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Liu J, Guan W, Guo J, Li X, Xia Y, Niu G, Yao Y. Optimization of superior vena cava isolation with aid of ablation index guidance. J Cardiovasc Electrophysiol 2023; 34:1820-1827. [PMID: 37493500 DOI: 10.1111/jce.16006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION To investigate the optimal range of quantitative ablation index (AI) value during superior vena cava (SVC) electrical isolation by radiofrequency catheter ablation (RFCA). METHODS First, in a development cohort of patients with atrial fibrillation (AF), the RFCA with 40 W was performed to complete SVC isolation guided by the conduction breakthrough point from the right atrium to SVC. Then, the range of AI value was calculated by offline analysis on different segments of SVC. Lastly, for the validation of AF patients, the safety and effectiveness of SVC isolation with the optimized target range of AI value were evaluated with an additional adenosine test. RESULTS A total of 101 patients with AF were included in the study (44 patients in the development cohort/57 in the validation cohort). The segmental ablation strategy was applied in 70% of the patients. According to the offline analysis of the AI values in the development cohort, the target AI value range was set as 350-400. The success rate of SVC isolation in the validation cohort was significantly higher than that in the exploration cohort (100% vs. 90.9%, p = .02), and no complications occurred in the exploration cohort. During the adenosine test, the recovery rate of electrical conduction in SVC was significantly lower than that in the pulmonary vein (3.5% vs. 17.5%). CONCLUSION The target AI value with a range from 350 to 400 is safe and effective for high-power RFCA to complete SVC isolation.
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Affiliation(s)
- Jun Liu
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Wenchi Guan
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Jinrui Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Xiaofeng Li
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Yu Xia
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
| | - Guodong Niu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Yan Yao
- Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China
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Lin C, Bao Y, Xie Y, Wei Y, Luo Q, Ling T, Zhang N, Jin Q, Pan W, Xie Y, Wu L. Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation. Clin Cardiol 2022; 46:126-133. [PMID: 36403256 PMCID: PMC9933103 DOI: 10.1002/clc.23947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/17/2022] [Accepted: 10/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Damage to the sinus node (SN) has been described as a potential complication of superior vena cava (SVC) isolation. There have been reports of permanent SN injury requiring pacemaker implantation during isolation of the SVC. HYPOTHESIS It is safe and effective to isolate SVC with the second-generation 28-mm cryoballoon by using a novel method. METHODS Forty-three patients (including six redo cases) with SVC-related atrial fibrillation (AF) from a consecutive series of 650 patients who underwent cryoballoon ablation were included. After pulmonary vein isolation was achieved, if the SVC trigger was identified, the SVC was electrically isolated using the cryoballoon. First, the cryoballoon was inflated in the right atrium (RA) and advanced towards the SVC-RA junction. After total occlusion was confirmed by dye injection with total retention of contrast in the SVC, the SVC-RA junction was determined. Next, the cryoballoon was deflated, advanced into SVC, then reinflated, and pulled back gently. The equatorial band of the cryoballoon was then set slightly (4.32 ± 0.71 mm) above the SVC-RA junction for isolation of the SVC. RESULTS Real-time SVC potential was observed in all patients during ablation. The mean time to isolation was 24.5 ± 10.7 s. The SVC was successfully isolated in all patients. The mean number of freeze cycles was 2.5 ± 1.4 per patient, and the mean ablation time was 99.8 ± 22.7 s. A transient phrenic nerve (PN) injury occurred in one patient (2.33%). There were no SN injuries. Freedom from AF rates at 6 and 12 months was 97.7% and 93.0%, respectively. CONCLUSIONS This novel method for SVC isolation using the cryoballoon is safe and feasible when the SVC driver during AF is determined and could avoid SN injury. PN function should still be carefully monitored during an SVC isolation procedure.
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Affiliation(s)
- Changjian Lin
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yangyang Bao
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yun Xie
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yue Wei
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qingzhi Luo
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tianyou Ling
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ning Zhang
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qi Jin
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenqi Pan
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yucai Xie
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liqun Wu
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Howard B, Haines DE, Verma A, Kirchhof N, Barka N, Onal B, Stewart MT, Sigg DC. Characterization of Phrenic Nerve Response to Pulsed Field Ablation. Circ Arrhythm Electrophysiol 2022; 15:e010127. [PMID: 35649121 PMCID: PMC9213085 DOI: 10.1161/circep.121.010127] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Phrenic nerve palsy is a well-known complication of cardiac ablation, resulting from the application of direct thermal energy. Emerging pulsed field ablation (PFA) may reduce the risk of phrenic nerve injury but has not been well characterized.
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Affiliation(s)
- Brian Howard
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
| | | | - Atul Verma
- McGill University Health Center, McGill University, Montreal, Quebec, Canada (A.V.)
| | - Nicole Kirchhof
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
| | - Noah Barka
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
| | - Birce Onal
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
| | - Mark T Stewart
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
| | - Daniel C Sigg
- Medtronic, Minneapolis, MN (B.H., N.K., N.B., B.O., M.T.S., D.C.S.)
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Miyazaki S, Hasegawa K, Mukai M, Aoyama D, Nodera M, Yamaguchi J, Shiomi Y, Tama N, Ikeda H, Ishida K, Uzui H, Tada H. Superior vena cava isolation using a novel ablation catheter incorporating local impedance monitoring. J Interv Card Electrophysiol 2021; 64:291-300. [PMID: 33755817 DOI: 10.1007/s10840-021-00980-6] [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: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A novel technology able to measure the local impedance (LI) during radiofrequency ablation has become available for clinical use. We investigated the change in the LI characteristics during superior vena cava isolations (SVCIs) using a novel catheter equipped with mini-electrodes. METHODS Twenty paroxysmal atrial fibrillation patients (68 ± 9 years; 14 males) underwent an SVCI by targeting breakthroughs. Subsequently, dormant conduction provoked by adenosine triphosphate (ATP) was evaluated. RESULTS Electrical SVCIs were successfully achieved in all with 7.2 ± 3.0 radiofrequency applications (RFA) without any complications. The procedure and fluoroscopic times were 13.1 ± 8.1 and 2.8 ± 2.3 min. No ablation was required at the anteroseptal SVC in 19 (95.0%) patients. The baseline LI and generator impedance (GI) were 125 ± 23 and 105 ± 14Ω. LI drops during RFA were significantly greater than GI drops (17 ± 12 vs. 4 ± 4Ω, p < 0.001). The correlation between the LI drops and GI drops was relatively high (R = 0.69, p < 0.001). LI drops were highest at the septal SVC and lowest at the lateral followed by antero-lateral SVC. The baseline electrogram amplitude between the mini-electrodes and tip-ring electrodes was 1.2 ± 1.4 and 0.8 ± 0.6 mV. The mini-electrode amplitude is more sharply attenuated with a greater magnitude than the tip-ring amplitude (p < 0.001). ATP-provoked dormant conduction was exposed in 10/17 (58.8%) patients and antero-lateral SVC gap locations in 7. Antero-lateral SVC LI drops were similar between patients with and without dormancy. CONCLUSIONS The LI drop magnitude during RFA significantly differed among the SVC segments. Antero-lateral SVC ATP-provoked dormant conduction was often exposed, and additional applications are recommended following the isolation for a robust SVCI.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Junya Yamaguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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Wakamatsu Y, Nagashima K, Kurokawa S, Otsuka N, Hayashida S, Yagyu S, Hirata S, Ohkubo K, Nakai T, Okumura Y. Impact of the combined use of intracardiac ultrasound and a steerable sheath visualized by a 3D mapping system on pulmonary vein isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:693-702. [PMID: 33595100 DOI: 10.1111/pace.14194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A novel steerable sheath visualized on a three-dimensional mapping system has become available in this era in which a durable pulmonary vein (PV) isolation (PVI) with reduced fluoroscopy is required. METHODS In 60 patients who underwent a PVI with a visualized sheath (n = 30) and non-visualized conventional sheath (n = 30), the fluoroscopic time and catheter stability during the PVI were analyzed. RESULTS The fluoroscopic time during the transseptal access (0 [0, 0.1] vs. 1.4 [0.8, 2.3] minutes, P < .001) and PVI (0 [0, 0.1] vs. 0.4 [0.2, 1.1] minutes, P < .001) were shorter in the visualized sheath group than conventional sheath group. The procedure time during the PVI (32.0 [26.8, 36.3] vs. 41.0 [31.8, 47.3] minutes, P = .01), particularly during the right PVI (15.0 [12.8, 18.0] vs. 23.0 [15.8, 26.3] minutes, P = .009), was shorter in the visualized sheath group than conventional sheath group, however, that during the other steps was equivalent. The standard deviation of the catheter contact force during each radiofrequency application was smaller in the visualized sheath group than conventional sheath group (4.5 ± 2.7 vs. 4.9 ± 3.1 g, P = .001). The impedance drop for each lesion was larger in the visualized sheath group than conventional sheath group (10.7 ± 6.5 vs. 9.8 ± 5.5 ohms, P < .001). The incidence of acute PV reconnections per patient (30% vs. 23%, P = .56) and per PV segment (2.5% vs. 2.3%, P = .83) were similar between the two groups. No major complications occurred in either sheath group. CONCLUSIONS The use of visualized sheaths may reduce the fluoroscopic time and improve the catheter stability during the PVI.
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Affiliation(s)
- Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kurokawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoto Otsuka
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Seina Yagyu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Shu Hirata
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Wei H, Guo X, Sun Q, Yang J, Xie H, Cao Z, Chen Y, Zhang S, Wu S, Ma J. Electrical isolation of the superior vena cava using second‐generation cryoballoon in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:1307-1314. [PMID: 32250512 DOI: 10.1111/jce.14477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hui‐Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical Science Guangzhou China
| | - Xiao‐Gang Guo
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qi Sun
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jian‐Du Yang
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hai‐Yang Xie
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhong‐Jing Cao
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yan‐Qiao Chen
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shu Zhang
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical Science Guangzhou China
| | - Jian Ma
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Wei HQ, Li J, Sun Q, Guo XG, Wang HY, Yang JD, Xie HY, Liang JJ, Zhang S, Ma J. Safety and efficacy of superior vena cava isolation using the second-generation cryoballoon ablation in a canine model. J Cardiol 2020; 75:368-373. [PMID: 31522792 DOI: 10.1016/j.jjcc.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The safety and efficacy of superior vena cava (SVC) isolation (SVCI) using second-generation cryoballoon (CB) ablation remains unknown. METHODS Electrical isolation of SVC was attempted using the second-generation CB ablation catheter in 14 canines. Ablation duration was randomized to either 90 s (7 canines) or 120 s (7 canines). SVC venography was performed to identify the SVC-right atrium (RA) junction. The 28-mm CB was positioned above SVC-RA junction. Repeat electrophysiological assessment in the live animals was conducted 40-60 days post-ablation, after which animals were euthanized for histological examination. RESULTS Acute SVCI was successfully performed in all canines. No significant differences in numbers of freezes (1.7 ± 0.8 vs. 1.5 ± 0.5, p = 0.658), time to isolation (TTI) (24.3 ± 8.1s vs. 22.7 ± 9.0s, p = 0.297), temperature at isolation (-23.4 ± 12.5 °C vs. -21.5 ± 11.1 °C, p = 0.370), and nadir temperature (-51.2 ± 6.2 °C vs. -53.3 ± 7.0 °C, p = 0.195) were observed between the 90-s and 120-s groups. There were no procedural complications except one transient sinus bradycardia in the 120-s group. After ablation, animals survived for 51 ± 5 days. Chronic SVCI was achieved in 6 of 7 (85.7%) SVCs in the 90-s group and 7 of 7 SVCs (100%) in the 120-s group (p = 0.299). Histological analysis revealed that a circumferential transmural lesion was achieved in all isolated SVCs. No sinus node (SN) and phrenic nerve injuries were observed. The minimum distance between ablation lesion and SN was 5.1 ± 3.0 mm. CONCLUSIONS The second-generation CB ablation catheter is both safe and effective in achieving SVC isolation in a canine model. Effective SVCI was found in the 90-s dosing strategy.
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Affiliation(s)
- Hui-Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Jin Li
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Yue Wang
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Yang Xie
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Goyal R, Gracia E, Fan R. The Role of Superior Vena Cava Isolation in the Management of Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2674-2680. [PMID: 32494445 PMCID: PMC7252918 DOI: 10.19102/icrm.2017.080406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
The superior vena cava (SVC) has been identified as one of the most common sources of non-pulmonary vein triggers for atrial fibrillation (AF). SVC isolation has been shown to improve long-term maintenance of normal sinus rhythm in patients with paroxysmal AF. However, ablation at the SVC is associated with risks of phrenic nerve injury, sinus node dysfunction, and SVC stenosis. The use of electroanatomical mapping, intracardiac echocardiography, compound motor action potentials, and segmental (rather than circumferential) ablation are all strategies to reduce complications. Given these risks, SVC isolation is most effective as an adjunct to pulmonary vein isolation for patients with paroxysmal AF who have been found to have an arrhythmogenic SVC.
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Affiliation(s)
- Rajat Goyal
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, NY
| | - Ely Gracia
- Department of Internal Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Roger Fan
- Heart Rhythm Center, Stony Brook University Hospital, Stony Brook, NY
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Chakrabarti S, Deyell M. Friendly Fire During RF: Be Firm but Gentle! J Cardiovasc Electrophysiol 2015; 27:296-7. [PMID: 26661509 DOI: 10.1111/jce.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Santabhanu Chakrabarti
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc Deyell
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
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