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Amin AM, Ghaly R, Ibrahim AA, Ali MA, Almaadawy O, Elzahaby A, Abuelazm M, Abdelazeem B, Munir MB. Efficacy and safety of high-power short-duration ablation for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2024; 67:1445-1461. [PMID: 38460090 PMCID: PMC11379757 DOI: 10.1007/s10840-024-01782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND High-power short-duration (HPSD) ablation has emerged as an alternative to conventional standard-power long-duration (SPLD) ablation. We aim to assess the efficacy and safety of HPSD versus SPLD for atrial fibrillation (AF) ablation. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL were performed through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID CRD42023471797. RESULTS We included six RCTs with a total of 694 patients. HPSD was significantly associated with a decreased total procedure time (MD: -22.88 with 95% CI [-36.13, -9.63], P = 0.0007), pulmonary vein isolation (PVI) time (MD: -19.73 with 95% CI [-23.93, -15.53], P < 0.00001), radiofrequency time (MD: -10.53 with 95% CI [-12.87, -8.19], P < 0.00001). However, there was no significant difference between HPSD and SPLD ablation with respect to the fluoroscopy time (MD: -0.69 with 95% CI [-2.00, 0.62], P = 0.30), the incidence of esophageal lesions (RR: 1.15 with 95% CI [0.43, 3.07], P = 0.77), and the incidence of first pass isolation (RR: 0.98 with 95% CI [0.88, 1.08], P = 0.65). CONCLUSION HPSD ablation was significantly associated with decreased total procedure time, PVI time, and radiofrequency time compared with SPLD ablation. On the contrary, SPLD ablation was significantly associated with low maximum temperature.
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Affiliation(s)
| | - Ramy Ghaly
- Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | - Amr Elzahaby
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
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Rosso R. Catheter ablation guided by intracardiac echocardiography: The "ICE" age during global warming. Heart Rhythm 2024:S1547-5271(24)02813-3. [PMID: 38925333 DOI: 10.1016/j.hrthm.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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De Potter T, Tong C, Maccioni S, Velleca M, Galvain T. Cost-utility of VISITAG SURPOINT in catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:568-576. [PMID: 38407315 DOI: 10.1111/pace.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Clinical studies have demonstrated the safety, efficacy, and efficiency of VISITAG SURPOINT® (VS), which provides important lesion markers during catheter ablation (CA) of atrial fibrillation (AF). The present study evaluated the cost-effectiveness of CA with VS compared to CA without VS in AF from the publicly-funded German and Belgium healthcare perspectives. METHODS We constructed a two-stage cost utility model that included a decision tree to simulate clinical events, costs, and utilities during the first year after the index procedure and a Markov model to simulate transitions between health states throughout a patient's lifetime. Model inputs included published literature, a meta-analysis of randomized controlled trials AF outcomes, and publicly available administrative data on costs. Deterministic and probabilistic sensitivity analyses were conducted to determine the robustness of the model. RESULTS CA with VS was associated with lower per patient costs vs CA without VS (Germany: €3295 vs. €3936, Belgium: €3194 vs. €3814) and similar quality-adjusted life-years (QALYs) per patient (Germany: 5.35 vs. 5.34, Belgium: 5.68 vs. 5.67). CA with VS was the dominant ablation strategy (incremental cost-effectiveness ratios: Germany: €-52,455/QALY, Belgium: €-50,676/QALY). The model results were robust and not highly sensitive to variation to individual parameters with regard to QALYs or costs. Freedom from AF and procedure time had the greatest impact on model results, highlighting the importance of these outcomes in ablation. CONCLUSIONS CA with VS resulted in cost savings and QALY gains compared to CA without VS, supporting the increased adoption of VS in CA in Germany and Belgium.
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Affiliation(s)
- Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan, Aalst, Belgium
| | - Cindy Tong
- Johnson and Johnson Medical, New Brunswick, New Jersey, USA
| | - Sonia Maccioni
- Johnson and Johnson Medical, New Brunswick, New Jersey, USA
| | - Maria Velleca
- Johnson and Johnson Medical, New Brunswick, New Jersey, USA
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Chen WJ, Gan CX, Cai YW, Liu YY, Xiao PL, Zou LL, Xiong QS, Qin F, Tao XX, Li R, Du HA, Liu ZZ, Yin YH, Ling ZY. Impact of high-power short-duration atrial fibrillation ablation technique on the incidence of silent cerebral embolism: a prospective randomized controlled study. BMC Med 2023; 21:461. [PMID: 37996906 PMCID: PMC10666361 DOI: 10.1186/s12916-023-03180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND High-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter. METHODS From June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator's discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24-72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. RESULTS All enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group (p = 0.685). No significant differences were observed between two groups regarding the average number of lesions (p = 0.751), maximum lesion diameter (p = 0.405), and total lesion volume per patient (p = 0.669). Persistent AF and CHA2DS2-VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure (p = 0.572) and at the 3-month follow-up (p = 0.743). CONCLUSIONS Involving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter. TRIAL REGISTRATION Clinicaltrials.gov: NCT04408716. AF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow.
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Affiliation(s)
- Wei-Jie Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Chun-Xia Gan
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yang-Wei Cai
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yang-Yang Liu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pei-Lin Xiao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Li-Li Zou
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Qing-Song Xiong
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Fang Qin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Xie-Xin Tao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Ran Li
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Hua-An Du
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Zeng-Zhang Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yue-Hui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Zhi-Yu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China.
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Waranugraha Y, Tsai CT, Lin LY. Index-Guided High-Power Radiofrequency Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis Study. Curr Cardiol Rep 2023; 25:1397-1414. [PMID: 37874469 DOI: 10.1007/s11886-023-01968-6] [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] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW Studies have suggested the superiority of high-power compared to standard-power radiofrequency ablation ablation (RFCA). This study aimed to assess the efficacy and safety of high-power compared to standard-power RFCA guided by ablation index (AI) or lesion index (LSI). RECENT FINDINGS A systematic review and meta-analysis study comparing IGHP and IGLP approaches for AF ablation was conducted. The relevant published studies comparing IGHP and IGSP methods for RFCA in AF patients until October 2022 were collected from Cochrane, ProQuest, PubMed, and ScienceDirect. A total of 2579 AF patients from 11 studies were included, 1682 received IGHP RFCA, and 897 received IGSP RFCA. To achieve successful pulmonary vein isolation (PVI), the IGHP RFCA group had a significantly shorter procedure time than the IGHP RFCA group (mean difference (MD) -19.91 min; 95% CI -25.23 to -14.59 min; p < 0.01), radiofrequency (RF) application time (MD -10.92 min; 95% CI -14.70 to -7.13 min; p < 0.01), and fewer number of lesions (MD -10.90; 95% CI -18.77 to -3.02; p < 0.01) than the IGSP RFCA. First-pass PVI was significantly greater in the IGHP RFCA group than in the IGSP RFCA group (risk ratio (RR) 1.17; 95% CI 1.07 to 1.28; p < 0.01). The IGHP RFCA is an effective and efficient strategy for AF ablation. The superiority of IGHP RFCA includes the shorter procedure time, shorter RF application time, fewer number of lesions for complete PVI, and more excellent first-pass PVI.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Li J, Zhou G, Li X, Huang S, Lin H, Lin S, Tan L, Chen W, Huang X, Wang Y. Comparisons of procedural characteristics and clinical outcomes between SMARTTOUCH SURROUNDFLOW catheter and other catheters for atrial fibrillation radiofrequency catheter ablation: a systematic literature review. BMJ Open 2023; 13:e075579. [PMID: 37848300 PMCID: PMC10582897 DOI: 10.1136/bmjopen-2023-075579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND SMARTTOUCH SURROUNDFLOW (STSF) catheter is the new generation of SMARTTOUCH (ST) catheter with an upgraded irrigation system for radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF). METHODS This systematic literature review searched the major English and Chinese bibliographic databases from 2016 to 2022 for any original clinical studies assessing the STSF catheter for RFCA in AF patients. Meta-analysis with a random effects model was used for evidence synthesis. RESULTS Pooled outcomes from 19 included studies indicated that STSF catheter was associated with a significantly shorter procedure time (weighted mean difference (WMD): -17.4 min, p<0.001), shorter ablation time (WMD: -6.6 min, p<0.001) and lower catheter irrigation fluid volume (WMD: -492.7 mL, p<0.001) than ST catheter. Pooled outcomes from four included studies with paroxysmal AF patients reported that using the STSF catheter for RFCA was associated with a significantly shorter ablation time (WMD: -5.7 min, p<0.001) and a lower risk of 1-year postablation arrhythmia recurrence (rate ratio: 0.504, p<0.001) than the SURROUNDFLOW (SF) catheter. Significant reductions in procedure time and ablation time associated with the STSF catheter were also reported in the other four studies using non-ST/SF catheters as the control. Overall complications of STSF catheter and control catheters were comparable. CONCLUSIONS Using the STSF catheter was superior to using the ST catheter to conduct RFCA for AF by significantly reducing procedure time, ablation time, fluoroscopy time and irrigation fluid volume. The superiority of the STSF catheter over the SF catheter and other non-ST/SF catheters for RFCA needs further confirmation.
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Affiliation(s)
- Jianyong Li
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Guifang Zhou
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Xinzhong Li
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Senlin Huang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Hairuo Lin
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Shaopeng Lin
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Liang Tan
- Changsha Normin Health Technology Ltd, Changsha, China
| | - Wendong Chen
- Normin Health Consulting Ltd, Mississauga, Ontario, Canada
- THETA Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Xiaobo Huang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Yuegang Wang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
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Zou F, Di Biase L. Pulmonary vein isolation with composite index tagging: are we making ablation simpler or simple? Europace 2023; 25:euad259. [PMID: 37656987 PMCID: PMC10492223 DOI: 10.1093/europace/euad259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023] Open
Affiliation(s)
- Fengwei Zou
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine at Montefiore Health System, 111 E 210th Street, Bronx, NY 10467, USA
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine at Montefiore Health System, 111 E 210th Street, Bronx, NY 10467, USA
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Kiedrowicz RM, Wielusinski M, Krasnik W, Jankowska O, Zakrzewski S, Duda L, Peregud-Pogorzelska M, Kladna A, Kazmierczak J. The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation. J Clin Med 2023; 12:5056. [PMID: 37568458 PMCID: PMC10420066 DOI: 10.3390/jcm12155056] [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: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes. METHODS A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments. RESULTS Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that AFR was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model. CONCLUSIONS Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.
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Affiliation(s)
- Radoslaw M. Kiedrowicz
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Maciej Wielusinski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Wojciech Krasnik
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Olga Jankowska
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Szymon Zakrzewski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Lukasz Duda
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | | | - Aleksandra Kladna
- Department of History of Medicine and Medical Ethics, Pomeranian Medical University, Rybacka 1, 70-204 Szczecin, Poland
| | - Jaroslaw Kazmierczak
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
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Sumi H, Hoshiyama T, Morihisa K, Noda K, Kaneko S, Kanazawa H, Ishii M, Fujisue K, Sueta D, Takashio S, Usuku H, Matsushita K, Tsujita K. Effect of contact vector direction on achieving cavotricuspid isthmus block. Sci Rep 2023; 13:2579. [PMID: 36781935 PMCID: PMC9925428 DOI: 10.1038/s41598-023-29738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cavotricuspid isthmus (CTI) ablation is an important treatment strategy for CTI-dependent atrial flutter (AFL). The location of the catheter contact area is confirmed by the contact vector direction (CVD) through three-dimensional mapping during the procedure. However, the relationship between CVD during radiofrequency ablation and its efficacy in achieving CTI block has not been clarified. This study aimed to investigate the relationship between CVD and efficacy in achieving CTI block. CVDs during radiofrequency ablation were divided into proximal vectors against the distal tip (P-vector) and other vectors (normal-vector). In 39 patients who underwent CTI linear ablation, the CTIs were divided into two segments: the tricuspid valve area (anterior) and inferior vena cava area (posterior). The frequency of the residual conduction gap was compared between segments in which the P- and normal-vectors were observed. P-vectors were observed in 13 of the 78 segments. The median ablation index was not significantly different between segments in which the P-vector and normal-vector were observed (398.2 [384.2-402.2] vs. 393.3 [378.3-400.1], p = 0.15). However, residual conduction gaps were significantly more frequently observed in the segment in which the P-vector was observed than those in which only the normal-vector was observed (6/13, 46.2% vs. 3/65, 4.6%; p < 0.01). During a 6-month follow-up, two patients required a second session of ablation due to AFL recurrence. A residual conduction gap was observed in one patient at the site where the P-vector was observed in the first session. Avoiding the P-vector might be an important factor in improving CTI block and reducing AFL recurrence.
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Affiliation(s)
- Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Kenji Morihisa
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Katsuo Noda
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
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10
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y. In vivo tissue temperatures during 90 W/4 sec-very high power-short-duration (vHPSD) ablation versus ablation index-guided 50 W-HPSD ablation: A porcine study. J Cardiovasc Electrophysiol 2023; 34:369-378. [PMID: 36527433 PMCID: PMC10107763 DOI: 10.1111/jce.15782] [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: 09/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neither the actual in vivo tissue temperatures reached with 90 W/4 s-very high-power short-duration (vHPSD) ablation for atrial fibrillation nor the safety and efficacy profile have been fully elucidated. METHODS We conducted a porcine study (n = 15) in which, after right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We compared tissue temperatures close to a QDOT MICRO catheter, between during 90 W/4 s-vHPSD ablation during ablation index (AI: target 400)-guided 50 W-HPSD ablation, both targeting a contact force of 8-15 g. RESULTS Maximum tissue temperature reached during 90 W/4 s-vHPSD ablation did not differ significantly from that during 50 W-HPSD ablation (49.2 ± 8.4°C vs. 50.0 ± 12.1°C; p = .69) and correlated inversely with distance between the catheter tip and the thermocouple, regardless of the power settings (r = -0.52 and r = -0.37). Lethal temperature (≥50°C) was best predicted at a catheter tip-to-thermocouple distance cut-point of 3.13 and 4.27 mm, respectively. All lesions produced by 90 W/4 s-vHPSD or 50 W-HPSD ablation were transmural. Although there was no difference in the esophageal injury rate (50% vs. 66%, p = .80), the thermal lesion was significantly shallower with 90 W/4 s-vHPSD ablation than with 50W-HPSD ablation (381.3 ± 127.3 vs. 820.0 ± 426.1 μm from the esophageal adventitia; p = .039). CONCLUSION Actual tissue temperatures reached with 90 W/4 s-vHPSD ablation appear similar to those with AI-guided 50 W-HPSD ablation, with the distance between the catheter tip and target tissue being shorter for the former. Although both ablation settings may create transmural lesions in thin atrial tissues, any resulting esophageal thermal lesions appear shallower with 90 W/4 s-vHPSD ablation.
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Affiliation(s)
- Naoto Otsuka
- 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
| | - Sayaka Kuorkawa
- 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
| | - Yuji Wakamatsu
- 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
| | - 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
| | - Hiroyuki Hao
- Department of Pathology and Microbiology Nihon University School of Medicine, Division of Human Pathology, Tokyo, Japan
| | - Rie Takahashi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
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11
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High-power short-duration versus low-power long-duration ablation guided by the ablation index. Int J Cardiol 2023; 370:209-214. [PMID: 36228764 DOI: 10.1016/j.ijcard.2022.10.013] [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: 06/10/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
AIMS To compare the two different ablation strategies, both guided by the Ablation Index (AI), in the setting of atrial fibrillation (AF) ablation: high-power short-duration (HPSD) ablation using 40 W on the posterior wall and 50 W elsewhere versus low-power long-duration (LPLD) using 25 W posteriorly and 35 W elsewhere. METHODS Prospective, multicenter nonrandomized, noninferiority study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. Ablation was guided by the AI (≥500 for anterior segments, ≥450 for the roof and inferior segments and 400 posteriorly) and an interlesion distance (ILD) ≤ 6 mm. Patients were separated into two groups: HPSD vs LPLD. Acute reconnection (after adenosine trial) and 2-year outcomes were assessed. RESULTS 160 patients (61% males, median age of 62 [IQR 51-69] years), fulfilled the study inclusion criteria - 80 patients (316 pulmonary veins [PV]) in the HPSD group and 80 patients (314 PV) in the LPLD. The probability of acute PV reconnection was similar between both groups: 2.2% in HPSD, 95%CI 0.6% to 3.8% vs. 3.4% in LPLD, 95%CI 1.4% to 5.4%; p < 0.001 for noninferiority. Median PV ablation time (20 min vs 30 min, p < 0.01) and procedure duration (80 min vs 100 min, p < 0.001) were shorter in the HPSD group. After a median follow-up of 26 months, arrhythmia recurrence was similar between groups (17.5% in HPSD group vs. 18.8% in LPLD group, p = 0.79). CONCLUSIONS In paroxysmal AF patients treated with the Ablation Index, a HPSD strategy is noninferior to the more standard LPLD ablation, while allowing for quicker procedures with shorter ablation times.
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12
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Popa MA, Bourier F, Lengauer S, Krafft H, Bahlke F, Förschner LV, Dorfmeister S, Kathan S, Telishevska M, Englert F, Lennerz C, Reents T, Hessling G, Deisenhofer I, Kottmaier M. Safety profile and long-term efficacy of very high-power short-duration (60-70 W) catheter ablation for atrial fibrillation: results of a large comparative analysis. Europace 2022; 25:408-416. [PMID: 36504120 PMCID: PMC9935037 DOI: 10.1093/europace/euac215] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS This retrospective study sought to compare complication rates and efficacy of power-controlled very high-power short-duration (vHPSD) and conventional catheter ablation in a large cohort of patients with atrial fibrillation (AF). METHODS AND RESULTS We analyzed 1115 consecutive patients with AF (38.7% paroxysmal, 61.3% persistent) who received first-time catheter ablation at our centre from 2015 to 2021. Circumferential pulmonary vein isolation ± additional substrate ablation using an irrigated-tip catheter was performed with vHPSD (70 W/5-7 s or 60 W/7-10 s) in 574 patients and with conventional power (30-35 W/15-30 s) in 541 patients. Baseline characteristics were well-balanced between groups (mean age 65.1 ± 11.2 years, 63.4% male). The 30-day incidence of cardiac tamponade [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598], pericardial effusion ≥ 10 mm [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598] and transient ischaemic attack [1/574 (0.17%) vs. 2/541 (0.37%), P = 0.529] was not significantly different between vHPSD and conventional ablation. No stroke, atrio-esophageal fistula, cardiac arrest or death occurred. Procedure (122.2 ± 46.8 min vs. 155.0 ± 50.5 min, P < 0.001), radiofrequency (22.4 ± 19.3 min vs. 52.9 ± 22.0 min, P < 0.001), and fluoroscopy (8.1 ± 7.2 vs. 9.2 ± 7.4, P = 0.016) duration were significantly shorter in the vHPSD group. At 12 months follow-up, freedom of any atrial arrhythmia was 44.1% vs. 34.2% (P = 0.010) in persistent AF and 78.1% vs. 70.2% in paroxysmal AF (P = 0.068). CONCLUSION vHPSD ablation is as safe as conventional ablation and is associated with an improved long-term efficacy in persistent AF.
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Affiliation(s)
- Miruna A Popa
- Corresponding author. Tel: +49 89 1218 2020, Fax: +49 89 1218 4593. E-mail address:
| | - Felix Bourier
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Sarah Lengauer
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Hannah Krafft
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Fabian Bahlke
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Leonie V Förschner
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Stephan Dorfmeister
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Susanne Kathan
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Marta Telishevska
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Florian Englert
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Carsten Lennerz
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Tilko Reents
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Gabriele Hessling
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Isabel Deisenhofer
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Marc Kottmaier
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
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13
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Schade A, Costello-Boerrigter L, Deneke T, Steinborn F, Chapran M, Vathie K, Milisavljevic N, Franz M, Surber R, Assani M, Hamo H, Khshfeh M, Lauten A, Mattea V. Oesophageal safety in voltage-guided atrial fibrillation ablation using ablation index or contact force only: a prospective comparison. Europace 2022; 24:1909-1916. [PMID: 35851917 DOI: 10.1093/europace/euac103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Left atrial ablation using radiofrequency (RF) is associated with endoscopically detected thermal oesophageal lesions (EDELs). The aim of this study was to compare EDEL occurrence after conventional contact force-guided (CFG) RF ablation vs. an ablation index-guided (AIG) approach in clinical routine of voltage-guided ablation (VGA). Predictors of EDEL were also assessed. METHODS AND RESULTS This study compared CFG (n = 100) with AIG (n = 100) in consecutive atrial fibrillation ablation procedures, in which both pulmonary vein isolation and VGA were performed. In the AIG group, AI targets were ≥500 anteriorly and ≥350-400 posteriorly. Upper endoscopy was performed after ablation.The CFG and AIG groups had comparable baseline characteristics. The EDEL occurred in 6 and 5% (P = 0.86) in the CFG and AIG groups, respectively. Category 2 lesions occurred in 4 and 2% (P = 0.68), respectively. All EDEL healed under proton pump inhibitor therapy. The AI > 520 was the only predictor of EDEL [odds ratio (OR) 3.84; P = 0.039]. The more extensive Category 2 lesions were predicted by: AI max > 520 during posterior ablation (OR 7.05; P = 0.042), application of posterior or roof lines (OR 5.19; P = 0.039), existence of cardiomyopathy (OR 4.93; P = 0.047), and CHA2DS2-VASc score (OR 1.71; P = 0.044). The only Category 2 lesion with AI max < 520 (467) occurred in a patient with low body mass index. CONCLUSIONS Both methods were comparable with respect to clinical complications and EDEL. In consideration of previous reconnection data and our study results regarding oesophageal safety, optimal AI target range might be between 400 and 450.
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Affiliation(s)
- Anja Schade
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Lisa Costello-Boerrigter
- Department of Cardiology and Center for Clinical Studies, Central Clinic Bad Berka, Robert-Koch-Alle 9, 99438 Bad Berka, Germany
| | - Thomas Deneke
- Department of Cardiology II/Interventional Electrophysiology, Rhoen-Klinikum Campus Bad Neustadt, Von-Guttenberg Str. 11, 97616 Bad Neustadt, Germany
| | - Frank Steinborn
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Mykhaylo Chapran
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Koroush Vathie
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Nemanja Milisavljevic
- Department of Internal Medicine 2, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Marcus Franz
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Ralf Surber
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Mohamad Assani
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Hussam Hamo
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Muhammed Khshfeh
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Alexander Lauten
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Violeta Mattea
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
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14
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Leung LWM, Akhtar Z, Elbatran AI, Bajpai A, Li A, Norman M, Kaba R, Sohal M, Zuberi Z, Gallagher MM. Effect of esophageal cooling on ablation lesion formation in the left atrium: Insights from Ablation Index data in the IMPACT trial and clinical outcomes. J Cardiovasc Electrophysiol 2022; 33:2546-2557. [PMID: 36284450 PMCID: PMC10091801 DOI: 10.1111/jce.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The IMPACT study established the role of controlled esophageal cooling in preventing esophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF). The effect of esophageal cooling on ablation lesion delivery and procedural and patient outcomes had not been previously studied. The objective was to determine the effect of esophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints, and clinical outcomes. METHODS Participants in the IMPACT trial underwent AF ablation guided by Ablation Index (30 W at 350-400 AI posteriorly, 40 W at ≥450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of the ensoETM® device to keep esophageal temperature at 4°C during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and clinical outcomes were analyzed. RESULTS Procedural data from 188 patients were analyzed. Procedure and fluoroscopy times were similar, and all pulmonary veins were isolated. First-pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs. 51/68; p = 0.54 and 5/64 vs. 7/68; p = 0.76, respectively). Posterior wall isolation was also similar: 24/33 versus 27/38; p = 0.88. Ablation effect on tissue, measured in impedance drop, was no different between the two randomized groups: 8.6Ω (IQR: 6-11.8) versus 8.76Ω (IQR: 6-12.2; p = 0.25). Arrhythmia recurrence was similar after 12 months (21.1% vs. 24.1%; 95% CI: 0.38-1.84; HR: 0.83; p = 0.66). CONCLUSIONS Esophageal cooling has been shown to be effective in reducing ablation-related thermal injury during RF ablation. This protection does not compromise standard procedural endpoints or clinical success at 12 months.
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Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Zaki Akhtar
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ahmed I Elbatran
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK.,Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abhay Bajpai
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Anthony Li
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Riyaz Kaba
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Manav Sohal
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | -
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
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15
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Badertscher P, Knecht S, Spies F, Völlmin G, Schaer B, Schärli N, Bosshard F, Osswald S, Sticherling C, Kühne M. High-power short-duration ablation index-guided pulmonary vein isolation protocol using a single catheter. J Interv Card Electrophysiol 2022; 65:633-642. [PMID: 35596105 PMCID: PMC9726791 DOI: 10.1007/s10840-022-01226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) is the most commonly performed electrophysiological procedure. To improve healthcare utilization, we aimed to compare the efficacy, efficiency, and safety of a minimalistic, streamlined single catheter ablation approach using a high-power short-duration ablation index-guided protocol (HPSD) vs. a control single-catheter protocol (SP). METHODS Pulmonary vein isolation (PVI) with a single transseptal puncture without a multipolar mapping catheter was performed in 91 patients. Left atrial mapping was performed with the ablation catheter, only. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD (n = 34) vs. a control (n = 57) ablation protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month blanking period. RESULTS Using the HPSD protocol the median procedure and RF ablation time were significantly shorter compared to the SP, 84 (IQR 76-100) vs. 118 min (IQR 104-141) and 1036 (898-1184) vs. 1949s (IQR 1693-2261), respectively, p < .001 for all. First-pass PVI was achieved using the HPSD protocol in 88% and using the SP in 87% of patients, p = 1.0. No procedural complications were observed. High-sensitivity cardiac troponin levels were significantly higher in patients using the HPSD protocol compared to the SP. At 12 months follow-up, 87% patients remained free from AF with no differences between groups. CONCLUSIONS A minimalistic, HPSD ablation index-guided PVI with a single-catheter approach is very efficient, safe, and associated with excellent clinical outcomes at 1 year.
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Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Gian Völlmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Nicolas Schärli
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Flurina Bosshard
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
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16
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Qiao Y, Zhao Z, Cai X, Guo Y, Fu M, Liu K, Guo J, Guo T, Niu G. Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance. Front Cardiovasc Med 2022; 9:922910. [PMID: 36204561 PMCID: PMC9530740 DOI: 10.3389/fcvm.2022.922910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The long-term outcomes of ablation index (AI)-guided radiofrequency catheter ablation (RFCA) on atrial fibrillation (AF) and different subtypes of heart failure (HF) remain unknown. The aim of the study was to evaluate the long-term prognosis of AI-guided RFCA procedures in patients with AF and concomitant HF. Methods We retrospectively included consecutive patients with AF and HF who underwent the initial RFCA procedure with AI guidance from March 2018 to June 2021 in our institution. The patients were categorized into two groups: HF with preserved ejection fraction (HFpEF) group and HF with mid-range ejection fraction (HFmrEF) +HF with reduced ejection fraction (HFrEF) group. Results A total of 101 patients were included. HFpEF and HFmrEF + HFrEF groups consisted of 71 (70.3%) and 30 patients (29.7%), respectively. During a median follow-up of 32.0 (18.2, 37.6) months, no significant difference was detected in AF recurrence between groups (21.1 vs. 33.3%) after multiple procedures, whereas the incidence of the composite endpoint of all-cause death, thromboembolic events, and HF hospitalization was significantly lower in HFpEF group (9.9 vs. 25.0%, Log-rank p = 0.018). In multivariable analysis, a history of hypertension [hazard ratio (HR) 4.667, 95% confidence interval (CI) 1.433–15.203, p = 0.011], left ventricular ejection fraction (LVEF) < 50% (HR 5.390, 95% CI 1.911–15.203, p = 0.001) and recurrent AF after multiple procedures (HR 7.542, 95% CI 2.355–24.148, p = 0.001) were independently associated with the incidence of the composite endpoint. Conclusion Long-term success could be achieved in 75% of patients with AF and concomitant HF after AI-guided RFCA procedures, irrespective of different HF subtypes. Preserved LVEF was associated with a reduction in the composite endpoint compared with impaired LVEF. Patients with recurrent AF tend to have a poorer prognosis.
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Affiliation(s)
- Yu Qiao
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Zhen Zhao
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Xiang Cai
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Yulong Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Mingpeng Fu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Ke Liu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Jinrui Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Tao Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Guodong Niu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Guodong Niu
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Effectiveness and Safety of High-Power Radiofrequency Ablation Guided by Ablation Index for the Treatment of Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5609764. [PMID: 35991126 PMCID: PMC9391153 DOI: 10.1155/2022/5609764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Background To investigate the efficacy and safety of ablation index- (AI-) guided high-power radiofrequency ablation in the treatment of atrial fibrillation (AF). Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50 W, 40 W, and 30 W; AI = 500). And a total of 100 consecutive patients with paroxysmal AF undergoing pulmonary vein isolation (PVI) were included. The patients were divided into two groups (n = 50 for each) as follows: control group, treated with conventional power (30 W) ablation mode; and study group, treated with high power (40 W) radiofrequency ablation mode. All groups were treated with the same AI value guided the ablation (target AI = 400/500 on posterior/anterior wall, respectively). Acute pulmonary vein (PV) reconnection was assessed post adenosine administration 20 minutes after ablation. Subsequently, pathological observation of porcine heart lesions and necrotic tissue was performed. Additionally, statistical analyses were carried out on patients' baseline clinical characteristics, surgical data, and total RF energy. Results In swine ventricular endocardial RF applications, compared with 40 W and 30 W, the use of 50 W was associated with shallower tissue lesion depth (p < 0.001) and greater lesion maximum diameter (p < 0.001). Compared with 40 W and 30 W, tissue necrosis caused by 50 W was the deepest and largest (p < 0.001). In pulmonary vein isolation (PVI), there was no significant difference in baseline data between the study group and control group (p > 0.05). In patients with paroxysmal atrial fibrillation, the procedure time in the high-power group was significantly shortened (p < 0.001). The ablation time was significantly shorter (p < 0.001). Compared with control group, RF energy per point and acute pulmonary vein (PV) reconnection were lower (p < 0.001), and first-pass PVI was higher (p < 0.01) in study group. There were no significant differences in complications and sinus rhythm maintenance at 12 months between the two groups (p > 0.05). Conclusions Compared with conventional (30 W) PVI, AI-guided high-power (40 W) was safe and associated with shorter procedure time and reduced acute PV reconnection.
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Procedural Efficiency, Efficacy, and Safety of High-Power, Short-Duration Radiofrequency Ablation Delivered by STSF Catheter for Paroxysmal Atrial Fibrillation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6009275. [PMID: 35979002 PMCID: PMC9377865 DOI: 10.1155/2022/6009275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Objectives To investigate the procedural efficiency, efficacy, and safety of high-power, short-term radiofrequency ablation delivered by the SmartTouch Surround Flow (STSF) catheter for paroxysmal atrial fibrillation (AF). Methods We retrospectively analyzed a total of 72 patients who were admitted with paroxysmal AF, and who underwent radiofrequency catheter ablation (RFCA) for the first time. Of these patients, 36 cases underwent low-power, long-duration (LPLD, (30–35 W/20–40 s) pulmonary vein isolation (PVI) delivered by an SmartTouch (ST) catheter (control group), and the other 36 cases underwent high-power, short-duration (HPSD, (45–50 W/10–20 s) PVI delivered by a STSF catheter (study group). The baseline data, duration of PVI, procedural time, fluoroscopy time, the rate of first-pass isolation, irrigation perfusion, eschar and steam pop occurrences, intraoperative complications, and the rate of stable sinus rhythm maintenance following a blanking period of three months were analyzed between the two groups. Results The isolation time of bilateral PVI and procedural time in the study group were markedly less than in controls (p < 0.01). The rate of first-pass isolation in the study group was significantly higher than in the control group (95.8% vs. 84.7%, p = 0.023), while the fluid perfusion in the study group was approximately 20% less than that in the control group (767 ± 171 vs. 966 ± 227 ml, p < 0.001). We observed no severe complications in any patients. The rate of freedom from AF recurrences following a blanking period of three months showed a tendency to be higher than in controls (93.9% vs. 87.1%, p = 0.348). Conclusions The HPSD strategy delivered by the STSF catheter was superior to conventional LPLD ablation through the ST catheter with respect to efficiency, acute procedural effectiveness, short-term safety, and the risk of heart failure in patients with paroxysmal AF.
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Jiang R, Chen M, Fan J, Yi F, Tang A, Liu X, Zhu W, Liu S, Huang X, Liu Q, Ju W, Zhang X, Li J, He J, Shi L, Zhou G, Wang Y, Fu G, Jiang C. Efficacy of ablation index-guided pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:1186-1193. [PMID: 35939332 DOI: 10.1111/pace.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation index (AI) is a novel technology of ablation lesion quality to help improve homogeneity of lesion size and continuity. In this study, we aim to evaluate whether AI-guided PVI improves clinical outcomes compared to CF-guided PVI in patients with paroxysmal AF (PAF). METHODS Patients undergoing first-time radiofrequency ablation for PAF were randomized in a 2:1 ratio to two groups: AI-guided PVI and CF-guided PVI. In the AI group, AI ≥500 was recommended at the anterior/superior/inferior walls, 350-400 at the posterior wall, and inter-lesion distance ≤4 mm. The primary endpoint is the freedom from atrial arrhythmia recurrence during 12 months follow-up, without antiarrhythmic drug therapy (ADT). The key secondary endpoints include intra-procedural efficiency and peri-procedural complications. RESULTS 225 patients were randomized (AI group (n = 149) and CF group(n = 76)). First-pass isolation rate in AI group was significantly higher than that in CF group (58.3% vs. 43.4%, p = 0.035). After a median follow-up of 12.2 months, 154/225(68.4%) of patients were free from atrial arrhythmia recurrence without ADT, which was higher in AI group compared with CF group, but without significant difference (71.1% vs. 63.2%, p = 0.253). The incidence of peri-procedural complications is low and without difference between two groups. CONCLUSIONS AI-guided ablation provided higher acute efficacy than CF-guided ablation in PV isolation for patients with paroxysmal AF. The long-term success rate in AI group was higher than CF group, but did not reach statistical significance. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Fan
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Fu Yi
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Anli Tang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingpeng Liu
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Wenqing Zhu
- The Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaowen Liu
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobo Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi Zhang
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Jie Li
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jiangui He
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Shi
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Genqing Zhou
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Liu Z, Liu LF, Liu XQ, Liu J, Wang YX, Liu Y, Liu XP, Yang XC, Chen ML. Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation. Front Cardiovasc Med 2022; 9:949918. [PMID: 35990990 PMCID: PMC9387669 DOI: 10.3389/fcvm.2022.949918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ablation in a milder AI-targeting setting are unknown. The goal of this study was to explore the efficacy and safety of HP-AI-guided ablation in a milder AI-targeting setting. Methods Patients who underwent pulmonary vein isolation (PVI) for AI-guided atrial fibrillation ablation in our center were enrolled and divided into 2 groups according to the ablation power used. In the HP-AI group, the ablation power was over 45 W, while the low power-AI group was ablated with <35 W power. The targeted AIs were 450–500 in the anterior wall and 350–400 in the posterior wall. The efficacy outcome was expressed as the single-procedure atrial arrhythmia-free survival between 91 days and 1 year. Safety outcomes included severe adverse events (SAEs), including symptomatic pulmonary vein (PV) stenosis, atrioesophagal fistula, cardiac tamponade, stroke, thromboembolism events, myocardial infarction, and major bleeding. Results A total of 134 patients were enrolled, of whom 74 underwent PVI using HP-AI, while 60 received low power-AI ablation. After a mean follow-up time of 7.4 months, 22 (16.4%) patients showed arrhythmia recurrence: 5 (6.8%) patients in the HP-AI group and 17 (28.3%) patients in the low power-AI group. The HP-AI group showed a significantly higher arrhythmia-free survival than the low power-AI group (p = 0.011). Two patients in the low power-AI group and 1 patient in the HP-AI group developed an SAE (p = NS). Compared with the low power-AI group, the HP-AI group demonstrated a higher PV first-pass isolation rate, shorter ablation time, and fewer patients with anatomical leakages and sites of unreached AI. Conclusion In a milder AI setting, HP-AI ablation might result in significantly higher arrhythmia-free survival than low power-AI ablation and a similar safety profile.
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21
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Di Biase L, Monir G, Melby D, Tabereaux P, Natale A, Manyam H, Athill C, Delaughter C, Patel A, Gentlesk P, Liu C, Arkles J, McElderry HT, Osorio J. Composite Index Tagging for PVI in Paroxysmal AF. JACC Clin Electrophysiol 2022; 8:1077-1089. [DOI: 10.1016/j.jacep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
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22
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Comparison between High-Power Short-Duration and Conventional Ablation Strategy in Atrial Fibrillation: An Updated Meta-Analysis. Cardiovasc Ther 2022; 2022:1065077. [PMID: 35975140 PMCID: PMC9355769 DOI: 10.1155/2022/1065077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
High-power short-duration (HPSD) setting during radiofrequency ablation has become an attempt to improve atrial fibrillation (AF) treatment outcomes. This study ought to compare the efficacy, safety, and effectiveness between HPSD and conventional settings. PubMed, Embase, and Cochrane Library were searched. Studies that compared HPSD and conventional radiofrequency ablation settings in AF patients were included while studies performed additional ablations on nonpulmonary vein targets without clear recording were excluded. Data were pooled with random-effect model. Efficacy endpoints include first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, free from AF, and free from atrial tachycardia (AT) during follow-up. Safety endpoints include esophagus injury rate and major complication rate. Effectiveness endpoints include complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time. We included 22 studies with 3867 atrial fibrillation patients in total (2393 patients received HPSD radiofrequency ablation). Perioperatively, the HPSD group showed a higher first-pass PVI rate (risk ratio,
,
) and less acute PV reconnection rate (
,
) than the conventional group. During follow-up, free from AF (
,
) or AT (
,
) rate did not differ between HPSD and conventional groups 6-month postsurgery. However, the HPSD group showed both higher free from AF (
,
) and AT (
,
) rate than the conventional group 12-month postsurgery. The esophagus injury (
,
) and major complications (
,
) rates did not differ between the two groups. The HPSD group took shorter total procedure time (
95% CI: -43.10 to -24.33,
), PVI time (
95% CI: -25.00 to -18.21,
), and PVI RF time (
, 95% CI: -14.45 to -13.00,
) than conventional groups while complete procedure rate did not differ between two groups (
,
). HPSD setting during AF radiofrequency ablation has better effectiveness, efficacy, and similar safety compared with the conventional setting.
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23
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Salló Z, Perge P, Balogi B, Orbán G, Piros K, Herczeg S, Nagy KV, Osztheimer I, Ábrahám P, Merkely B, Gellér L, Szegedi N. Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:935705. [PMID: 35872909 PMCID: PMC9300971 DOI: 10.3389/fcvm.2022.935705] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHigh-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.MethodsOne hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).ResultsBilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001).ConclusionOur prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.
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24
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Sousa PA, Puga L, Adão L, Primo J, Khoueiry Z, Lebreiro A, Fonseca P, Lagrange P, Elvas L, Gonçalves L. Two years after pulmonary vein isolation guided by ablation index-a multicenter study. J Arrhythm 2022; 38:346-352. [PMID: 35785367 PMCID: PMC9237314 DOI: 10.1002/joa3.12696] [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: 02/16/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Abstract
Background The use of the Ablation Index (AI) software for paroxysmal atrial fibrillation (AF) has been associated with higher acute effectiveness and higher 1-year arrhythmia freedom. There is, however, a lack of data concerning longer follow-up. We aim to evaluate the 2-year outcomes after a standardized AI-guided pulmonary vein isolation (PVI). Methods Prospective, multicenter study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. PVI was guided by a tailored AI value (≥500 for anterior segment, ≥450 for the roof segments and inferior segments, and 400 for the posterior wall) and an ILD ≤6 mm. The primary endpoints were acute and long-term effectiveness. Results The study included 218 (842 PV) patients (61% males, median age of 60 [IQR 49-68] years) with paroxysmal AF. First-pass isolation was obtained in 93% of the patients, with an acute reconnection occurring in 10.6% of the patients (3.2% of the PV) following adenosine trial. After a median follow-up of 26 (IQR 20-30) months, freedom from any documented atrial arrhythmia was 83.4%, off-AAD. The rate of adverse events was 1.4%. Although procedural parameters differ across centers (p < 0.001), the acute (p = 0.56) and long-term effectiveness (p = 0.83) were consistent between centers. Conclusions Patients with paroxysmal AF submitted to an AI-guided PVI workflow presented high arrhythmia freedom at 2-years of follow-up.
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Affiliation(s)
- Pedro A. Sousa
- Pacing & Electrophysiology Unit, Cardiology DepartmentCoimbra's Hospital and University CenterCoimbraPortugal
| | - Luís Puga
- Pacing & Electrophysiology Unit, Cardiology DepartmentCoimbra's Hospital and University CenterCoimbraPortugal
| | - Luís Adão
- Cardiology DepartmentUniversity Hospital Center of São JoãoPortoPortugal
| | - João Primo
- Cardiology DepartmentVila Nova de Gaia & Espinho Hospital CenterPortugal
| | - Ziad Khoueiry
- Cardiology DepartmentClinique Saint PierrePerpignanFrance
| | - Ana Lebreiro
- Cardiology DepartmentUniversity Hospital Center of São JoãoPortoPortugal
| | - Paulo Fonseca
- Cardiology DepartmentVila Nova de Gaia & Espinho Hospital CenterPortugal
| | | | - Luís Elvas
- Pacing & Electrophysiology Unit, Cardiology DepartmentCoimbra's Hospital and University CenterCoimbraPortugal
| | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology DepartmentCoimbra's Hospital and University CenterCoimbraPortugal
- ICBR, Faculty of MedicineUniversity of CoimbraCoimbraPortugal
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Knecht S, Badertscher P. Time to say good bye? – the value of waiting period after pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1734-1736. [DOI: 10.1111/jce.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sven Knecht
- Department of CardiologyUniversity Hospital BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselBaselSwitzerland
| | - Patrick Badertscher
- Department of CardiologyUniversity Hospital BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselBaselSwitzerland
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Chen L, Chen JQ, Zou T, Chen Q, Lian LH, Yang ZP, Wu MQ, Lin YZ, Peng YM, Lin W, Liao XW, Huang QL, Zhang JC. Efficacy of extended antrum ablation based on substrate mapping plus pulmonary vein isolation in the treatment of atrial fibrillation. Rev Port Cardiol 2022; 41:17-26. [DOI: 10.1016/j.repc.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
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Khanra D, Hamid A, Deshpande S, Mukherjee A, Petkar S, Saeed M, Basu-Ray I. Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation. Anatol J Cardiol 2022; 26:2-14. [PMID: 35191380 PMCID: PMC8878944 DOI: 10.5152/anatoljcardiol.2021.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other. METHODS A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. RESULTS Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I2=62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups. CONCLUSION HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.
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Affiliation(s)
| | | | | | | | - Sanjiv Petkar
- Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust; Wolverhampton-United Kingdom
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Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. Europace 2021; 24:874-886. [PMID: 34964469 DOI: 10.1093/europace/euab279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is an important alternative to antiarrhythmic drugs in the treatment of symptomatic atrial fibrillation. However, the inability to consistently achieve durable isolation of the pulmonary veins hampers the long-term efficacy of PVI procedures. The large number of factors involved in RF lesion formation and the complex interplay of these factors complicate reliable creation of durable and transmural ablation lesions. Various surrogate markers of ablation lesion formation have been proposed that may provide information on RF lesion completeness. Real-time assessment of these surrogates may aid in the creation of transmural ablation lesions, and therefore, holds potential to decrease the risk of PV reconnection and consequent post-PVI arrhythmia recurrence. Moreover, titration of energy delivery until lesions is transmural may prevent unnecessary ablation and subsequent adverse events. Whereas several surrogate markers of ablation lesion formation have been described over the past decades, a 'gold standard' is currently lacking. This review provides a state-of-the-art overview of ablation strategies that aim to enhance durability of RF-PVI, with special focus on real-time available surrogates of RF lesion formation in light of the biophysical basis of RF ablation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Mulder MJ, Kemme MJB, Hopman LHGA, Hagen AMD, van de Ven PM, Hauer HA, Tahapary GJM, van Rossum AC, Allaart CP. Ablation Index-guided point-by-point ablation versus Grid annotation-guided dragging for pulmonary vein isolation: A randomized controlled trial. J Cardiovasc Electrophysiol 2021; 33:64-72. [PMID: 34820931 PMCID: PMC9299027 DOI: 10.1111/jce.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
Introduction Radiofrequency (RF) atrial fibrillation (AF) ablation using a catheter dragging technique may shorten procedural duration and improve durability of pulmonary vein isolation (PVI) by creating uninterrupted linear ablation lesions. We compared a novel AF ablation approach guided by Grid annotation allowing for “drag lesions” with a standard point‐by‐point ablation approach in a single‐center randomized study. Methods Eighty‐eight paroxysmal or persistent AF patients were randomized 1:1 to undergo RF‐PVI with either a catheter dragging ablation technique guided by Grid annotation or point‐by‐point ablation guided by Ablation Index (AI) annotation. In the Grid annotation arm, ablation was visualized using 1 mm³ grid points coloring red after meeting predefined stability and contact force criteria. In the AI annotation arm, ablation lesions were created in a point‐by‐point fashion with AI target values set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Patients were followed up for 12 months after PVI using ECGs, 24‐h Holter monitoring and a mobile‐based one‐lead ECG device. Results Procedure time was not different between the two randomization arms (Grid annotation 71 ± 19 min, AI annotation 72 ± 26 min, p = .765). RF time was significantly longer in the Grid annotation arm compared with the AI annotation arm (49 ± 8 min vs. 37 ± 8 min, respectively, p < .001). Atrial tachyarrhythmia recurrence was documented in 10 patients (23%) in the Grid annotation arm compared with 19 patients (42%) in the AI annotation arm with time to recurrence not reaching statistical significance (p = .074). Conclusions This study shows that a Grid annotation‐guided dragging approach provides an alternative to point‐by‐point RF‐PVI using AI annotation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Kawaji T, Aizawa T, Hojo S, Kushiyama A, Yaku H, Nakatsuma K, Kaneda K, Kato M, Yokomatsu T, Miki S. The impact of current strategy using intracardiac echocardiography, lesion index, and minimum substrate ablation on clinical outcomes after catheter ablation procedure for atrial fibrillation. J Arrhythm 2021; 37:1278-1286. [PMID: 34621426 PMCID: PMC8485827 DOI: 10.1002/joa3.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We developed the intracardiac echocardiography (ICE) technique to minimize radiation exposure and other recent technology during ablation procedure for atrial fibrillation (AF). The aim of this study was to validate the impact of the current strategy using the recent technology for AF ablation on outcomes after procedure. METHODS We evaluated the safety and efficacy of the current strategy in consecutive set of patients undergoing first-time ablation for AF (N = 233) compared with the conventional strategy in earlier consecutive set of patients (N = 223). The current strategy included the technique of ICE to reduce radiation exposure, Ablation Index®-guided pulmonary veins isolation, and minimum substrate ablation targeting only for induced AF. Outcome measures were radiation exposure, procedure time, in-hospital adverse outcomes, and event-free survival from tachyarrhythmias. RESULTS Puncture-to-ablation time was slightly, but significantly increased in the current strategy than in the conventional strategy (48.0 minutes vs 44.7 minutes, P = .002), although total procedure time was significantly decreased in the current strategy (143.9 minutes vs 156.9 minutes, P < .001). Likewise, radiation time and absorbed dose were significantly decreased in the current strategy (9.8 minutes vs 38.8 minutes, P < .001; 102.3 mGy vs 490.5 mGy, P < .001). The incidence of overall in-hospital adverse outcomes was 3.9% in the current strategy and each complication rate was comparable with the conventional protocol. The event-free survival from recurrent atrial tachyarrhythmias was not significantly different between two groups (72.3% vs 77.1% at 2-year, P = .32). CONCLUSION The current strategy using the recent technology with ICE, lesion index, and minimum substrate ablation was feasible and reduced total procedure time and radiation exposure. However, the arrhythmia-free survival could not be improved.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
- Department of Cardiovascular Medicine Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shun Hojo
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | | | - Hidenori Yaku
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Kenji Nakatsuma
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Kazuhisa Kaneda
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Masashi Kato
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | | | - Shinji Miki
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
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Yazaki K, Ejima K, Kataoka S, Kanai M, Higuchi S, Yagishita D, Shoda M, Hagiwara N. Regional differences in the predictors of acute electrical reconnection following high-power pulmonary vein isolation for paroxysmal atrial fibrillation. J Arrhythm 2021; 37:1260-1269. [PMID: 34621424 PMCID: PMC8485794 DOI: 10.1002/joa3.12597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Acute pulmonary vein reconnection (PVR) is associated with long procedure times and large radiofrequency (RF) energy delivery during pulmonary vein isolation (PVI). Although the efficacy of high-power PVI (HP-PVI) has been recently established, the determinants of acute PVR following HP-PVI remain unclear. METHODS We evaluated data on 62 patients with paroxysmal atrial fibrillation undergoing unipolar signal modification (USM)-guided HP-PVI. A 50-W RF wave was applied for 3-5 seconds after USM. In the segments adjacent to the esophagus (SAEs), the RF time was limited to 5 seconds. Each circle was subdivided into six regions (segments), and the possible predictors of acute PVR, including minimum contact force (CFmin), minimum force-time integral (FTImin), minimum ablation index (AImin), minimum impedance drop (Imp-min), and maximum inter-lesion distance (ILDmax), were assessed in each segment. RESULTS We investigated 1162 ablations in 744 segments (including 124 SAEs). Acute PVR was observed in 21 (17%) SAEs and 43 (7%) other segments (P = .001). The acute PVR segments were characterized by significantly lower CFmin, FTImin, AImin, and Imp-min values in the segments other than the SAEs and larger ILDmax values in the SAEs. Furthermore, lower Imp-min and larger ILDmax values independently predicted acute PVR in the segments other than the SAEs and SAEs (odds ratios 0.90 and 1.39 respectively). Acute PVR was not significantly associated with late atrial fibrillation recurrence. CONCLUSIONS Avoiding PVR remains a challenge in HP-PVI cases, but it might be resolved by setting the optimal target impedance drop and lesion distance values.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Miwa Kanai
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Satoshi Higuchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
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32
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Lee SR, Park HS, Choi EK, Lee E, Oh S. Acute and long-term efficacy of ablation index-guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry. J Arrhythm 2021; 37:1250-1259. [PMID: 34621423 PMCID: PMC8485805 DOI: 10.1002/joa3.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 07/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Theoretically, targeting the same ablation index (AI) using higher power may achieve the same lesion size with a shorter ablation time. We evaluated the acute and long-term efficacy of higher-powered ablation guided by ablation index (HPAI) compared with conventional-powered ablation guided by AI (CPAI) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). METHODS Drug refractory symptomatic AF patients who had been ablated with 40 W on the anterior/roof segments and 30 W on the posterior/inferior/carina segments were enrolled (HPAI group). We compared the HPAI group with the CPAI group who were ablated with 30 W on the anterior/roof segments and 25 W on the posterior/inferior/carina segments. The same AI was targeted (≥450 on the anterior/roof segments and ≥350 on the posterior/inferior/carina segments). We compared ablation time, acute pulmonary vein reconnection (PVR) and 1-year AF recurrence between the two groups. RESULTS A total of 118 patients were included (86 in the HPAI group and 32 in the CPAI group, paroxysmal AF, 73%). There was no significant difference in the acute PVR rate between the HPAI and the CPAI groups (3.7% vs. 4.2%, P = .580) with a 41% reduction in ablation time for PVI (38.7 ± 8.3 vs. 65.8 ± 13.7 minutes, P < .001). The 1-year AF recurrence rate was not significantly different between HPAI and CPAI groups (12.8% vs. 21.9%, Log-rank P = .242). There were no major complications in either group. CONCLUSIONS Increased power during AF ablation, using the same AI targets, reduced the procedure and ablation times, and showed a comparable acute and long-term outcome without compromising safety. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique identifier: NCT04379557.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Hyoung-Seob Park
- Division of Cardiology Department of Internal Medicine Dongsan Medical Center Keimyung University Daegu Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Seil Oh
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
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Abstract
This article reviews and compares the rationale and evidence supporting high-power, short-duration radiofrequency (RF) ablation with those of conventional-power, conventional-duration RF ablation for atrial fibrillation (AF). The pros and cons of each approach, biophysics of ablation, pre-clinical studies informing clinical utilization, and the accumulated clinical evidence are presented. Both conventional-power, conventional-duration RF ablation and high-power, short-duration ablation are similarly safe, and effective approaches for AF ablation. Theoretical advantages of high-power, short-duration ablation, including greater procedure efficiency and limited conductive heating of collateral structures, must be weighed against the narrower safety margin related to rapid energy delivery during high power ablation.
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34
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Ravi V, Poudyal A, Abid QUA, Larsen T, Krishnan K, Sharma PS, Trohman RG, Huang HD. High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2021; 23:710-721. [PMID: 33523184 DOI: 10.1093/europace/euaa327] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). METHODS AND RESULTS MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10-1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) -37.35 min, P < 0.001], fluoroscopy duration (MD -5.23 min, P = 0.001), and RF ablation time (MD -16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29-2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08-2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21-2.25; P = 0.002). CONCLUSION High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.
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Affiliation(s)
- Venkatesh Ravi
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Abhushan Poudyal
- Division of Cardiology, Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | - Qurrat-Ul-Ain Abid
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Timothy Larsen
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Kousik Krishnan
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Parikshit S Sharma
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
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Comparison of lesion characteristics between conventional and high-power short-duration ablation using contact force-sensing catheter in patients with paroxysmal atrial fibrillation. BMC Cardiovasc Disord 2021; 21:387. [PMID: 34372779 PMCID: PMC8353766 DOI: 10.1186/s12872-021-02196-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/28/2021] [Indexed: 01/05/2023] Open
Abstract
Background Transmural lesion creation is essential for effective atrial fibrillation (AF) ablation. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear.
Methods Eighty consecutive AF patients who received CF with conventional energy setting (power control: 25–30 W, force–time integral = 400 g s, n = 40) or with HPSD (power control: 40–50 W, 10 s, n = 40) ablation were analyzed. Of them, 15 patients in each conventional and HPSD group were matched by age and gender respectively for ablation lesions analysis. Type A and B lesions were defined as a lesion with and without significant voltage reduction after ablation, respectively. The anatomical distribution of these lesions and ablation outcomes among the 2 groups were analyzed.
Results 1615 and 1724 ablation lesions were analyzed in the conventional and HPSD groups, respectively. HPSD group had a higher proportion of type A lesion compared to conventional group (P < 0.01). In the conventional group, most type A lesions were at the right pulmonary vein (RPV) posterior wall (50.2%) whereas in the HPSD group, most type A lesions were at the RPV anterior wall (44.0%) (P = 0.04). The procedure time and ablation time were significantly shorter in the HPSD group than that in the conventional group (91.0 ± 12.1 vs. 124 ± 14.2 min, P = 0.03; 30.7 ± 19.2 vs. 57.8 ± 21 min, P = 0.02, respectively). At a mean follow-up period of 11 ± 1.4 months, there were 13 and 7 patients with recurrence in conventional and HPSD group respectively (P = 0.03). Conclusion Optimal ablation lesion characteristics and distribution after conventional and HPSD ablation differed significantly. HPSD ablation had shorter ablation time and lower recurrence rate than did conventional ablation.
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Nakamura K, Sasaki T, Minami K, Take Y, Inoue M, Sasaki W, Kishi S, Yoshimura S, Okazaki Y, Motoda H, Niijima K, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Funabashi N, Naito S. Prevalence, characteristics, and predictors of endocardial and nonendocardial conduction gaps during local impedance-guided extensive pulmonary vein isolation of atrial fibrillation with high-resolution mapping. J Cardiovasc Electrophysiol 2021; 32:2045-2059. [PMID: 34254714 DOI: 10.1111/jce.15152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Local impedance (LI) drops during radiofrequency ablation can predict lesion formation. Some conduction gaps during pulmonary vein isolation (PVI) can be associated with nonendocardial connections. This study aimed to investigate the incidence, characteristics, and predictors of endocardial and nonendocardial conduction gaps during an LI-guided PVI. METHODS AND RESULTS We prospectively enrolled 157 consecutive patients undergoing an initial LI-guided extensive PVI of atrial fibrillation (AF). After the first-pass encirclement, the residual conduction gaps and reconnected gaps were mapped using Rhythmia (Boston Scientific) and a mini-basket catheter. Right and left PV (RPV/LPV) gaps were observed in 22.3% and 18.5% of the patients, respectively: 27 endocardial and 49 nonendocardial gaps. The carina regions were common sites for the gaps (51 carina-related vs. 25 noncarina-related). The carina-related gaps consisted of more nonendocardial gaps than endocardial gaps (RPVs: 90.0% vs. 10.0%, p = .001; LPVs: 76.2% vs. 23.8%, p < .001). A univariate analysis revealed that paroxysmal AF and the left atrial (LA) volume index for RPV endocardial gaps (odds ratio [OR]: 8.640 and 0.946; p = .043 and 0.009), minor right inferior PV diameter for RPV nonendocardial gaps (OR: 1.165; p = .028), and major left inferior PV diameter for LPV endocardial gaps (OR: 1.233; p = .028) were significant predictors. CONCLUSIONS During the LI-guided PVI, approximately two-thirds of the conduction gaps were nonendocardial. The carina regions had more conduction gaps than noncarina regions, which was due to the presence of nonendocardial connections. Paroxysmal AF, a lower LA volume index, and larger inferior PV diameters may increase the risk of conduction gaps.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kentaro Minami
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Mitsuho Inoue
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Yoshinori Okazaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Hiroyuki Motoda
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Katsura Niijima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Keiko Koyama
- Division of Radiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Nobusada Funabashi
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
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Ioannou A, Papageorgiou N, Lim WY, Wongwarawipat T, Hunter RJ, Dhillon G, Schilling RJ, Creta A, El Haddad M, Duytschaever M, Hussein A, Dhiraj G, Ahsan S, Providencia R. Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis. Europace 2021; 22:1659-1671. [PMID: 32862230 DOI: 10.1093/europace/euaa224] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Despite recent advances in catheter ablation for atrial fibrillation (AF), pulmonary vein reconnection (PVR), and AF recurrence remain significantly high. Ablation index (AI) is a new method incorporating contact force, time, and power that should optimize procedural outcomes. We aimed to evaluate the efficacy and safety of AI-guided catheter ablation compared to a non-AI-guided approach. METHODS AND RESULTS A systematic search was performed on MEDLINE (via PubMED), EMBASE, COCHRANE, and European Society of Cardiology (ESC) databases (from inception to 1 July 2019). We included only studies that compared AI-guided with non-AI-guided catheter ablation of AF. Eleven studies reporting on 2306 patients were identified. Median follow-up period was 12 months. Ablation index-guided ablation had a significant shorter procedural time (141.0 vs. 152.8 min, P = 0.01; I2 = 90%), ablation time (21.8 vs. 32.0 min, P < 0.00001; I2 = 0%), achieved first-pass isolation more frequently [odds ratio (OR) = 0.09, 95%CI 0.04-0.21; 93.4% vs. 62.9%, P < 0.001; I2 = 58%] and was less frequently associated with acute PVR (OR = 0.37, 95%CI 0.18-0.75; 18.0% vs 35.0%; P = 0.006; I2 = 0%). Importantly, atrial arrhythmia relapse post-blanking was significantly lower in AI compared to non-AI catheter ablation (OR = 0.41, 95%CI 0.25-0.66; 11.8% vs. 24.9%, P = 0.0003; I2 = 35%). Finally, there was no difference in complication rate between AI and non-AI ablation, with the number of cardiac tamponade events in the AI group less being numerically lower (OR = 0.69, 95%CI 0.30-1.60, 1.6% vs. 2.5%, P = 0.39; I2 = 0%). CONCLUSIONS These data suggest that AI-guided catheter ablation is associated with increased efficacy of AF ablation, while preserving a comparable safety profile to non-AI catheter ablation.
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Affiliation(s)
- Adam Ioannou
- Department of Cardiology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1 E6DD, UK
| | - Wei Yao Lim
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Tanakal Wongwarawipat
- Department of General Medicine, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Ross J Hunter
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Gurpreet Dhillon
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Richard J Schilling
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Antonio Creta
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Milad El Haddad
- Department of Electrophysiology, Sint-Jan Hospital Bruges, Ruddershove, 8000 Brugge, Belgium
| | - Matthias Duytschaever
- Department of Electrophysiology, Sint-Jan Hospital Bruges, Ruddershove, 8000 Brugge, Belgium
| | - Ahmed Hussein
- Division of Cardiology, St. Louis University, N Grand Blvd, St. Louis, MO 63103, USA
| | - Gupta Dhiraj
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool, L14 3PE, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
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Shin DG, Ahn J, Han SJ, Lim HE. Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial. Europace 2021; 22:1495-1501. [PMID: 32810203 DOI: 10.1093/europace/euaa144] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/11/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The formation of radiofrequency lesions depends on the power and duration of ablation, and the contact force (CF). Although high power (HP) creates continuous and transmural lesions, most centres still use 25-30 W for 30-40 s for safety reasons. We evaluated the clinical efficacy and safety of a HP and short-duration (HPSD) strategy for atrial fibrillation (AF) ablation. METHODS AND RESULTS One hundred and fifty patients [58.2 ± 10.0 years, 48% with paroxysmal AF (PAF)] scheduled for index AF ablation using a CF-sensing catheter were randomly assigned to three groups [30 W, 40 W, and 50 W at ablation sites of anterior, roof, and inferior segments of pulmonary vein (PV) antra and roof line between each upper PV]. In 25-30 W for ≤20 s was applied at posterior wall ablation site in all subjects. Compared with the 30 W and 40 W groups, procedure (P < 0.001) and ablation times (P < 0.001) were shorter and ablation number for PV isolation (P < 0.001) was smaller in the 50 W group. There were no significant differences in the CF and ablation index (AI) among the three groups. There were no significant differences in the procedure-related complication rates. During the 12-month follow-up, AF recurred in 24 (16%) patients with no significant difference among the groups (P = 0.769). In the multivariate analysis, non-PAF [hazard ratio (HR) 2.836, P = 0.045] and AI (HR 0.983, P = 0.001) were independent risk factors for AF recurrence. CONCLUSION Radiofrequency ablation with HPSD is a safe and effective strategy with reduced ablation number and shortened procedure time compared to conventional ablation.
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Affiliation(s)
- Dong Geum Shin
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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Safety and Efficacy of High Power Shorter Duration Ablation Guided by Ablation Index or Lesion Size Index in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis. J Interv Cardiol 2021; 2021:5591590. [PMID: 34149322 PMCID: PMC8192211 DOI: 10.1155/2021/5591590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 01/11/2023] Open
Abstract
Background High power shorter duration (HPSD) ablation may lead to safe and rapid lesion formation. However, the optimal radio frequency power to achieve the desired ablation index (AI) or lesion size index (LSI) is insubstantial. This analysis aimed to appraise the clinical safety and efficacy of HPSD guided by AI or LSI (HPSD-AI or LSI) in patients with atrial fibrillation (AF). Methods The Medline, PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing HPSD-AI or LSI and low power longer duration (LPLD) ablation. Results Seven trials with 1013 patients were included in the analysis. The analyses verified that HPSD-AI or LSI revealed benefits of first-pass pulmonary vein isolation (PVI) (RR: 1.28; 95% CI: 1.05–1.56, P = 0.01) and acute pulmonary vein reconnection (PVR) (RR: 0.65; 95% CI: 0.48–0.88, P = 0.005) compared with LPLD. HPSD-AI or LSI showed higher freedom from atrial tachyarrhythmia (AT) (RR = 1.32, 95% CI: 1.14–1.53, P = 0.0002) in the subgroup analysis of studies with PVI ± (with or without additional ablation beyond PVI). HPSD-AI or LSI could short procedural time (WMD: −22.81; 95% CI, −35.03 to −10.60, P = 0.0003), ablation time (WMD: −10.80; 95% CI: −13.14 to −8.46, P < .00001), and fluoroscopy time (WMD: −7.71; 95% CI: −13.71 to −1.71, P = 0.01). Major complications and esophageal lesion in HPSD-AI or LSI group were no more than LDLP group (RR: 0.58; 95% CI: 0.20–1.69, P = 0.32) and (RR: 0.84; 95% CI: 0.43–1.61, P = 0.59). Conclusions HPSD-AI or LSI was efficient for treating AF with shorting procedural, ablation, and fluoroscopy time, higher first-pass PVI, and reducing acute PVR and may increase freedom from AT for patients with additional ablation beyond PVI compared with LPLD. Moreover, complications and esophageal lesion were low and no different between two groups.
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Inoue K, Tanaka N, Ikada Y, Mizutani A, Yamamoto K, Matsuhira H, Harada S, Okada M, Iwakura K, Fujii K. Characterizing clinical outcomes and factors associated with conduction gaps in VISITAG SURPOINT-guided catheter ablation for atrial fibrillation. J Arrhythm 2021; 37:574-583. [PMID: 34141010 PMCID: PMC8207404 DOI: 10.1002/joa3.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Although usefulness of VISITAG SURPOINT (VS) on pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation has been reported, optimal VS thresholds can depend on the inter-tag distance (ITD) and vice versa. We validated the efficacy of PVI with lower target ITDs and VS values than in previous studies. METHODS Retrospective review of consecutive patients (N = 100) with paroxysmal (n = 32) or persistent AF (n = 68) undergoing VS-guided ablation between 09/2018 and 08/2019 was conducted. All procedures were performed by two operators. Target VS values were 425 (anterior), 375 (posterior), and 325 (near the esophagus). Target ITD was 4 mm. RESULTS Acute PVI was achieved in all cases, however, 13 residual gaps in 12 patients were observed after initial encirclement (first pass isolation: 88%). Ten gaps due to spontaneous PV reconnections (PVR) were found in nine patients (9%). These 23 gaps had similar median VS (gap-related vs non-gap: 429 vs 410, P = .4545) and power (36 vs 36W, P = .4843), higher contact force (13.8 vs 11.0g, P = .0061), and larger ITD (5.3 vs 3.7mm, P < .001) when compared to the remaining tags. Only ITDs were independently associated with gap formation in multivariate analysis. One-year Kaplan-Meier freedom from any atrial arrhythmia was 87.2%. Eight patients received repeat ablation (8.1%) and of these, 6 (75%) were free from PVR. CONCLUSION Favorable rates of first pass isolation, acute PVR, and long-term procedure success were achieved using lower VS values than in previous reports. With a target VS value of 375-425, ITDs of 4 mm was sufficient for durable PVI.
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Affiliation(s)
- Koichi Inoue
- Sakurabashi Watanabe HospitalOsakaJapan
- Cardiovascular DivisionNational Hospital Organization Osaka National HospitalOsakaJapan
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Wang YJ, Tian Y, Shi L, Zeng LJ, Xie BQ, Li XX, Yang XC, Liu XP. Pulmonary vein isolation guided by moderate ablation index targets combined with strict procedural endpoints for patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1842-1848. [PMID: 34028119 DOI: 10.1111/jce.15106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ablation index (AI)-guided radiofrequency ablation has been increasingly used for the treatment of drug-resistant paroxysmal atrial fibrillation (AF),but the optimal AI targets remain to be determined. We aimed to examine the efficacy and safety of catheter ablation guided by moderate AI values but more strict procedural endpoints in patients with paroxysmal AF. METHODS We conducted a retrospective review of a consecutive series of patients who received their first AI-guided ablation for paroxysmal AF from 2017 to 2018. The standard procedural protocol recommends AI targets as follows: anterior: 400-450; posterior: 280-330; and roof/inferior wall: 380-430. After circumferential pulmonary vein isolation (PVI), we performed bipolar pacing along the ablation line, adenosine triphosphate (ATP)-provocation, and waited for 30 min to verify PVI. The primary clinical outcome was the rate of freedom from AF recurrence at 12 months. RESULTS A total of 140 consecutive patients were included. The mean procedure and ablation times were 132.2 ± 30.2 min and 24.2 ± 7.9 min, respectively. The first-pass isolation and final isolation rates were documented in 49.3% and in 100% of the patients, respectively. At 12 months, single-procedure freedom from atrial tachyarrhythmias was observed in 92.1% of patients. No major procedure-related complications were encountered. CONCLUSIONS Moderate AI-guided catheter ablation is highly effective for the treatment of drug-refractory paroxysmal AF in real-world settings. Over 90% of patients achieved single-procedure arrhythmia-free survival at 1 year. The outcome was obtained without major complications and the procedure involved relatively short procedure and ablation times.
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Affiliation(s)
- Yan-Jiang Wang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Liang Shi
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bo-Qia Xie
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xue-Xun Li
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Hu X, Wu S, Qin M, Jiang W, Liu X. Radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia and interruption of the inferior vena cava: a case report. Eur Heart J Case Rep 2021; 5:ytab191. [PMID: 34268479 PMCID: PMC8276615 DOI: 10.1093/ehjcr/ytab191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
Background Dextrocardia with interruption of the inferior vena cava (I-IVC) is a very rare
anatomical variant. Catheter ablation of atrial fibrillation (AF) in patients with this
anatomical variant is challenging for electrophysiologists. This case report presents a
safe, effective, and radiation-free approach for high-power ablation of AF via a
superior transseptal approach in patients with dextrocardia and I-IVC. Case summary A 57-year-old man with paroxysmal AF with dextrocardia and I-IVC with azygos
continuation was referred to our hospital for radiofrequency (RF) ablation. It was
evident that transseptal puncture and pulmonary vein isolation (PVI) would be impossible
using an IVC approach via the femoral vein. Therefore, we decided to perform left atrium
(LA) ablation via the superior vena cava approach. A phased array intracardiac
echocardiography (ICE) catheter was inserted in the right femoral vein.
Three-dimensional (3D) anatomical reconstruction of LA, right atrium (RA), and coronary
sinus (CS) ostium were performed using ICE with azygos vein and RA imaging.
Navigation-enabled electrodes were inserted into annotated CS on cardiac 3D ICE image.
The left internal jugular vein was accessed using an SL1 transseptal sheath and
Brockenbrough needle. Transseptal puncture was performed under ICE with an RF-assisted
approach. We accomplished ablation index guided high-power pulmonary vein isolation
using a bi-directional guiding sheath with visualization capabilities and a surround
flow contact force-sensing catheter. No complications occurred during or after the
procedure. Discussion With the application of multitude of newer technologies, we can accomplish safe,
effective, and fluoroscopy-free RF ablation of AF using the superior approach in
patients with complex anomaly.
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Affiliation(s)
- Xiaofeng Hu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Weifeng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China
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Rosso R, Chorin E, Schwartz AL, Levi Y, Hochstadt A, Viskin S. Pulmonary Vein Isolation With Ablation Index via Single Transseptal Crossing: Critical Role of Carina Isolation. Heart Lung Circ 2021; 30:1373-1378. [PMID: 33863667 DOI: 10.1016/j.hlc.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/27/2021] [Indexed: 01/01/2023]
Abstract
AIM Reconnection of the pulmonary veins (PVs) is the most common reason for the recurrence of atrial fibrillation (AF). The ablation index is a marker of ablation lesion quality that achieves high percentages of first-pass isolation and improved AF ablation results. Most operators use a double transseptal approach with confirmation of PV isolation with a circular mapping catheter. In the present study we aimed to show that an ablation index-guided procedure using a single transseptal approach and ablation catheter only would achieve adequate PV isolation while demonstrating the critical role of the carina in PV isolation. METHOD Sixty-six (66) consecutive patients with paroxysmal AF were included. Thirty-four (34) patients underwent wide antral circumferential ablation (WACA-only) and 32 underwent WACA+ (WACA + empiric carina isolation). All procedures were performed via single transseptal approach. Pulmonary vein isolation was confirmed with the use of a circular mapping catheter in both groups. RESULTS Compared to WACA-only, WACA+ increased the odds of PV isolation from 65% to 94% (p=0.011). In the WACA-only procedure, ablation of the carina was needed to achieve PV isolation. At the 18-month follow-up (interquartile range 15.2-20.8 months), freedom from AF was 84% for the entire cohort. CONCLUSIONS Our study confirmed the high success rate of PV isolation using the ablation index and showed that this can be achieved via a single transseptal crossing. Our study confirmed the role of the carina in PV isolation.
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Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Levi
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li MF, Wu J, Jin CL, Chen CF, Xu YZ. Safety and efficacy of high power shorter duration ablation for atrial fibrillation: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e13732. [PMID: 32975347 DOI: 10.1111/ijcp.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection because of insufficient lesions. High power shorter duration ablation (HPSD) was seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF. METHODS The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation. RESULTS A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18-1.37, P < .001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50-0.98, P = .04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): -44.62; 95% CI, -63.00 to -26.23, P < .001], ablation time (WMD: -21.25; 95% CI: -25.36 to -17.13, P < .001), and fluoroscopy time (WMD: -4.13; 95% CI: -7.52 to -0.74, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.64; 95% CI: 0.17-2.39, P = .51). CONCLUSION HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLD. Moreover, major complications and ETI were similar between two groups.
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Affiliation(s)
- Miao-Fu Li
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
| | - Jing Wu
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| | - Chao-Lun Jin
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
| | - Chao-Feng Chen
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yi-Zhou Xu
- Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China
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Guandalini GS, Marchlinski FE. High power, short duration ablation: At least for the right pulmonary vein carina, maybe not so fast. J Cardiovasc Electrophysiol 2021; 32:1229-1231. [PMID: 33724624 DOI: 10.1111/jce.15007] [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] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cui L, Chu Y, Han Y, Dong S. Comparison of higher-power and conventional power ablation of atrial fibrillation using contact force-sensing catheters: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 62:1-7. [PMID: 33730302 DOI: 10.1007/s10840-021-00975-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/07/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contact force-sensing catheters have been widely used in catheter ablation. During the past few decades, more attention has been paid on the technique of high-power ablation. The purpose of this meta-analysis is to compare the efficacy and safety of conventional power and high power on atrial fibrillation radiofrequency ablation by contact force-sensing catheters. METHODS We identified studies through searching MEDLINE, Embase, the Web of Science, Scopus, and the Cochrane Library from inception up until July 2020. The primary outcomes were defined as recurrence of atrial tachyarrhythmia and complications. The secondary outcomes were acute reconnections of pulmonary veins (PVs), ablation time, and the total procedural time. RESULTS Four nonrandomized, observational studies (nROS) were selected involving 231 patients with high-power ablation and 239 patients with conventional power ablation. There were insignificant differences in the recurrence rate of atrial tachyarrhythmia (14.2% versus 20.5%, OR: 0.64, 95%CI: 0.39 to 1.04, Z = 1.82, P = 0.07) and clinical complications (1.7% versus 2.5%, OR: 0.72, 95%CI: 0.21 to 2.47, Z = 0.51, P = 0.61) between high-power and conventional power ablation. However, compared with conventional power group, the high-power group had fewer acute PVs reconnections (P = 0.0001), shorter in ablation time (P < 0.0001), and the total procedural time (P < 0.0001). CONCLUSIONS High-power ablation could not only ablate safely and efficiently but also reduce focal ablation time and total procedural time significantly.
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Affiliation(s)
- Luqian Cui
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yingjie Chu
- Department of Cardiology, Henan Province People's Hospital, Zhengzhou, China.
| | - Yongmei Han
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Shujuan Dong
- Department of Cardiology, Henan Province People's Hospital, Zhengzhou, China
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Motoike Y, Harada M, Ito T, Nomura Y, Nishimura A, Koshikawa M, Watanabe E, Ozaki Y, Izawa H. Wall thickness-based adjustment of ablation index improves efficacy of pulmonary vein isolation in atrial fibrillation: Real-time assessment by intracardiac echocardiography. J Cardiovasc Electrophysiol 2021; 32:1620-1630. [PMID: 33694206 DOI: 10.1111/jce.15000] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ablation index (AI) linearly correlates with lesion depth and may yield better therapeutic performance in pulmonary vein isolation (PVI) when tailored to a patient's wall thickness (WT) in the left atrium (LA). METHODS AND RESULTS First study: In paroxysmal atrial fibrillation patients (PAF; n = 20), the average LA WT (mm) in each anatomical segment for PVI was measured by intracardiac echocardiography (ICE) placed in the LA; the optimal AI for creating 1-mm transmural lesion (AI/mm) was calculated. Second study: PAF (n = 80) patients were randomly assigned either to a force-time integral protocol (FTI; 400 g·s, n = 40) or a tailored-AI protocol (TAI; n = 40). In TAI, the LA WT in each segment was individually measured by ICE before starting ablation; a target AI was adjusted according to the individual WT in each segment (AI/mm × WT). The acute procedure outcomes and the 1-year AF-recurrence rate were compared between FTI and TAI. TAI had higher success rate of first-pass isolation (88% vs. 65%) and had lower incidence of residual PV-potentials/conduction-gaps after a circular ablation than FTI (15% vs. 45%). The procedure time to complete PVI decreased in TAI compared to FTI (52 vs. 83 min), being attributed to the increased radiofrequency power and the decreased radiofrequency application time in each point in TAI. TAI had a lower 1-year AF-recurrence rate than FTI. CONCLUSION TAI increased acute procedure success, decreased time for PVI, and reduced the 1-year AF-recurrence rate, compared to FTI. Understanding the precise ablation target and tailoring AI would improve the efficacy of PVI.
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Affiliation(s)
- Yuji Motoike
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Takehiro Ito
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshihiro Nomura
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Asuka Nishimura
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Koshikawa
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
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Yoshimura S, Kaseno K, Kimura K, Sasaki W, Okazaki Y, Haraguchi Y, Kishi S, Sasaki T, Goto K, Miki Y, Take Y, Nakamura K, Naito S. Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation. Heart Vessels 2021; 36:1421-1429. [PMID: 33687545 DOI: 10.1007/s00380-021-01820-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the impact of the size of the isolated surface area and non-ablated left atrial posterior area after extensive encircling pulmonary vein isolation (EEPVI) for non-paroxysmal atrial fibrillation (AF) on arrhythmia recurrence. This study included 132 consecutive persistent AF patients who underwent EEPVI guided by Ablation Index (AI). The isolated antral surface area (IASA) excluding the pulmonary veins, the non-ablated left atrial (LA) posterior wall surface area (PWSA), the ratio of IASA to LA surface area (IASA/LA ratio), and the ratio of PWSA to LA surface area (PWSA/LA ratio) were assessed using CARTO3 and the association with AF and atrial tachycardia (AT) recurrence was examined. At a mean follow-up of 13.2 ± 7.3 months, sinus rhythm was maintained in 115 (87%) patients. In the univariate Cox regression analysis, the factors that significantly predicted AT/AF recurrence were a history of heart failure, a higher CHA2DS2-VASc score, a larger LA diameter, and a larger PWSA/LA ratio. Multivariate Cox regression analysis revealed that the independent predictors of AT/AF recurrence were LA diameter [hazard ratio (HR) 1.120 per 1 mm increase; 95% confidence interval (CI) 1.006-1.247; P = 0.039] and PWSA/LA ratio (HR 1.218 per 1% increase; 95% CI 1.041-1.425; P = 0.014). Receiver operating characteristics curve analysis yielded an optimal cut-off value of 8% for the PWSA/LA ratio. The Kaplan-Meier survival curve showed that patients with a larger PWSA/LA ratio had poorer clinical outcomes (Log-rank P = 0.001). A larger PWSA/LA ratio was associated with a high AT/AF recurrence rate in patients with non-paroxysmal atrial fibrillation.
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Affiliation(s)
- Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan.
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Yoshinori Okazaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi, Gunma, 371-0004, Japan
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Sun X, Qi P, Yang B, Li Z, Bie Z, Li X. The procedural efficiency, efficacy and safety of high power and short duration ablation in patients with atrial fibrillation: A systemic review and meta-analysis. Int J Cardiol 2021; 325:76-81. [PMID: 33080286 DOI: 10.1016/j.ijcard.2020.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Xuerong 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
| | - Peng Qi
- Department of Cardiology, Hebei General Hospital, Hebei, China
| | - Bin Yang
- Department of Cardiology, People's Hospital of Lingcheng District, Dezhou, China
| | - Zhonghe Li
- Department of Cardiology, People's Hospital of Lingcheng District, Dezhou, China
| | - Zidong Bie
- Department of Cardiology, Feixian people's Hospital, Linyi, China
| | - Xuexun Li
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China; Capital Medical University, Beijing, China.
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Lepillier A, Strisciuglio T, De Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, De Simone A, Bertaglia E, Solimene F, Stabile G. Impact of ablation index settings on pulmonary vein reconnection. J Interv Card Electrophysiol 2021; 63:133-142. [PMID: 33570717 DOI: 10.1007/s10840-021-00944-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
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Affiliation(s)
- A Lepillier
- Centre Cardiologique du Nord, St Denis, Paris, France
| | - T Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,University of Naples Federico II, Naples, Italy
| | | | | | - M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F A Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - D Pecora
- Fondazione Poliambulanza, Brescia, Italy
| | | | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - G Viola
- Ospedale San Francesco, Nuoro, Italy
| | - E Pisanò
- Ospedale Vito Fazzi, Lecce, Italy
| | - S Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | - A Pani
- Ospedale di Lecco, Lecco, Italy
| | | | - G Sgarito
- A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy
| | - A De Simone
- Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy
| | - E Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - F Solimene
- Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy. .,Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. .,Anthea Hospital, Bari, Italy.
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