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Solimene F, Maggio R, De Sanctis V, Escande W, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Ferraro A, Mantica M, Zucchelli G, Dell'Era G, Mascia G, Ricci Maga R, Pandozi C, Rossi P, Scaglione M, Zingarini G, Garnier F, Loricchio ML, Pelargonio G, Lepillier A. Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from an international multicenter clinical setting. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01849-0. [PMID: 38972960 DOI: 10.1007/s10840-024-01849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). OBJECTIVE We report the outcomes of our acute and long-term clinical evaluation of CF-LI-guided PVI in consecutive AF ablation cases from an international multicenter clinical setting. METHODS Three hundred twenty-four consecutive patients from 20 European centers undergoing RF catheter ablation with the Stablepoint™ catheter were enrolled in the CHARISMA registry. Of these, 275 had a minimum follow-up of 1 year and were included in the primary analysis. RESULTS The mean procedure duration was 115 ± 47 min, and the mean fluoroscopy time was 9.9 ± 6 min. At the end of the procedures, all PVs had been successfully isolated in all study patients. Minor complications were reported in 12 patients (4.4%). At 1 year, 36 (13.1%) patients had had an AF recurrence, and freedom from antiarrhythmic drugs and AF recurrence was achieved in 228 (82.9%) patients. The recurrence rate was higher in patients with persistent AF (21/116, 18.1%) than in those with paroxysmal AF (15/159, 9.4%; p = 0.0459). On multivariate logistic analysis adjusted for baseline confounders, only time > 6 months from first diagnosis of AF to ablation (HR = 2.93, 95%CI 1.03 to 8.36, p = 0.0459) was independently associated with recurrences. CONCLUSION An ablation strategy for PVI guided by CF-LI technology proved safe and effective and resulted in a low recurrence rate of AF over 1-year follow-up, irrespective of the underlying AF type. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice. (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.
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Affiliation(s)
- Franscesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Ruggero Maggio
- Laboratorio Di Elettrofisiologia, Infermi Hospital, 29, Rivoli, Italy.
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute E Della Scienza Di Torino" Hospital, University of Turin, Turin, Italy
| | - Anna Ferraro
- Laboratorio Di Elettrofisiologia, Infermi Hospital, 29, Rivoli, Italy
| | | | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell'Era
- Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | | | | | | | - Pietro Rossi
- Fatebenefratelli Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
| | | | | | | | | | - Gemma Pelargonio
- Istituto Di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Kewcharoen J, Shah K, Bhardwaj R, Turagam MK, Contractor T, Mandapati R, Lakkireddy D, Garg J. Catheter-related and clinical complications associated with QDOT MICRO TM Ablation Catheter. J Cardiovasc Electrophysiol 2024. [PMID: 38978283 DOI: 10.1111/jce.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION The QDOT MICROTM Ablation Catheter is a next-generation ablation catheter that allows for high-power ablation up to 90 watts. METHODS We aimed to assess AE associated with the QDOT MICROTM catheter using the MAUDE database. A MAUDE database search was conducted on May 25, 2024, to capture all AEs (since FDA approval) associated with this ablation catheter. RESULTS A total of 302 AEs from November 23, 2022, to April 30, 2024, were reported including 148 (49%) catheter-related issues and 154 (51%) clinical complications. Among the catheter-related issues, physical catheter damage (74.3%, n = 110) was most common, followed by communication or display issue (10.8%, n = 16), irrigation issue (9.5%, n = 14), signal issue or artifact (3.4%, n = 5), and inaccurate temperature measurement (2.0%, n = 3). Regarding clinical complications, the most common AE was pericardial effusion (43.5%, n = 67), followed by char formation (11.7%, n = 18), catheter thrombosis (7.1%, n = 11), stroke (7.1%, n = 11), pericarditis (7.1%, n = 11), esophageal complications (6.5%, n = 10), phrenic nerve palsy (3.9%, n = 6), cardiac arrest (3.9%, n = 6), significant AV block (3.9%, n = 6), pulmonary vein stenosis (3.2%, n = 5), coronary artery spasm (1.3%, n = 2), and pulmonary embolism (0.6%, n = 1). There were 11 deaths (five related to esophageal complications, five related to cardiac arrest, and one related to pericardial effusion with cardiac tamponade). CONCLUSION As high-power ablation strategy with novel ablation catheters is becoming more widely utilized, operators must be aware of potential catheter-related issues and clinical complications that may arise. More data are needed to further evaluate risks of these complications to improve the catheter's safety and efficacy.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, Iowa, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
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Dai M, Barbhaiya C. One shot to challenge single-shot. J Interv Card Electrophysiol 2024; 67:699-700. [PMID: 38557947 DOI: 10.1007/s10840-024-01787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Matthew Dai
- Leon H. Charney Division of Cardiology, New York University Langone Health, 550 1St Avenue, New York, NY, 10016, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone Health, 550 1St Avenue, New York, NY, 10016, USA.
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Compagnucci P, Volpato G, Cipolletta L, Parisi Q, Valeri Y, Campanelli F, D'Angelo L, Ciliberti G, Stronati G, Carboni L, Giovagnoni A, Guerra F, Natale A, Casella M, Dello Russo A. Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation. Heart Rhythm O2 2024; 5:374-384. [PMID: 38984361 PMCID: PMC11228279 DOI: 10.1016/j.hroo.2024.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Background Posterior wall ablation (PWA) is commonly added to pulmonary vein isolation (PVI) during catheter ablation (CA) of persistent atrial fibrillation (AF). Objective The purpose of this study was to compare PVI plus PWA using very-high-power short-duration (vHPSD) vs standard-power (SP) ablation index-guided CA among consecutive patients with persistent AF and to determine the voltage correlation between microbipolar and bipolar mapping in AF. Methods We compared 40 patients undergoing PVI plus PWA using vHPSD to 40 controls receiving PVI plus PWA using SP. The primary efficacy endpoint was recurrence of atrial tachyarrhythmias after a 3-month blanking period. The primary safety outcome was a composite of major complications within 30 days after CA. In the vHPSD group, high-density mapping of the posterior wall was performed using both a multipolar catheter and microelectrodes on the tip of the ablation catheter. Results PVI was more commonly obtained with vHPSD compared to SP ablation (98%vs 75%; P = .007), despite shorter procedural and fluoroscopy times (P <.001). Survival free from recurrent atrial tachyarrhythmias at 18 months was 68% and 47% in the vHPSD and SP groups, respectively (log-rank P = .071), without major adverse events. The vHPSD approach was significantly associated with reduced risk of recurrent AF at multivariable analysis (hazard ratio 0.39; P = .030). Microbipolar voltage cutoffs of 0.71 and 1.69 mV predicted minimum bipolar values of 0.16 and 0.31 mV in AF, respectively, with accuracies of 0.67 and 0.88. Conclusion vHPSD PWA plus PVI may be faster and as safe as SP CA among patients with persistent AF, with a trend for superior efficacy. Adapted voltage cutoffs should be used for identifying atrial low-voltage areas with microbipolar mapping.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Francesca Campanelli
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Leonardo D'Angelo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Laura Carboni
- Cardiac Surgery Anesthesia and Critical Care Unit, Marche University Hospital, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital "Ospedali Riuniti," Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
- Department of Interventional Electrophysiology, Scripps Clinic, San Diego, California
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
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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.
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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.
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Calvert P, Koniari I, Mills MT, Ashrafi R, Snowdon R, Gupta D, Luther V. Lesion metrics and 12-month outcomes of very-high power short duration radiofrequency ablation (90W/4 s) under mild conscious sedation. J Cardiovasc Electrophysiol 2024; 35:1165-1173. [PMID: 38571287 DOI: 10.1111/jce.16269] [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: 12/20/2023] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is often performed under general anaesthesia (GA) or deep sedation. Anaesthetic availability is limited in many centers, and deep sedation is prohibited in some countries without anaesthetic support. Very high-power short duration (vHPSD-90W/4 s) PVI using the Q-Dot catheter is generally well tolerated under mild conscious sedation (MCS) though an understanding of catheter stability and long-term effectiveness is lacking. We analyzed lesion metrics and 12-month freedom from atrial arrythmia with this approach. METHODS Our approach to radiofrequency (RF) PVI under MCS is standardized and includes a single catheter approach with a steerable sheath. We identified patients undergoing Q-Dot RF PVI between March 2021 and December 2022 in our center, comparing those undergoing vHPSD ablation under MCS (90W/MCS) against those undergoing 50 W ablation under GA (50 W/GA) up to 12 months of follow-up. Data were extracted from clinical records and the CARTO system. RESULTS Eighty-three patients met our inclusion criteria (51 90W/MCS; 32 50 W/GA). Despite shorter ablation times (353 vs. 886 s; p < .001), the 90 W/MCS group received more lesions (median 87 vs. 58, p < .001), resulting in similar procedure times (149.3 vs. 149.1 min; p = .981). PVI was achieved in all cases, and first pass isolation rates were similar (left wide antral circumferential ablation [WACA] 82.4% vs. 87.5%, p = .758; right WACA 74.5% vs. 78.1%, p = .796; 90 W/MCS vs. 50 W/GA respectively). Analysis of 6647 ablation lesions found similar mean impedance drops (10.0 ± 1.9 Ω vs. 10.0 ± 2.2 Ω; p = .989) and mean contact force (14.6 ± 2.0 g vs. 15.1 ± 1.6 g; p = .248). Only median 2.5% of lesions in the 90 W/MCS cohort failed to achieve ≥ 5 Ω drop. In the 90 W/MCS group, there were no procedural related complications, and 12-month freedom from atrial arrhythmia was observed in 78.4%. CONCLUSION vHPSD PVI is feasible under MCS, with encouraging acute and long-term procedural outcomes. This provides a compelling option for centers with limited anaesthetic support.
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Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Dhiraj Gupta
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Vishal Luther
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Dello Russo A, Compagnucci P, Anselmino M, Schillaci V, Campanelli F, Ascione MR, Volpato G, Cipolletta L, Parisi Q, Valeri Y, D'Angelo L, Chiariello P, Casella M, Solimene F. Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience. Heart Rhythm 2024:S1547-5271(24)02653-5. [PMID: 38810922 DOI: 10.1016/j.hrthm.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Pulsed field ablation (PFA) and very high-power short-duration (vHPSD) radiofrequency ablation are the most recently introduced technologies for atrial fibrillation (AF) ablation. The procedural performance, safety, and effectiveness of PFA vs vHPSD are currently unknown. OBJECTIVE The study aimed to compare PFA with vHPSD for the treatment of paroxysmal or persistent AF. METHODS We conducted an observational, multicenter study enrolling 534 consecutive patients (63 ± 9 years; 36% female) with paroxysmal (n = 368 [69%]) or persistent (n = 166 [31%]) AF undergoing ablation by either PFA (Farapulse; n = 192) or vHPSD (90 W/4 seconds; QDOT Micro; n = 342) between 2020 and 2023. Atrial tachyarrhythmia recurrence after a 1-month blanking period was the primary efficacy end point and was assessed both overall and in propensity score-matched patients. The primary safety end point was a composite of procedure-related complications. RESULTS Successful pulmonary vein isolation was achieved in all patients, with shorter procedure duration (PFA,70 minutes; vHPSD, 100 minutes; P < .001) but longer fluoroscopy time (PFA, 15 minutes; vHPSD, 7 minutes; P < .001) in the PFA group. PFA was associated with more frequent use of general anesthesia (P < .001). Primary safety outcome events occurred in 19 patients (3.5%), with similar prevalence in both groups (PFA, 4%; vHPSD, 3%; P = .745). After a median follow-up of 12 (9-12) months, survival free from recurrent atrial tachyarrhythmia was similar between the PFA and vHPSD groups, both overall (12-month estimate: PFA, 75%; vHPSD, 76%; log-rank P = .73) and in propensity score-matched patients (n = 342; 12-month estimate: PFA, 75%; vHPSD, 77%; log-rank P = .980). CONCLUSION In a large, multicenter experience, PFA was associated with more common use of general anesthesia, shorter procedural times, and longer fluoroscopy exposure compared with vHPSD ablation, with both techniques displaying superimposable safety and efficacy.
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Affiliation(s)
- Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy.
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Francesca Campanelli
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Maria Rosaria Ascione
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Leonardo D'Angelo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paola Chiariello
- Santa Maria Incoronata Dell'Olmo Hospital, Cava Dei Tirreni, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Francesco Solimene
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Clinica Montevergine, Mercogliano, Avellino, Italy
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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.
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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
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9
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De Potter TJR, De Becker B, Duytschaever M. Durable pulmonary vein isolation with optimized high-power and very high-power short-duration temperature-controlled ablation: A step-by-step guide. J Cardiovasc Electrophysiol 2024; 35:886-894. [PMID: 38433316 DOI: 10.1111/jce.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Through systematic scientific rigor, the CLOSE guided workflow was developed and has been shown to improve pulmonary vein isolation durability. However, this technique was developed at a time when using power-controlled ablation catheters with conventional power ranges was the norm. There has been increased adoption of a high-power and very high-power short-duration ablation practice propelled by the availability of the temperature-controlled radiofrequency QDOT MICRO catheter. METHODS There are fundamental differences in biophysics between very high-powered temperature guided ablation and conventional ablation strategy that may impact patient outcomes. The catheter's design and ablation modes offer flexibility in technique while accommodating the individual operator's clinical discretion and preference to deliver a durable, transmural, and contiguous lesion set. RESULTS Here, we provide recommendations for 3 different workflows using the QDOT MICRO catheter in a step-by-step manner for pulmonary vein isolation based on our cumulative experience as early adopters of the technology and the data available in the scientific literature. CONCLUSIONS With standardization, temperature-controlled ablation with the QDOT MICRO catheter provides operators the flexibility of implementing different ablation strategies to ensure durable contiguous pulmonary vein isolation depending on patient characteristics.
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Affiliation(s)
- Tom J R De Potter
- Cardiovascular Center, Division of Cardiology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Benjamin De Becker
- Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove, Brugge, Belgium
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10
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De Potter T, Grimaldi M, Duytschaever M, Anic A, Vijgen J, Neuzil P, Van Herendael H, Verma A, Skanes A, Scherr D, Pürerfellner H, Rackauskas G, Jais P, Reddy VY. Predictors of Success for Pulmonary Vein Isolation With Pulsed-field Ablation Using a Variable-loop Catheter With 3D Mapping Integration: Complete 12-month Outcomes From inspIRE. Circ Arrhythm Electrophysiol 2024; 17:e012667. [PMID: 38655693 PMCID: PMC11111320 DOI: 10.1161/circep.123.012667] [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: 12/01/2023] [Accepted: 02/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND We previously presented the safety and early efficacy of the inspIRE study (Study for Treatment of Paroxysmal Atrial Fibrillation [PAF] by Pulsed-field Ablation [PFA] System With Irreversible Electroporation [IRE]). With the study's conclusion, we report the outcomes of the full pivotal study cohort, with an additional analysis of predictors of success. METHODS InspIRE was a prospective, multicenter, single-arm clinical trial of drug-refractory paroxysmal atrial fibrillation. Pulmonary vein isolation was performed with a variable-loop circular catheter integrated with a 3-dimensional mapping system. Follow-up with 24-hour Holter was at 3, 6, and 12 months, as well as remote rhythm monitoring: weekly from 3 to 5 months, monthly from 6 to 12 months, and for symptoms. The primary effectiveness end point (PEE) was acute pulmonary vein isolation plus freedom from any atrial arrhythmia at 12 months. Additional subanalyses report predictors of PEE success. RESULTS The patient cohort included 186 patients: aged 59±10 years, female 30%, and CHA2DS2-VASc 1.3±1.2. The previously reported primary adverse event rate was 0%. One serious procedure-related adverse event, urinary retention, was reported. The PEE was achieved in 75.6% (95% CI, 69.5%-81.8%). The clinical success of freedom from symptomatic recurrence was 81.7% (95% CI, 76.1%-87.2%). Simulating a monitoring method used in standard real-world practice (without protocol-driven remote rhythm monitoring), this translates to a freedom from all and symptomatic recurrence of 85.8% (95% CI, 80.8%-90.9%) or 94.0% (95% CI, 90.6%-97.5%), respectively. Multivariate analyses revealed that left ventricular ejection fraction ≥60% (adjusted odds ratio, 0.30) and patients receiving ≥48 PFA applications (adjusted odds ratio, 0.28) were independent predictors of PEE success. Moreover, PEE success was 79.2% in patients who received ≥12 PFA applications per vein compared with 57.1% in patients receiving fewer PFA applications. CONCLUSIONS The inspIRE study confirms the safety and effectiveness of pulmonary vein isolation using the novel 3-dimensional mapping integrated circular loop catheter. An optimal number of PFA applications (≥48 total or ≥12 per vein) resulted in an improved 1-year success rate of ≈80%. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04524364.
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Affiliation(s)
- Tom De Potter
- OLV Hospital, Dienst Cardiologie, Aalst, Belgium (T.D.P.)
| | - Massimo Grimaldi
- Ospedale Generale Regionale “F. Miulli” UOC Cardiologia, Bari, Italy (M.G.)
| | | | - Ante Anic
- University Hospital Center Split, Split, Croatia (A.A.)
| | | | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.)
| | | | - Atul Verma
- McGill University Health Center, Montréal, Canada (A.V.)
| | - Allan Skanes
- University of Western Ontario, London, Canada (A.S.)
| | | | | | - Gediminas Rackauskas
- Centre for Cardiology & Angiology, Department of Cardiovascular Diseases, Vilnius University, Lithuania (G.R.)
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France (P.J.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY; Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (V.Y.R.)
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11
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Macle L, Nair GM, Skanes A, Aguilar M, Pantano A, Khaykin Y, Verma A. Safety and acute performance of atrial fibrillation ablation using a temperature-controlled, very high-power short-duration catheter and a new radiofrequency generator. J Interv Card Electrophysiol 2024; 67:453-455. [PMID: 37930503 PMCID: PMC11015997 DOI: 10.1007/s10840-023-01652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/17/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Laurent Macle
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Allan Skanes
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada.
- McGill University Health Centre, Montreal, QC, Canada.
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12
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Hirata S, Kurokawa S, Okumura Y. Where is the gap after a 90 W/4 s very-high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness. J Arrhythm 2024; 40:256-266. [PMID: 38586851 PMCID: PMC10995583 DOI: 10.1002/joa3.13009] [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: 09/06/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Background Although pulmonary vein isolation (PVI) for atrial fibrillation (AF) utilizing radiofrequency (RF) applications with a very high-power and short-duration (vHPSD) has shortened the procedure time, the determinants of pulmonary vein (PV) gaps in the first-pass PVI and acute PV reconnections are unclear. Methods An extensive encircling PVI was performed with the QDOT MICRO catheter with a vHPSD (90 W-4 s) in 30 patients with AF (19 men, 64 ± 10 years). The association of the PV gap sites (first-pass PVI failure, acute PV reconnections [spontaneous reconnections or dormant conduction provoked by adenosine triphosphate] or both) with the left atrial (LA) wall thickness and LA bipolar voltage on the PVI line and ablation-related parameters were assessed. Results PV gaps were observed in 29 (6%) of 480 segments (16 segments per patient) in 17 patients (56%). The PV gaps were associated with the LA wall thickness, bipolar voltage, and the number of RF points (LA wall thickness, 2.5 ± 0.5 vs. 1.9 ± 0.4 mm, p < .001; bipolar voltage, 2.59 ± 1.62 vs. 1.34 ± 1.14 mV, p < .001; RF points, 6 ± 2 vs. 4 ± 2, p = .008) but were not with the other ablation-related parameters. Receiver operating characteristic curves yielded that an LA wall thickness ≥2.3 mm and bipolar voltage ≥2.40 mV were determinants of PV gaps with an area under the curve of 0.82 and 0.73, respectively. Conclusions The LA voltage and wall thickness on the PV-encircling ablation line were highly associated with PV gaps using the 90 W/4 s-vHPSD ablation.
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Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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13
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Heeger CH, Kuck KH, Tilz RR. Very high-power short-duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series. J Cardiovasc Electrophysiol 2024; 35:547-556. [PMID: 37855621 DOI: 10.1111/jce.16113] [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: 09/17/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
The QDOT MICRO™ Catheter is a novel open-irrigated contact force-sensing radiofrequency ablation catheter. It offers very high-power short-duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.
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Affiliation(s)
- Christian-H Heeger
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roland R Tilz
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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14
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Szegedi N, Salló Z, Nagy VK, Osztheimer I, Hizoh I, Lakatos B, Boussoussou M, Orbán G, Boga M, Ferencz AB, Komlósi F, Tóth P, Perge P, Kovács A, Merkely B, Gellér L. Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study. Circ Arrhythm Electrophysiol 2024; 17:e012402. [PMID: 38284286 PMCID: PMC10876176 DOI: 10.1161/circep.123.012402] [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: 06/07/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90- versus 50-W power setting. METHODS Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS We included 46 patients (mean age, 64 years; women, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90- versus 50-W procedures, while the number of radiofrequency applications was higher with 90 versus 50 W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90 and 50 W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90- and 50-W energy setting groups, respectively; effect size: 72/78-68/77=0.040, lower 95% CI=-0.051 (noninferiority limit=-0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90- and 50-W groups (P =0.2). CONCLUSIONS Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90 and 50 W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90 W compared with 50 W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05459831.
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Affiliation(s)
- Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vivien Klaudia Nagy
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Osztheimer
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Hizoh
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Orbán
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Boga
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Arnold Béla Ferencz
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc Komlósi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Patrik Tóth
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Perge
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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15
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Wong CX, Buch EF, Beygui R, Lee RJ. Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation. J Clin Med 2024; 13:679. [PMID: 38337373 PMCID: PMC10856493 DOI: 10.3390/jcm13030679] [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: 11/28/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Atrial fibrillation (AF) is a growing health problem that increases morbidity and mortality, and in most patients progresses to more advanced diseases over time. Recent research has examined the underlying mechanisms, risk factors, and progression of AF, leading to updated AF disease classification schemes. Although endocardial catheter ablation is effective for early-stage paroxysmal AF, it consistently achieves suboptimal outcomes in patients with advanced AF. Identification of the factors that lead to the increased risk of treatment failure in advanced AF has spurred the development and adoption of hybrid ablation therapies and collaborative heart care teams that result in higher long-term arrhythmia-free survival. Patients with non-paroxysmal AF, atrial remodeling, comorbidities, or AF otherwise deemed difficult to treat may find hybrid treatment to be the most effective option. Future research of hybrid therapies in advanced AF patient populations, including those with dual diagnoses, may provide further evidence establishing the safety and efficacy of hybrid endo-epicardial ablation as a first line treatment.
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Affiliation(s)
- Christopher X. Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide 5001, Australia
- Cardiac Electrophysiology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Eric F. Buch
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ramin Beygui
- Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Randall J. Lee
- Cardiac Electrophysiology, University of California San Francisco, San Francisco, CA 94143, USA
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16
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Keegan R, Garmendia F, Gregorietti F, Urruti R, Onetto L. Very high-power and short-duration radiofrequency ablation for atrial fibrillation in a Latin American low-volume private center. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01756-4. [PMID: 38261105 DOI: 10.1007/s10840-024-01756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Center volume and operator experience/training are important factors impacting outcomes in AFib CA. Setting for RF delivery (power, duration, and contact force) associated with better outcomes remains to be determined. METHODS This is an observational, longitudinal, and retrospective study. All consecutive procedures performed between December 12, 2013, and March 9, 2023, in a low-volume private center in Latin America were analyzed. Procedure characteristics and outcomes were compared between STD and vHPSD. RESULTS Two hundred ten procedures were performed on 194 patients. Median annual number of procedures was 19 (7-29). Median age was 62 (52-68), and majority were male (71%). Median procedure duration was 155 (125-195) min, mean fluoroscopy time 32.8 ± 15 min and mean fluoroscopy dose 373.5 ± 208.9 mGray. Median follow-up was 27 months, significantly longer in STD compared with vHPSD group (43 [31-68] vs. 13 [8-19], respectively; P ≤ 0.001). The recurrence rate was 33.2% and major complications 8.6%. Compared with STD, vHPSD resulted in a significantly shorter procedure duration (125 vs. 180 min, P ≤ 0.001), shorter fluoroscopy time (22.7 ± 9.5 vs. 39.2 ± 14.3 min, P ≤ 0.001), and lower fluoroscopy dose (283.8 ± 161.1 vs. 438.3 ± 216.1 mGray, P ≤ 0.001). No long-term recurrence difference was observed when the follow-up periods were comparable. No difference in complication rate was observed (8.5% vs. 8.6%, P = 0.988). CONCLUSIONS Outcomes in AFib CA in a Latin American low-volume private center can be considered acceptable, with efficacy and safety similar to those reported in the literature. Compared with STD ablation, vHPSD showed higher efficiency with similar efficacy and safety.
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Affiliation(s)
- Roberto Keegan
- Electrophysiology Service, Hospital Privado del Sur, Bahía Blanca, Argentina.
| | - Francisco Garmendia
- Electrophysiology Service, Hospital Privado del Sur, Bahía Blanca, Argentina
| | - Franco Gregorietti
- Electrophysiology Service, Hospital Privado del Sur, Bahía Blanca, Argentina
| | - Ricardo Urruti
- Electrophysiology Service, Hospital Privado del Sur, Bahía Blanca, Argentina
| | - Leonardo Onetto
- Electrophysiology Service, Hospital Privado del Sur, Bahía Blanca, Argentina
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Ahmad A, Karnik AA, Doshi R. A Year in Review: Atrial Fibrillation 2023. J Innov Card Rhythm Manag 2024; 15:5704-5708. [PMID: 38304091 PMCID: PMC10829408 DOI: 10.19102/icrm.2024.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Amier Ahmad
- Department of Clinical Cardiac Electrophysiology, Scottsdale, AZ, USA
| | - Ankur A. Karnik
- Department of Clinical Cardiac Electrophysiology, Scottsdale, AZ, USA
| | - Rahul Doshi
- Department of Clinical Cardiac Electrophysiology, Scottsdale, AZ, USA
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18
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Pranata R, Karwiky G, Iqbal M. Very-high-power Short-duration Ablation versus Conventional Ablation for Pulmonary Vein Isolation in Atrial Fibrillation: Systematic Review and Meta-analysis. Arrhythm Electrophysiol Rev 2023; 12:e30. [PMID: 38173799 PMCID: PMC10762667 DOI: 10.15420/aer.2023.19] [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: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 01/05/2024] Open
Abstract
The aim of this study was to compare the effectiveness and safety of very-high-power short-duration (VHPSD) ablation (70-90 W/4-7 s) with conventional ablation (30-40 W/>20 s, 50 W/7-11 s) for pulmonary vein isolation (PVI) in patients with AF. A total of 13 studies were included in this analysis (1,527 patients). AF recurrence occurred in 14% (95% CI [11-18%]) of the VHPSD group. VHPSD was associated with lower AF recurrence (OR 0.65; 95% CI [0.48-0.89]; p=0.006) compared with the conventional ablation group. Subgroup analysis showed that additional ablation beyond PVI had a similar rate of AF recurrence (16% versus 10%) compared with PVI alone. Procedure and ablation durations were significantly shorter in the VHPSD group with a mean differences of -14.4 minutes (p=0.017) and -14.1 minutes (p<0.001), respectively. Complications occurred in 6% (95% CI [3-9%]) of the VHPSD group, and the rate was similar between the two groups (OR 1.03; 95% CI [0.60-1.80]; p=0.498). VHPSD ablation resulted in less AF recurrence and a shorter procedure time. Additional ablation beyond PVI alone in VHPSD may not provide additional benefits.
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Affiliation(s)
- Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | - Giky Karwiky
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
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Hussein AA, Delaughter MC, Monir G, Natale A, Dukkipati S, Oza S, Daoud E, Di Biase L, Mansour M, Fishel R, Valderrabano M, Ellenbogen K, Osorio J. Paroxysmal atrial fibrillation ablation with a novel temperature-controlled CF-sensing catheter: Q-FFICIENCY clinical and healthcare utilization benefits. J Cardiovasc Electrophysiol 2023; 34:2493-2503. [PMID: 37870157 DOI: 10.1111/jce.16093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The prospective, nonrandomized, multicenter Q-FFICIENCY study demonstrated the safety and 12-month efficacy of paroxysmal atrial fibrillation (AF) ablation with the novel QDOT MICRO temperature-controlled, contact force-sensing, radiofrequency (RF) catheter. Participants underwent pulmonary vein isolation with very high-power short-duration (vHPSD) mode (90 W, ≤4 s) alone or combined with conventional-power temperature-controlled (CPTC) mode (25-50 W). This study aimed to assess quality-of-life (QOL) and healthcare utilization (HCU) benefits experienced by Q-FFICIENCY study participants. METHODS Besides evaluating procedural efficiency, QOL and HCU were assessed through 12 months postablation via Atrial Fibrillation Effect on Quality-of-Life Tool (AFEQT) score, antiarrhythmic drug (AAD) use, and incidence of cardioversion and cardiovascular hospitalization. RESULTS Of 191 participants enrolled, 166 were ablated with the new catheter. Compared to baseline, statistically significant, clinically meaningful improvements in composite and subcategories of AFEQT scores were observed at 3 months and sustained through 12 months (12-month increase, 29.3-44.2 points). Class I/III AAD use decreased from 97.6% (162/166) at baseline to 19.6% (31/158) during Months 6-12, representing a significant 79.9% reduction. The cardioversion rate significantly declined by 93.9% from 31.3% (12 months preablation) to 1.9% (evaluation period). One-year Kaplan-Meier estimates of freedom from all-cause and cardiovascular hospitalization were 80.9% (95% confidence interval [CI], 74.8%-86.9%) and 88.8% (95% CI, 84.0%-93.7%), respectively. CONCLUSIONS Paroxysmal AF ablation with the novel temperature-controlled RF catheter in vHPSD mode, alone or with CPTC mode, led to clinically meaningful improvement in QOL and significant reduction in AAD use, cardioversion, and cardiovascular hospitalization.
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Affiliation(s)
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | - Saumil Oza
- St. Vincent's Medical Center, Jacksonville, Florida, USA
| | - Emile Daoud
- Ohio State University Medical Center, Columbus, Ohio, USA
| | - Luigi Di Biase
- Montefiore Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Miguel Valderrabano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Jose Osorio
- Grandview Medical Center Alabama Cardiovascular Group, Birmingham, Alabama, USA
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Osorio J, Maccioni S, Sharma R, Patel L, Spin P, Natale A. QDOT MICRO™ versus THERMOCOOL ® SMARTTOUCH™ and THERMOCOOL SMARTTOUCH ® Surround Flow in radiofrequency ablation of paroxysmal atrial fibrillation. J Comp Eff Res 2023; 12:e230005. [PMID: 37584396 PMCID: PMC10690395 DOI: 10.57264/cer-2023-0005] [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: 01/17/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Aim: The objective of this study was to indirectly compare QDOT MICRO™ (QDOT), Thermocool® SmartTouch™ (ST) and Thermocool® SmartTouch® Surround Flow (STSF) to treat paroxysmal atrial fibrillation. Methods: Differences in baseline characteristics between study cohorts were reduced by reweighting patients using inverse probability of treatment weighting. The primary outcome was procedure time. Secondary outcomes were fluoroscopy time, clinical success at 12 months, and rhythm monitoring-adjusted recurrence. Results: QDOT was associated with significantly faster mean procedure and fluoroscopy time, and significant improvement in the rate of recurrence compared with pooled ST/STSF. No difference was observed for clinical success at 12 months. Conclusion: QDOT was associated with greater efficiency, greater effectiveness in rhythm monitoring-adjusted recurrence and similar effectiveness in clinical success at 12 months compared with pooled ST/STSF.
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Affiliation(s)
- Jose Osorio
- Medical Director Electrophysiology, Electrophysiology - Cardiovascular Group, HCA Florida Miami, Miami, FL 33133, USA
| | - Sonia Maccioni
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, CA 92618, USA
| | - Reecha Sharma
- Johnson & Johnson Medical Devices, Clinical Research, Irvine, CA 92618, USA
| | | | - Paul Spin
- EVERSANA, Burlington, ON, L7N 3H8, Canada
| | - Andrea Natale
- Executive Medical Director, Texas Cardiac Arrhythmia Research, St. David's Medical Center, Austin, TX 78705, USA
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