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Ohkura T, Yamasaki T, Kakita K, Hattori T, Nishimura T, Iwakoshi H, Shimoo S, Shiraishi H, Matoba S, Senoo K. Comparison of maximum-sized visually guided laser balloon and cryoballoon ablation. Heart Vessels 2022; 38:691-698. [PMID: 36441215 PMCID: PMC10085885 DOI: 10.1007/s00380-022-02208-7] [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: 08/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
AbstractBalloon ablation therapy has recently been used for atrial fibrillation (AF) ablation. Laser balloons possess the property in which the balloon size can be changed. Standard laser balloon ablation (Standard LBA) was followed by additional ablation using a maximally extended balloon (Extended LBA) and its lesion characteristics were compared to cryoballoon ablation (CBA), another balloon technology. From June 2020 to July 2021, patients with paroxysmal AF who underwent an initial pulmonary vein (PV) isolation were enrolled. Sixty-five patients with paroxysmal AF were included, 32 in the LBA and 33 in the CBA group. To measure the isolated surface area after the ablation procedures, left atrial voltage mapping was performed after Standard LBA, Extended LBA, and CBA. The baseline patient characteristics did not differ between LBA and CBA. Extended LBA could successfully increase the isolated area more than Standard LBA for all four PVs. Compared to CBA, the isolated area of both superior PVs was significantly greater with Extended LBA (left superior PV: 8.5 ± 2.1 vs 7.3 ± 2.4, p = 0.04, right superior PV: 11.4 ± 3.7 vs 8.7 ± 2.7, p < 0.01), and thus the non-isolated posterior wall (PW) was smaller (8.5 ± 3.4 vs 12.4 ± 3.3, p < 0.01). Nevertheless, changes in the cardiac injury markers were significantly lower with LBA than CBA. There was no significant correlation between the cardiac injury level and isolated area in both groups. In conclusion, Extended LBA exhibited a significantly greater isolation of both superior PVs and resulted in a smaller non-isolated PW, but the cardiac injury markers were significantly suppressed as compared to CBA.
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Affiliation(s)
- Takashi Ohkura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
| | | | - Tetsuro Nishimura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hibiki Iwakoshi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Shimoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Keitaro Senoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan.
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Bińkowski BJ, Kucejko T, Łagodziński A, Lubiński A. How to avoid unnecessary RF applications in cavo-tricuspid isthmus: common atrial flutter ablation using 8-mm-tip mini-electrode-equipped catheter. J Interv Card Electrophysiol 2020; 60:109-114. [PMID: 32103404 DOI: 10.1007/s10840-020-00715-z] [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: 11/28/2018] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Eight-millimeter-tip ablation catheters are characterized by poor mapping resolution as they depend on electrode size and spacing. IntellaTip MiFi XP 8-mm (Boston Scientific) catheters offer high mapping resolution due to 3 mini-electrodes (ME) located at the distal tip of the catheter and are dedicated for cavo-tricuspid isthmus (CTI) radiofrequency ablation (RFA). The aim of the study was to evaluate the usefulness, effectiveness and safety of novel IntellaTip MiFi XP catheter for CTI RFA and its ability to localize anatomical structures of the heart. METHODS The study included 10 patients referred for atrial flutter ablation. The 3D mapping system EnSite Velocity was utilized for catheter visualization. The ME signals were used for tricuspid annulus visualization, RF delivery effectiveness assessment defined as ME signal attenuation, and localization of the gaps in the ablation line. The use of ME signals for TV annulus localization resulted in a 13.9 mm (35.5 ± 4.8 mm vs 49.4 ± 7.8 mm; p < 0.01) shorter ablation line in comparison with the potential ablation line designed using standard bipol. The ablation endpoint, bidirectional block, was achieved in all 10 cases (100%) and lasted for at least 15 min after the last RF delivery. The ablation endpoint was reached after 5.1 ± 1.67 RF applications. The total RF time was 220 ± 61 s. Total procedure time was 66 ± 13.5 min, fluoroscopy time 3.92 ± 4.21 min, and total fluoroscopy dose 40.3 ± 56.5 mGy. RESULTS In 3 out of 10 cases, there was a need of filling the gap with 1-2 additional applications after the first linear lesion set. No additional RF applications were required at the annular end of the ablation line. The indirect comparison with previously conducted studies using a standard 8-mm ablation catheter shows that the studied catheter has at least the same or even better performance. CONCLUSIONS The use of the novel IntellaTip MiFi XP may help to avoid unnecessary RF application especially at the annular part of cavo-tricuspid isthmus and enables a purely electrophysiological approach to atrial flutter ablation, as high-resolution ME signals help to understand local electrophysiological phenomena.
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Affiliation(s)
- Bartłomiej Jacek Bińkowski
- Department of Interventional Cardiology and Cardiac Arrhythmias, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Lodz, Medical University of Lodz, Żeromskiego 113, 90-549, Łódź, Poland.
| | - Tomasz Kucejko
- Department of Interventional Cardiology and Cardiac Arrhythmias, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Lodz, Medical University of Lodz, Żeromskiego 113, 90-549, Łódź, Poland
| | - Artur Łagodziński
- Department of Interventional Cardiology and Cardiac Arrhythmias, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Lodz, Medical University of Lodz, Żeromskiego 113, 90-549, Łódź, Poland
| | - Andrzej Lubiński
- Department of Interventional Cardiology and Cardiac Arrhythmias, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Lodz, Medical University of Lodz, Żeromskiego 113, 90-549, Łódź, Poland
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Evaluation of myocardial injury induced by different ablation approaches (radiofrequency ablation versus cryoablation) in atrial flutter patients: a meta-analysis. Biosci Rep 2019; 39:BSR20182251. [PMID: 31076543 PMCID: PMC6533206 DOI: 10.1042/bsr20182251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 11/28/2022] Open
Abstract
Background: To evaluate myocardial injury in Atrial flutter (AFL) patients undergoing Radiofrequency ablation (RF) and cryoablation (CRYO) treatments. Methods: We conducted a systematic search on PubMed, Embase, Cochrane Library, and CBM databases. All relevant clinical trials (up to October 2018) on myocardial injury in AFL patients were retrieved and subsequent results analyzed with a random-effects model or a fixed-effects model. Results: A total of eight clinical trials with a sample size of 644 patients, were identified and incorporated in the present study. The results indicated no significant differences in creatine kinase (CK) levels (mean difference (MD) = 62.74, P=0.46; 4–6 h and MD = 30.73, P=0.49; 12–24 h after ablation), creatine kinase MB(CK-MB) levels (MD = 17.32, P=0.25; 12–24 h post-ablation), troponinI (TnI) levels (MD = 0.12, P=0.08; 6 h after ablation), and troponin T (TnT) levels (MD = 0.30, P=0.08; 4–6 h post-ablation) between the two treatment approaches. However, patients receiving CRYO xhibited higher levels of CK (MD = 179.54, P=0.04; tested immediately after the procedure), CK-MB (MD = 10.08, P=0.004) 4–6 h after ablation, and TnT (MD = 0.19, P=0.002) tested the next morning. Moreover, those patients had a significantly reduced pain perception (odds ratio (OR) = 0.05, P=0.04) compared with those in the RF group. Conclusion: These results indicate that CRYO in comparison with RF significantly increases myocardial injury in AFL patients. Additionally, it decreases pain perception during the procedure. Further large-sampled studies are needed to support these findings.
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Vloka C, Nelson DW, Wetherbee J. Atriocaval Rupture After Right Atrial Isthmus Ablation for Atrial Flutter. Am J Cardiol 2016; 117:1856-7. [PMID: 27112285 DOI: 10.1016/j.amjcard.2016.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
A patient with symptomatic typical atrial flutter (AFL) underwent right atrial isthmus ablation with an 8-mm catheter. Eight months later, his typical AFL recurred. Ten months later, he underwent a repeat right atrial isthmus ablation with an irrigated tip catheter and an 8-mm tip catheter. Six weeks after his second procedure, while performing intense sprint intervals on a treadmill, he developed an abrupt onset of chest pain, hypotension, and cardiac tamponade. He underwent emergency surgery to repair an atriocaval rupture and has done well since. Our report suggests that an association of multiple radiofrequency ablations with increased risk for delayed atriocaval rupture occurring 1 to 3 months after ablation. In conclusion, although patients generally were advised to limit exercise for 1 to 2 weeks after AFL ablation procedures in the past, it may be prudent to avoid intense exercise for at least 3 months after procedure.
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ATTANASIO PHILIPP, HUEMER MARTIN, SHOKOR PARWANI ABDUL, BOLDT LEIFHENDRIK, MÜGGE ANDREAS, HAVERKAMP WILHELM, WUTZLER ALEXANDER. Pain Reactions during Pulmonary Vein Isolation under Deep Sedation: Cryothermal versus Radiofrequency Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:452-7. [DOI: 10.1111/pace.12840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- PHILIPP ATTANASIO
- Department of Cardiology, Charité - Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - MARTIN HUEMER
- Department of Cardiology, Charité - Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - ABDUL SHOKOR PARWANI
- Department of Cardiology, Charité - Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - LEIF-HENDRIK BOLDT
- Department of Cardiology, Charité - Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - ANDREAS MÜGGE
- Cardiovascular Center, St. Josef-Hospital; Ruhr-University Bochum; Bochum Germany
| | - WILHELM HAVERKAMP
- Department of Cardiology, Charité - Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - ALEXANDER WUTZLER
- Cardiovascular Center, St. Josef-Hospital; Ruhr-University Bochum; Bochum Germany
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Tzeis S, Pastromas S, Andrikopoulos G. Ablation of Cavotricuspid Isthmus-Dependent Flutter Using a Mini-Electrode-Equipped 8-mm Ablation Catheter: Case Series. Hellenic J Cardiol 2016; 57:53-8. [PMID: 26856204 DOI: 10.1016/s1109-9666(16)30021-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Stylianos Tzeis
- Henry Dunant Hospital Center, Department of Cardiology, Athens, Greece
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Saygi S, Drca N, Insulander P, Schwieler J, Jensen-Urstad M, Bastani H. Myocardial injury during radiofrequency and cryoablation of typical atrial flutter. J Interv Card Electrophysiol 2015; 46:177-81. [PMID: 26546105 DOI: 10.1007/s10840-015-0074-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Cardiac enzyme elevation after radiofrequency (RF) catheter ablation of atrial flutter (AFL) is common. Some studies found that cryoablation (CRYO) of AFL, compared to RF, is associated with higher levels of troponin, a finding that may indicate CRYO causes a greater amount of myocardial injury than RF. However, other investigations found no significant differences between troponin levels after CRYO versus RF. We have in a randomized study compared the post-procedural troponin I levels in RF and CRYO and the possible relation to procedural outcome and complications. METHODS We randomized 153 patients with cavotricuspid isthmus (CTI)-dependent AFL to CRYO or RF (78 CRYO; 75 RF). RF was performed with a 3.5-mm open-irrigated-tip catheter, and CRYO was performed with an 8-mm-tip catheter. Troponin I levels were measured before and 6 h after ablation. RESULTS Acute procedural success was achieved in 71/75 patients in the RF and in 72/78 patients in the CRYO. Troponin I levels were significantly elevated in both groups (baseline 0.012, 6th hour 0.35 ng/ml; p < 0.001). Troponin I levels were similar for RF and CRYO. Troponin I levels were higher in patients with acute failure compared to patients with acute success (0.48 ± 0.4 and 0.34 ± 0.16 ng/ml, p = 0.029); however, there was no difference between patients with or without late recurrence. There were no major complications in any group. CONCLUSION RF and CRYO for CTI-dependent AFL resulted in similar amounts of procedural myocardial injury. Troponin I levels had no prognostic value for late recurrence of AFL and there were no complications related to high troponin I levels.
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Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. .,Cardiology Department, Karolinska University Hospital, M52, 141 86, Huddinge, Stockholm, Sweden.
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Chen YH, Lin H, Xie CL, Zhang XT, Li YG. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis. Sci Rep 2015; 5:10910. [PMID: 26039980 PMCID: PMC4454189 DOI: 10.1038/srep10910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/06/2015] [Indexed: 11/09/2022] Open
Abstract
We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Lin
- Department of Respiratory, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiao-Ting Zhang
- Department of Dermatology, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
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Affiliation(s)
- Suraj Kapa
- From the Department of Medicine, Division of Cardiology (S.K., S.J.A.), and Division of Pediatric Cardiology (S.J.A.), Mayo Clinic College of Medicine, Rochester, MN
| | - Samuel J Asirvatham
- From the Department of Medicine, Division of Cardiology (S.K., S.J.A.), and Division of Pediatric Cardiology (S.J.A.), Mayo Clinic College of Medicine, Rochester, MN.
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Peyrol M, Sbragia P, Uhry S, Boccara G, Dolla E, Quatre A, Guenoun M, Lévy S, Paganelli F. Slow pathway elimination for atrioventricular nodal reentrant tachycardia with the 8-mm tip cryoablation catheter: an 18-month follow-up study. J Interv Card Electrophysiol 2012; 37:105-9. [DOI: 10.1007/s10840-012-9768-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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Bastani H, Drca N, Insulander P, Schwieler J, Braunschweig F, Kennebäck G, Sadigh B, Tapanainen J, Jensen-Urstad M. Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison. ACTA ACUST UNITED AC 2012; 15:420-8. [DOI: 10.1093/europace/eus261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Manusama R, Timmermans C, van der Schoot M, Philippens S, Rodriguez LM. Comparison of a 6.5, 10, and 15 mm cryoablation catheter-tip for the treatment of common atrial flutter. Europace 2012; 14:1634-8. [DOI: 10.1093/europace/eus091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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DE SISTI ANTONIO, TONET JOELCI. Cryoablation of Atrioventricular Nodal Reentrant Tachycardia: A Clinical Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:233-40. [DOI: 10.1111/j.1540-8159.2011.03244.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andrew P, Hamad Y, Jerat S, Montenero A, O’Connor S. Approaching a decade of cryo catheter ablation for type 1 atrial flutter—a meta-analysis and systematic review. J Interv Card Electrophysiol 2011; 32:17-27. [DOI: 10.1007/s10840-011-9582-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 04/18/2011] [Indexed: 11/27/2022]
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Solheim E, Off MK, Hoff PI, De Bortoli A, Schuster P, Ohm OJ, Chen J. Remote magnetic versus manual catheters: evaluation of ablation effect in atrial fibrillation by myocardial marker levels. J Interv Card Electrophysiol 2011; 32:37-43. [PMID: 21476086 PMCID: PMC3184221 DOI: 10.1007/s10840-011-9567-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/09/2011] [Indexed: 11/28/2022]
Abstract
Background A remote magnetic navigation (MN) system is available for radiofrequency ablation of atrial fibrillation (AF), challenging the conventional manual ablation technique. The myocardial markers were measured to compare the effects of the two types of MN catheters with those of a manual-irrigated catheter in AF ablation. Methods AF patients underwent an ablation procedure using either a conventional manual-irrigated catheter (CIR, n = 65) or an MN system utilizing either an irrigated (RMI, n = 23) or non-irrigated catheter (RMN, n = 26). Levels of troponin T (TnT) and the cardiac isoform of creatin kinase (CKMB) were measured before and after ablation. Results Mean procedure times and total ablation times were longer employing the remote magnetic system. In all groups, there were pronounced increases in markers of myocardial injury after ablation, demonstrating a significant correlation between total ablation time and post-ablation levels of TnT and CKMB (CIR r = 0.61 and 0.53, p < 0.001; RMI r = 0.74 and 0.73, p < 0.001; and RMN r = 0.51 and 0.59, p < 0.01). Time-corrected release of TnT was significantly higher in the CIR group than in the other groups. Of the patients, 59.6% were free from AF at follow-up (12.2 ± 5.4 months) and there were no differences in success rate between the three groups. Conclusions Remote magnetic catheters may create more discrete and predictable ablation lesions measured by myocardial enzymes and may require longer total ablation time to reach the procedural endpoints. Remote magnetic non-irrigated catheters do not appear to be inferior to magnetic irrigated catheters in terms of myocardial enzyme release and clinical outcome.
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Affiliation(s)
- Eivind Solheim
- Institute of Medicine, University of Bergen, Bergen, Norway.
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Schwagten B, Van Belle Y, Jordaens L. Cryoablation: how to improve results in atrioventricular nodal reentrant tachycardia ablation? Europace 2010; 12:1522-5. [PMID: 20719780 PMCID: PMC2963480 DOI: 10.1093/europace/euq294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Ablation for atrioventricular nodal reentry tachycardia is very effective, with a potential for damage to the normal conduction system. Cryoablation is an alternative, as it allows cryomapping, which permits assessment of slow pathway elimination at innocent freezing temperatures, avoiding permanent damage to the normal conduction system. It is associated with shorter radiation times and the absence of heart block in all published data. We discuss in this overview different approaches of cryoenergy delivery (focusing on spot catheter ablation), and how lesion formation is influenced by catheter tip size, application duration, and freezing rate. Some advantages of cryoenergy are explained. Whether these features also apply for an approach with a cryoballoon, e.g. for atrial fibrillation is unclear.
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Affiliation(s)
| | | | - Luc Jordaens
- Corresponding author. Tel: +31 10 463 2699; Fax: +31 10 463 2701, E-mail:
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Kuniss M, Vogtmann T, Ventura R, Willems S, Vogt J, Grönefeld G, Hohnloser S, Zrenner B, Erdogan A, Klein G, Lemke B, Neuzner J, Neumann T, Hamm CW, Pitschner HF. Prospective randomized comparison of durability of bidirectional conduction block in the cavotricuspid isthmus in patients after ablation of common atrial flutter using cryothermy and radiofrequency energy: the CRYOTIP study. Heart Rhythm 2009; 6:1699-705. [PMID: 19959115 DOI: 10.1016/j.hrthm.2009.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/06/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have shown that cryoablation and radiofrequency (RF) ablation are comparable with regard to success rates and safety in the treatment of common atrial flutter (AFL). Long-term success requires persistence of bidirectional conduction block (BCB) in the inferior cavotricuspid isthmus (CTI). OBJECTIVE The purpose of this study was to determine the persistence of BCB in a prospective randomized multicenter trial of the two ablation techniques. METHODS A total of 191 patients were randomized to RF ablation or cryoablation of the CTI using an 8-mm-tip catheter. In all patients, BCB was defined as the ablation end-point. Primary end-point of the study was nonpersistence of achieved BCB and/or ECG-documented relapse of common AFL within 3-month follow-up. RESULTS Acute success rates were 91% (83/91) in the RF group and 89% (80/90) in the cryoablation group (P = NS). Invasive follow-up after 3 months with repeated electrophysiologic study was available for 60 patients in the RF group and 64 patients in the cryoablation group. Persistent BCB could be confirmed in 85% of the RF group versus 65.6% of the cryoablation group. The primary end-point was achieved in 15% of the RF group and 34.4% of the cryoablation group (P = .014). As a secondary end-point, pain perception during ablation was significant lower in the cryoablation group (P <.001). CONCLUSION Persistence of BCB in patients treated with cryoablation reinvestigated after 3 months is inferior to that patients treated with RF ablation, as evidenced by the higher recurrence rate of common AFL seen in this study.
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Affiliation(s)
- Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
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Manusama R, Timmermans C, Pison L, Philippens S, Perez D, Rodriguez LM. Typical atrial flutter can effectively be treated using single one-minute cryoapplications: results from a repeat electrophysiological study. J Interv Card Electrophysiol 2009; 26:65-72. [PMID: 19521755 PMCID: PMC2746293 DOI: 10.1007/s10840-009-9405-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Purpose Catheter-based cryoablation (cryo) has proven to be as effective as radiofrequency energy (RF) ablation for the treatment of arrhythmias. Nevertheless, the duration of cryoapplications has been reported as being significantly longer than RF applications. Methods Thirty-seven consecutive patients (28 men; mean age 59 ± 14 years) with typical atrial flutter (AFL) underwent cryo of the cavotricuspid isthmus (CTI). Applications of 1 min were delivered with a 10-French, 10-mm tipped catheter (CryoCor™). If bidirectional CTI block was not obtained after 12 1-min applications, applications of 3 min were selectively delivered to areas of conduction breakthrough. The endpoint of the procedure was creation of bidirectional CTI block and non-inducibility of AFL. Results A median of 7 (range 3 to 12) 1-min applications were given along the CTI with a mean temperature of −88.6 ± 2.3°C. Mean fluoroscopy and procedure time were 27 ± 14 min and 110 ± 28 min respectively. Five patients required additional 3-min applications; in one patient an overextended ablation catheter prevented the completion of the index-procedure. The acute success rate of the index-procedure was 97%. In 12/24 patients, two with AFL recurrence, resumption of CTI conduction was found 4 months post-ablation. In all patients bidirectional CTI block was re-obtained after a median of one 1-min application. No additional AFL recurrences occurred, after a mean follow-up of 37 ± 3 (range 30 to 44) months. Conclusions Cryo of AFL can successfully be performed using the same application duration as used for RF ablation. Both acute and long-term results are comparable to RF ablation. AFL recurrences occurred in only a minority of patients with resumption of CTI conduction.
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Affiliation(s)
- Randy Manusama
- Department of Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, P.O. Box 5800, AZ 6202, Maastricht, The Netherlands
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