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Buschmann E, Van Steenkiste G, Duytschaever M, Boussy T, Vernemmen I, Ibrahim L, Schauvliege S, Decloedt A, van Loon G. Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system. Equine Vet J 2024; 56:1068-1076. [PMID: 38151793 DOI: 10.1111/evj.14037] [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: 07/03/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Recently, treatment of equine atrial tachycardia by three-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) has been described. Myocardial sleeves in the caudal vena cava and pulmonary veins are a potential trigger for initiation and perpetuation of atrial tachycardia and atrial fibrillation in the horse. Isolation of these myocardial sleeves by RFCA may be an effective treatment for these arrhythmias. OBJECTIVES To describe the feasibility of 3D EAM and RFCA to isolate caudal vena cava and pulmonary veins in adult horses using 3D mapping and a contact force (CF)-guided ablation system. STUDY DESIGN In vivo experiments. METHODS 3D EAM and RFCA was performed in five horses without cardiovascular disease under general anaesthesia, using the CF-guided system CARTO®3. Point-by-point RFCA aimed for isolation of caudal vena cava and pulmonary veins. Radiofrequency energy was delivered in power-controlled mode with a target power of 45 W, CF between 10 and 15 g and 30 mL/min irrigation rate, until an ablation-index of 450-500 was reached. RESULTS In the right atrium, myocardial sleeves of the caudal vena cava were isolated (n = 5). In the left atrium, isolation of ostium II (n = 3), ostium III (n = 1) and ostium I, II and III en bloc (n = 1) was performed. Successful isolation was confirmed by entrance and exit block. MAIN LIMITATIONS Horses were euthanised at the end of the procedure, so long term effects such as potential reconnection of isolated veins could not be studied. CONCLUSIONS This is the first description of 3D EAM and RFCA with CARTO®3 in horses, thereby showing the technical feasibility and successful caudal vena cava and pulmonary vein isolation. CF measurement allowed monitoring of catheter-tissue contact, resulting in efficient acute lesion creation as confirmed by entrance and exit block. This is a promising treatment for cardiac arrhythmias in horses.
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Affiliation(s)
- Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Bengel P, Sossalla S, Dinov B. Case report of persistent atrial fibrillation with durably isolated pulmonary veins: what's next? Eur Heart J Case Rep 2024; 8:ytae358. [PMID: 39104517 PMCID: PMC11299017 DOI: 10.1093/ehjcr/ytae358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/22/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
Background Pulmonary vein isolation (PVI) has emerged as a safe and effective treatment for patients with paroxysmal and persistent atrial fibrillation. Nevertheless, in some patients, a relapse of atrial fibrillation occurs although pulmonary veins are durably isolated. For those patients, the underlying mechanisms of atrial fibrillation perpetuation are manifold and optimal treatment options are not yet defined. Case summary We describe a case of a 55-year-old man with a history of atrial fibrillation and previous PVI presenting with persistent AF and arrhythmia induced cardiomyopathy. During the redo procedure, electro-anatomical mapping revealed durably isolated PV. Bipolar mapping showed large low-voltage areas at the posterior wall and the septum. As the patient was refractory to electrical cardioversion, it was decided to modify the large low-voltage areas as potential arrhythmic substrate. After performing additional ablation with isolation of the posterior wall and two anterior/septal lines, the patient spontaneously converted to sinus rhythm. Discussion Ablation in patients with persistent AF despite durable PVI remains a challenge for the treating team. Individualized ablation approaches addressing additional arrhythmic substrates or extra-PV triggers can be considered to treat patients with persistent AF and durable PVI.
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Affiliation(s)
- Philipp Bengel
- Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392 Giessen, Germany
| | - Samuel Sossalla
- Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392 Giessen, Germany
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Borislav Dinov
- Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392 Giessen, Germany
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Kueffer T, Stefanova A, Madaffari A, Seiler J, Thalmann G, Kozhuharov N, Maurhofer J, Galuszka O, Haeberlin A, Noti F, Servatius H, Tanner H, Roten L, Reichlin T. Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation. J Interv Card Electrophysiol 2024; 67:503-511. [PMID: 37523023 PMCID: PMC11015999 DOI: 10.1007/s10840-023-01608-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies. OBJECTIVE To present post-market data in patients with recurrent arrhythmias. METHODS Consecutive patients undergoing a redo procedure after an index PFA PVI using a bipolar-biphasic PFA system were included. 3-D electro-anatomical maps (3D-EAM) on redo procedure were compared to the 3D-EAM acquired after ablation during the index procedure. PVI durability was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesion extent around veins with durable isolation was compared to study lesion regression. RESULTS Of 341 patients treated with a PFA PVI, 29 (8.5%) underwent a left atrial redo ablation due to arrhythmia recurrence. At the end of the index procedure, 110/112 veins (98%, four common ostia) were isolated. On redo procedures performed a median of 6 months after the first ablation, 3D-EAM identified 69/110 (63%) PVs with durable isolation. In 6 (21%) patients, all PVs were durably isolated. Reconnections were more often found on the right-sided veins and on the anterior aspects of the upper veins. Only minor lesion regression was observed between the index and redo procedure (a median of 3 mm (0 - 9.5) on the posterior wall). CONCLUSION In patients with arrhythmia recurrence after PFA PVI using a first-generation PFA device, durable isolation was observed in 63% of the veins and 21% of the patients showed durable isolation of all previously isolated veins.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
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Kueffer T, Bordignon S, Neven K, Blaauw Y, Hansen J, Adelino R, Ouss A, Füting A, Roten L, Mulder BA, Ruwald MH, Mené R, van der Voort P, Reinsch N, Boveda S, Albrecht EM, Schneider CW, Chun KRJ, Schmidt B, Reichlin T. Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry. JACC Clin Electrophysiol 2024; 10:698-708. [PMID: 38340118 DOI: 10.1016/j.jacep.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce. OBJECTIVES This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA. METHODS Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified. RESULTS Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50). CONCLUSIONS In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.
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Affiliation(s)
- Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jim Hansen
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Alexandre Ouss
- Heart Center Catharina Hospital, Eindhoven, the Netherlands
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H Ruwald
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Roberto Mené
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | | | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland.
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Narita M, Higuchi S, Kawano D, Sasaki W, Matsumoto K, Tanaka N, Mori H, Tsutsui K, Ikeda Y, Arai T, Nakano S, Kato R, Matsumoto K. Does the same lesion index mean the same efficacy and safety profile: influence of the differential power, time, and contact force on the lesion size and steam pops under the same lesion index. J Interv Card Electrophysiol 2024; 67:147-155. [PMID: 37311981 DOI: 10.1007/s10840-023-01583-z] [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: 03/20/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The lesion index (LSI) helps predict the lesion size and is widely used in ablation of various types of arrhythmias. However, the influence of the ablation settings on the lesion formation and incidence of steam pops under the same LSI value remains unclear. METHODS Using a contact force (CF) sensing catheter (TactiCath™) in an ex vivo swine left ventricle model, RF lesions were created with a combination of various power steps (30 W, 40 W, 50 W) and CFs (10 g, 20 g, 30 g, 40 g, 50 g) under the same LSI values (5.2 and 7.0). The correlation between the lesion formation and ablation parameters was evaluated. RESULTS Ninety RF lesions were created under a target LSI value of 5.2, and eighty-four were developed under a target LSI value of 7.0. In the LSI 5.2 group, the resultant lesion size widely varied according to the ablation power, and a multiple regression analysis indicated that the ablation energy delivered was the best predictor of the lesion formation. To create a lesion depth > 4 mm, an ablation energy of 393 J is the best cutoff value, suggesting a possibility that ablation energy may be used as a supplemental marker that better monitors the progress of the lesion formation in an LSI 5.2 ablation. In contrast, such inconsistency was not obvious in the LSI 7.0 group. Compared with 30 W, the 50-W ablation exhibited a higher incidence of steam pops in both the LSI 5.2 and 7.0 groups. CONCLUSIONS The LSI-lesion size relationship was not necessarily consistent, especially for an LSI of 5.2. To avoid any unintentional, weak ablation, the ablation energy may be a useful supportive parameter (393 J as a cutoff value for a 4-mm depth) during ablation with an LSI around 5.2. Thanks to a prolonged ablation time, the LSI-lesion size relationship is consistent for an LSI of 7.0. However, it is accompanied by a high incidence of steam pops. Care should be given to the ablation settings even when the same LSI value is used.
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Affiliation(s)
- Masataka Narita
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Syunta Higuchi
- Department of Medical Engineer, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Wataru Sasaki
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Naomichi Tanaka
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan.
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Takahide Arai
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
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Kueffer T, Tanner H, Madaffari A, Seiler J, Haeberlin A, Maurhofer J, Noti F, Herrera C, Thalmann G, Kozhuharov NA, Reichlin T, Roten L. Posterior wall ablation by pulsed-field ablation: procedural safety, efficacy, and findings on redo procedures. Europace 2023; 26:euae006. [PMID: 38225174 PMCID: PMC10803044 DOI: 10.1093/europace/euae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data are scarce. METHODS AND RESULTS Consecutive patients undergoing PWA using PFA were included. Posterior wall ablation was performed using a pentaspline PFA catheter and verified by 3D-electroanatomical mapping. Follow-up was performed using 7-day Holter ECGs 3, 6, and 12 months after ablation. Recurrence of any atrial arrhythmia lasting more than 30 s was defined as failure. Lesion durability was assessed during redo procedures. Posterior wall ablation was performed in 215 patients (70% males, median age 70 [IQR 61-75] years, 67% redo procedures) and was successful in all patients (100%) by applying a median of 36 (IQR 32-44) PFA lesions. Severe adverse events were cardiac tamponade and vascular access complication in one patient each (0.9%). Median follow-up was 7.3 (IQR 5.0-11.8) months. One-year arrhythmia-free outcome in Kaplan-Meier analysis was 53%. A redo procedure was performed in 26 patients (12%) after a median of 6.9 (IQR 2.4-11) months and showed durable PWA in 22 patients (85%) with only minor lesion regression. Among four patients with posterior wall reconnection, three (75%) presented with roof-dependent AT. CONCLUSION Posterior wall ablation with this pentaspline PFA catheter can be safely and efficiently performed with a high durability observed during redo procedures. The added value of durable PWA for the treatment of atrial fibrillation remains to be evaluated.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Herrera
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola A Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Serban T, Mannhart D, Abid QUA, Höchli A, Lazar S, Krisai P, Bettelini AS, Knecht S, Kühne M, Sticherling C, du Fay de Lavallaz J, Badertscher P. Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review. Europace 2023; 25:euad335. [PMID: 37944133 PMCID: PMC10664405 DOI: 10.1093/europace/euad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.
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Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | | | - Andres Höchli
- Department of Cardiology, Triemli Stadtspital, Zürich, Switzerland
| | - Sorin Lazar
- Department of Cardiology, Cook County Health, Chicago, IL, USA
| | - Philipp Krisai
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Arianna Sofia Bettelini
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
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8
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Bordignon S, My I, Tohoku S, Rillig A, Schaack D, Chen S, Reißmann B, Urbanek L, Hirokami J, Efe T, Ebrahimi R, Butt M, Ouyang F, Chun JKR, Metzner A, Schmidt B. Efficacy and safety in patients treated with a novel radiofrequency balloon: a two centres experience from the AURORA collaboration. Europace 2023; 25:euad106. [PMID: 37116126 PMCID: PMC10228597 DOI: 10.1093/europace/euad106] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/03/2023] [Indexed: 04/30/2023] Open
Abstract
AIMS A novel irrigated radiofrequency (RF) balloon (RFB) for pulmonary vein (PV) isolation (PVI) was released in selected centres. We pooled the procedural data on efficacy and safety of RFB-PVI from two high volume German centres. METHODS AND RESULTS Consecutive patients with RFB procedures were enrolled. A 3D electroanatomical left atrial map guided the RFB navigation. Every RF delivery lasted 60 s, and duration was automatically reduced to 20 s for electrodes facing the posterior wall. Procedural data and post-procedural endoscopy data (<48 h) were analysed. Data from 140 patients were collected (57% male, 67 ± 11 years, 57% paroxysmal atrial fibrillation). There were 547 PVs identified, and 99.1% could be isolated using solely the RFB. Single-shot PVI was recorded in 330/547 (60%) PVs. Median time to isolation during the first application was 10 s (IQR 8-13). A total of 2.1 ± 1.8 applications per PV were delivered, with the left superior PV requiring more application compared to other PVs. Median procedure and fluoroscopy time were 77 min (61-99) and 13 min (10-17), respectively. Major safety events were recorded only in the first 25 cases at each centre and included 1/140(0.7%) cardiac tamponade, 1/140(0.7%) phrenic nerve palsy, and 2/140 strokes (1.4%). An oesophageal temperature rise was recorded in 81/547 (15%) PVs, and endoscopy detected oesophageal lesions in 7/85 (8%) patients undergoing endoscopy. CONCLUSION The RFB showed a high efficacy allowing for fast PVI procedures, and 60% of PVs could be isolated at the first application. Most safety events were recorded during the learning phase. An oesophageal temperature monitoring is suggested: oesophageal lesions were detected in 8% of patients.
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Affiliation(s)
- Stefano Bordignon
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Ilaria My
- Universitäres Herz- und Gefäßzentrum - Klinik für Kardiologie - Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Shota Tohoku
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Andreas Rillig
- Medizinische Klinik 3 - Universitätsklinikum der Goethe Universität, Frankfurt, Germany
| | - David Schaack
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shaojie Chen
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Bruno Reißmann
- Medizinische Klinik 3 - Universitätsklinikum der Goethe Universität, Frankfurt, Germany
| | - Lukas Urbanek
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Jun Hirokami
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Tolga Efe
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Ramin Ebrahimi
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Mahi Butt
- Universitäres Herz- und Gefäßzentrum - Klinik für Kardiologie - Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Feifan Ouyang
- Universitäres Herz- und Gefäßzentrum - Klinik für Kardiologie - Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Julian K R Chun
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum - Klinik für Kardiologie - Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Boris Schmidt
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
- Medizinische Klinik 3 - Universitätsklinikum der Goethe Universität, Frankfurt, Germany
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Del Monte A, Almorad A, Pannone L, Della Rocca DG, Bisignani A, Monaco C, Mouram S, Ramak R, Gauthey A, Overeinder I, Bala G, Sorgente A, Ströker E, Sieira J, Brugada P, La Meir M, Chierchia GB, de Asmundis C. Pulmonary vein isolation with the radiofrequency balloon catheter: a single centre prospective study. Europace 2023; 25:896-904. [PMID: 36738245 PMCID: PMC10062286 DOI: 10.1093/europace/euad017] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS The multielectrode radiofrequency balloon catheter (RFB) has been developed to achieve safe and effective pulmonary vein isolation (PVI) for atrial fibrillation (AF) ablation. This single-centre study aimed to evaluate the midterm clinical outcome and predictors of single-shot PVI with the novel RFB. METHODS AND RESULTS All consecutive patients with symptomatic paroxysmal or persistent AF undergoing first-time PVI with the RFB were prospectively included. Clinical and procedural parameters were systematically collected. The primary safety endpoint was defined as any major periprocedural complications. The primary efficacy endpoint consisted of freedom from any atrial tachyarrhythmias (ATas) lasting >30 s during the follow-up after a 3-month blanking period. Persistent single-shot PVI was defined as PVI achieved with a single RFB application without acute reconnection. A total of 104 consecutive patients (mean age 64.3 ± 11.4 years, 56.7% males) were included. 15 patients (14.4%) presented with persistent AF. The procedure time was 59.0 min with a dwell time of 20.0 min. One major complication occurred in one patient. At a mean follow-up of 10.1 ± 5.3 months, freedom from ATas was 82.9%. ATas occurred in 14 patients, 11/69 patients (15.9%) with paroxysmal AF and 3/13 (23.1%) with persistent AF. The best cut-offs to predict persistent single-shot PVI were impedance drop >19.2 Ω [area under the receiver operator characteristic curve (AUC) 0.74] and temperature rise >11.1° C (AUC 0.77). CONCLUSION In a large cohort of patients undergoing PVI with the RFB, the complication rate was 1%. At a mid-term follow-up of 10.1 ± 5.3 months, freedom from ATas was 82.9%. Specific cut-offs of impedance drop and temperature rise may be useful to predict persistent single-shot isolation.
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Affiliation(s)
- Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
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