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Pick AW, Kotschet E, Healy S, Adam D, Bittinger L. Hybrid Totally Thoracoscopic Maze and Catheter Ablation for Persistent Atrial Fibrillation: Initial Experience. Heart Lung Circ 2023; 32:1107-1114. [PMID: 37460351 DOI: 10.1016/j.hlc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/29/2023] [Accepted: 06/06/2023] [Indexed: 10/06/2023]
Abstract
Atrial fibrillation is now a pandemic in our ageing community. Although James L. Cox devised a surgical procedure with near-universal curative success in 1987, catheter-based interventions have flourished. For persistent atrial fibrillation (AF), however, an isolated endocardial approach has limitations: procedural times are long, carry risk, and the outcomes are not durable. By combining left atrial endocardial and epicardial interventions with staged mapping, we optimise the benefits of both approaches. Our initial series of hybrid ablation for persistent atrial fibrillation reports excellent early outcomes, freedom from complications and excellent success at follow-up.
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Affiliation(s)
- Adrian W Pick
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia; Peninsula Private Hospital, Melbourne, Vic, Australia.
| | - Emily Kotschet
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia
| | - Stewart Healy
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia
| | - David Adam
- Victorian Heart Hospital, Melbourne, Vic, Australia
| | - Logan Bittinger
- Victorian Heart Hospital, Melbourne, Vic, Australia; Peninsula Private Hospital, Melbourne, Vic, Australia
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Ishibashi T, Masuda T, Kato M, Yamashita Y, Takei Y, Tsukamoto A, Matsumoto K, Sakamoto H. NATIONWIDE SURVEY OF RADIATION EXPOSURE FOR RADIOFREQUENCY CATHETER ABLATION FOR PULMONARY VEIN ISOLATION AND NONPULMONARY VEIN ISOLATION IN JAPAN. RADIATION PROTECTION DOSIMETRY 2022; 198:16-22. [PMID: 35021232 DOI: 10.1093/rpd/ncab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
To propose typical values for the arrhythmia region between pulmonary vein isolation (PVI) and nonpulmonary vein isolation (non-PVI) in Japan. A nationwide questionnaire was posted to 343 facilities, to which 125 facilities (36.4%) responded. Results is the median for PVI and non-PVI were in terms of Ka,r (317 and 196 mGy), PKA (40.8 and 26.3 Gy.cm2), FT (43.0 and 27.3 min), and CI (326 and 102 images). When comparing PVI and non-PVI procedures, there were significant differences in Ka, r, PKA, FT, and CI (p < 0.05). In other words, by classifying into two types, PVI and non-PVI, we contributed to the establishment of typical values in Japan's RFCA.
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Affiliation(s)
- Toru Ishibashi
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Takanori Masuda
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Mamoru Kato
- Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima 730-8655, Japan
| | - Yukari Yamashita
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Yasutaka Takei
- Department of Radiological Technology, Faculty of Health Science and Technology, 288 Matsushima, Kurashiki-City, Okayama 701-0193, Japan
| | - Atsuko Tsukamoto
- Department of Radiology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Kazuma Matsumoto
- Department of Clinical Radiology, Hyogo College of Medicine College Hospital, 1-3-6 Minatojima, Chuo-ku, Kobe City, Hyogo 663-8501, Japan
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, 2-1-1 Hongo, bunkyou-ku, Tokyo 113-8421, Japan
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Octogenarian Atrial Fibrillation Ablation with New NavX EnSite "Live View" Tool. Case Rep Cardiol 2021; 2021:8834133. [PMID: 33628520 PMCID: PMC7895548 DOI: 10.1155/2021/8834133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Atrial Fibrillation ablation in older patients represents a challenge to be addressed to ensure the improvement of the quality of life and survival of these patients. New mapping system tools can help to treat older patients because of its ability to simplify and reduce procedural risks. The new NavX EnSite “Live view” tool allows dynamic “beat to beat” activation and voltage mapping visualization in order to instantly recognize vein disconnection and minimize RF deliveries. Methods An 81-year old patient with paroxysmal AF and well-documented firing focus trigger underwent pulmonary veins isolation using NavX EnSite Precision, HD Grid multipolar catheter, and the new “Live view” tool. Results All pulmonary veins were successfully isolated with no procedural complications. “Live view” tool allows to perform shorter and safer procedure (total procedural time: 90 minutes, left atrium dwell time: 60 minutes, total RF delivery number: 78). Conclusion “Live view tool” allows dynamic activation and voltage mapping in order to perform a safe and tailored approach to ablation, especially in older patients.
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Kukendrarajah K, Papageorgiou N, Jewell P, Hunter RJ, Ang R, Schilling R, Providencia R. Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials. J Cardiovasc Electrophysiol 2020; 31:2192-2205. [PMID: 32495462 DOI: 10.1111/jce.14598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
AIMS We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined.
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Affiliation(s)
- Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Paul Jewell
- Department of Critical Care, Royal Free Hospital, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - Rui Providencia
- The Farr Institute of Health Informatics Research, University College London, London, UK
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Wenker S, van Lieshout C, Frederix G, van der Heijden J, Loh P, Chamuleau SAJ, van Slochteren F. MRI-guided pulmonary vein isolation for atrial fibrillation: what is good enough? An early health technology assessment. Open Heart 2019; 6:e001014. [PMID: 31798911 PMCID: PMC6861091 DOI: 10.1136/openhrt-2019-001014] [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: 01/28/2019] [Revised: 05/29/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Next to anticoagulation, pulmonary vein isolation (PVI) is the most important interventional procedure in the treatment of atrial fibrillation (AF). Despite widespread clinical application of this therapy, patients often require multiple procedures to reach clinical success. In contrast to conventional imaging modalities, MRI allows direct visualisation of the ablation lesion. Therefore, the use of real-time MRI to guide cardiac electrophysiology procedures may increase clinical effectiveness. An essential aspect, from a decision-making point of view, is the effect on costs and the potential cost-effectiveness of new technologies. Generally, health technology assessment (HTA) studies are performed when innovations are close to clinical application. However, early stage HTA can inform users, researchers and funders about the ultimate clinical and economic potential of a future innovation. Ultimately, this can guide funding allocation. In this study, we performed an early HTA evaluate MRI-guided PVIs. Methods We performed an economic evaluation using a decision tree with a time-horizon of 1 year. We calculated the clinical effectiveness (defined as the proportion of patients that is long-term free of AF after a single procedure) required for MRI-guided PVI to be cost-effective compared with conventional treatment. Results Depending on the cost-effectiveness threshold (willingness to pay for one additional quality-of-life adjusted life year (QALY), interventional MRI (iMRI) guidance for PVI can be cost-effective if clinical effectiveness is 69.8% (at €80 000/QALY) and 77.1% (at €20 000/QALY), compared with 64% for fluoroscopy-guided procedures. Conclusion Using an early HTA, we established a clinical effectiveness threshold for interventional MRI-guided PVIs that can inform a clinical implementation strategy. If crucial technologies are developed, it seems plausible that iMRI-guided PVIs will be able to reach this threshold.
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Affiliation(s)
- Steven Wenker
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris van Lieshout
- Julius Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Frederix
- Julius Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frebus van Slochteren
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Schoene K, Arya A, Jahnke C, Paetsch I, Nedios S, Hilbert S, Bollmann A, Hindricks G, Sommer P. Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation: Single-Center Experience in Catheter Interventional Treatment. JACC Cardiovasc Interv 2019; 11:1626-1632. [PMID: 30139470 DOI: 10.1016/j.jcin.2018.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/02/2018] [Accepted: 05/08/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of the present study was to analyze and report a single-center experience with catheter interventional treatment of radiofrequency-induced pulmonary vein stenosis (PVS) following atrial fibrillation (AF) ablation. BACKGROUND Catheter interventional treatment of radiofrequency-induced PVS following AF ablation remains a challenging field because of a lack of randomized data and treatment guidelines. METHODS All patients at a single center who underwent catheter interventional treatment for radiofrequency-induced PVS were retrospectively assessed. RESULTS From January 2004 to September 2017, the total rate of PVS following interventional AF ablation was 0.78% (87 of 11,103). Thirty-nine patients with PVS were treated with 84 catheter interventions: 68 (81%) with percutaneous transluminal balloon angioplasty (PTA) and 16 (19%) with stent implantation. The distribution of stent type was 3 drug-eluting stents (19%) and 13 bare-metal stents (81%). The overall restenosis rate was 53% after PTA versus 19% after stent implantation (p = 0.007) after a median follow-up period of 6 months (interquartile range: 3 to 55 months). The total complication rate for PTA was 10% versus 13% for stenting (p = NS). CONCLUSIONS This study demonstrates significantly better outcomes in terms of restenosis after stent implantation versus PTA only, with comparable complication rates for these 2 options of interventional treatment of radiofrequency-induced PVS. In summary, despite the lack of randomized studies, the present data and currently available published studies seem to favor stent implantation as a first-line therapy in patients with radiofrequency-induced severe PVS.
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Affiliation(s)
- Katharina Schoene
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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High-power, low-flow, short-ablation duration—the key to avoid collateral injury? J Interv Card Electrophysiol 2018; 55:9-16. [DOI: 10.1007/s10840-018-0473-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/11/2018] [Indexed: 01/05/2023]
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Adiyaman A, Buist TJ, Beukema RJ, Smit JJJ, Delnoy PPH, Hemels ME, Sie HT, Ramdat Misier AR, Elvan A. Randomized Controlled Trial of Surgical Versus Catheter Ablation for Paroxysmal and Early Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e006182. [DOI: 10.1161/circep.118.006182] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Ahmet Adiyaman
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Thomas J. Buist
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Rypko J. Beukema
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Jaap Jan J. Smit
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Peter Paul H.M. Delnoy
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Martin E.W. Hemels
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Hauw T. Sie
- Department of Cardiothoracic Surgery, Isala Heart Centre, Zwolle, the Netherlands. (H.T.S.)
| | - Anand R. Ramdat Misier
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
| | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands. (A.A., T.J.B., R.J.B., J.J.J.S., P.P.H.M.D., M.E.W.H., A.R.R.M., A.E.)
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de Groot JR. Clinical electrophysiology in the Netherlands: where do we stand? Neth Heart J 2017; 25:533-535. [PMID: 28770397 PMCID: PMC5612870 DOI: 10.1007/s12471-017-1030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- J R de Groot
- Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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