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Hindricks G, Weiner S, McElderry T, Jaïs P, Maddox W, Garcia-Bolao JI, Yong Ji S, Sacher F, Willems S, Mounsey J, Maury P, Bollmann A, Duffy E, Raciti G, Tung R, Wong T. Acute safety, effectiveness, and real-world clinical usage of ultra-high density mapping for ablation of cardiac arrhythmias: results of the TRUE HD study. Europace 2020; 21:655-661. [PMID: 30815690 PMCID: PMC6452400 DOI: 10.1093/europace/euy191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS The objective of this study was to verify acute safety, performance, and usage of a novel ultra-high density mapping system in patients undergoing ablation procedure in a real-world clinical setting. METHODS AND RESULTS The TRUE HD study enrolled patients undergoing catheter ablation with mapping for all arrhythmias (excluding de novo atrial fibrillation) who were followed for 1 month. Safety was determined by collecting all serious adverse events and adverse events associated with the study devices. Performance was determined as the composite of: ability to map the arrhythmia/substrate, complete the ablation applications, arrhythmia termination (where applicable), and ablation validation. Use of mapping system in the ablation validation workflow was also evaluated. Among the 519 patients who underwent a complete (504) or attempted (15) procedure, 21 (4%) serious ablation-related complications were collected, with 3 (0.57%) potentially related to the mapping catheter. Four hundred and twenty treated patients resulted in a successful procedure confirmed by arrhythmia-specific validation techniques (83.3%; 95% confidence interval: 79.8-86.5%). A total of 1419 electroanatomical maps were created with a median acquisition time of 9:23 min per map. Of these, 372 maps in 222 (44%) patients were collected for ablation validation purposes. Following validation mapping, 162/222 (73%) patients required additional ablation. CONCLUSION In the TRUE HD study mapping was associated with rates of acute success and complications consistent with previously published reports. Importantly, a low percentage of events (0.57%) was attributed to the mapping catheter. When performed, validation mapping was useful for identifying additional targets for ablation in the majority of patients.
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Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr., Leipzig, Germany
| | - Stanislav Weiner
- Clinic Electrophysiology Department, Trinity Mother Frances, Tyler, TX, USA
| | - Tom McElderry
- Cardiac Electrophysiology, Division of Cardiovascular Disease, University of Alabama Birmingham, Birmingham, AL, USA
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, University of Bordeaux, CHU Bordeaux, IHU LIRYC, Bordeaux, France
| | - William Maddox
- Cardiac Electrophysiology, Division of Cardiovascular Disease, University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Sang Yong Ji
- Cardiac Electrophysiology, Division of Cardiology, Torrance Memorial Medical Center, Torrance, CA, USA
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, University of Bordeaux, CHU Bordeaux, IHU LIRYC, Bordeaux, France
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - John Mounsey
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Philippe Maury
- Division of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr., Leipzig, Germany
| | | | | | - Roderick Tung
- Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Tom Wong
- Heart Rhythm Centre, Royal Brompton and Harefield foundation Trust and Imperial College, London, UK
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2
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Te ALD, Chen SA. Pearl and pitfall of catheter ablation for atrial fibrillation: Lesson from an extremely long-term 12-year outcome study. Heart Rhythm 2017; 14:493-494. [PMID: 28062248 DOI: 10.1016/j.hrthm.2016.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,; Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Santangeli P, Di Biase L, Al-Ahmad A, Horton R, Burkhardt JD, Sanchez JE, Gallinghouse GJ, Zagrodzky J, Bai R, Pump A, Mohanty S, Lewis WR, Natale A. Ablation as First-Line Therapy for Atrial Fibrillation: Yes. Card Electrophysiol Clin 2016; 4:287-97. [PMID: 26939948 DOI: 10.1016/j.ccep.2012.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article addresses the use of catheter ablation (CA) as first-line therapy for atrial fibrillation (AF). CA increases long-term freedom from AF, reduces hospitalizations, and improves quality of life compared with antiarrhythmic drug (AAD) therapy in patients with symptomatic AF who have already failed one AAD. The role of CA as first-line therapy for AF, however, is still controversial. Evidence from randomized controlled trials shows that CA is definitely superior to AADs as first-line therapy for relatively young patients with paroxysmal AF, with comparable complication rates and results consistently reproducible across different institutions, operators, and types of ablation approaches.
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Affiliation(s)
- Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; University of Foggia, Foggia, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; University of Foggia, Foggia, Italy
| | - Amin Al-Ahmad
- Division of Cardiology, Stanford University, 300 Pasteur Drive, MC 5319 A260, Stanford, CA, USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Rong Bai
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Tong-Ji Hospital, Tong-Ji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Agnes Pump
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Heart Institute, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - William R Lewis
- Heart and Vascular Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Division of Cardiology, Stanford University, 300 Pasteur Drive, MC 5319 A260, Stanford, CA, USA; Heart and Vascular Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; EP Services, California Pacific Medical Center, San Francisco, CA, USA
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4
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Imberti D, Ambrosoli A, Cimminiello C, Compagnone C, Fanelli A, Tripodi A, Ottani F. Periprocedural management of rivaroxaban-treated patients. Expert Opin Pharmacother 2015; 16:685-91. [DOI: 10.1517/14656566.2015.1013939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Santangeli P, Di Biase L, Natale A. Ablation versus drugs: what is the best first-line therapy for paroxysmal atrial fibrillation? Antiarrhythmic drugs are outmoded and catheter ablation should be the first-line option for all patients with paroxysmal atrial fibrillation: pro. Circ Arrhythm Electrophysiol 2014; 7:739-46. [PMID: 25140019 DOI: 10.1161/circep.113.000629] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.)
| | - Luigi Di Biase
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.)
| | - Andrea Natale
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.).
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Stec S, Śledź J, Mazij M, Raś M, Ludwik B, Chrabąszcz M, Śledź A, Banasik M, Bzymek M, Młynarczyk K, Deutsch K, Labus M, Śpikowski J, Szydłowski L. Feasibility of implementation of a "simplified, No-X-Ray, no-lead apron, two-catheter approach" for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol 2014; 25:866-874. [PMID: 24654678 DOI: 10.1111/jce.12414] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although the "near-zero-X-Ray" or "No-X-Ray" catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used "No-X-Ray," simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients. METHODS Data were obtained from a prospective multicenter CA registry of patients with regular SVTs. After femoral access, 2 catheters were used to create simple, 3D electroanatomic maps and to perform electrophysiologic studies. Medical staff did not use lead aprons after the first 10 MINI CA cases. RESULTS A total of 188 patients (age, 45 ± 21 years; 17% <19 years; 55% women) referred for the No-X-Ray approach were included. They were compared to 714 consecutive patients referred for a simplified approach using X-rays (age, 52 ± 18 years; 7% <19 years; 55% women). There were 9 protocol exceptions that necessitated the use of X-rays. Ultimately, 179/188 patients underwent the procedure without fluoroscopy, with an acute success rate of 98%. The procedure times (63 ± 26 vs. 63 ± 29 minutes, P > 0.05), major complications (0% vs. 0%, P > 0.05) and acute (98% vs. 98%, P > 0.05) and long-term (93% vs. 94%, P > 0.05) success rates were similar in the "No-X-Ray" and control groups. CONCLUSIONS Implementation of a strict "No-X-Ray, simplified 2-catheter" CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
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Affiliation(s)
- Sebastian Stec
- Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw.,ELMedica EP-Network, Kielce.,Podkarpackie Center for Cardiovascular Interventions, Sanok
| | - Janusz Śledź
- ELMedica EP-Network, Kielce.,Carint Medica, Kraków.,Division of Interventional Cardiology, Center of Invasive Cardiology, Angiology and Electrotherapy in Ostrowiec, Poland
| | - Mariusz Mazij
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Małgorzata Raś
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Bartosz Ludwik
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Michał Chrabąszcz
- ELMedica EP-Network, Kielce.,Institute of Physics, Department of Atomic Physics, Jan Kochanowski University, Kielce
| | | | | | | | | | - Karol Deutsch
- Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw
| | - Michał Labus
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Jerzy Śpikowski
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Silesian Medical University, Katowice, Poland
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Mohanty S, Biase LD, Bai R, Santangeli P, Pump A, Horton R, Sanchez JE, Natale A. Quality of life and patient-centered outcomes following atrial fibrillation ablation: short- and long-term perspectives to improving care. Expert Rev Cardiovasc Ther 2014; 10:889-900. [DOI: 10.1586/erc.12.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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Santangeli P, Di Biase L, Bai R, Horton R, Burkhardt JD, Sanchez J, Price J, Natale A. Advances in catheter ablation: atrial fibrillation ablation in patients with mitral mechanical prosthetic valve. Curr Cardiol Rev 2012; 8:362-7. [PMID: 23003204 PMCID: PMC3492819 DOI: 10.2174/157340312803760767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 05/26/2012] [Accepted: 05/26/2012] [Indexed: 11/30/2022] Open
Abstract
Atrial fibrillation (AF) is common in patients with mitral valve replacement (MVR). Treatment of AF in these subjects is challenging, as the arrhythmia is often refractory to antiarrhythmic drug therapy. Radiofrequency catheter ablation (RFCA) is usually avoided or delayed in patients with MVR due to the higher perceived risks and difficulty of left atrial catheter manipulation in the presence of a mechanical valve. Over the last few years, several investigators have reported the feasibility and safety of RFCA of AF in patients with MVR. Five case-control studies have evaluated the feasibility and safety of RFCA of AF or perimitral flutter (PMFL) in patients with MVR. Overall, a total of 178 patients with MVR have been included (21 undergoing ablation of only PMFL), and have been compared with a matched control group of 285 patients. Total procedural duration (weigthed mean difference [WMD] = +24.5 min, 95% confidence interval [CI] +10.2 min to +38.8 min, P = 0.001), and fluoroscopy time (WMD = +13.5 min, 95% CI +3.7 min to +23.4 min, P = 0.007) were longer in the MVR group. After a mean follow-up of 11.5 ± 8.6 months, 64 (36%) patients in the MVR group experienced recurrence of AF/PMFL, as compared to 73 (26%) patients in the control group, accounting for a trend toward an increased rate of recurrences in patients with MVR (odds ratio [OR] = 1.66, 95% CI 0.99 to 2.78, P = 0.053). Periprocedural complications occurred in 10 (5.6%) patients in the MVR group, and in 8 (2.8%) patients in the control group (OR = 2.01, 95% CI 0.56 to 7.15, P = 0.28). In conclusion, a quantitative analysis of the available evidence supports a trend toward a worse arrhythmia-free survival and a higher absolute rate of periprocedural complications in patients with MVR undergoing RFCA of AF or PMFL, as compared to a matched control group without mitral valve disease. These data would encourage the adoption of RFCA of AF in MVR patients mostly by more experienced Institutions.
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Affiliation(s)
- Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute - St. David's Medical Center, Austin, TX 78705, USA
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The use of high-frequency jet ventilation for out of operating room anesthesia. Curr Opin Anaesthesiol 2012; 25:482-5. [DOI: 10.1097/aco.0b013e3283554375] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University School of Medicine
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