1
|
Valeriano C, Buytaert D, Fabbricatore D, De Schouwer K, Addeo L, De Braekeleer L, Geelen P, De Potter T. High efficiency single-catheter workflow for radiofrequency atrial fibrillation ablation in the QDOT catheter era. J Interv Card Electrophysiol 2024; 67:817-826. [PMID: 38092999 DOI: 10.1007/s10840-023-01709-3] [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: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 06/12/2024]
Abstract
BACKGROUND High-power short-duration (HPSD) ablation may improve the consistency and efficiency of pulmonary vein isolation (PVI). The novel QDOT Micro™ catheter (Biosense Webster, Inc.) with temperature feedback and microelectrodes aims to enhance PVI efficiency and safety. This study wants to evaluate the feasibility, safety, and efficiency of a standardized single-catheter workflow for PVI using QDOT (Q-FLOW). METHODS The Q-FLOW includes single transeptal access, radiofrequency encircling of the PVs using a power of 50 W in a temperature/flow-controlled mode, and validation of the circles with microelectrodes. A 1:1 propensity-matched cohort of patients treated with conventional power-controlled ablation using a circular mapping catheter (CMC-FLOW) was used to compare procedural and clinical outcomes. RESULTS A total of 150 consecutive atrial fibrillation patients (paroxysmal 67%, persistent 33%) were included. First-pass isolation rate was 86%. Procedural time, X-ray time, and dose were significantly lower for the Q-FLOW vs the CMC-FLOW (67.2 ± 17.9 vs 88.3 ± 19.2 min, P < 0.001; 3.0 ± 1.9 vs 5.0 ± 2.4 min, P < 0.001; 4.3 ± 1.9 vs 6.4 ± 2.3 Gycm2, P < 0.001). Complications were numerically but not significantly lower in the Q-FLOW group (2 [1.3%] vs 7 [4.7%], P = 0.091). There was no difference in arrhythmia recurrence at 12 months (atrial arrhythmia-free survival rate, 87.5% vs 84.4%, P = 0.565). CONCLUSION A streamlined single-catheter workflow for PVI using QDOT was feasible and safe, resulting in a high rate of first-pass isolation and a low complication rate. The Q-FLOW further improved the efficiency of PVI compared to the standard CMC-FLOW, without difference in the 12-month outcome.
Collapse
Affiliation(s)
- Chiara Valeriano
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Dimitri Buytaert
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Koen De Schouwer
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Lucio Addeo
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Lisa De Braekeleer
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Peter Geelen
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Tom De Potter
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium.
| |
Collapse
|
2
|
Duytschaever M, Račkauskas G, De Potter T, Hansen J, Knecht S, Phlips T, Vijgen J, Scherr D, Szeplaki G, Van Herendael H, Kronborg MB, Berte B, Pürerfellner H, Lukac P. Dual energy for pulmonary vein isolation using dual-energy focal ablation technology integrated with a three-dimensional mapping system: SmartfIRE 3-month results. Europace 2024; 26:euae088. [PMID: 38696675 PMCID: PMC11065353 DOI: 10.1093/europace/euae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 05/04/2024] Open
Abstract
AIMS Contact force (CF)-sensing radiofrequency (RF) catheters with an ablation index have shown reproducible outcomes for the treatment of atrial fibrillation (AF) in large multicentre studies. A dual-energy (DE) focal CF catheter to deliver RF and unipolar/biphasic pulsed field ablation (PFA), integrated with a three-dimensional (3D) mapping system, can provide operators with additional flexibility. The SmartfIRE study assessed the safety and efficacy of this novel technology for the treatment of drug-refractory, symptomatic paroxysmal AF. Results at 3 months post-ablation are presented here. METHODS AND RESULTS Pulmonary vein isolation (PVI) was performed using a DE focal, irrigated CF-sensing catheter with the recommendation of PFA at posterior/inferior and RF ablation at the anterior/ridge/carina segments. Irrespective of energy, a tag size of 3 mm; an inter-tag distance ≤6 mm; a target index of 550 for anterior, roof, ridge, and carina; and a target index of 400 for posterior and inferior were recommended. Cavotricuspid isthmus ablation was permitted in patients with documented typical atrial flutter. The primary effectiveness endpoint was acute procedural success. The primary safety endpoint was the rate of primary adverse events (PAEs) within 7 days of the procedure. A prespecified patient subset underwent oesophageal endoscopy (EE; 72 h post-procedure), neurological assessment (NA; pre-procedure and discharge), and cardiac computed tomography (CT)/magnetic resonance angiogram (MRA) imaging (pre-procedure and 3 months post-procedure) for additional safety evaluation, and a mandatory remapping procedure (Day 75 ± 15) for PVI durability assessment. Of 149 patients enrolled between February and June 2023, 140 had the study catheter inserted (safety analysis set) and 137 had ablation energy delivered (per-protocol analysis set). The median (Q1/Q3) total procedure and fluoroscopy times were 108.0 (91.0/126.0) and 4.2 (2.3/7.7) min (n = 137). The acute procedural success rate was 100%. First-pass isolation was achieved in 89.1% of patients and 96.8% of veins. Cavotricuspid isthmus ablations were successfully performed in 12 patients [pulsed field (PF) only: 6, RF only: 5, and RF/PF: 1]. The PAE rate was 4.4% [6/137 patients; 2 pulmonary vein (PV) stenoses, 2 cardiac tamponades/perforations, 1 stroke, and 1 pericarditis]. No coronary artery spasm was reported. No oesophageal lesion was seen in the EE subset (0/31, 0%). In the NA subset (n = 30), microemboli lesions were identified in 2 patients (2/30, 6.7%), both of which were resolved at follow-up; only 1 was symptomatic (silent cerebral lesion, 3.3%). In the CT/MRA subset (n = 30), severe PV narrowing (of >70%) was detected in 2 patients (2/30, 6.7%; vein level 2/128, 1.6%), of whom 1 underwent dilatation and stenting and 1 was asymptomatic; both were associated with high index values and a small inter-tag distance. In the PV durability subset (n = 30), 100/115 treated PVs (87%) were durably isolated and 18/30 patients (60.0%) had all PVs durably isolated. CONCLUSION A DE focal CF catheter with 3D mapping integration showed a 100% acute success rate with an acceptable safety profile in the treatment of paroxysmal AF. Prespecified 3-month remapping showed notable PVI durability. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05752487.
Collapse
Affiliation(s)
| | - Gediminas Račkauskas
- Vilnius University Hospital, Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | | | - Jim Hansen
- Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | | | | | | | | | - Gabor Szeplaki
- Heart and Vascular Centre, Mater Private Hospital, Dublin, Ireland
- Cardiovascular Research Institute, Royal College of Surgeons, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|
3
|
Gasimova NZ, Nechepurenko AA, Kropotkin EB, Ivanitsky EA, Kolunin GV, Shavshin DA, Antolic B, Artyukhina EA, Abdrakhmanov AS, Korolev KS, Lebedev DS, Mikhaylov EN. Performance of the ablation index during pulmonary vein isolation: periprocedural data from a multicenter registry. J Interv Card Electrophysiol 2022; 65:167-177. [PMID: 35575867 PMCID: PMC9109667 DOI: 10.1007/s10840-022-01242-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study aimed to assess the achievement of target ablation index (AI) values and their impact on first-pass pulmonary vein isolation (FPI) as well as to identify FPI predictors. METHODS Atrial fibrillation (AF) ablation was performed according to the local practice, and target AIs were evaluated. The actual AI was calculated as the median value of all ablation points for the anterior and posterior left atrial (LA) walls. RESULTS A total of 450 patients from nine centers were enrolled. Patients with first-time ablation (n = 408) were divided into the FPI and non-FPI groups. In the FPI group, a higher median target AI was reported for both the anterior and posterior LA walls than those in the non-FPI group. A higher actual AI was observed for the anterior LA wall in the FPI group. The actual AI was equal to or higher than the target AI for the posterior, anterior, and both LA walls in 54%, 47%, and 35% (n = 158) cases, respectively. Parameters such as hypertension, stroke, ablation power, actual AI value on the anterior wall, target AI values on both LA walls, AI achievement on the posterior wall, carina ablation, and operator experience were all associated with FPI in a univariate logistic regression model; only carina ablation was an independent predictor of FPI. CONCLUSIONS According to our multicenter study, FPI and a target AI were not achieved in a significant proportion of AF ablation procedures. Higher actual and target AI values were associated with FPI, but only carina ablation can independently predict FPI.
Collapse
Affiliation(s)
- Nigar Z Gasimova
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia.
| | - Anatoly A Nechepurenko
- Federal Center of Cardiovascular Surgery, 4 Pokrovskaya Roscha str, 414011, Astrakhan, Russia
| | - Evgeny B Kropotkin
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Eduard A Ivanitsky
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Grigorii V Kolunin
- Tyumen Cardiology Research Center, 111 Melnikayte str, 625026, Tyumen, Russia
| | - Dmitry A Shavshin
- Federal Center of High Medical Technologies, 4a Kaliningradskoe highway, 238312, Kaliningrad, Russia
| | - Bor Antolic
- University Medical Center, 7 Zaloska cesta, 1000, Lyublyana, Slovenia
| | - Elena A Artyukhina
- Vishnevskiy National Medical Research Center of Surgery, 27 Bolshaya Serpukhovskaya str, 117997, Moscow, Russia
| | - Ayan S Abdrakhmanov
- National Research Cardiac Surgery Center, 38 Turan ave, 010000, Nur-Sultan, Kazakhstan
| | - Konstantin S Korolev
- Saint-Petersburg Pediatric University, 2 Litovskaya str, 194100, Saint-Petersburg, Russia
| | - Dmitry S Lebedev
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
| | - Evgeny N Mikhaylov
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
| |
Collapse
|
4
|
Katić J, Anić A, Brešković T, Jurišić Z. Higher than recommended lesion size index target values for pulmonary vein isolation result in better clinical outcomes in paroxysmal atrial fibrillation patients. J Interv Card Electrophysiol 2021; 64:463-468. [PMID: 34453647 DOI: 10.1007/s10840-021-01053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Catheter ablation is a cornerstone of the therapy for paroxysmal atrial fibrillation. The importance of effective lesion size formation during pulmonary vein isolation is gauged through conduction recovery and recurrence of arrhythmia. Therefore, the lesion size index (LSI) is designed to utilize traditional intraprocedural parameters and predict procedural success. The impact of the optimal LSI index and the respective segments of the pulmonary veins has not been commonly evaluated. We aimed to assess whether higher and targeted LSI on the different segments of pulmonary veins could actually lead to better clinical outcomes of paroxysmal atrial fibrillation ablation. METHODS Retrospective analyses of drug-refractory paroxysmal atrial fibrillation patients who underwent first catheter ablation were conducted. Targeted LSI of 6.5 at the anterior wall and 5.2 at the posterior wall, roof, and floor of the pulmonary vein was applied. The primary endpoint was defined as arrhythmias recurrence assessed by routine electrocardiograms and 24-h ambulatory electrocardiographic monitoring at 3, 6, and 12 months post-ablation. RESULTS Among the included 39 patients, the single-procedure 12-month freedom from arrhythmias was reached in 92.3% of patients. Interestingly, there was no tendency towards an increased number of adverse effects using a higher LSI index. CONCLUSIONS Atrial fibrillation ablation guided by targeted LSI value showed efficiency on the freedom from arrhythmias during 1-year follow-up period without harmful effects.
Collapse
Affiliation(s)
- Josip Katić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia.
| | - Ante Anić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Toni Brešković
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Zrinka Jurišić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| |
Collapse
|