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Melero-Polo J, Cabrera-Ramos M, Alfonso-Almazán JM, Marín-García I, Montilla-Padilla I, Ruiz-Arroyo JR, López-Rodríguez G, Ramos-Maqueda J. Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach. Front Cardiovasc Med 2024; 10:1322743. [PMID: 38239876 PMCID: PMC10794657 DOI: 10.3389/fcvm.2023.1322743] [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: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. Methods We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. Results A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. Conclusions LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.
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Affiliation(s)
- Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | | | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
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Abuelazm M, Mohamed I, Seri AR, Almaadawy O, Abdelazeem B, Brašić JR. Contact Force-Guided versus Contact Force-Blinded Cavo-Tricuspid Isthmus Ablation for Atrial Flutter: A Systematic Review and Meta-Analysis. Diseases 2023; 11:98. [PMID: 37489450 PMCID: PMC10366732 DOI: 10.3390/diseases11030098] [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: 06/17/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023] Open
Abstract
Contact force (CF) is a novel approach developed to increase the safety and efficacy of catheter ablation. However, the value of CF-sensing technology for atrial flutter (AFL) cavo-tricuspid isthmus ablation (CTIA) is inconclusive. To generate a comprehensive assessment of optimal extant data on CF for AFL, we synthesized randomized controlled trials (RCTs) and observational studies from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 29 November 2022, using the odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with a corresponding 95% confidence interval (CI). Two RCTs and three observational studies with a total of 376 patients were included in our analysis. CF-guided ablation was associated with (A) a higher rate of AFL recurrence (OR: 2.26 with 95% CI [1.05, 4.87]) and total CF (MD: 2.71 with 95% CI [1.28, 4.13]); (B) no effect on total procedure duration (MD: -2.88 with 95% CI [-7.48, 1.72]), fluoroscopy duration (MD: -0.96 with 95% CI [-2.24, 0.31]), and bidirectional isthmus block (BDIB) (OR: 1.50 with 95% CI [0.72, 3.11]); and (C) decreased radiofrequency (RF) duration (MD: -1.40 with 95% CI [-2.39, -0.41]). We conclude that although CF-guided CTIA was associated with increased AFL recurrence and total CF and reduced RF duration, it did not affect total procedure duration, fluoroscopy duration, or BDIB. Thus, CF-guided CTIA may not be the optimal intervention for AFL. These findings indicate the need for (A) providers to balance the benefits and risks of CF when utilizing precision medicine to develop treatment plans for individuals with AFL and (B) clinical trials investigating CF-guided catheter ablation for AFL to provide definitive evidence of optimal CF-sensing technology.
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Affiliation(s)
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Amith Reddy Seri
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - Omar Almaadawy
- Department of Internal Medicine, MedStar Health, Baltimore Internal Medicine Residency Program, Baltimore, MD 21218, USA
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - James Robert Brašić
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
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Pang N, Gao J, Zhang N, Guo M, Wang R. Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1060542. [PMID: 36684611 PMCID: PMC9853203 DOI: 10.3389/fcvm.2022.1060542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
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Affiliation(s)
- Naidong Pang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Rui Wang,
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Ducceschi V, Zingarini G, Nigro G, Brasca FMA, Malacrida M, Carbone A, Lavalle C, Maglia G, Infusino T, Aloia A, Nicolis D, Auricchio C, Uccello A, Notaristefano F, Rago A, Botto GL, Esposito L. Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter. Pacing Clin Electrophysiol 2022; 45:612-618. [PMID: 35383979 DOI: 10.1111/pace.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. METHODS RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. RESULTS 392 point-by-point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4±12Ω prior to ablation and 92.0±11Ω after ablation (p<0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8±6Ω vs 8.7±4Ω; RedV: 17.2±6Ω vs 7.8±5Ω; UPC: 19.6±6Ω vs 10.1±5Ω, all p<0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure-related adverse events were reported. CONCLUSIONS A LI-guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | - Antonio Aloia
- Division of Cardiology, Presidio Ospedaliero di Vallo della Lucania, Italy
| | | | | | | | | | - Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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Sasaki T, Nakamura K, Minami K, Take Y, Nakatani Y, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Naito S. Local impedance measurements during contact force-guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation. J Arrhythm 2022; 38:245-252. [PMID: 35387143 PMCID: PMC8977576 DOI: 10.1002/joa3.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background An ablation catheter capable of contact force (CF) and local impedance (LI) monitoring (IntellaNav StablePoint, Boston Scientific) has been recently launched. We evaluated the relationship between the CF and LI values during radiofrequency catheter ablation (RFCA) along the cavotricuspid isthmus (CTI). Methods Fifty consecutive subjects who underwent a CTI-RFCA using IntellaNav StablePoint catheters were retrospectively studied. The initial CF and LI at the start of the RF applications and mean CF and minimum LI during the RF applications were measured. The absolute and percentage LI drops were calculated as the difference between the initial and minimum LIs and 100 × absolute LI drop/initial LI, respectively. Results We analyzed 602 first-pass RF applications. A weak correlation was observed between the initial CF and LI (r = 0.13) and between the mean CF and LI drops (r = 0.22). The initial LI and absolute and percentage LI drops were greater at effective ablation sites than ineffective ablation sites (median, 151 vs. 138 Ω, 22 vs. 14 Ω, and 14.4% vs. 9.9%; p < .001), but the initial and mean CF did not differ. At optimal cutoffs of 21 Ω and 10.8% for the absolute and percentage LI drops according to the receiver-operating characteristic analysis, the sensitivity, and specificity for predicting an effective ablation were 57.4% and 88.9% and 80.0%, and 61.1%, respectively. Conclusions The effective sites during the CF-guided CTI-RFCA had greater initial LI and LI drops than the ineffective sites. Absolute and percentage LI drops of 21 Ω and 10.8% may be appropriate targets for an effective ablation.
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Affiliation(s)
- Takehito Sasaki
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kohki Nakamura
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kentaro Minami
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yutaka Take
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yosuke Nakatani
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Yuko Miki
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Koji Goto
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Kenichi Kaseno
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Eiji Yamashita
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Keiko Koyama
- Division of RadiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
| | - Shigeto Naito
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashi CityJapan
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Asvestas D, Sousonis V, Kotsovolis G, Karanikas S, Xintarakou A, Sakadakis E, Rigopoulos AG, Kalogeropoulos AS, Vardas P, Tzeis S. Cavotricuspid isthmus ablation guided by force-time integral - A randomized study. Clin Cardiol 2022; 45:503-508. [PMID: 35301726 PMCID: PMC9045076 DOI: 10.1002/clc.23805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Force‐time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram‐seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking. Hypothesis We sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions. Methods Fifty patients with CTI‐dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine‐mediated recovery of transisthmus conduction, after a 20‐min waiting period. Results The study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First‐pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first‐pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first‐pass block (29.2% vs. 7.7% respectively, p = .048). Conclusions CTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine‐mediated recurrence of transisthmus conduction, compared to 400 gs lesions.
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Affiliation(s)
| | | | - George Kotsovolis
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Stavros Karanikas
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
| | | | | | | | | | - Panos Vardas
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
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Rowe MK, Claughton A, Davis J, Yee L, Kaye GC, Dauber K, Hill J, Gould PA. Ablation of typical atrial flutter using mini electrode measurements for maximum voltage-guided ablation: A randomized, controlled trial. J Arrhythm 2022; 38:106-114. [PMID: 35222756 PMCID: PMC8851573 DOI: 10.1002/joa3.12665] [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: 05/25/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Novel ablation catheters with mini electrode (ME) sensing have become available but their utility is unclear. We investigated whether ablation of the cavotricuspid isthmus (CTI) for atrial flutter (AFL) would be improved using ME signals. METHODS Sixty-one patients (76% male, 63 ± 10 years) with CTI-dependent AFL underwent ablation using a maximum voltage-guided approach, randomized to either standard 8 mm non-irrigated catheter with bipolar signals or IntellaTip MiFi catheter using ME signals alone. RESULTS Acute bidirectional block was achieved in 97%. Mean follow-up was 16.7 ± 10 months. The median number of ablation lesions was 13 in both groups (range 3-62 vs. 1-43, p = .85). No significant differences were observed in AFL recurrences (17% vs. 11%, p = .7), median procedure durations (97 min [interquartile range (IQR), 71-121] vs. 87 min [IQR, 72-107], p = .55) or fluoroscopy times (31 min [IQR, 21-52] vs. 38 min [IQR, 25-70], p = .56). Amplitudes of ME signals were on average 160% greater than blinded bipolar signals. In 23.7% of lesions where bipolar signals were difficult to interpret, 13.6% showed a clear ME signal. CONCLUSIONS There was no difference in the effectiveness of CTI ablation guided by ME signals, compared with using bipolar signals from a standard 8 mm ablation catheter. While ME signal amplitudes were larger and sometimes present when the bipolar signal was unclear, this did not improve procedural characteristics or outcomes. The results suggest future research should focus on lesion integrity rather than signal sensing.
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Affiliation(s)
- Matthew K. Rowe
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Andrew Claughton
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Jason Davis
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Lauren Yee
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Gerald C. Kaye
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Kieran Dauber
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - John Hill
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Paul A. Gould
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
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Giehm-Reese M, Kronborg MB, Lukac P, Kristiansen SB, Jensen HK, Gerdes C, Kristensen J, Nielsen JM, Nielsen JC. Recurrent atrial arrhythmia in a randomised controlled trial comparing contact force-guided and contact force-blinded ablation for typical atrial flutter. J Interv Card Electrophysiol 2022; 63:699-707. [PMID: 35022997 DOI: 10.1007/s10840-022-01119-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Contact force (CF)-guided catheter ablation (CA) is a novel technology developed to improve efficacy and reduce complications. In a randomised controlled trial (RCT), we previously documented that after 3 months, rate of persistent conduction block was similar with and without using CF while performing CA for typical atrial flutter (AFL). Clinical effect of CF on recurrent arrhythmia is unknown. Our objective is to study recurrent atrial arrhythmia during 12-month follow-up in a RCT investigating whether CF-guided CA for typical AFL is superior to CF-blinded CA. METHODS Patients were randomised 1:1 to CA guided by CF (intervention group) or blinded to CF (control group). After 12 months, patients attended clinical check-up preceded by a 5-day ambulatory Holter monitor recording. Primary outcome was any recurrent atrial arrhythmia ≥ 30 s within 12 months and documented in 12-lead ECG or Holter monitor recording. RESULTS We included 156 patients, four patients withdrew consent and two died during follow-up. Thus, 150 patients were included in final analysis. Recurrent arrhythmia was detected in 36 of 77 (47%) patients in the intervention group, and 32 of 73 patients (44%) in the control group (p = 0.51). Atrial fibrillation was detected in 23 (30%) and 29 (40%) patients in the intervention and control groups respectively. AFL was detected in 11 (14%) and 5 (7%) patients in the intervention and control groups respectively. CONCLUSIONS Contact force-guided ablation for typical atrial flutter does not reduce recurrent atrial arrhythmia after 12-month follow-up as compared with ablation blinded for contact force.
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Affiliation(s)
- Mikkel Giehm-Reese
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jan Møller Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sasaki T, Nakamura K, Inoue M, Minami K, Miki Y, Goto K, Take Y, Kaseno K, Yamashita E, Koyama K, Naito S. Optimal local impedance drops for an effective radiofrequency ablation during cavo-tricuspid isthmus ablation. J Arrhythm 2020; 36:905-911. [PMID: 33024468 PMCID: PMC7532274 DOI: 10.1002/joa3.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A novel ablation catheter capable of local impedance (LI) monitoring (IntellaNav MiFi OI, Boston Scientific) has been recently introduced to clinical practice. We aimed to determine the optimal LI drops for an effective radiofrequency ablation during cavo-tricuspid isthmus (CTI) ablation. METHODS This retrospective observational study enrolled 50 consecutive patients (68 ± 9 years; 34 males) who underwent a CTI ablation using the IntellaNav MiFi OI catheter, guided by Rhythmia. The LI at the start of radiofrequency applications (initial LI) and minimum LI during radiofrequency applications were evaluated. The absolute and percentage LI drops were defined as the difference between the initial and minimum LIs and 100× absolute LI drop/initial LI, respectively. RESULTS A total of 518 radiofrequency applications were analyzed. The absolute and percentage LI drops were significantly greater at effective ablation sites than ineffective sites (median, 15 ohms vs 8 ohms, P < .0001; median, 14.7% vs 8.3%, P < .0001). A receiver-operating characteristic analysis demonstrated that at optimal cutoffs of 12 ohms and 11.6% for the absolute and percentage LI drops, the sensitivity and specificity for predicting the effectiveness of the ablation were 66.5% and 88.2%, and 65.1% and 88.2%, respectively. Finally, bidirectional conduction block along the CTI was achieved in all patients. CONCLUSIONS During the LI-guided CTI ablation, the effective RF ablation sites exhibited significantly greater absolute and percentage LI drops than the ineffective RF ablation sites. Absolute and percentage LI drops of 12 ohms and 11.6% may be suitable targets for effective ablation.
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Affiliation(s)
- Takehito Sasaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Mitsuho Inoue
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kentaro Minami
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yuko Miki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Koji Goto
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yutaka Take
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kenichi Kaseno
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Eiji Yamashita
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Keiko Koyama
- Division of Radiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Shigeto Naito
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
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Giehm-Reese M, Kronborg MB, Lukac P, Kristiansen SB, Jensen HK, Gerdes C, Kristensen J, Nielsen JM, Nielsen JC. A randomized trial of contact force in atrial flutter ablation. Europace 2020; 22:947-955. [DOI: 10.1093/europace/euaa049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/07/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
Aims
Contact force (CF) sensing has emerged as a tool to guide and improve outcomes for catheter ablation (CA) for cardiac arrhythmias. The clinical benefit on patient outcomes remains unknown. To study whether CF-guided CA for typical atrial flutter (AFL) is superior to CA not guided by CF.
Methods and results
In a double-blinded controlled superiority trial, we randomized patients 1:1 to receive CA for typical AFL guided by CF (intervention group) or blinded to CF (control group). In the intervention group, a specific value of the lesion size index (LSI), estimating ablation lesions size was targeted for each ablation lesion. Patients underwent electrophysiological study (EPS) after 3 months to assess occurrence of the primary endpoint of re-conduction across the cavo-tricuspid isthmus (CTI). We included 156 patients with typical AFL, median age was 68 [interquartile range (IQR) 61–74] years and 120 (77%) patients were male. At index procedure median LSI was higher in the intervention group [6.4 (IQR 5.1–7) vs. 5.6 (IQR 4.5–6.9), P < 0.0001]. After 3 months, 126 patients (58 in intervention group) underwent EPS for primary endpoint assessment. Thirty (24%) patients had CTI re-conduction, distributed with 15 patients in each treatment group (P = 0.62). We observed no difference between treatment groups with regard to fluoroscopy, ablation, or procedure times, nor peri-procedural complications.
Conclusion
Contact force-guided ablation does not reduce re-conduction across the CTI after 3 months, nor does CF-guided ablation shorten fluoroscopy, ablation, or total procedure times.
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Affiliation(s)
- Mikkel Giehm-Reese
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jan Møller Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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The combination of electroanatomic mapping and minielectrodes in a series of cases of redo procedures. Indian Heart J 2019; 70 Suppl 3:S372-S376. [PMID: 30595292 PMCID: PMC6310706 DOI: 10.1016/j.ihj.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background In patients with supraventricular tachycardia, catheter ablation is an important treatment option. However, approximately one quarter of these patients remain symptomatic, so sustainable strategies for the treatment of those patients who do not benefit from the first catheter ablation are required. Methods In a series of redo procedures, we investigated the combined use of an electro-anatomic mapping system and an ablation catheter with mini-electrodes. Results Catheter ablation was successful in two patients with recurrent common type atrial flutter and one patient with recurrent ectopic atrial tachycardia. In a patient with recurrent perimitral flutter, the ablation procedure had to be stopped early, due to pericardial effusion. Conclusion The combination of electro-anatomic mapping and mini-electrodes might be useful, especially in the treatment of ectopic atrial tachycardias, but also in redo procedures of CTI ablations, that require not only the visualization of the tachycardia, but also the detection of a local focus or a local gap. For an optimal use of the ME ablation catheter, the generator settings should be evaluated in further studies.
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Levy MR, Merchant FM, Langberg JJ, Delurgio DB. Use of microelectrode near-field signals to determine catheter contact. J Arrhythm 2018; 34:23-29. [PMID: 29721110 PMCID: PMC5828270 DOI: 10.1002/joa3.12006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background The utility of standard distal bipolar electrograms (sEGMs) for assessing catheter‐tissue contact may be obscured by the presence of far‐field signals. Microelectrode electrograms (mEGMs) may overcome this limitation. Methods We compared 5 mEGM characteristics (amplitude, frequency content, temporal signal variability, presence of injury current, and amplitude differential between bipoles) with the sEGM for determining tissue contact in 20 patients undergoing ablation of typical atrial flutter. Visualization of catheter‐tissue contact by intracardiac echocardiography (ICE) served as the gold standard for assessing contact. Correlation between electrograms and ICE‐verified contact level was reported as percent concordance. Results Three of 5 mEGM characteristics demonstrated significantly better concordance with ICE‐verified contact level than the sEGM (52% concordance with ICE): mEGM frequency content (59% concordance with ICE, P < .001 for comparison with sEGM); mEGM amplitude (concordance 59%, P < .001); and mEGM presence of injury current (56% concordance, P = .001). Concordance of amplitude differential between mEGM bipoles with ICE (49%) was not significantly different than the sEGM (P = .638) whereas mEGM temporal variability (39%) was significantly worse than the sEGM. Using a median of all 5 mEGM characteristics provided additive information (concordance with ICE 64%) and was significantly better than all of the individual mEGM characteristics except frequency content (P = .976). Conclusion Microelectrode EGMs (in particular frequency content, amplitude, and presence of injury current) can improve real‐time assessment of catheter contact compared to the use of standard bipolar EGMs. Broader use of mEGMs may enhance ablation efficacy.
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Affiliation(s)
- Mathew R Levy
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - Faisal M Merchant
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - Jonathan J Langberg
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - David B Delurgio
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
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Bhatt AG, Mittal S. The waiting period following cavotricuspid isthmus ablation: Opportunity for watchful observation or a waste of time? J Cardiovasc Electrophysiol 2017; 28:882-884. [PMID: 28543927 DOI: 10.1111/jce.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Advay G Bhatt
- Arrhythmia Institute of the Valley Health System, Ridgewood, NJ, USA
| | - Suneet Mittal
- Arrhythmia Institute of the Valley Health System, Ridgewood, NJ, USA
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