51
|
Kusa S, Hachiya H, Sato Y, Hara S, Ohya H, Miwa N, Yamao K, Iesaka Y, Sasano T. Superior vena cava isolation with 50 W high power, short duration ablation strategy. J Cardiovasc Electrophysiol 2021; 32:1602-1609. [PMID: 33949738 DOI: 10.1111/jce.15060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The optimal ablation strategy is unknown regarding a superior vena cava isolation (SVCI). This study aimed to examine the feasibility and safety and to analyze the lesion characteristics of the SVCI using high-power, short-duration (HPSD) ablation. METHODS AND RESULTS A total of 100 patients underwent an index SVCI using HPSD (n = 50, HPSD group) or conventional lower-power and longer-duration (n = 50, LPLD group) ablation, using the Thermocool Smarttouch SF. In the HPSD group, ablation was performed with a power of 50 W for 7 s, and was limited to 4 s at the lateral segment close to the right phrenic nerve. The ablation setting used in the LPLD group was 20-25 W for 20-30 s and was limited to 10-20 W for 15-30 s at the lateral segment when diaphragmatic capture was seen. An electrical SVCI was achieved in all patients. The HPSD group required a significantly shorter procedure time (10.8 ± 3.2 vs. 14.8 ± 6.4 min; p < .01), shorter radiofrequency duration (49 ± 16 vs. 282 ± 124 s; p < .01), fewer lesions (8.3 ± 2.5 vs. 10.4 ± 4.4; p < .01), and lower ablation index (316 ± 38 vs. 356 ± 62; p < .001) than the LPLD group. The incidence of a postprocedural asymptomatic mild diaphragmatic elevation was comparable (2% in the HPSD group vs. 6% in the LPLD group; p = .61). CONCLUSION The 50-W HPSD ablation strategy allowed for a successful, fast, and safe SVCI with the fewer ablation lesions and the lower ablation index.
Collapse
Affiliation(s)
- Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshikazu Sato
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Satoshi Hara
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Ohya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Naoyuki Miwa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kazuya Yamao
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
52
|
Rattanakosit T, Franke K, Munawar DA, Page AJ, Boyd MA, Lau DH, Mahajan R. Role of Indices Incorporating Power, Force and Time in AF Ablation: A Systematic Review of Literature. Heart Lung Circ 2021; 30:1379-1388. [PMID: 33958295 DOI: 10.1016/j.hlc.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Successful pulmonary vein isolation (PVI) for atrial fibrillation (AF) depends on the formation of durable transmural lesions. Recently, novel indices have emerged to guide lesion delivery. The aim of the systematic review of literature was to determine AF recurrence following ablation guided by indices incorporating force, power and time, and compare acute procedural outcomes and 12-month AF recurrence with ablation guided by contact force (CF) guided only. METHODS PubMed, EMBASE, and Web of Science Core Collection databases were searched on 27 January 2020 using the keywords; catheter ablation, ablation index (AI), lesion size index (LSI), contact force, atrial fibrillation. RESULTS After exclusions, seven studies were included in the analysis. AI-guided catheter ablation was associated with a 91% (n=5, 0.91 95% CI; 0.88-0.93) and 80% (n=5, 0.80, 95% CI; 0.77-0.84) freedom from AF at 12 months with and without the use of anti-arhythmic drugs respectively. As compared to CF guided ablation, AI-guided catheter ablation was associated with a 49% increase in successful first pass isolation (n=3; RR: 1.49, 95% CI; 1.38, 1.61), a 50% decrease in number of acute reconnections (n=4; RR: 0.50, 95% CI; 0.39-0.65) and a 22% (n=4, RR: 1.22, 95% CI; 1.10-1.35) increase in AF freedom without anti-arrhythmic drugs at 12 months. CONCLUSIONS Radiofrequency ablation guided by AI was associated with higher successful first pass isolation and lower rates of acute reconnection which translates to greater freedom from AF at 12 months [CRD42019131469].
Collapse
Affiliation(s)
- Thirakan Rattanakosit
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Kyle Franke
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Dian Andina Munawar
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Amanda J Page
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Rajiv Mahajan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia.
| |
Collapse
|
53
|
Rosso R, Chorin E, Schwartz AL, Levi Y, Hochstadt A, Viskin S. Pulmonary Vein Isolation With Ablation Index via Single Transseptal Crossing: Critical Role of Carina Isolation. Heart Lung Circ 2021; 30:1373-1378. [PMID: 33863667 DOI: 10.1016/j.hlc.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/27/2021] [Indexed: 01/01/2023]
Abstract
AIM Reconnection of the pulmonary veins (PVs) is the most common reason for the recurrence of atrial fibrillation (AF). The ablation index is a marker of ablation lesion quality that achieves high percentages of first-pass isolation and improved AF ablation results. Most operators use a double transseptal approach with confirmation of PV isolation with a circular mapping catheter. In the present study we aimed to show that an ablation index-guided procedure using a single transseptal approach and ablation catheter only would achieve adequate PV isolation while demonstrating the critical role of the carina in PV isolation. METHOD Sixty-six (66) consecutive patients with paroxysmal AF were included. Thirty-four (34) patients underwent wide antral circumferential ablation (WACA-only) and 32 underwent WACA+ (WACA + empiric carina isolation). All procedures were performed via single transseptal approach. Pulmonary vein isolation was confirmed with the use of a circular mapping catheter in both groups. RESULTS Compared to WACA-only, WACA+ increased the odds of PV isolation from 65% to 94% (p=0.011). In the WACA-only procedure, ablation of the carina was needed to achieve PV isolation. At the 18-month follow-up (interquartile range 15.2-20.8 months), freedom from AF was 84% for the entire cohort. CONCLUSIONS Our study confirmed the high success rate of PV isolation using the ablation index and showed that this can be achieved via a single transseptal crossing. Our study confirmed the role of the carina in PV isolation.
Collapse
Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Levi
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
54
|
Osorio J, Hunter TD, Rajendra A, Zei P, Silverstein J, Morales G. Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 2021; 32:1814-1821. [PMID: 33825242 DOI: 10.1111/jce.15028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter-tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1-year clinical success after PAF ablation, including first pass isolation. METHODS Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide-area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10-20 s. Radiofrequency energy was set at 40-45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. RESULTS A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90-day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). CONCLUSION In a real-world setting, first pass isolation was highly predictive of 12-month clinical success after CF-guided ablation in a PAF population.
Collapse
Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Tina D Hunter
- CTI Clinical Trial & Consulting Services, Covington, Kentucky, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul Zei
- Brigham And Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | |
Collapse
|
55
|
Sørensen SK, Johannessen A, Worck R, Hansen ML, Hansen J. Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden: The RACE-AF Randomized Controlled Trial. Circ Arrhythm Electrophysiol 2021; 14:e009573. [PMID: 33835823 PMCID: PMC8136462 DOI: 10.1161/circep.120.009573] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Recurrent paroxysmal atrial fibrillation (AF) after catheter ablation is presumably caused by failure to achieve durable pulmonary vein isolation (PVI). The primary methods of PVI are radiofrequency catheter ablation (RF) and cryoballoon catheter ablation (CRYO), but these methods have not been directly compared with respect to PVI durability and the effect thereof on AF burden (% of time in AF). Methods: Accordingly, we performed a randomized trial including 98 patients (68% male, 61 [55–67] years) with paroxysmal AF assigned 1:1 to PVI by contact-force sensing, irrigated radiofrequency catheter, or second-generation cryoballoon catheter. Implantable cardiac monitors were inserted ≥1 month before PVI for assessment of AF burden and recurrence, and all patients, irrespective of AF recurrence, underwent a second procedure 4 to 6 months after PVI to determine PVI durability. Results: In the second procedure, 152 out of 199 (76%) pulmonary veins (PVs) were found durably isolated after RF and 161 out of 200 (81%) after CRYO (P=0.32), corresponding to durable isolation of all veins in 47% of patients in both groups (P=1.0). Median AF burden before PVI was 5.4% (interquartile range, 0.5%–13.0%) versus 4.0% (0.6%–18.1%), RF versus CRYO (P=0.71), and reduced to 0.0% (0.0%–0.1%) and 0.0% (0.0%–0.5%), respectively (P=0.58)—a reduction of 99.9% (92.9%–100.0%) and 99.3% (85.9%–100.0%; P=0.36). AF burden after PVI significantly correlated to the number of durably isolated PVs (P<0.01), but 9 out of 45 (20%) patients with durable isolation of all veins had recurrence of AF within 4 to 6 months after PVI (excluding a 3-month blanking period). Conclusions: PVI by RF and CRYO produce similar moderate to high PVI durability. Both treatments lead to marked reductions in AF burden, which is related to the number of durably isolated PVs. However, for one-fifth of paroxysmal AF patients, complete and durable PVI was not sufficient to prevent even short-term AF recurrence. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03805555.
Collapse
Affiliation(s)
- Samuel K Sørensen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Arne Johannessen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - René Worck
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Morten L Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Jim Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| |
Collapse
|
56
|
Li MF, Wu J, Jin CL, Chen CF, Xu YZ. Safety and efficacy of high power shorter duration ablation for atrial fibrillation: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e13732. [PMID: 32975347 DOI: 10.1111/ijcp.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection because of insufficient lesions. High power shorter duration ablation (HPSD) was seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF. METHODS The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation. RESULTS A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18-1.37, P < .001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50-0.98, P = .04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): -44.62; 95% CI, -63.00 to -26.23, P < .001], ablation time (WMD: -21.25; 95% CI: -25.36 to -17.13, P < .001), and fluoroscopy time (WMD: -4.13; 95% CI: -7.52 to -0.74, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.64; 95% CI: 0.17-2.39, P = .51). CONCLUSION HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLD. Moreover, major complications and ETI were similar between two groups.
Collapse
Affiliation(s)
- Miao-Fu Li
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
| | - Jing Wu
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| | - Chao-Lun Jin
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
| | - Chao-Feng Chen
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yi-Zhou Xu
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| |
Collapse
|
57
|
Maclean E, Simon R, Ang R, Dhillon G, Ahsan S, Khan F, Earley M, Lambiase PD, Rosengarten J, Chow AW, Dhinoja M, Providencia R, Markides V, Wong T, Hunter RJ, Behar JM. A multi-center experience of ablation index for evaluating lesion delivery in typical atrial flutter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1039-1046. [PMID: 33782987 DOI: 10.1111/pace.14228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. METHODS Thirty-eight patients underwent CTI ablation at two tertiary centers. Operators delivered 682 lesions with a target ablation index (AI) of 600 Wgs. Ablation parameters were recorded every 10-20 ms. Post hoc, Visitags were trisected according to CTI position: inferior vena cava (IVC), middle (Mid), or ventricular (V) lesions. RESULTS There were no complications. 92.1% of patients (n = 35) remained in sinus rhythm after 14.6 ± 3.4 months. For the whole CTI, peak AI correlated with mean impedance drop (ID) (R2 = 0.89, p < .0001). However, analysis by anatomical site demonstrated a non-linear relationship Mid CTI (R2 = 0.15, p = .21). Accordingly, while mean AI was highest Mid CTI (IVC: 473.1 ± 122.1 Wgs, Mid: 539.6 ± 103.5 Wgs, V: 486.2 ± 111.8 Wgs, ANOVA p < .0001), mean ID was lower (IVC: 10.7 ± 7.5Ω, Mid: 9.0 ± 6.5Ω, V: 10.9 ± 7.3Ω, p = .011), and rate of ID was slower (IVC: 0.37 ± 0.05 Ω/s, Mid: 0.18 ± 0.08 Ω/s, V: 0.29 ± 0.06 Ω/s, p < .0001). Mean contact force was similar at all sites; however, temporal fluctuations in contact force (IVC: 19.3 ± 12.0 mg/s, Mid: 188.8 ± 92.1 mg/s, V: 102.8 ± 32.3 mg/s, p < .0001) and catheter angle (IVC: 0.42°/s, Mid: 3.4°/s, V: 0.28°/s, p < .0001) were greatest Mid CTI. Use of a long sheath attenuated these fluctuations and improved energy delivery. CONCLUSIONS Ablation characteristics vary across the CTI. At the Mid CTI, higher AI values do not necessarily deliver more effective ablation; this may reflect localized fluctuations in catheter angle and contact force.
Collapse
Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ron Simon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Richard Ang
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Gurpreet Dhillon
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Syed Ahsan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Fakhar Khan
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mark Earley
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - James Rosengarten
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Mehul Dhinoja
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Rui Providencia
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Vias Markides
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Tom Wong
- Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan M Behar
- Department of Cardiac Electrophysiology, St Bartholomew's Hospital, W Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Electrophysiology, Royal Brompton Hospital, London, UK
| |
Collapse
|
58
|
Tomlinson DR, Biscombe K, True J, Hosking J, Streeter AJ. Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment. J Cardiovasc Electrophysiol 2021; 32:994-1004. [PMID: 33570226 DOI: 10.1111/jce.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND During automated radiofrequency (RF) annotation-guided pulmonary vein isolation (PVI), respiratory motion adjustment (RMA) is recommended, yet lacks in vivo validation. METHODS Following contact force (CF) PVI (continuous RF, 30 W) using general anesthesia and automated RF annotation-guidance (VISITAG™: force-over-time 100% minimum 1 g; 2 mm position stability; ACCURESP™ RMA "off") in 25 patients, we retrospectively examined RMA settings "on" versus "off" at the left atrial posterior wall (LAPW). RESULTS Respiratory motion detection occurred in eight, permitting offline retrospective comparison of RMA settings. Significant differences in LAPW RF auto-annotation occurred according to RMA setting, with curves displaying catheter position, CF and impedance data indicating "best-fit" for catheter motion detection using RMA "off." Comparing RMA "on" versus "off," respectively: total annotated sites, 82 versus 98; median RF duration per-site, 13.3 versus 10.6 s (p < 0.0001); median force time integral 177 versus 130 gs (p = 0.0002); mean inter-tag distance (ITD), 6.0 versus 4.8 mm (p = 0.002). Considering LAPW annotated site 1-to-2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0 g CF demonstrated < 0.6 s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range: 2.1-7.0 mm) demonstrated (mean) site-1 RF duration difference 3.7 s (range: -1.3 to 11.3 s): considering multiple measures of catheter position instability, the appropriate indication of deliberate catheter motion occurred with RMA "off" in all. CONCLUSIONS ACCURESP™ respiratory motion adjustment importantly delayed the identification of deliberate and clinically relevant catheter motion during LAPW RF delivery, rendering auto-annotated RF display invalid. Operators seeking greater accuracy during auto-annotated RF delivery should avoid RMA use.
Collapse
Affiliation(s)
- David R Tomlinson
- South West Cardiothoracic Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Katie Biscombe
- Department of Medical Statistics, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK
| | - John True
- Department of Medical Statistics, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK
| | - Joanne Hosking
- Department of Medical Statistics, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK
| | - Adam J Streeter
- Department of Medical Statistics, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK.,Klinische Epidemiologie, Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| |
Collapse
|
59
|
Lepillier A, Strisciuglio T, De Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, De Simone A, Bertaglia E, Solimene F, Stabile G. Impact of ablation index settings on pulmonary vein reconnection. J Interv Card Electrophysiol 2021; 63:133-142. [PMID: 33570717 DOI: 10.1007/s10840-021-00944-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
Collapse
Affiliation(s)
- A Lepillier
- Centre Cardiologique du Nord, St Denis, Paris, France
| | - T Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,University of Naples Federico II, Naples, Italy
| | | | | | - M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F A Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - D Pecora
- Fondazione Poliambulanza, Brescia, Italy
| | | | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - G Viola
- Ospedale San Francesco, Nuoro, Italy
| | - E Pisanò
- Ospedale Vito Fazzi, Lecce, Italy
| | - S Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | - A Pani
- Ospedale di Lecco, Lecco, Italy
| | | | - G Sgarito
- A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy
| | - A De Simone
- Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy
| | - E Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - F Solimene
- Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy. .,Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. .,Anthea Hospital, Bari, Italy.
| |
Collapse
|
60
|
Adeola O, Al Aboud A, Richardson T, Michaud G. Catheter ablation for atrial fibrillation using the ablation index-high power strategy. Do we have the ideal target? J Cardiovasc Electrophysiol 2021; 32:625-627. [PMID: 33484205 DOI: 10.1111/jce.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Oluwaseun Adeola
- Arrhythmia Section, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Asad Al Aboud
- Arrhythmia Section, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis Richardson
- Arrhythmia Section, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory Michaud
- Arrhythmia Section, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
61
|
Tscholl V, Kamieniarz P, Nagel P, Landmesser U, Attanasio P, Huemer M. The use of a high-power (50 W), ablation index-guided protocol for ablation of the cavotricuspid isthmus. J Arrhythm 2020; 36:1045-1050. [PMID: 33335623 PMCID: PMC7733584 DOI: 10.1002/joa3.12443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/30/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High-power (HP) ablation protocols are increasingly used for ablation procedures to shorten procedural times and improve short- and long-term success. The ablation index (AI) combines contact force, power settings, and ablation time. It can be used in combination with HP protocols to guide operators toward standardized lesions. The purpose of this study was to evaluate both a HP and AI-guided strategy for ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL). METHODS In this single-center study, consecutive patients with typical AFL (n = 52, mean age 68.7 ± 8.3 years, 21/52 [40.4%] female) underwent AI-guided HP radiofrequency (RF) ablation of the CTI. Ablation was performed with 50 W and AI target values of 550 with a maximum ablation duration of 25 seconds per lesion. Target interlesion distance was ≤6 mm. Ablation was performed with a 3.5 mm porous tip Smarttouch SF catheter. RESULTS Acute CTI block was achieved in 52 of 52 patients (100%), and first-pass conduction block was achieved in 41 of 52 patients (80.4%). Spontaneous reconduction after 30 minutes waiting time occurred in 1 of 52 (1.9%) patient. Average ablation time until CTI block was 3:51 ± 1:40; 2:33 ± 1:01 minutes of bonus ablation pulses were applied after CTI block. An audible steam pop was noted in one patient (1.9%). No major complications occurred. After a mean follow-up of 193.7 ± 152.2 days, no patient showed recurrence of typical AFL. CONCLUSION In this pilot study, AI-guided HP ablation of the CTI was fast, safe, and effective.
Collapse
Affiliation(s)
- Verena Tscholl
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| | - Paul Kamieniarz
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| | - Patrick Nagel
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| | - Ulf Landmesser
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| | - Philipp Attanasio
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| | - Martin Huemer
- Department of CardiologyCharité Universitaetsmedizin Berlin, Campus Benjamin FranklinBerlinGermany
| |
Collapse
|
62
|
Virk S, Kumar S. The quandary of study design in evaluating effectiveness of contact force sensing catheter in atrial fibrillation ablation: Authors' reply. Europace 2020; 22:840. [PMID: 32170947 DOI: 10.1093/europace/euaa022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sohaib Virk
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| |
Collapse
|
63
|
Wang Y, Zhou G, Chen S, Wei Y, Lu X, Xu J, Wu X, Liu S. Tailored ablation index for pulmonary vein isolation according to wall thickness within the ablation circle. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:575-585. [PMID: 33184894 DOI: 10.1111/pace.14125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ablation index (AI), a novel lesion quality marker, includes contact force, time, and power of radiofrequency (RF) application, but not regional variation in wall thickness within the wide antral catheter ablation (WACA) circle. This study explored the relationships among AI target value, atrial wall thickness, and gap formation within the WACA circle in patients with paroxysmal atrial fibrillation (PAF). METHODS We evaluated 102 consecutive patients (mean age, 65 ± 9 years) with PAF who underwent AI-guided WACA for ipsilateral pulmonary vein isolation (PVI). Each WACA circle was subdivided into eight segments, and overall 7143 RF applications were delivered, including 125 gaps in PVI ablation lines. For each RF tag within the ablation circle, we collected data on ablation lesion depth surrogates (time of application, delivery power, impedance drop, average contact force, force-time integral [FTI], and AI) and left atrial wall thickness measured by multidetector computer tomography scanning. RESULTS The anterior and roof walls were the thickest segments of the ablation circle, in which 85.8% of gaps concentrated, while the posterior and inferior walls were the thinnest. Gap formation was significantly associated with FTI, AI, wall thickness, FTI/wall thickness, and AI/wall thickness. AI/wall thickness had the highest predictive value for gap formation, with a cutoff of 195.6 au/mm for effective ablation. CONCLUSIONS In AI-guided PVI of PAF, AI/wall thickness by normalizing myocardial thickness variation along the WACA circle was a strong predictor of gap formation, with a target of 195.6 au/mm appearing suitable for effective ablation.
Collapse
Affiliation(s)
- Yong Wang
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Cardiology, The Second People's Hospital of Wuhu, Anhui, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Wu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| |
Collapse
|
64
|
Kristiansen SB, Shafaq A, Tofig BJ, Gerdes C, Jensen HK, Kristensen J, Parner ET, Lukac P. Repeat pulmonary vein isolation in patients with atrial fibrillation: low ablation index is associated with increased risk of recurrent arrhythmia. SCAND CARDIOVASC J 2020; 55:29-34. [PMID: 33073633 DOI: 10.1080/14017431.2020.1831051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to investigate the predictors of recurrent arrhythmia after repeated pulmonary vein isolation (PVI) performed in the era of contact force without additional substrate ablation. One of the predictors studied, ablation index (AI), incorporates power, contact force, and time in a weighted formula and is reported to predict lesion size in animals. Design. Consecutive patients (n = 108) undergoing repeat PVI without additional substrate modification using a contact force sensing catheter were included retrospectively at a tertiary center. All ablation points were analyzed offline. A new variable, normalized AI (AI corrected for the location of the lesion-anterior vs. posterior) was calculated. The patients were systematically followed with clinical visit and 12-lead ECG as well as review of the regional electronic patient files at 3 and 12 months after the procedure with 5-day Holter at 12 months. Results. Electrical reconnection to at least one pulmonary vein (PV) was seen in 97% of the patients. The recurrence rate was 35%. There was no recurrence in patients with nAI above 1.15 (n = 26). Patients with electrical reconnection of up to two PVs had a higher risk of recurrence compared with patients having electrical reconnection of three or four PVs (p = .003), and this risk was especially high in patients with persistent atrial fibrillation (69 [39-91]%). Conclusions. The risk of recurrence is higher in patients with ablations performed with low levels of AI and in patients with reconnection to up to two PVs. Our data may indicate the need for higher target levels of AI during repeat PVI than normally used during de-novo PVI.
Collapse
Affiliation(s)
| | - Ajmal Shafaq
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bawer J Tofig
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik T Parner
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
65
|
Pearman CM, Redfern J, Williams EA, Snowdon RL, Modi P, Hall MCS, Modi S, Waktare JEP, Mahida S, Todd DM, Mediratta N, Gupta D. Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation. Europace 2020; 21:738-745. [PMID: 30753411 PMCID: PMC6479510 DOI: 10.1093/europace/euy303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
Collapse
Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, 3.14 Core Technology Facility, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Emmanuel A Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Johan E P Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Derick M Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| |
Collapse
|
66
|
Sasaki T, Nakamura K, Inoue M, Minami K, Miki Y, Goto K, Take Y, Kaseno K, Yamashita E, Koyama K, Naito S. Optimal local impedance drops for an effective radiofrequency ablation during cavo-tricuspid isthmus ablation. J Arrhythm 2020; 36:905-911. [PMID: 33024468 PMCID: PMC7532274 DOI: 10.1002/joa3.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A novel ablation catheter capable of local impedance (LI) monitoring (IntellaNav MiFi OI, Boston Scientific) has been recently introduced to clinical practice. We aimed to determine the optimal LI drops for an effective radiofrequency ablation during cavo-tricuspid isthmus (CTI) ablation. METHODS This retrospective observational study enrolled 50 consecutive patients (68 ± 9 years; 34 males) who underwent a CTI ablation using the IntellaNav MiFi OI catheter, guided by Rhythmia. The LI at the start of radiofrequency applications (initial LI) and minimum LI during radiofrequency applications were evaluated. The absolute and percentage LI drops were defined as the difference between the initial and minimum LIs and 100× absolute LI drop/initial LI, respectively. RESULTS A total of 518 radiofrequency applications were analyzed. The absolute and percentage LI drops were significantly greater at effective ablation sites than ineffective sites (median, 15 ohms vs 8 ohms, P < .0001; median, 14.7% vs 8.3%, P < .0001). A receiver-operating characteristic analysis demonstrated that at optimal cutoffs of 12 ohms and 11.6% for the absolute and percentage LI drops, the sensitivity and specificity for predicting the effectiveness of the ablation were 66.5% and 88.2%, and 65.1% and 88.2%, respectively. Finally, bidirectional conduction block along the CTI was achieved in all patients. CONCLUSIONS During the LI-guided CTI ablation, the effective RF ablation sites exhibited significantly greater absolute and percentage LI drops than the ineffective RF ablation sites. Absolute and percentage LI drops of 12 ohms and 11.6% may be suitable targets for effective ablation.
Collapse
Affiliation(s)
- Takehito Sasaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Mitsuho Inoue
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kentaro Minami
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yuko Miki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Koji Goto
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yutaka Take
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kenichi Kaseno
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Eiji Yamashita
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Keiko Koyama
- Division of Radiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Shigeto Naito
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| |
Collapse
|
67
|
Esophageal Endoscopy After Catheter Ablation of Atrial Fibrillation Using Ablation-Index Guided High-Power. JACC Clin Electrophysiol 2020; 6:1253-1261. [DOI: 10.1016/j.jacep.2020.05.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
|
68
|
Yazaki K, Ejima K, Higuchi S, Yagishita D, Shoda M, Hagiwara N. Regional differences in the effects of the ablation index and interlesion distance on acute electrical reconnections after pulmonary vein isolation. J Arrhythm 2020; 36:912-919. [PMID: 33024469 PMCID: PMC7532268 DOI: 10.1002/joa3.12397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In pulmonary vein isolation, the regional differences in the ablation index (AI) and interlesion distance (ILD) remain unclear. This study aimed to evaluate the association between the AI, ILD, and other relevant indices with pulmonary vein reconnections (PVRs) during the surgical intervention with a focus on the heterogeneous regional variability through a retrospective analysis. METHODS We divided the wide area circumferential ablation (WACA) region into 12 segments in 32 consecutive patients, which resulted in a 384 segment analysis to evaluate the association of the minimum AI (AI min) and maximum ILD (ILD max) with acute PVRs, which were defined as spontaneous PVRs or dormant conduction after adenosine triphosphate administration. RESULTS Acute PVRs were observed in 48 (13%) segments and 40 (63%) WACA regions. The AI min was significantly lower and ILD max greater in segments with PVRs than in those without (372 vs 403 au and 6.5 vs 5.7 mm, respectively). PVRs were more frequent in the left posterior segments, adjacent to the esophagus, than in other segments (23% vs 10%, respectively). Notably, ILD max was significantly greater in the left posterior segments with acute PVRs with AI min < 297 (median; 6.5 vs 5.1 mm); a similar finding was not observed when with AI min ≥ 297. CONCLUSION Smaller ILD may prevent acute PVRs when the AI min is low in the left posterior segments.
Collapse
Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
| | - Koichiro Ejima
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University School of Medicine Shinjuku-ku Japan
| | - Satoshi Higuchi
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
| | - Daigo Yagishita
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
| | - Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University School of Medicine Shinjuku-ku Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Shinjuku-ku Japan
| |
Collapse
|
69
|
Kobayashi S, Fukaya H, Oikawa J, Saito D, Sato T, Matsuura G, Arakawa Y, Shirakawa Y, Nishinarita R, Horiguchi A, Ishizue N, Kishihara J, Niwano S, Ako J. Optimal interlesion distance in ablation index-guided pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2020; 62:123-131. [PMID: 32975734 DOI: 10.1007/s10840-020-00881-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Ablation index (AI) is a useful tool of the CARTO® system to make effective lesions during pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the optimal distance between neighboring ablation points (interlesion distance (ILD)) is still unclear. Here, we evaluated the optimal ILDs in the AI-guided PVI. METHODS Forty-nine AF patients who underwent AI-guided PVI in our institute from July 2018 to March 2019 were retrospectively enrolled in this study. Target AI was set at 500 and 400 for anterior and posterior walls, respectively, and we compared the ILDs with and without electrical gaps after a first encircling PVI. RESULTS In both PV, the ILDs with electrical gaps were longer than those without electrical gaps. The best cutoff values of ILD to detect the electrical gaps using the ROC curve were 5.4 mm for the RPV anterior wall (AUC, 0.67; sensitivity, 0.42; specificity, 0.84, P < 0.01) and 4.4 mm for the RPV posterior wall (AUC, 0.68; sensitivity, 0.91; specificity, 0.39, P < 0.01). Similarly, the best cutoff values of ILD were 5.5 mm for the LPV anterior wall (AUC, 0.74; sensitivity, 0.65; specificity, 0.82, P < 0.01) and 5.1 mm for the LPV posterior wall (AUC, 0.67; sensitivity, 0.79; specificity, 0.53, P =0.03). CONCLUSION The optimal interlesion distances for PVI were different in each PV segment. To achieve the first-pass isolation, less than 5.4/4.4 mm for the RPV anterior/posterior and 5.5/5.1 mm for the LPV anterior/posterior walls of interlesion distances were the best cutoff values in the patients with AF.
Collapse
Affiliation(s)
- Shuhei Kobayashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan.
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Arakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Shirakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ryo Nishinarita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ai Horiguchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| |
Collapse
|
70
|
Kaneshiro T, Kamioka M, Hijioka N, Yamada S, Yokokawa T, Misaka T, Hikichi T, Yoshihisa A, Takeishi Y. Characteristics of Esophageal Injury in Ablation of Atrial Fibrillation Using a High-Power Short-Duration Setting. Circ Arrhythm Electrophysiol 2020; 13:e008602. [PMID: 32915644 DOI: 10.1161/circep.120.008602] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanism of esophageal thermal injury (ETI; esophageal mucosal injury and periesophageal nerve injury leading to gastric hypomotility) remains unknown when using a high-power short-duration (HP-SD) setting. This study sought to evaluate the characteristics of esophageal injuries in atrial fibrillation ablation using a HP-SD setting. METHODS After exclusion of 5 patients with their esophagus at the right portion of left atrium and 21 patients with additional ablations such as box isolation and low voltage area ablation in left atrium posterior wall, 271 consecutive patients (62±10 years, 56 women) who underwent pulmonary vein isolation by radiofrequency catheter ablation were analyzed. In the 101 patients, a HP-SD setting at 45 to 50 W with an Ablation Index module was used (HP-SD group). In the remaining 170 patients before introduction of the HP-SD setting, a conventional power setting of 20 to 30 W with contact force monitoring was used (conventional group). We performed esophagogastroduodenoscopy after pulmonary vein isolation in all patients and investigated the incidence and characteristics of ETI. RESULTS Although the incidence of ETI was significantly higher in the HP-SD group compared with the conventional group (37% versus 22%, P=0.011), the prevalence of esophageal lesions did not differ between the groups (7% versus 8%). Multivariate logistic regression analysis revealed that the use of the HP-SD setting (odds ratio, 6.09, P<0.001), and the parameters that suggest anatomic proximity surrounding the esophagus, were independent predictors of ETI. However, the majority of ETI in the HP-SD group was gastric hypomotility, and the thermal injury was limited to the shallow layer of the periesophageal wall using the HP-SD setting. CONCLUSIONS Although the use of the HP-SD setting was a strong predictor of ETI, it could avoid deeper thermal injuries that reach the esophageal mucosal layer.
Collapse
Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
- Department of Arrhythmia and Cardiac Pacing (T.K., Y.T.), Fukushima Medical University, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
| | - Takuto Hikichi
- Department of Endoscopy (T.H.), Fukushima Medical University, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
- Department of Advanced Cardiac Therapeutics (A.Y., Y.T.), Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine (T.K., M.K., N.H., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Japan
- Department of Arrhythmia and Cardiac Pacing (T.K., Y.T.), Fukushima Medical University, Japan
- Department of Advanced Cardiac Therapeutics (A.Y., Y.T.), Fukushima Medical University, Japan
| |
Collapse
|
71
|
Virk SA, Ariyaratnam J, Bennett RG, Kumar S. Updated systematic review and meta-analysis of the impact of contact force sensing on the safety and efficacy of atrial fibrillation ablation: discrepancy between observational studies and randomized control trial data. Europace 2020; 21:239-249. [PMID: 30544134 DOI: 10.1093/europace/euy266] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Despite widespread adoption of contact force (CF) sensing technology in atrial fibrillation (AF) ablation, randomized data suggests lack of improvement in clinical outcomes. We aimed to assess the safety and efficacy of CF-guided vs. non CF-guided AF ablation. Methods and results Electronic databases were searched for randomized controlled trials (RCTs) and controlled observational studies (OS) comparing outcomes of AF ablation performed with vs. without CF guidance. The primary efficacy endpoint was freedom from AF at follow-up. The primary safety endpoint was major peri-procedural complications. Secondary endpoints included procedural, fluoroscopy, and ablation duration. Subgroup analyses were performed by AF type and study design. Nine RCTs (n = 903) and 26 OS (n = 8919) were included. Overall, CF guidance was associated with improved freedom from AF [relative risk (RR) 1.10; 95% confidence interval (CI) 1.02-1.18], and reduced total procedure duration [mean difference (MD) 15.33 min; 95% CI 6.98-23.68], ablation duration (MD 3.07 min; 95% CI 0.29-5.84), and fluoroscopy duration (MD 5.72 min; 95% CI 2.51-8.92). When restricted to RCTs however, CF guidance neither improved freedom from AF (RR 1.03; 95% CI 0.95-1.11), independent of AF type, nor did it reduce procedural, fluoroscopy, or ablation duration. Contact force guidance did not reduce the incidence of major peri-procedural complications (RR 0.89; 95% CI 0.64-1.24). Conclusion Meta-analysis of randomized data demonstrated that CF guidance does not improve the safety or efficacy of AF ablation, despite initial observational data showing dramatic improvement. Rigorous evaluation in randomized trials is needed before widespread adoption of new technologies.
Collapse
Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | | | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia
| |
Collapse
|
72
|
Miyazaki Y, Hirayama Y, Adachi K, Kawata M. Effect of the interatrial connection on the isolation line of the right pulmonary vein. HeartRhythm Case Rep 2020; 6:583-587. [PMID: 32983871 PMCID: PMC7498505 DOI: 10.1016/j.hrcr.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
73
|
Du Z, Hu F, Wu L, Zheng L, Ding L, Liang E, Chen G, Yao Y. Single transseptal puncture technique and contact force catheter: A simplified ablation strategy for paroxysmal atrial fibrillation. Exp Ther Med 2020; 20:2611-2616. [PMID: 32793307 PMCID: PMC7418501 DOI: 10.3892/etm.2020.9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/01/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to evaluate the safety and efficacy of an optimized single transseptal puncture technique and contact force sensing atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) strategy within a clinical setting. Fast anatomic mapping and contact force sensing ablation was applied to patients with paroxysmal AF (PAF) ablation between September 2014 and December 2016 using a single trans-septal sheath. Pulmonary vein isolation (PVI) and linear ablation were performed in PAF individually with a 10-20 g contact force with minimal fluoroscopy. Stimulation with 10 mA outputs on the lesions without capture was used as endpoint. A total of 419 consecutive patients who underwent first-time RFCA were enrolled in the current study, and acute PVI was achieved in all patients. The average procedure time was 74.5±9.7 min, with an average ablation time of 27.3±7.8 min. The average fluoroscopy time was 4.7±3.3 min and the average radiation dose was 24.3±25.2 mGy. At a mean follow-up time of 14.5 ± 4.1 months, sinus rhythm was maintained at 85.0%. Cardiac tamponade occurred in one case. The results indicated that this simplified technique was a simple, safe and effective approach for PAF ablation therapy.
Collapse
Affiliation(s)
- Zhongpeng Du
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Feng Hu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lingmin Wu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Ligang Ding
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Erpeng Liang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Gang Chen
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| |
Collapse
|
74
|
Chin SH, O'Brien J, Epicoco G, Peddinti P, Gupta A, Modi S, Waktare J, Snowdon R, Gupta D. The feasibility and effectiveness of a streamlined single-catheter approach for radiofrequency atrial fibrillation ablation. J Arrhythm 2020; 36:685-691. [PMID: 32782640 PMCID: PMC7411237 DOI: 10.1002/joa3.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol. METHODS A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre- and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block. RESULTS The CMC-free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148 ± 32 minutes, ablation time of 27.5 ± 5.7 minutes, and fluoroscopy time of 7.8 ± 1.0 minutes. First-pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF. The CMC-free approach resulted in a cost saving of £47,190. CONCLUSION A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, and is associated with excellent clinical outcomes at 1 year.
Collapse
Affiliation(s)
- Shui Hao Chin
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Jim O'Brien
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Gianluca Epicoco
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | | | | | - Simon Modi
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Johan Waktare
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Richard Snowdon
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Dhiraj Gupta
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
- School of MedicineUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
75
|
Hoffmann P, Diaz Ramirez I, Baldenhofer G, Stangl K, Mont L, Althoff TF. Randomized study defining the optimum target interlesion distance in ablation index-guided atrial fibrillation ablation. Europace 2020; 22:1480-1486. [DOI: 10.1093/europace/euaa147] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
While the CLOSE protocol proposes a maximally tolerable interlesion distance (ILD) of 6 mm for ablation index ablation index-guided atrial fibrillation (AF) ablation, a target ILD has never been defined. This randomized study sought to establish a target ILD for ablation index-guided AF ablation.
Methods and results
Consecutive patients scheduled for first-time pulmonary vein (PV) isolation (PVI) were randomly assigned to ablation protocols with a target ILD of 5.0–6.0 mm or 3.0–4.0 mm, with the primary endpoint of first-pass PVI. In compliance with the CLOSE protocol, the maximum tolerated ILD was 6.0 mm in both study protocols. A target ablation index of ≥550 (anterior) or ≥400 (posterior) was defined for the ‘5–6 mm’ protocol and ≥500 (anterior) or ≥350 (posterior) for the ‘3–4 mm’ protocol. The study was terminated early for superiority of the ‘3–4 mm’ protocol. Forty-two consecutive patients were randomized and 84 ipsilateral PV pairs encircled according to the study protocol. First-pass PVI was accomplished in 35.0% of the ‘5–6 mm’ group and 90.9% of the ‘3–4 mm’ group (P < 0.0001). Median ILD was 5.2 mm in the ‘5–6 mm’ group and 3.6 mm in the ‘3–4 mm’ group (P < 0.0001). In line with the distinct ablation index targets, median ablation index was lower in the ‘3–4 mm’ group (416 vs. 452, P < 0.0001). While mean procedure time was shorter in the ‘3–4 mm’ group (149 ± 27 vs. 167 ± 33min, P = 0.004), fluoroscopy times did not differ significantly (4.7 ± 2.2 vs. 5.1 ± 1.8 min, P = 0.565).
Conclusion
In ablation index-guided AF ablation, an ILD of 3.0–4.0 mm should be targeted rather than 5.0–6.0 mm. Moreover, the lower target ILD may allow for less extensive ablation at each given point.
Collapse
Affiliation(s)
- Philipp Hoffmann
- Department of Cardiology and Angiology, Charité—University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ivan Diaz Ramirez
- Department of Cardiology and Angiology, Charité—University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerd Baldenhofer
- Department of Cardiology and Angiology, Charité—University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charité—University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Lluís Mont
- Hospital Clínic Atrial Fibrillation Unit (UFA), Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Till F Althoff
- Department of Cardiology and Angiology, Charité—University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Hospital Clínic Atrial Fibrillation Unit (UFA), Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| |
Collapse
|
76
|
Mulder MJ, Kemme MJB, Hagen AMD, Hopman LHGA, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation. IJC HEART & VASCULATURE 2020; 29:100574. [PMID: 32642554 PMCID: PMC7334811 DOI: 10.1016/j.ijcha.2020.100574] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
Ablation Index-guided ablation allows for ablation lesions of consistent depth. Ablation Index-guided ablation is limited by ignoring local wall thickness. Local atrial wall thickness is associated with acute pulmonary vein reconnection. Wall thickness adjusted Ablation Index targets may improve ablation outcomes.
Background Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI.
Collapse
Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| |
Collapse
|
77
|
Kukendrarajah K, Papageorgiou N, Jewell P, Hunter RJ, Ang R, Schilling R, Providencia R. Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials. J Cardiovasc Electrophysiol 2020; 31:2192-2205. [PMID: 32495462 DOI: 10.1111/jce.14598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
AIMS We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined.
Collapse
Affiliation(s)
- Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Paul Jewell
- Department of Critical Care, Royal Free Hospital, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - Rui Providencia
- The Farr Institute of Health Informatics Research, University College London, London, UK
| |
Collapse
|
78
|
Mulder MJ, Kemme MJB, Götte MJW, van de Ven PM, Hauer HA, Tahapary GJM, van Rossum AC, Allaart CP. Differences between gap-related persistent conduction and carina-related persistent conduction during radiofrequency pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:1616-1627. [PMID: 32406138 PMCID: PMC7383882 DOI: 10.1111/jce.14544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND During pulmonary vein isolation (PVI), nonisolation after initial encircling of the pulmonary veins (PVs) may be due to gaps in the initial ablation line, or alternatively, earliest PV activation may occur on the intervenous carina and ablation within the wide-area circumferential ablation (WACA) circle is needed to eliminate residual conduction. This study investigated prognostic implications and predictors of gap-related persistent conduction (gap-RPC) and carina-related persistent conduction (carina-RPC) during PVI. METHODS AND RESULTS Two hundred fourteen atrial fibrillation (AF) patients (57% paroxysmal, 61% male, mean age 62 ± 9 years) undergoing first contact force-guided radiofrequency PVI were studied. Preprocedural cardiac computed tomography imaging was used to assess left atrial and PV anatomy. PVI was assessed directly after initial WACA circle creation, after a minimum waiting period of 30 minutes, and after adenosine infusion. Persistent conduction was targeted for additional ablation and classified as gap-RPC or carina-RPC, depending on the earliest activation site. The 1-year AF recurrence rate was higher in patients with gap-RPC (47%) compared to patients without gap-RPC (28%; P = .003). No significant difference in 1-year recurrence rate was found between patients with carina-RPC (37%) and patients without carina-RPC (31%; P = .379). Multivariate analyses identified paroxysmal AF and WACA circumference as independent predictors of gap-RPC, whereas carina width and WACA circumference correlated with carina-RPC. CONCLUSIONS Gap-RPC is associated with increased AF recurrence risk after PVI, whereas carina-RPC does not predict AF recurrence. Moreover, gap-RPC and carina-RPC have different correlates and may thus have different underlying mechanisms.
Collapse
Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Location Amsterdam Zuid, Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
79
|
Zhang ZW, Zhang P, Jiang RH, Liu Q, Sun YX, Yu L, Lin JW, Chen SQ, Sheng X, Fu GS, Jiang CY. Risk of esophageal thermal injury during catheter ablation for atrial fibrillation guided by different ablation index. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:633-639. [PMID: 32419141 DOI: 10.1111/pace.13941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/24/2020] [Accepted: 05/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND During ablation for atrial fibrillation (AF), energy delivery toward the left atrial posterior wall may cause esophageal injury (EI). Ablation index (AI) was introduced to estimate ablation lesion size, however, the impact of AI technology on the risk of EI has not been explored. METHOD From March 2019 to December 2019, 60 patients with paroxysmal AF undergoing first-time ablation were prospectively enrolled. The first 30 consecutive patients were ablated with the AI target value of 400 (AI-400 group), and the later 30 consecutive patients were ablated with the AI target value of 350 at the posterior wall (AI-350 group). Endoscopic ultrasonography was used to evaluate EI postablation. EI was classified as a category 1 (erythema or erosion) or a category 2 (hematoma or ulceration). RESULTS Compared with the AI-400 group (59.9 ± 8.4 years; male, 60%), the AI-350 group (59.1 ± 9.9 years; male, 50%) had a lower incidence of EI (3.3% vs 26.7%, P = .03). There was no significant difference in the percentage of first-pass PVI between the AI-400 group and the AI-350 group (left PVI: 80% vs 73.4%, P = .54; right PVI: 80% vs 60%, P = .1). Neither ablation time nor fluoroscopy time was significantly different between the AI-400 group and the AI-350 group. CONCLUSIONS AF ablation guide by AI target value of 350 may reduce esophageal thermal injury and has a similar efficiency on the acute success rate of first-pass PVI compared with an AI target value of 400 at the posterior wall.
Collapse
Affiliation(s)
- Zu-Wen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ru-Hong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Xun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Wei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shi-Quan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen-Yang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and, Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang, China
| |
Collapse
|
80
|
Rationale and study design for ablation of paroxysmal atrial fibrillation guided by ablation index: a multi-center, prospective randomized trial (PAF-AI trial). J Interv Card Electrophysiol 2020; 60:439-444. [PMID: 32394103 DOI: 10.1007/s10840-020-00763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation, but long-term success rates remains suboptimal, due in large part to late PV reconnection and insufficient ostial substrate modification. OBJECTIVE To evaluate whether ablation index (AI)-guided PVI with electrical isolation and quantified ostial substrate modification improves clinical outcomes when compared with contact force (CF)-guided ablation in patients with paroxysmal atrial fibrillation (PAF). METHODS The PAF-AI trial (ChiCTR1900022041) is a prospective, multi-center, randomized controlled clinical trial enrolling patients with PAF with an indication for catheter ablation. Patients are randomized into a 2:1 fashion to two treatment arms: AI-guided PVI (n = 151) and CF-guided PVI (n = 75). In the AI-guided PVI group, real-time automated display of radiofrequency applications (Visitag™) is used with AI ≥ 500 recommended at the anterior/superior/inferior walls and 350-400 at the posterior wall. In CF-guided PVI group, the value and direction of CF are displayed, with the lesion dots manually annotated. The primary endpoint is the freedom from AF recurrence at 12 months following ablation, without antiarrhythmic drug. The primary pre-specified secondary endpoints include intraprocedural efficiency and peri-procedural complications. CONCLUSIONS PAF-AI trial compares the effectiveness and safety of two different strategies of PVI in patients with PAF, AI-guided PVI versus more established CF-guided PVI. This prospective, multi-center, randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to evaluate the impact of AI-guided strategy on AF ablation compared with the current standard of care RF ablation approach.
Collapse
|
81
|
Stabile G, Lepillier A, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Viola G, Rossi L, De Santis V, Landolina M, Castro A, Grimaldi M, Badenco N, Del Greco M, De Simone A, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, Dugo D, Bertaglia E, Strisciuglio T, Solimene F. Reproducibility of pulmonary vein isolation guided by the ablation index: 1-year outcome of the AIR registry. J Cardiovasc Electrophysiol 2020; 31:1694-1701. [PMID: 32369225 DOI: 10.1111/jce.14531] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single-procedure arrhythmia-free survival in single-center studies. This prospective, multi-center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. METHODS A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330-450 or 380-500 at anterior wall or posterior wall, respectively). RESULTS At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330-450, 12.2% in group ST 380-500, 14.9% in group STSF330-450, 9.4% in group STSF380-500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1-year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. CONCLUSIONS An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1-year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.
Collapse
Affiliation(s)
- Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Clinica San Michele, Maddaloni, Caserta, Italy.,Anthea Hospital, Bari, Italy
| | | | | | | | - Matteo Anselmino
- Department of Medical Sciences, A. O. U. Citta della Salute e della Scienza di Torino, University of Turin, Italy
| | | | | | | | | | | | - Luca Rossi
- Ospedale Civili Guglielmo da Saliceto, Piacenza, Italy
| | | | | | | | - Massimo Grimaldi
- Ospedale Regionale Miulli, Acquaviva delle Fonti, Metropolitan City of Bari, Italy
| | | | | | | | | | - Salim Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | | | | | | | - Daniela Dugo
- AUO Policlinico Vittorio Emanuele, Catania, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padua, Italy
| | - Teresa Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | |
Collapse
|
82
|
van Rosmalen F, Delhaas T, Dagres N, Arbelo E, Blomström-Lundqvist C, Crijns HJGM, Da Costa A, Pytkowski M, Sharikov N, Laroche C, Tavazzi L, Brugada J, Pison L. Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry. J Interv Card Electrophysiol 2020; 60:395-406. [PMID: 32356163 PMCID: PMC8134287 DOI: 10.1007/s10840-020-00744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
Background Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety. Methods The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared. Results Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991). Conclusions The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
Collapse
Affiliation(s)
- Frank van Rosmalen
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antoine Da Costa
- C.H.U. de Saint Etienne, Hôpital Nord, Saint-Priest-en-Jarez, France
| | - Mariusz Pytkowski
- Heart Rhythm Division of the 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warszawa, Poland
| | - Nikita Sharikov
- Department of Surgical Treatment of Complex Rhythm Disturbances and Electro-cardio-stimulation, District Clinical Hospital, Khanty-Mansiysk, Autonomous Okrug-Yugra, Russia
| | - Cécile Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S., Maria Cecilia Hospital, Cotignola, Italy
| | - Joseph Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.
| |
Collapse
|
83
|
Kalman JM, Sugumar H. Approach to ablative management of patient with persistent atrial fibrillation and enduring pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:1867-1868. [PMID: 32243640 DOI: 10.1111/jce.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/25/2020] [Accepted: 02/17/2020] [Indexed: 11/27/2022]
Abstract
Enduring isolation of the pulmonary veins (PV) is becoming increasingly common in patients undergoing repeat catheter ablation for atrial fibrillation. We describe our approach to ablation strategy in a patient with enduring isolation of PV and briefly discuss the role of non-PV triggers.
Collapse
Affiliation(s)
- Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Hariharan Sugumar
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,The Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
84
|
Chung MK, Refaat M, Shen WK, Kutyifa V, Cha YM, Di Biase L, Baranchuk A, Lampert R, Natale A, Fisher J, Lakkireddy DR. Atrial Fibrillation. J Am Coll Cardiol 2020; 75:1689-1713. [DOI: 10.1016/j.jacc.2020.02.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
|
85
|
Heeger CH, Subin B, Wissner E, Fink T, Mathew S, Maurer T, Lemes C, Rillig A, Wohlmuth P, Reissmann B, Tilz RR, Ouyang F, Kuck KH, Metzner A. Second-generation cryoballoon-based pulmonary vein isolation: Lessons from a five-year follow-up. Int J Cardiol 2020; 312:73-80. [PMID: 32241572 DOI: 10.1016/j.ijcard.2020.03.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB2) for atrial fibrillation (AF) treatment has demonstrated encouraging procedural success rates and mid-term results. However, long-term follow-up data on outcome is sparse. The current study is reporting on five-year clinical outcomes following CB2-based PVI in patients with paroxysmal AF (PAF) and persistent AF (PersAF). METHODS A total of 139 patients underwent index CB2-based PVI patients (PAF: n = 105, 76% and PersAF: n = 34, 34%) in two electrophysiology centers. Freeze-cycle duration was 240 s. After successful PVI a bonus freeze-cycle of the same duration was applied in the first 71 patients while the bonus-freeze was omitted in 68 following patients. Three patients (2.2%) were lost to follow-up. RESULTS After a median follow-up duration of 60 months (interquartile range: 46, 72 months) 74/136 (54.4%) patients remained in stable sinus rhythm (PAF: 62/104, 59.6%; PersAF: 15/32, 46.9%). Significant differences were observed concerning 5-year clinical outcome between PAF and PersAF patients (p = 0.0315). After a mean of 1.32 ± 0.6 procedures (2nd and 3rd procedure by radiofrequency ablation) and a median follow-up duration of 60 (37, 68) months 90/136 (66.2%) patients remained in stable sinus rhythm (PAF: 72/104 (69.2%), PersAF: 21/32 (65.6%), p = 0.0276). For the comparison of bonus-freeze vs no-bonus-freeze protocols no differences were observed (53.5% vs 57.4%, p = 0.650). CONCLUSIONS The five-year single-procedure success rate for CB2-based PVI was 54.4% and increased to 66.2% following repeat RF-based procedures. No differences were detected comparing bonus-freeze and no-bonus-freeze protocols.
Collapse
Affiliation(s)
- Christian-Hendrik Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
| | - Behnam Subin
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Erik Wissner
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Division of Cardiology, University of Illinois at Chicago, USA
| | - Thomas Fink
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Peter Wohlmuth
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Feifan Ouyang
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Fuwai Hospital/National Center of Cardiovascular Diseases, Beijing, China; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany
| |
Collapse
|
86
|
Kyriakopoulou M, Wielandts J, Strisciuglio T, El Haddad M, Pooter JD, Almorad A, Hilfiker G, Phlips T, Unger P, Lycke M, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions. J Cardiovasc Electrophysiol 2020; 31:1091-1098. [DOI: 10.1111/jce.14438] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/10/2020] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Maria Kyriakopoulou
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
- Department of CardiologyUniversite Libre de Bruxelles (ULB)Brussels Belgium
| | | | | | | | | | | | | | - Thomas Phlips
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
| | - Philippe Unger
- Department of CardiologyCHU Saint‐PierreBrussels Belgium
| | - Michelle Lycke
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
| | | | - Rene Tavernier
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
| | | | | |
Collapse
|
87
|
Gunawardene MA, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Schlüter M, Meyer C, Willems S, Schaeffer B. Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current. J Cardiovasc Electrophysiol 2020; 31:1051-1061. [DOI: 10.1111/jce.14413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Ruken Ö. Akbulak
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | | | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LübeckBerlin Germany
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Benjamin Schaeffer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| |
Collapse
|
88
|
Virk SA, Bennett RG, Trivic I, Campbell T, Kumar S. Contact Force and Ablation Index. Card Electrophysiol Clin 2020; 11:473-479. [PMID: 31400871 DOI: 10.1016/j.ccep.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Radiofrequency ablation of arrhythmias depends on durable lesion formation. Catheter tip-tissue contact force (CF) is a key determinant of lesion quality; excessive CF is associated with major complications, whereas insufficient CF increases the risk of electrical reconnection and arrhythmia recurrence. In recent years, CF-sensing catheters have emerged with the ability to directly measure CF and provide operators with real-time feedback. CF-guided ablation has been associated with improved outcomes in observational studies. However, randomized controlled trials have not shown any reduction in procedural durations, fluoroscopy exposure, incidence of major complications, or long-term arrhythmia recurrence with use of CF-sensing catheters.
Collapse
Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
| |
Collapse
|
89
|
Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation. Adv Ther 2020; 37:785-799. [PMID: 31865547 PMCID: PMC7004430 DOI: 10.1007/s12325-019-01173-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 01/12/2023]
Abstract
Introduction Ablation Index, also known as VISITAG SURPOINT™, is a novel lesion-quality marker that improves outcomes in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). There is no direct evidence on the comparative effectiveness of RF ablation with Ablation Index and cryoballoon (CB). The objective of the present study was to conduct a matching-adjusted indirect comparison (MAIC) using individual patient-level data (IPD) to compare the effectiveness of RF ablation with Ablation Index to that of CB on recurrence of atrial arrhythmias 12 months after catheter ablation in patients with paroxysmal AF (PAF). Methods Individual patient-level data for RF ablation with Ablation Index were obtained from two studies: Solimene et al. [J Interv Card Electrophysiol 54(1):9–15, 2019] and Hussein et al. [J Cardiovasc Electrophysiol 28(9):1037–1047, 2017]. Comparable CB studies identified from a systematic literature review were pooled. Prognostic variables for adjustment were ranked a priori by several practicing electrophysiologists. In the absence of a common treatment arm between the Ablation Index and CB studies, an unanchored MAIC was conducted. Primary analysis compared the Solimene et al. study to pooled CB studies. A secondary analysis compared pooled RF ablation with Ablation Index studies to pooled CB studies. Several scenario and sensitivity analyses were conducted. Results Primary analyses showed statistically significant reductions in the rate of arrhythmia recurrence with RF ablation with Ablation Index compared to CB in unmatched, unadjusted (HR 0.50, 95% CI 0.27–0.95) and matched (0.42, 0.21–0.86) analyses. Greater reductions in the rate of arrhythmia recurrence that favored RF ablation with Ablation Index were observed after matching and adjusting for age (0.41, 0.20–0.85), age and left ventricular ejection fraction (0.37, 0.16–0.88), and age, sex, and left ventricular ejection fraction (0.30, 0.13–0.71). Secondary and sensitivity analyses showed similar reductions. Conclusions Radiofrequency ablation with Ablation Index was associated with reductions in recurrence of atrial arrhythmias at 12 months compared to CB in unmatched and unadjusted, matched, and matched and adjusted comparisons. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01173-4) contains supplementary material, which is available to authorized users.
Collapse
|
90
|
Gupta D, Potter TD, Disher T, Eaton K, Goldstein L, Patel L, Grima D, Velleca M, Costa G. Comparative effectiveness of catheter ablation devices in the treatment of atrial fibrillation: a network meta-analysis. J Comp Eff Res 2020; 9:115-126. [PMID: 31913063 DOI: 10.2217/cer-2019-0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Atrial fibrillation (AF) ablation is most commonly performed using radiofrequency (RF) and cryoballoon (CB) catheters. Ablation Index is a novel lesion-quality marker associated with improved outcomes in RF ablation. Due to lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option. Aim: To conduct a network meta-analysis to evaluate the comparative effectiveness of RF with Ablation Index to other catheter ablation devices in the treatment of AF. Methods: Searches for randomized and nonrandomized prospective comparative studies of ablation catheters were conducted in multiple databases. The outcome of interest was 12-month freedom from atrial arrhythmias after a single ablation procedure. Studies were grouped as high-, low- and unclear-quality based on study design and balanced baseline patient characteristics. Bayesian hierarchical network meta-analysis was conducted and results presented as relative risk ratios with 95% credible intervals (CrIs). Results: 12 studies evaluating five different catheter ablation devices were included. Radiofrequency ablation with Ablation Index was associated with statistically significantly greater probability of 12-month freedom from atrial arrhythmias than Arctic Front (relative risk: 1.77; 95% CrI: 1.21-2.87), Arctic Front Advance™ (1.41; 1.06-2.47), THERMOCOOL™ (1.34; 1.17-1.48) and THERMOCOOL SMARTTOUCH™ (1.09; 1-1.3). Results were robust in multiple sensitivity analyses. Conclusion: Radiofrequency catheter with Ablation Index is superior to currently available options for 12-month freedom from atrial arrhythmias after AF ablation. This study provides decision-makers with robust, pooled, comparative evidence of the latest ablation technologies.
Collapse
Affiliation(s)
| | | | - Tim Disher
- Cornerstone Research Group, 207 - 275 Charlotte Street, Sydney, NS B1P1C6, Canada
| | - Kiefer Eaton
- Cornerstone Research Group, 204 - 3228 South Service Road, Burlington, ON L7N3H8, Canada
| | - Laura Goldstein
- Biosense Webster, 33 Technology Drive, Irvine, CA 92618, USA
| | - Leena Patel
- Cornerstone Research Group, 204 - 3228 South Service Road, Burlington, ON L7N3H8, Canada
| | - Daniel Grima
- Cornerstone Research Group, 204 - 3228 South Service Road, Burlington, ON L7N3H8, Canada
| | | | - Graça Costa
- Johnson & Johnson Medical NV, Diegem, Belgium
| |
Collapse
|
91
|
Terricabras M, Piccini JP, Verma A. Ablation of persistent atrial fibrillation: Challenges and solutions. J Cardiovasc Electrophysiol 2019; 31:1809-1821. [PMID: 31828883 DOI: 10.1111/jce.14311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 12/25/2022]
Abstract
Catheter ablation is commonly used for treatment of persistent atrial fibrillation (AF). Pulmonary vein isolation (PVI) is still the cornerstone for the procedure, however, outcomes are consistently lower compared to paroxysmal AF. It is hypothesized that it could be due to lack of durable lesions or the presence of non-PV targets that remain after PVI. Numerous advances in ablation catheter technologies and mapping systems may potentially achieve lower recurrence rates in the future. Ongoing research is required to discover the best technique for persistent AF ablation. The purpose of this review is to describe the new, developing technologies that may improve the outcome of this procedure in the persistent AF population.
Collapse
Affiliation(s)
- Maria Terricabras
- Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| |
Collapse
|
92
|
Münkler P, Gunawardene MA, Jungen C, Klatt N, Schwarzl JM, Akbulak RÖ, Dinshaw L, Hartmann J, Jularic M, Kahle AK, Riedel R, Merbold L, Eickholt C, Willems S, Meyer C. Local impedance guides catheter ablation in patients with ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 31:61-69. [PMID: 31701589 DOI: 10.1111/jce.14269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
AIMS Catheter contact and local tissue characteristics are relevant information for successful radiofrequency current (RFC)-ablation. Local impedance (LI) has been shown to reflect tissue characteristics and lesion formation during RFC-ablation. Using a novel ablation catheter incorporating three mini-electrodes, we investigated LI in relation to generator impedance (GI) in patients with ventricular tachycardia (VT) and its applicability as an indicator of effective RFC-ablation. METHODS AND RESULTS Baseline impedance, Δimpedance during ablation and drop rate (Δimpedance/time) were analyzed for 625 RFC-applications in 28 patients with recurrent VT undergoing RFC-ablation. LI was lower in scarred (87.0 Ω [79.0-95.0]) compared to healthy myocardium (97.5 Ω ([82.75-111.50]; P = .03) while GI did not differ between scarred and healthy myocardium. ΔLI was higher (18 Ω [9.4-26.0]) for VT-terminating as compared to non-terminating RFC-ablation (ΔLI 13 Ω [8.85-18.0]; P = .03), but did not differ for ΔGI between terminating vs nonterminating RFC-ablation. Correspondingly, LI drop rate was higher for RFC-ablation terminating the VT compared with RFC-ablation not terminating the VT (0.63 Ω/s [0.52-0.76] vs 0.32 Ω [0.20-0.58]; P = .008) while there was no difference for GI drop rate. ΔLI was higher in patients with nonischemic cardiomyopathy vs patients with ischemic cardiomyopathy (16 Ω [11.0-20.0] vs 11.0 Ω [7.85-17.00]; P = .003). CONCLUSION Our findings suggest that LI is a sensitive parameter to guide RFC-ablation in patients with VT. LI indicates differences in tissue characteristics and generally is higher in patients with nonischemic cardiomyopathy. Hence, the etiology of the underlying cardiomyopathy needs to be considered when adopting LI for monitoring catheter ablation of VT.
Collapse
Affiliation(s)
- Paula Münkler
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Melanie A Gunawardene
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Niklas Klatt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - René Riedel
- Max Planck Institute for Evolutionary Biology, Plön, Germany
| | | | - Christian Eickholt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| |
Collapse
|
93
|
Okamatsu H, Koyama J, Sakai Y, Negishi K, Hayashi K, Tsurugi T, Tanaka Y, Nakao K, Sakamoto T, Okumura K. High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation. J Cardiovasc Electrophysiol 2019; 30:2751-2758. [DOI: 10.1111/jce.14223] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Hideharu Okamatsu
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Junjiro Koyama
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Yoshirou Sakai
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Koudai Negishi
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Katsuhide Hayashi
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Takuo Tsurugi
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Yasuaki Tanaka
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Koichi Nakao
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Tomohiro Sakamoto
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| | - Ken Okumura
- Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamoto Japan
| |
Collapse
|
94
|
Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias: Evolution or History Repeating Itself? JACC Clin Electrophysiol 2019; 4:707-723. [PMID: 29929663 DOI: 10.1016/j.jacep.2018.03.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)-sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.
Collapse
Affiliation(s)
- Nilshan Ariyarathna
- Cardiology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - William G Stevenson
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
95
|
Bartoletti S, Mann M, Gupta A, Khan AM, Sahni A, El‐Kadri M, Modi S, Waktare J, Mahida S, Hall M, Snowdon R, Todd D, Gupta D. Same‐day discharge in selected patients undergoing atrial fibrillation ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1448-1455. [DOI: 10.1111/pace.13807] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022]
Affiliation(s)
| | - Mandeep Mann
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Akanksha Gupta
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | | | - Ankita Sahni
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Moutaz El‐Kadri
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
- Sheikh Khalifa Medical City Abu Dhabi United Arab Emirates
| | - Simon Modi
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Johan Waktare
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Saagar Mahida
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Mark Hall
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | | | - Derick Todd
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart And Chest Hospital Liverpool United Kingdom
- Faculty of Health SciencesUniversity of Liverpool United Kingdom
| |
Collapse
|
96
|
Zhang T, Wang Y, Han Z, Zhao H, Liang Z, Wang Y, Wu Y, Ren X. Cavotricuspid isthmus ablation using ablation index in typical right atrial flutter. J Cardiovasc Electrophysiol 2019; 30:2414-2419. [PMID: 31502295 DOI: 10.1111/jce.14156] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Tao Zhang
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Yunlong Wang
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Zhihong Han
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Hua Zhao
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Zhuo Liang
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Ye Wang
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Yongquan Wu
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| | - Xuejun Ren
- Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing China
| |
Collapse
|
97
|
An ablation index operator-independent approach to improve efficacy in atrial fibrillation ablation at 24-month follow-up: a single center experience. J Interv Card Electrophysiol 2019; 57:241-249. [DOI: 10.1007/s10840-019-00587-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
|
98
|
Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation. J Interv Card Electrophysiol 2019; 58:9-19. [PMID: 31197583 DOI: 10.1007/s10840-019-00576-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Adverse left atrial (LA) remodeling is known to be associated with persistent atrial fibrillation (PeAF). The time course and pattern of reversal of LA remodeling following catheter ablation is poorly understood. We aimed to evaluate LA chamber volumes and dimensions, LA conduction velocities, and LA bipolar voltages at baseline and at 2 months after catheter ablation for PeAF. METHODS Twenty-three patients with PeAF underwent detailed LA mapping during fixed rate atrial pacing using the CARTO3 navigation system prior to undergoing pulmonary vein isolation. All patients returned for protocol-mandated repeat electrophysiology study at 2 months, irrespective of symptoms or arrhythmia recurrence, during which all measurements were repeated using an identical mapping protocol. Patients then underwent daily ECG monitoring for 12 months. RESULTS Nineteen out of twenty-three (83.6%) patients had durable PVI of all veins at repeat electrophysiology study, while 4 (17.4%) patients had late reconnection of a single vein each. In the blinded offline analysis, LA volume at follow-up was significantly lower as compared with baseline (55 ± 14 mL/m2 vs. 65 ± 15 mL/m2, P < 0.001). LA conduction velocities were significantly greater at 2 months (0.90 ± 0.13 m/s vs. 0.78 ± 0.13 m/s, P = 0.01). There was non-uniform regional LA voltage evolution, with a significant increase in bipolar voltages observed on the LA posterior wall (2.18 ± 0.85 mV vs. 1.83 ± 0.49 mV, P = 0.04), but not elsewhere. Individual variables of remodeling were not associated with AF recurrence. CONCLUSION Significant structural and electrical reverse remodeling of the LA can be seen as early as 2 months following successful catheter ablation for PeAF.
Collapse
|
99
|
Macle L, Frame D, Gache LM, Monir G, Pollak SJ, Boo LM. Atrial fibrillation ablation with a spring sensor-irrigated contact force-sensing catheter compared with other ablation catheters: systematic literature review and meta-analysis. BMJ Open 2019; 9:e023775. [PMID: 31189669 PMCID: PMC6575819 DOI: 10.1136/bmjopen-2018-023775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The objective of our review was to systematically assess available evidence on the effectiveness, safety and efficiency of a spring sensor-irrigated contact force (CF) catheter (THERMOCOOL SMARTTOUCH Catheter (ST)) for percutaneous ablation of paroxysmal or persistent atrial fibrillation (AF), compared with other ablation catheters, or with the ST with the operator blinded to CF data. DESIGN Systematic literature review and meta-analysis. BACKGROUND Emerging evidence suggests improved clinical outcomes of AF ablation using CF-sensing catheters; however, reviews to date have included data from multiple, distinct CF technologies. METHODS We conducted a systematic review and meta-analysis of published studies comparing the use of ST versus other ablation catheters for the treatment of AF. A comprehensive search of electronic and manual sources was conducted. The primary endpoint was freedom from recurrent atrial tachyarrhythmia (AT) at 12 months. Procedural and safety data were also analysed. RESULTS Thirty-four studies enrolling 5004 patients were eligible. The use of ST was associated with increased odds of freedom from AT at 12 months (71.0%vs60.8%; OR 1.454, 95% CI 1.12 to 1.88, p=0.004) over the comparator group, and the effect size was most evident in paroxysmal AF patients (75.6%vs64.7%; OR 1.560, 95% CI 1.09 to 2.24, p=0.015). Procedure and fluoroscopy times were shorter with ST (p=0.05 and p<0.01, respectively, vs comparator groups). The reduction in procedure time is estimated at 15.5 min (9.0%), and fluoroscopy time 4.8 min (18.7%). Complication rates, including cardiac tamponade, did not differ between groups. CONCLUSIONS Compared with the use of other catheters, AF ablation using the CF-sensing ST catheter for AF is associated with improved success rates, shorter procedure and fluoroscopy times and similar safety profile.
Collapse
Affiliation(s)
- Laurent Macle
- Department of Medicine, Institut De Cardiologie de Montreal, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Diana Frame
- Real World Evidence (RWE), CTI Clinical Trial and Consulting Services Inc., Covington, Kentucky, USA
| | - Larry M Gache
- Real World Evidence (RWE), CTI Clinical Trial and Consulting Services Inc., Covington, Kentucky, USA
| | - George Monir
- Cardiology, Arrhythmia and Ablation Center, Florida Hospital, Orlando, Florida, USA
| | - Scott J Pollak
- Cardiology, Arrhythmia and Ablation Center, Florida Hospital, Orlando, Florida, USA
| | - Lee Ming Boo
- Clinical Research, Biosense Webster, Inc., Irvine, California, USA
| |
Collapse
|
100
|
Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon. J Cardiol 2019; 73:497-506. [DOI: 10.1016/j.jjcc.2019.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
|