest that such injuries may occur more frequently in cryoballoon ablations than in radiofrequency therapies. Ten human heart-lung blocs were prepared in an end-diastolic state, scanned with MRI, and analyzed using Mimics software as a means to make anatomical measurements. Next, generated computer models of ArticFront cryoballoons (23, 28 mm) were mated with reconstructed pulmonary vein ostias to determine relative distances between the phrenic nerves and projected balloon placements, simulating pulmonary vein isolation. The effects of deep seating balloons were also investigated. Interestingly, the relative anatomical differences in placement of 23 and 28 mm cryoballoons were quite small, e.g., the determined difference between mid spline distance to the phrenic nerves between the two cryoballoon sizes was only 1.7 ± 1.2 mm. Furthermore, the right phrenic nerves were commonly closer to the pulmonary veins than the left, and surprisingly tips of balloons were further from the nerves, yet balloon size choice did not significantly alter calculated distance to the nerves. Such computational modeling is considered as a useful tool for both clinicians and device designers to better understand these associated anatomies that, in turn, may lead to optimization of therapeutic treatments.
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494
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A long-term evaluation of cryoballoon ablation in 205 atrial fibrillation patients: a single center experience. Wien Klin Wochenschr 2015; 127:779-85. [PMID: 26142169 DOI: 10.1007/s00508-015-0816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atrial fibrillation is the most prevalent cardiac arrhythmia with significant healthcare impact with regards to treatment costs, morbidity, and mortality. Many of the focal electrical activities that initiate and sustain atrial fibrillation have been found to reside within or near the pulmonary veins. Consequently, pulmonary vein isolation by catheter ablation has emerged as an effective method to eliminate the focal triggers associated with atrial fibrillation. METHODS In this single-center study, 205 patients were ablated for atrial fibrillation using a cryoballoon catheter and followed-up long-term by retrospective chart examination to evaluate their post-procedural freedom from atrial fibrillation. RESULTS Patients were followed for up to 6 years with a cohort median of 3 years of post-ablation evaluation. Overall, at 12, 24, and 36 months post-ablation, 71, 49, and 31% of evaluated patients were free of atrial fibrillation, respectively. We found the type of atrial fibrillation (paroxysmal vs. persistent) as an independent predictor for arrhythmia recurrence (HR 1.97; 95% CI: 1.24-3.13, P = 0.006). The cohort median atrial fibrillation-free survival time was 24 months (27 months for paroxysmal atrial fibrillation patients and 14 months for persistent atrial fibrillation patients). There were a total of 37 (18%) complications, 8 (3.9%) were categorized as major complications, all without permanent sequels. The most common complication was phrenic nerve palsy which occurred in 14 (6.8%) patients. CONCLUSION Long-term outcomes in this study suggest that the pulmonary vein isolation using the cryoballoon technique is relatively an effective method especially in the treatment of paroxysmal atrial fibrillation.
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495
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496
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Sousa PA, Boveda S, Combes N, Combes S, Albenque JP. Ablation of paroxysmal atrial fibrillation in 2015: radiofrequency or cryoenergy? Interv Cardiol 2015. [DOI: 10.2217/ica.15.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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497
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Wright M, Narayan SM. Ablation of atrial fibrillation. Trends Cardiovasc Med 2015; 25:409-19. [PMID: 25572010 PMCID: PMC4764083 DOI: 10.1016/j.tcm.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 01/08/2023]
Abstract
Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multicenter trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.
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Affiliation(s)
- Matthew Wright
- BHF Centre of Excellence, London, UK; Division of Imaging Sciences and Biomedical Engineering, King׳s College London, King׳s Health Partners, St. Thomas׳ Hospital, London, UK
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498
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Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures. Heart Rhythm 2015; 12:1658-66. [DOI: 10.1016/j.hrthm.2015.03.021] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Indexed: 11/21/2022]
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499
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Aksu T, Baysal E, Guler TE, Golcuk SE, Erden İ, Ozcan KS. Predictors of atrial fibrillation recurrence after cryoballoon ablation. J Blood Med 2015; 6:211-7. [PMID: 26170730 PMCID: PMC4492636 DOI: 10.2147/jbm.s81551] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation (AF). There are conflicting results about the predictors of AF recurrence. The aim of this study is to evaluate the role of hematological indices to predict AF recurrence after CA. Methods A total of 49 patients (mean age 58.3±12.2 years, 51.02% female) with symptomatic paroxysmal AF underwent CA procedure. One hundred and sixty-eight pulmonary veins were used for pulmonary vein isolation with the second-generation cryoballoon. The hematological samples were obtained before and 24 hours after ablation. Results At a mean follow-up of 10.2±2.4 months, the probability of being arrhythmia-free after a single procedure was 86%. Patients with AF recurrence had higher red cell distribution width levels (16.10%±1.44% vs 14.87%±0.48%, P=0.035). The neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein levels were detected in the patients with or without recurrence. Left atrial diameter (46.28±4.30 mm vs 41.02±4.10 mm, P=0.002), duration of AF (6.71±4.57 years vs 3.59±1.72 years, P=0.003), and age (65.01±15.39 years vs 54.29±11.32 years, P=0.033) were the other independent predictors of clinical recurrence after CA. Multiple regression analysis revealed that left atrial diameter was the only independent predictor for AF recurrence (P=0.012). Conclusion In this study of patients with paroxysmal AF undergoing cryoablation, increased preablation red cell distribution width levels, and not C-reactive protein or erythrocyte sedimentation rate, was associated with a higher rate of AF recurrence. Our results support the role of a preablation, proinflammatory, and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Tümer Erdem Guler
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Sukriye Ebru Golcuk
- Department of Cardiology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - İsmail Erden
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kazim Serhan Ozcan
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
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500
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Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan GA, Gulizia M, Halvorsen S, Hindricks G, Kuck KH, Moya A, Potpara T, Roldan V, Tilz R, Lip GY, Gorenek B, Indik JH, Kirchhof P, Ma CS, Narasimhan C, Piccini J, Sarkozy A, Shah D, Savelieva I. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). ACTA ACUST UNITED AC 2015; 17:1197-214. [DOI: 10.1093/europace/euv190] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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