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Pavani P, Olanrewaju OA, Sagar RS, Bai M, Chand J, Bhatia V, Sagar F, Karishma F, Islam H, Kumar A, Versha F, Islam R, Nadeem T. Comparative Analysis of Clinical Outcomes of High-power, Short-duration Ablation versus Low-power, Long-duration Ablation Strategy in Patients with Atrial Fibrillation: A Comprehensive Umbrella Review of Meta-analyses. J Innov Card Rhythm Manag 2024; 15:5963-5980. [PMID: 39193534 PMCID: PMC11346500 DOI: 10.19102/icrm.2024.15083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 08/29/2024] Open
Abstract
Atrial fibrillation (AF) affects around 33 million people worldwide, rendering it a common cardiac arrhythmia. Catheter ablation (CA) has evolved as a leading therapeutic intervention for symptomatic AF. This umbrella review systematically evaluates existing systematic reviews and meta-analyses to assess the safety, efficacy, and potential of high-power, short-duration (HPSD) ablation as an alternative therapy option for AF. A thorough exploration was undertaken across PubMed, the Cochrane Library, and Embase to identify pertinent studies for inclusion in this umbrella review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was employed to assess the overall certainty of the evidence comprehensively, and the quality of the incorporated reviews was meticulously evaluated through use of the AMSTAR 2 tool, the Cochrane Collaboration tool, and the Newcastle-Ottawa scale. In this study, we initially identified 35 systematic reviews and meta-analyses, narrowing them down to a final selection of 11 studies, which collectively integrated data from 6 randomized controlled trials and 26 observational studies. For primary efficacy outcomes, the HPSD approach led to a non-significant decrease in the risk of atrial tachyarrhythmia recurrence (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.70-1.12; I 2 = 90%; P = .31) and a significantly reduced risk of AF recurrence (RR, 0.53; 95% CI, 0.42-0.67; I 2 = 0%; P < .00001) compared to the low-power, long-duration (LPLD) approach. In terms of primary safety outcomes, the HPSD approach significantly reduced the risk of esophageal thermal injury (ETI) (RR, 0.71; 95% CI, 0.61-0.83; I 2 = 0%; P < .00001) and facilitated a non-significant decrease in the risk of other major complications (RR, 0.87; 95% CI, 0.73-1.03; I 2 = 0%; P = .10). In conclusion, HPSD therapy is safer and more effective than LPLD therapy, facilitating decreased AF recurrence rates along with reductions in ETI, total procedure duration, ablation number, ablation time, fluoroscopy time, and acute pulmonary vein reconnection.
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Affiliation(s)
- Peddi Pavani
- Department of Surgery, Kurnool Medical College, Kurnool, India
| | | | - Raja Subhash Sagar
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Monika Bai
- Department of Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan
| | - Jai Chand
- Department of Medicine, Khairpur Medical College, Khairpur, Pakistan
| | - Vishal Bhatia
- Department of Medicine, Khairpur Medical College, Khairpur, Pakistan
| | - Fnu Sagar
- Department of Medicine, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Fnu Karishma
- Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Hamza Islam
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Aman Kumar
- Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Fnu Versha
- Department of Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan
| | - Rabia Islam
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Taha Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
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Lazarus C, Sherman J, Putzel N, Zagrodzky W, Sharkoski T, Ro A, Nazari J, Fisher W, Kulstad E, Metzl M. Reduced Continuity Index with Proactive Esophageal Cooling Compared to Luminal Temperature Monitoring During Radiofrequency Ablation: Improved Lesion Continuity with Esophageal Cooling. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305586. [PMID: 38645228 PMCID: PMC11030476 DOI: 10.1101/2024.04.09.24305586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Proactive esophageal cooling is FDA cleared to reduce the likelihood of esophageal injury during radiofrequency ablation for treatment of atrial fibrillation (AF). Long-term follow-up data have also shown improved freedom from arrhythmia with proactive esophageal cooling compared to luminal esophageal temperature (LET) monitoring during pulmonary vein isolation (PVI). One hypothesized mechanism is improved lesion contiguity (as measured by the Continuity Index) with the use of cooling. We aimed to compare the Continuity Index of PVI cases using proactive esophageal cooling to those using LET monitoring. Methods Continuity Index was calculated for PVI cases at two different hospitals within the same health system using a slightly modified Continuity Index to facilitate both real-time calculation during observation of PVI cases and retrospective determination from recorded cases. The results were then compared between proactively cooled cases and those using LET monitoring. Results Continuity Indices for a total of 101 cases were obtained; 77 cases using proactive esophageal cooling and 24 cases using traditional LET monitoring. With proactive esophageal cooling, the average Continuity Index was 2.7 (1.3 on the left pulmonary vein, and 1.5 on the right pulmonary vein). With LET monitoring, the average Continuity Index was 27.3 (14.3 on the left, and 12.9 on the right), for a difference of 24.6 (p < 0.001). Conclusion Proactive esophageal cooling during PVI is associated with significantly improved lesion contiguity when compared to LET monitoring. This finding may offer a mechanism for the greater freedom from arrhythmia seen with proactive cooling in long-term follow-up.
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Affiliation(s)
| | - Jacob Sherman
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | - Alex Ro
- NorthShore University Hospital, Evanston, IL, USA
| | - Jose Nazari
- NorthShore University Hospital, Evanston, IL, USA
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark Metzl
- NorthShore University Hospital, Evanston, IL, USA
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Kreidieh O, Hunter TD, Goyal S, Varley AL, Thorne C, Osorio J, Silverstein J, Varosy P, Metzl M, Leyton-Mange J, Singh D, Rajendra A, Moretta A, Zei PC. Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL-AF registry. J Cardiovasc Electrophysiol 2024; 35:440-450. [PMID: 38282445 DOI: 10.1111/jce.16190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION During atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long-term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI. METHODS We reviewed AFA procedures in a multicenter prospective registry of AFA (REAL-AF). A multivariate ordinal logistic regression, weighted by inverse proceduralist volume, was used to determine predictors of FPI. RESULTS A total of 2671 patients were included with 1806 achieving FPI in both vein sides, 702 achieving FPI in one, and 163 having no FPI. Individually, age, left atrial (LA) scar, higher power usage (50 W), greater posterior contact force, ablation index >350 posteriorly, Vizigo™ sheath utilization, nonstandard ventilation, and high operator volume (>6 monthly cases) were all related to improved odds of FPI. Conversely sleep apnea, elevated body mass index (BMI), diabetes mellitus, LA enlargement, antiarrhythmic drug use, and center's higher fluoroscopy use were related to reduced odds of FPI. Multivariate analysis showed that BMI > 30 (OR 0.78 [0.64-0.96]) and LA volume (OR per mL increase = 1.00 [0.99-1.00]) predicted lower odds of achieving FPI, whereas significant left atrial scarring (>20%) was related to higher rates of FPI. Procedurally, the use of high power (50 W) (OR 1.32 [1.05-1.65]), increasing force posteriorly (OR 2.03 [1.19-3.46]), and nonstandard ventilation (OR 1.26 [1.00-1.59]) predicted higher FPI rates. At a site level, high procedural volume (OR 1.89 [1.48-2.41]) and low fluoroscopy centers (OR 0.72 [0.61-0.84]) had higher rates of FPI. CONCLUSION FPI rates are affected by operator experience, patient comorbidities, and procedural strategies. These factors may be postulated to impact acute lesion formation.
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Affiliation(s)
- Omar Kreidieh
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tina D Hunter
- CTI Clinical Trial and Consulting, Covington, Kentucky, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | | | - Jose Osorio
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul Varosy
- Medicine-Cardiology, University of Colorado, Denver, Aurora, Colorado, USA
| | - Mark Metzl
- NorthShore University Health System, Bannockburn, Illinois, USA
| | | | - David Singh
- John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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Joza J, Nair GM, Birnie DH, Nery PB, Redpath CJ, Sarrazin JF, Champagne J, Bernick J, Wells GA, Essebag V. High-power short-duration versus low-power long-duration ablation for pulmonary vein isolation: A substudy of the AWARE randomized controlled trial. J Cardiovasc Electrophysiol 2024; 35:136-145. [PMID: 37990448 DOI: 10.1111/jce.16123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Pulmonary vein isolations (PVI) are being performed using a high-power, short-duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low-power, long-duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF). METHODS Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1-year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14-day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RRa ) and mean difference (MDa ) estimates. RESULTS Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RRa 0.77 (95% confidence interval [CI]) 0.55-1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RRa 1.59 [95% CI 0.77-3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RRa 3.95 [95% CI 1.00-15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MDa 97.5 min [95% CI 84.8-110.4)]; p < .0001) with no difference in adjudicated serious adverse events. CONCLUSIONS An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy.
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Affiliation(s)
- Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Girish M Nair
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David H Birnie
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pablo B Nery
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Calum J Redpath
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Jean Champagne
- Division of Cardiology, IUCPQ, Quebec City, Quebec, Canada
| | - Jordan Bernick
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- Divison of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
- Division of Cardiology, Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada
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Junarta J, Rodriguez S, Ullah W, Siddiqui MU, Riley JM, Patel A, O'Neill P, Dikdan SJ, Fradin JJ, Rosen JL, Frisch DR. Comparison of very high-power short-duration, high-power short-duration, and low-power long-duration radiofrequency ablation for atrial fibrillation: A systematic review and network meta-analysis. Pacing Clin Electrophysiol 2023; 46:1609-1634. [PMID: 37971718 DOI: 10.1111/pace.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The optimal power and duration settings for radiofrequency (RF) atrial fibrillation (AF) ablation to improve efficacy and safety is unclear. We compared low-power long-duration (LPLD), high-power short-duration (HPSD), and very HPSD (vHPSD) RF settings for AF ablation. METHODS This network meta-analysis (NMA) was structured according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Observational and randomized studies were included. Eligible studies compared outcomes in AF patients who underwent first-time RF ablation with the following settings: vHPSD (70-90 W, 3-10 s), HPSD (45-60 W, 5-10 s), or LPLD (20-40 W, 20-60 s). RESULTS Thirty-six studies comprising 10,375 patients were included (33% female). Frequentist NMA showed LPLD tended toward a lower odds of freedom from arrhythmia (FFA) versus HPSD (OR 0.93, 95% CI 0.86-1.00). There was no difference in FFA between vHPSD versus HPSD. Splitwise interval estimates showed a lower odds of FFA in LPLD versus vHPSD on direct (OR 0.78, 95% CI 0.65-0.93) and network estimates (OR 0.85, 95% CI 0.73-0.98). Frequentist NMA showed less total procedural (TP) time with HPSD versus LPLD (generic variance 1.06, 95% CI 0.83 to 1.29) and no difference between HPSD versus vHPSD. CONCLUSION This NMA shows improved procedural times in HPSD and vHPSD versus LPLD. Although HPSD tended toward improved odds of FFA compared to LPLD, the overall result was not statistically significant. The odds of FFA in LPLD was lower versus vHPSD on direct and network estimates on splitwise interval analysis. Large prospective head-to-head randomized trials are needed to validate HPSD and vHPSD settings.
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Affiliation(s)
- Joey Junarta
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Sebastian Rodriguez
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Waqas Ullah
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Muhammad U Siddiqui
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Joshua M Riley
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Anjani Patel
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Parker O'Neill
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Sean J Dikdan
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - James J Fradin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Daniel R Frisch
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, USA
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6
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Zhu J, Lin XH. Safety and efficacy of ablation index-guided high-power ablation for the treatment of atrial fibrillation. Heliyon 2023; 9:e15311. [PMID: 37113792 PMCID: PMC10126854 DOI: 10.1016/j.heliyon.2023.e15311] [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: 01/08/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Objective To study the safety and efficacy of high-power ablation for atrial fibrillation (AF) guided by lesion size index (LSI) and impedance cutoff. Method A total of 223 patients who underwent radiofrequency catheter ablation of atrial fibrillation (including paroxyparal atrial fibrillation and persistent atrial fibrillation) in the Department of Cardiology of Anhui Provincial Hospital from February 2019 to July 2020 were enrolled, and were divided into 123 patients in the high-power ablation group (HPAI) and 100 patients in the conventional power ablation group (CPAI). The HPAI group adopted high-power (40-50 W) ablation by impedance cutoff, and the CPAI group adopted conventional-power (30-35 W) ablation. Patients in both groups were ablated guided by the same LSI. For both groups, we analyzed the pulmonary vein single-circle isolation rate, ablation time, X-ray exposure, impedance drop value, incidence of complications, and recurrence rate within one year after operation. Results There was no significant difference in the success rate of pulmonary vein single-circle isolation, X-ray perspective time, and X-ray exposure quantity between the HPAI group and the CPAI group (88.60% vs 82.00%, P = 0.161; 8.7 ± 3.74 min vs 7.82 ± 3.86 min, P = 0.067; 54.74 ± 28 min vs 52.78 ± 39.58 min, P = 0.139); the annular pulmonary vein ablation time and total ablation time were less in the HPAI group (35.74 ± 7.25 min vs 65.49 ± 7.34 min, P < 0.01; 55.42 ± 11.61 min vs 76.9 ± 6.79 min, P < 0.01); the impedance drop values at 10-15Ω and 15-20Ω were higher in the HPAI group (25.3% vs 19.1%, P < 0.05; 24.1% vs 19.1%, P < 0.05); there was no significant difference in the recurrence rate within one year after operation between the two groups; and no serious complications occurred in the two groups. Conclusion High-power ablation guided by LSI and impedance cutoff could significantly shorten the AF ablation time and reduce complications.
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Affiliation(s)
- Jing Zhu
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province 230000, China
- Department of Cardiology, The Provincial Hospital Affiliated to Anhui Medical University, Hefei City, Anhui Province 230000, China
| | - Xian-he Lin
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province 230000, China
- Corresponding author.
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7
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Jin S, Lin W, Fang X, Liao H, Zhan X, Fu L, Jiang J, Ye X, Liu H, Chen Y, Pu S, Wu S, Deng H, Xue Y. High-Power, Short-Duration Ablation under the Guidance of Relatively Low Ablation Index Values for Paroxysmal Atrial Fibrillation: Long-Term Outcomes and Characteristics of Recurrent Atrial Arrhythmias. J Clin Med 2023; 12:jcm12030971. [PMID: 36769620 PMCID: PMC9917927 DOI: 10.3390/jcm12030971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the difference in effectiveness and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation (RFA) guided by relatively low ablation index (AI) values and conventional RFA in paroxysmal atrial fibrillation (PAF) patients. METHODS The HPSD RFA strategy (40-50 W, AI 350-400 for anterior, 320-350 for posterior wall; n = 547) was compared with the conventional RFA strategy (25-40 W, without AI; n = 396) in PAF patients who underwent their first ablation. Propensity-score matching analyses were used to compare the outcomes of the two groups while controlling for confounders. RESULTS After using propensity-score matching analysis, the HPSD group showed a higher early recurrence rate (22.727% vs. 13.636%, p = 0.003), similar late recurrence rate, and comparable safety (p = 0.604) compared with the conventional group. For late recurrent atrial arrhythmia types, the rate of regular atrial tachycardia was significantly higher in the HPSD group (p = 0.013). Additionally, the rate of chronic pulmonary vein reconnection and non-pulmonary vein triggers during repeat procedures was similar in both groups. CONCLUSIONS For PAF patients, compared with the conventional RFA strategy, the HPSD RFA strategy at relatively low AI settings had a higher early recurrence rate, similar long-term success rate, and comparable safety.
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Affiliation(s)
- Shuyu Jin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Weidong Lin
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianhong Fang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hongtao Liao
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianzhang Zhan
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lu Fu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Junrong Jiang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xingdong Ye
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huiyi Liu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yanlin Chen
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Sijia Pu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Shulin Wu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hai Deng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
| | - Yumei Xue
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
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8
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Mitrzak K, Peller M, Krzowski B, Maciejewski C, Balsam P, Marchel M, Grabowski M, Lodziński P. Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results. Cardiol J 2023; 31:603-611. [PMID: 36588315 PMCID: PMC11374326 DOI: 10.5603/cj.a2022.0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter, QDot MicroTM (Biosense Webster) was designed to improve the effectiveness of AF ablation within a shorter procedure time. The aim of this study was to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode and conventional ablation-index-guided ablation (ThermoCool Smarttouch SF catheter). METHODS This single-center, retrospective, observational study enrolled 108 patients with AF, referred for catheter ablation between December 16, 2019 and December 3, 2021. In 54 procedures (mean age: 58.0 ± 12.3; 66.67% male), a QDot MicroTM catheter was used (vHPSD-group), and 54 patients (mean age: 57.2 ± 11.8; 70.37% male) were treated with a ThermoCool SmarttouchTM SF catheter (AI-group). The primary endpoint was freedom from AF 3 months after ablation. RESULTS Atrial fibrillation was found to recur in 14.81% of patients in the vHPSD-group and in 31.48% of patients in the AI-group (p = 0.07). There was no difference in treatment-emergent adverse events between the two groups (6.3% vs. 0%; p = 0.10). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during QDot MicroTM catheter-based PVI (p < 0.01). The vHPSD-based PVI was associated with shorter radiofrequency application time (p < 0.001), fluoroscopy time (p < 0.0001), and total procedure time (p < 0.0001). CONCLUSIONS This study suggests vHPSD ablation is safe, can reduce the dosage of analgesics during significantly shorter procedures and may enhance the success rate of catheter-based PVI.
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Affiliation(s)
- Karolina Mitrzak
- 1st Department of Cardiology, Medical University of Warsaw, Poland.
| | - Michał Peller
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Bartosz Krzowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Paweł Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Piotr Lodziński
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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9
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Comparison of Effectiveness and Safety between High-Power Short-Duration Ablation and Conventional Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Interv Cardiol 2022; 2022:6013474. [PMID: 36072362 PMCID: PMC9398879 DOI: 10.1155/2022/6013474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aim. We aimed to evaluate the effectiveness and safety between high-power short-duration (HPSD) radiofrequency ablation (RFA) and conventional RFA in patients with atrial fibrillation (AF). Methods. Studies comparing HPSD and traditional applications in patients undergoing initial catheter ablation for atrial fibrillation from inception through December 2021 were searched on Pubmed, Medline, Cochrane, and Clinicaltrials.gov. Results. The meta-analysis included seventeen studies with a total of 4934 patients. HPSD group decreased procedure duration (mean difference (MD) −38.28 min,
), RF duration (MD −20.51 min,
), fluoroscopy duration (MD −5.19 min,
), and acute pulmonary vein reconnection (Odds ratio (OR) 0.40,
), while improving the freedom from atrial arrhythmia at one year (OR 1.48, 95% confidence interval (CI) 1.12–1.94,
) and rates of first-pass isolation (OR 8.92,
). Compared with the conventional group, freedom from atrial arrhythmia at one-year follow-up was higher in the HPSD group without the guidance of AI/LSI (OR 1.66,
) and studies with a power setting of 40–50 W (OR 1.93,
). Nevertheless, the two groups had similar effectiveness with a power setting of 50 W in the HPSD RFA (OR 1.10,
). There was no difference in complications between the two groups (
). Conclusion. HPSD RFA was associated with shorter procedure duration, higher freedom from atrial arrhythmia, and comparable safety compared to conventional RFA.
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10
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Procedural Efficiency, Efficacy, and Safety of High-Power, Short-Duration Radiofrequency Ablation Delivered by STSF Catheter for Paroxysmal Atrial Fibrillation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6009275. [PMID: 35979002 PMCID: PMC9377865 DOI: 10.1155/2022/6009275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Objectives To investigate the procedural efficiency, efficacy, and safety of high-power, short-term radiofrequency ablation delivered by the SmartTouch Surround Flow (STSF) catheter for paroxysmal atrial fibrillation (AF). Methods We retrospectively analyzed a total of 72 patients who were admitted with paroxysmal AF, and who underwent radiofrequency catheter ablation (RFCA) for the first time. Of these patients, 36 cases underwent low-power, long-duration (LPLD, (30–35 W/20–40 s) pulmonary vein isolation (PVI) delivered by an SmartTouch (ST) catheter (control group), and the other 36 cases underwent high-power, short-duration (HPSD, (45–50 W/10–20 s) PVI delivered by a STSF catheter (study group). The baseline data, duration of PVI, procedural time, fluoroscopy time, the rate of first-pass isolation, irrigation perfusion, eschar and steam pop occurrences, intraoperative complications, and the rate of stable sinus rhythm maintenance following a blanking period of three months were analyzed between the two groups. Results The isolation time of bilateral PVI and procedural time in the study group were markedly less than in controls (p < 0.01). The rate of first-pass isolation in the study group was significantly higher than in the control group (95.8% vs. 84.7%, p = 0.023), while the fluid perfusion in the study group was approximately 20% less than that in the control group (767 ± 171 vs. 966 ± 227 ml, p < 0.001). We observed no severe complications in any patients. The rate of freedom from AF recurrences following a blanking period of three months showed a tendency to be higher than in controls (93.9% vs. 87.1%, p = 0.348). Conclusions The HPSD strategy delivered by the STSF catheter was superior to conventional LPLD ablation through the ST catheter with respect to efficiency, acute procedural effectiveness, short-term safety, and the risk of heart failure in patients with paroxysmal AF.
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11
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Grosse Meininghaus D, Freund R, Kushnir A, Koerber B, Geller JC, Kleemann T. Asymptomatic esophageal perforation following high-power short-duration pulmonary vein isolation—A case of conservative cure. HeartRhythm Case Rep 2022; 8:661-665. [PMID: 36310731 PMCID: PMC9596363 DOI: 10.1016/j.hrcr.2022.07.005] [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: 12/02/2022] Open
Affiliation(s)
- Dirk Grosse Meininghaus
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
- Address reprint requests and correspondence: Dr Dirk Grosse Meininghaus, Department of Cardiology, Carl-Thiem-Hospital, Thiemstr. 111, 03048 Cottbus, Germany.
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Anton Kushnir
- Department of Radiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Britta Koerber
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J. Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik Bad Berka, Bad Berka, Germany
- Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
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12
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Grosse Meininghaus D, Freund R, Kleemann T, Christoph Geller J. Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high-power short-duration radiofrequency pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1167-1176. [PMID: 35445476 DOI: 10.1111/jce.15509] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Luminal esophageal temperature (LET) monitoring is not associated with reduced esophageal injury following pulmonary vein isolation (PVI). OBJECTIVE Detailed analysis of (the temporal and spatial gradients of) LET measurements may better predict the risk for esophageal injury. METHODS Between January 2020 and December 2021, LET maxima, duration of LET rise above baseline, and area under the LET curve (AUC) were calculated offline and correlated with (endoscopy and endoscopic ultrasound detected) esophageal injury (i.e., mucosal esophageal lesions [ELs], periesophageal edema, and gastric motility disorders) following PVI using moderate-power moderate-duration (MPMD [25-30 W/25-30s]) and high-power short-duration (HPSD [50 W/13s]) radiofrequency (RF) settings. RESULTS 63 patients (69 ± 9 years old, 32 male, 51 MPMD and 12 HPSD) were studied. The esophageal injury was frequent (40% in both groups), mucosal ELs were more common with MPMD, and edema was frequently observed following HPSD. RF-duration, total RF-energy at the left atrial (LA) posterior wall, and distance between LA and esophagus were not different between patients with/without esophageal injury. In contrast, to LET and LET duration above baseline, AUC was the best predictor and significantly increased in patients with esophageal injury (3422 vs. 2444 K. s). CONCLUSION For both ablation strategies, AUC of the LET curves best predicted esophageal injury. HPSD is associated with similar rates of esophageal injury when (mostly subclinical) periesophageal alterations (that are of unclear clinical relevance) are included. Whether integration of these calculated LET parameters is useful to prevent esophageal injury remains to be seen.
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Affiliation(s)
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital, Cottbus, Germany
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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13
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Xu M, Yang Y, Zhang D, Jiang W. Meta-analysis of high power short duration in atrial fibrillation ablation - a superior efficient ablation strategy. Acta Cardiol 2022; 77:14-32. [PMID: 34218737 DOI: 10.1080/00015385.2021.1939512] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The high power short duration (HPSD) approach was hoped to further improve the efficacy and safety in radiofrequency ablation of atrial fibrillation (AF), compared with Low power long duration (LPLD). However, the conclusion was controversial based on the previous limited data. The aim of this meta-analysis was to evaluate whether the clinical benefits of HPSD are superior to that of LPLD. METHODS The PubMed, OVID, the Cochrane Library, and Elsevier's ScienceDirect databases were searched for clinical studies to compare HPSD and LPLD approach by simple search strings benefiting to a wider screened scope. RESULTS Fifteen trials with 3255 patients were included in this analysis. Pooled analyses suggested that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at 1-year follow-up (OR: 0.49; 95% CI: 0.35 to 0.67, p < .0001), benefitted from AF recurrence reduced (OR: 0.46; 95% CI: 0.31 to 0.67, p < .0001), rather than atrial tachycardia/atrial flutter (AT/AFL), but similar at 6 months follow-up, with a decreased oesophageal thermal injury (ETI) (OR: 0.48; 95% CI: 0.30 to 0.77, p = .002). Meanwhile, the HPSD approach benefitted to increase first-pass pulmonary vein isolation (FPI) (OR: 0.47; 95% CI: 0.34 to 0.64, p < .00001) and decrease acute pulmonary vein re-isolation (PVR) (OR: 0.45; 95% CI: 0.35 to 0.58, p < .00001), both mainly embodied in left pulmonary veins (PVs). HPSD showed a decreased procedural time (SMD: -0.95; 95% CI: -1.06 to -0.85, p < .00001), ablation number for pulmonary vein isolation (PVI) (SMD: -0.41; 95% CI: -0.58 to -0.24, p < .00001) and fluoroscopy time (SMD: -0.22; 95% CI: -0.32 to -0.12, p < .0001), which benefits from PVI + additional ablation strategy (SMD: -0.33; 95% CI: -0.46 to -0.21, p < .0001). CONCLUSIONS The HPSD approach was associated with decreasing post-ablation AF recurrence in the 1-year follow-up, ETI, acute PVR (increasing FPI correspondingly), procedural time, ablation number for PVI and fluoroscopy time, benefitted to improve clinical outcomes and procedural process with improved safety.
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Affiliation(s)
- Min Xu
- Department of Cardiology, The Second Affiliated Hospital of North Sichuan Medical College (Mianyang 404 Hospital), Mianyang, SiChuan, China
| | - Yan Yang
- Department of Cardiology, The Second Affiliated Hospital of North Sichuan Medical College (Mianyang 404 Hospital), Mianyang, SiChuan, China
| | - Dayong Zhang
- Department of Cardiology, The Second Affiliated Hospital of North Sichuan Medical College (Mianyang 404 Hospital), Mianyang, SiChuan, China
| | - Weifeng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
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14
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Nagahara A, Shiotani A, Iijima K, Kamada T, Fujiwara Y, Kasugai K, Kato M, Higuchi K. The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract). Dig Endosc 2022; 34:63-72. [PMID: 33772880 DOI: 10.1111/den.13982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and high-resolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.
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Affiliation(s)
- Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University School of Medicine, Akita, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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15
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Junarta J, Dikdan SJ, Upadhyay N, Bodempudi S, Shvili MY, Frisch DR. High-power short-duration versus standard-power standard-duration settings for repeat atrial fibrillation ablation. Heart Vessels 2021; 37:1003-1009. [PMID: 34846561 PMCID: PMC9114024 DOI: 10.1007/s00380-021-01987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/05/2021] [Indexed: 10/28/2022]
Abstract
INTRODUCTION High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation. METHODS We studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 and 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure. RESULTS A total of 61 patients underwent repeat ablation (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p = 0.01). There was no difference in sinus rhythm maintenance by Kaplan-Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA2DS2-VASc score, or left ventricular ejection fraction. CONCLUSION We demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.
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Affiliation(s)
- Joey Junarta
- Department of Medicine, Jefferson Heart Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA, 19107, USA
| | - Sean J Dikdan
- Department of Medicine, Jefferson Heart Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA, 19107, USA
| | - Naman Upadhyay
- Department of Medicine, Jefferson Heart Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA, 19107, USA
| | - Sairamya Bodempudi
- Department of Medicine, Jefferson Heart Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA, 19107, USA
| | - Michael Y Shvili
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Daniel R Frisch
- Department of Medicine, Jefferson Heart Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA, 19107, USA.
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16
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Park JW, Yang SY, Kim M, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation. Front Cardiovasc Med 2021; 8:709585. [PMID: 34692779 PMCID: PMC8530188 DOI: 10.3389/fcvm.2021.709585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Whereas, high-power short-duration (HPSD) radiofrequency (RF) ablation is generally used in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and influence on autonomic function have not been well established in a large population. This study compared HPSD-AFCA and conventional power (ConvP)-AFCA in propensity score matched-population. Methods: In 3,045 consecutive patients who underwent AFCA, this study included 1,260 patients (73.9% male, 59 ± 10 years old, 58.2% paroxysmal type) after propensity score matching: 315 in 50~60W HPSD group vs. 945 in the ConvP group. This study investigated the procedural factors, complication rate, rhythm status, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results: Procedure time was considerably short in the HPSD group (135 min in HPSD vs. 181 min in ConvP, p < 0.001) compared to ConvP group, but there was no significant difference in the complication rate (2.9% in HPSD vs. 3.7% in ConvP, p = 0.477) and the 3-month HRV between the two groups. At the one-year follow-up, there was no significant difference in rhythm outcomes between the two groups (Overall, Log-rank p = 0.885; anti-arrhythmic drug free, Log-rank p = 0.673). These efficacy and safety outcomes were consistently similar irrespective of the AF type or ablation lesion set. The Cox regression analysis showed that the left atrium volume index estimated by computed tomography (HR 1.01 [1.00–1.02]), p = 0.003) and extra-pulmonary vein triggers (HR 1.59 [1.03–2.44], p = 0.036) were independently associated with one-year clinical recurrence, whereas the HPSD ablation was not (HR 1.03 [0.73–1.44], p = 0.887). Conclusion: HPSD-AFCA notably reduced the procedure time with similar rhythm outcomes, complication rate, and influence on autonomic function as ConvP-AFCA, irrespective of the AF type or ablation lesion set.
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Affiliation(s)
- Je-Wook Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Song-Yi Yang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Min Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
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17
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Waranugraha Y, Rizal A, Firdaus AJ, Sihotang FA, Akbar AR, Lestari DD, Firdaus M, Nurudinulloh AI. The superiority of high-power short-duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta-analysis study. J Arrhythm 2021; 37:975-989. [PMID: 34386124 PMCID: PMC8339091 DOI: 10.1002/joa3.12590] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) using the high-power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta-analysis purposed to investigate the safety and efficacy profile between HPSD and low-power long-duration (LPLD) ablation strategies to treat atrial fibrillation (AF) patients. METHODS We completed the literature review after identifying the relevant articles comparing HPSD and LPLD ablation methods for AF recorded in ClinicalTrials.com, CENTRAL, PubMed, and ScienceDirect until February 2021. The overall effects were calculated using pooled risk ratio (RR) and mean difference (MD) for categorical and continuous data, respectively. We also estimated the 95% confidence interval (CI). RESULTS The HPSD strategy took shorter procedure time (MD = -33.75 min; 95% CI = -44.54 to -22.97; P < .01), fluoroscopy time (MD = -5.73 min; 95% CI = -8.77 to -2.70; P < .001), and ablation time (MD = -17.71; 95% CI = -21.02 to -14.41) than LPLD strategy. The HPSD RFCA was correlated with lower risk of esophageal thermal injury (RR = 0.75; 95% CI = 0.59 to 0.94; P = .02). The HPSD method resulted in higher first-pass pulmonary vein isolation (PVI) (RR = 1.36; 95% CI = 1.13 to 1.64; P < .01), lower PV reconnection (RR = 0.47; 95% CI = 0.34 to 0.64; P < .01), and lower recurrent AF (RR = 0.72; 95% CI = 0.54 to 0.96; P = .02) than LPLD strategy. CONCLUSION HPSD RFCA was superior to the conventional LPLD RFCA in terms of safety and efficacy in treating AF patients.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Ardian Rizal
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Achmad J. Firdaus
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Fransiska A. Sihotang
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Akita R. Akbar
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Defyna D. Lestari
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Muhammad Firdaus
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
| | - Akhmad I. Nurudinulloh
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangIndonesia
- Brawijaya Cardiovascular Research CenterUniversitas BrawijayaMalangIndonesia
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18
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Efficiency, Safety, and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Atrial Fibrillation. Cardiol Res Pract 2021; 2021:8821467. [PMID: 33643666 PMCID: PMC7902128 DOI: 10.1155/2021/8821467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone therapy of atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) is performed using a point-by-point method to achieve durable PVI. However, this procedure remains complex and time-consuming, and the long-term clinical outcomes are still not satisfactory. Recently, there has been increasing interest in the clinical application of high-power short-duration (HPSD) approaches in the field of RFCA. HPSD ablation, distinguishing it from the conventional ablation strategy, delivers RF energy at a high power and saves the dwell time at each site. It is unknown whether the HPSD approach can bring some gratifying changes in the field of RF energy ablation. A number of experimental studies and clinical studies have been conducted regarding this topic. The review aimed to summarize the research findings and evaluate the procedural efficiency, safety, and clinical outcomes of the HPSD approach based on the evidence available to date.
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19
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Chen CF, Wu J, Jin CL, Liu MJ, Xu YZ. Comparison of high-power short-duration and low-power long-duration radiofrequency ablation for treating atrial fibrillation: Systematic review and meta-analysis. Clin Cardiol 2020; 43:1631-1640. [PMID: 33107625 PMCID: PMC7724222 DOI: 10.1002/clc.23493] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
Background High power shorter duration (HPSD) ablation seen to increase efficacy and safety treating of atrial fibrillation (AF); however, comparative data between HPSD and low power longer duration (LPLD) ablation are limited. Hypothesis We thought that HPSD might bring more clinical benefits. The aim of this meta‐analysis was 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 LPLD ablation. Results Ten trials with 2467 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first‐pass pulmonary vein isolation (PVI) (risk ratio [RR]: 1.20; 95% confidence interval [CI]: 1.10‐1.31, P < .001) and recurrence of atrial arrhythmias (RR: 0.73; 95% CI: 0.58‐0.91, P = .005). Additionally, HPSD could reduce procedural time (weighted mean difference [WMD]: −42.93; 95% CI, −58.10 to −27.75, P < .001), ablation time (WMD: −21.01; 95% CI: −24.55 to −17.47, P < .001), and fluoroscopy time (WMD: −4.11; 95% CI: −6.78 to −1.45, 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: 0.57; 95% CI: 0.21‐1.51, P = .26). Conclusions HPSD was safe and efficient for treating AF. Compared with LPLD, HPSD was associated with advantages of procedural features, higher first‐pass PVI and reducing recurrence of atrial arrhythmias. Moreover, major complications and ETI were similar between two groups.
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Affiliation(s)
- Chao-Feng Chen
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Jing Wu
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Chao-Lun Jin
- Department of Cardiology, Nanjing Medical University, Nanjing, Jiangshu, China
| | - Mei-Jun Liu
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Yi-Zhou Xu
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.,Department of Cardiology, Nanjing Medical University, Nanjing, Jiangshu, China
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