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Wu C, Hu L, Kong Y, Zhao B, Mao W, Zhou X. Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation. Front Cardiovasc Med 2023; 10:1184467. [PMID: 37560114 PMCID: PMC10407100 DOI: 10.3389/fcvm.2023.1184467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Balloon-based catheter ablation (CA) technologies, including hot balloon ablation (HBA), laser balloon ablation (LBA) and cryoballoon ablation (CBA) have been introduced in recent years as alternatives to conventional radiofrequency ablation therapy for atrial fibrillation (AF). However, the results remain controversial concerning the optimal approach. Thus, we conducted a network meta-analysis (NMA) to comprehensively evaluate the efficacy and safety of HBA, LBA and CBA. METHODS Clinical trials comparing the efficacy and safety of HBA, LBA and CBA were identified through a systematic search up to October 2022. The primary outcomes of interest were the recurrence of AF and procedure-related complications. RESULTS Twenty clinical trials with a total of 1,995 patients were included in the meta-analysis. The NMA results demonstrated that HBA, LBA and CBA had comparable AF recurrence rates (HBA vs. CBA: odds ratio OR = 0.88, 95% credible interval CrI: 0.56-1.4; LBA vs. CBA: OR = 1.1, 95% CrI: 0.75-1.5; LBA vs. HBA: OR = 1.2, 95% CrI: 0.70-2.0) and procedure-related complications (HBA vs. CBA: OR = 0.93, 95% CrI: 0.46-2.3; LBA vs. CBA: OR = 1.1, 95% CrI: 0.63-2.1; LBA vs. HBA: OR = 1.2, 95% CrI: 0.44-2.8). The surface under the cumulative ranking curve (SUCRA) suggested that HBA may be the optimal approach concerning the primary outcomes (SUCRA = 74.4%; 61.1%, respectively). However, HBA (40.1%) had a significantly higher incidence of touch-up ablation (TUA) than LBA (8.5%, OR = 2.8, 95% CrI: 1.1-7.1) and CBA (11.9%, OR = 3.7, 95% CrI: 1.9-7.5). LBA required more procedure time than CBA [mean difference (MD = 32.0 min, 95% CrI: 19.0-45.0 min)] and HBA (MD = 26.0 min, 95% CrI: 5.6-45.0 min), but less fluoroscopy time than HBA (MD = -9.4 min, 95% CrI: -17.0--2.4 min). CONCLUSIONS HBA, LBA and CBA had comparable efficacy and safety as initial treatments for AF. HBA ranked highest in the primary outcomes, but at the cost of a higher incidence of TUA and longer fluoroscopy time. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022381954, identifier: CRD42022381954.
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Affiliation(s)
- Chenxia Wu
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Luoxia Hu
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Youjin Kong
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Bowen Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Wei Mao
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
- Key Laboratory of Integrative Chinese and Western Medicine for the Diagnosis and Treatment of Circulatory Diseases of Zhejiang Province, Hangzhou, China
| | - Xinbin Zhou
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
- Key Laboratory of Integrative Chinese and Western Medicine for the Diagnosis and Treatment of Circulatory Diseases of Zhejiang Province, Hangzhou, China
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Sawada M, Kurokawa S, Okumura Y. Trends over the recent 6 years in ablation modalities and strategies, post-ablation medication, and clinical outcomes of atrial fibrillation ablation. J Arrhythm 2023; 39:366-375. [PMID: 37324765 PMCID: PMC10264728 DOI: 10.1002/joa3.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post-ablation medication and clinical outcomes remains to be fully investigated. Methods We divided 682 patients who had undergone AF ablation in 2014-2019 (420 paroxysmal AFs [PAF], 262 persistent AFs [PerAF]) into three groups according to the period, that is, the 2014-2015 (n = 139), 2016-2017 (n = 244), and 2018-2019 groups (n = 299), respectively. Results Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra-pulmonary vein (PV)-LA ablation was more frequently performed in the 2014-2015 group than in the 2016-2017 and 2018-2019 groups (41.1% vs. 9.1% and 8.1%; p < .001). The 2-year freedom rate from AF/atrial tachycardias for PAF was similar among the three groups (84.0% vs. 83.1% vs. 86.7%; p = .98) but lowest in the 2014-2015 group for PerAF (63.9% vs. 82.7% and 86.3%; p = .025) despite the highest post-ablation antiarrhythmic drug use. Cardiac tamponade was significantly decreased in the 2018-2019 group (3.6% vs. 2.0% vs. 0.33%; p = 0.021). There was no difference in the 2-year clinically relevant events among the three groups. Conclusion Although ablation was performed in a more diseased LA and extra-PV-LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased. Clinically relevant events remained unchanged over the recent 6 years, suggesting that the impact of the recent ablation modalities and strategies on remote clinically relevant events may be small during this study period.
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Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Satoshi Hayashida
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Masanaru Sawada
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience. J Interv Card Electrophysiol 2022; 65:739-750. [PMID: 35945311 DOI: 10.1007/s10840-022-01321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common. METHOD We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI. RESULTS A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, a mean number of 1.50 ± 0.8 PVs/patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs/patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI (70.8% vs 10%, p < 0.001). At a 2-year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF-free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085-4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279-4.618, p = 0.007) were independent predictors of AF recurrence. CONCLUSIONS The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation.
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Yan C. Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications? Expert Rev Cardiovasc Ther 2022; 20:895-903. [PMID: 36329641 DOI: 10.1080/14779072.2022.2144233] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Personalized and stable interatrial communication is an important palliative therapy for patients with heart failure. However, this remains a technically challenging task. AREAS COVERED In the past decades, substantial advancements in atrial septostomy for the creation of controllable and durable interatrial communication have been made, and numerous novel devices and techniques are in various stages of development. In this review, we discuss the evolving indications for atrial septostomy, current approaches with or without device implantation, and indicators for optimal interatrial communication. The combined use of radiofrequency ablation and balloon dilation (CURB) is an individualized management approach based on underlying hemodynamics, which demonstrates unique advantages in creating a sufficient interatrial communication with satisfactory stability. The advantages and disadvantages of this implant-free procedure are analyzed and its clinical prospects are assessed. EXPERT OPINION With ready availability, high safety, and efficacy, CURB is a promising procedure for creating personalized and stable interatrial communication without device implantation. Further research is required to simplify the procedure, screen optimal reference parameters for personalized therapy, and evaluate the long-term outcome in a large population of patients.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Fuwai Hospital, 100037, Beijing, China
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5
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Blockhaus C, Guelker JE, Feyen L, Bufe A, Seyfarth M, Shin DI. Pulsed field ablation for pulmonary vein isolation: real-world experience and characterization of the antral lesion size compared with cryoballoon ablation. J Interv Card Electrophysiol 2022; 66:567-575. [PMID: 36038739 DOI: 10.1007/s10840-022-01359-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/22/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a new, non-thermal technology in the treatment of atrial fibrillation (AF). Early investigations have shown a promising safety profile with durable pulmonary vein isolation (PVI) and large antral lesions. However, clinical data remains scarce. METHODS We investigated a cohort of 43 patients. Twenty-three patients underwent PVI with PFA in our hospital and we analyzed them with regard to procedural characteristics and with regard to the size of acute antral lesion which was estimated by using an electroanatomical map of the left atrium (LA). We compared these data with data of 20 patients who had undergone cryoballon (CB) PVI in our hospital. RESULTS We could show acute isolation of all veins in all patients (100% PFA, 100% CB). Post-ablation high-density mapping revealed no early reconnection (0%). The acute antral lesion size of PFA was significantly higher compared to the CB (67.03 ± 12.69% vs. 57.39 ± 10.91%, p = 0.01). In the PFA group, we found no acute phrenic nerve injury, no major or minor bleeding, and no tamponade but one (4.34%) patient suffered from a stroke. Transient hypotension was observed frequently as well as transient bradycardia or asystole episodes requiring right ventricular pacing. In the CB group, no complications occurred. Furthermore, we discuss practical issues on PFA procedures. CONCLUSIONS PFA is a promising technology with high acute PV isolation rate and large antral lesions compared to CB. However, larger trials with more patients and data on long-term freedom of AF but also complications are needed.
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Affiliation(s)
- Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany. .,Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany.
| | - Jan-Erik Guelker
- Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany.,Department of Cardiology, Petrus Hospital, 42283, Wuppertal, Germany
| | - Ludger Feyen
- Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany.,Department of Diagnostic and Interventional Radiology, Helios Clinic Krefeld, 47805, Krefeld, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital, 42283, Wuppertal, Germany
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.,Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany
| | - Melchior Seyfarth
- Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany.,Department of Cardiology, Helios University Hospital, 42283, Wuppertal, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.,Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany
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Tsukamoto K, Tanahashi A, Harada H, Takaoka M, Sohara H. Development of a new HotBalloon TM ablation catheter equipped with a balloon surface temperature monitoring sensor for pulmonary vein isolation. J Med Eng Technol 2022; 46:687-692. [DOI: 10.1080/03091902.2022.2094010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kota Tsukamoto
- Hot Balloon Catheter Business Department, Toray Industries, Inc., Tokyo, Japan
| | - Akio Tanahashi
- Hot Balloon Catheter Business Department, Toray Industries, Inc., Tokyo, Japan
| | - Hiroyuki Harada
- Hot Balloon Catheter Business Department, Toray Industries, Inc., Tokyo, Japan
| | - Motoki Takaoka
- Hot Balloon Catheter Business Department, Toray Industries, Inc., Tokyo, Japan
| | - Hiroshi Sohara
- Division of Cardiology, Shonantobu General Hospital, Kanagawa, Japan
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Radiofrequency Current Versus Balloon-Based Ablation for Atrial Fibrillation. Am J Cardiol 2022; 178:52-59. [PMID: 35817597 DOI: 10.1016/j.amjcard.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
Abstract
The basis for selection of contemporary ablation technologies for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains unclear. We compared procedural data and efficacy in a propensity score-matched cohort treated with 4 ablation technologies in a center mainly using cryoballoon (CB). A total of 819 consecutive patients with AF underwent PVI, using radiofrequency current (RFC) (65 patients), CB (693 patients), hot balloon (HB) (74 patients), and laser balloon (LB) (52 patients). A total of patients (82% paroxysmal AF) were selected from each group according to the propensity score. Procedural data and freedom from atrial tachyarrhythmia recurrence after the index procedure were compared. All pulmonary veins were isolated in all groups. Procedure time was shorter in CB and HB groups (RFC: 148 ± 53 vs CB: 85 ± 37 vs HB: 102 ± 31 vs LB: 140 ± 28 minutes, p <0.001). RFC touch-up was most commonly required for PVI in the HB group among balloon groups (40%) (p <0.001). Total complication rate was 4% to 18% without any statistical differences between groups (p = 0.123). Phrenic nerve injury occurred most often in the CB group (16%) (p <0.001). During a mean follow-up of 21 ± 6 months, there were no significant differences among groups for freedom from atrial tachyarrhythmia recurrence after the index procedure (RFC: 68% vs CB: 78% vs HB: 76% vs LB: 76%, p = 0.440). In conclusion, all the ablation technologies facilitate safe and efficient PVI, with slight differences in the procedural data and complications.
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8
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Yan C, Wan L, Li H, Wang C, Guo T, Niu H, Li S, Yundan P, Wang L, Fang W. First in-human modified atrial septostomy combining radiofrequency ablation and balloon dilation. Heart 2022; 108:1690-1698. [PMID: 35676068 DOI: 10.1136/heartjnl-2022-321212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). METHODS Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66-92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8-23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. RESULTS After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1-5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1-2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). CONCLUSION The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. TRIAL REGISTRATION NUMBER NCT03554330.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Linyuan Wan
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hua Li
- Department of Cardiology, Beijing Tongren Hospital, Beijing, China
| | - Cheng Wang
- Department of Cardiology, Xuzhou Medical University Affiliated Hospital, Xuzhou, Jiangsu, China
| | - Tingting Guo
- Center for Respiratory and Pulmonary Vascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hanxu Niu
- Johnson and Johnson Medical China Ltd, Shanghai, China
| | - Shiguo Li
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Pingcuo Yundan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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Peng X, Liu X, Tian H, Chen Y, Li X. Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Cardiovasc Med 2022; 8:787270. [PMID: 34977192 PMCID: PMC8714841 DOI: 10.3389/fcvm.2021.787270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional catheter atrial fibrillation (AF) ablation owing to their impressive procedural advantages and better clinical outcomes and safety. However, the differences in characteristics, effectiveness, safety, and efficacy between HBA and CBA remain undetermined. This study compares the characteristic and prognosis differences between HBA and CBA. Methods: Electronic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv) with specific search strategies. Eligible studies were selected based on specific criteria; all records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were assessed using predefined criteria. Results: Seven studies were included in the final meta-analysis. Compared with CBA, more patients in the HBA group had residual conduction and required a higher incidence of touch-up ablation (TUA) [OR (95% CI) = 2.76 (2.02–3.77), P = 0.000]. The most frequent sites of TUA were the left superior pulmonary veins (PVs) in the HBA group vs. the right inferior PVs in the CBA group. During HBA surgery, the left and right superior PVs were more likely to have a higher fluid injection volume. Furthermore, the procedure time was longer in the HBA group than in the CBA group [weighted mean difference (95% CI) = 14.24 (4.39–24.09), P = 0.005]. Patients in the CBA group could have an increased risk of AF occurrence, and accepted more antiarrhythmic drug therapy; however, the result was insignificant. Conclusions: HBA and CBA are practical ablation approaches for AF treatment. Patients who received HBA had a higher incidence of TUA and longer procedure time. Clinical outcomes during the mid-term follow-up between HBA and CBA were comparable. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259487, identifier: CRD42021259487.
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Affiliation(s)
- Xinyi Peng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao Liu
- Department of Cardiology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Hongbo Tian
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yu Chen
- Peking University International Hospital, Beijing, China
| | - Xuexun Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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11
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Ifedili I, Mouksian K, Jones D, El Masri I, Heckle M, Jefferies J, Levine YC. Ablation Therapy for Persistent Atrial Fibrillation. Curr Cardiol Rev 2022; 18:e290721195115. [PMID: 34325644 PMCID: PMC9413731 DOI: 10.2174/1573403x17666210729101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Atrial Fibrillation (AF) is the most common form of electrical disturbance of the heart and contributes to significant patient morbidity and mortality. With a better understanding of the mechanisms of atrial fibrillation and improvements in mapping and ablation technologies, ablation has become a preferred therapy for patients with symptomatic AF. Pulmonary Vein Isolation (PVI) is the cornerstone for AF ablation therapy, but particularly in patients with AF occurring for longer than 7 days (persistent AF), identifying clinically significant nonpulmonary vein targets and achieving durability of ablation lesions remains an important challenge.
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Affiliation(s)
- Ikechukwu Ifedili
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - David Jones
- Methodist le Bonheur Cardiovascular Institute, Memphis, TN, USA
| | - Ibrahim El Masri
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mark Heckle
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John Jefferies
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yehoshua C Levine
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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12
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Nakahara S, Wakamatsu Y, Fukuda R, Hori Y, Nishiyama N, Sato H, Nagashima K, Mizutani Y, Ishikawa T, Kobayashi S, Taguchi I, Okumura Y. Utility of hot-balloon-based pulmonary vein isolation under balloon surface temperature monitoring: First clinical experience. J Cardiovasc Electrophysiol 2021; 32:2625-2635. [PMID: 34350665 DOI: 10.1111/jce.15196] [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: 05/06/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A new hot balloon system that registers balloon surface temperature (BST) during energy delivery is now available for clinical use in Japan. This study sought to investigate the utility of BST measurement for achievement of pulmonary vein isolation (PVI) by a single-shot energy delivery strategy during hot balloon ablation (HBA). METHODS We applied and tested the system in 30 consecutive patients undergoing HBA for paroxysmal or early-persistent atrial fibrillation (AF). We also performed real-time PV potential monitoring using a circular catheter. RESULTS Acute PVI was achieved with single hot balloon shots in 88% (106/120) of the PVs. Real-time BSTs and PV potentials were recorded in all cases. Mean BST at documentation of PVI was 49.4°C, and acute reconnections were observed in most cases (86%, 12/14) in which the single-shot technique was ineffective. Time-to-isolation (TTI) (23.1 ± 8.7 s vs. 36.3 ± 9.3 s, p < .01) and median BST (59.9 ± 2.6°C vs. 55.7 ± 1.9°C, p < .01) differed significantly between cases in which PVI was achieved (vs. those in which PVI was not achieved). Multivariable analysis revealed strong association between both TTI and median BST and acute PVI. The best median BST cutoff value for achieving PVI with a single shot was >58.7°C (sensitivity 67.0%, specificity 100%). CONCLUSION Our data suggest that real-time BST monitoring during energy applications is useful for predicting achievement of acute PVI by a single shot during HBA.
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Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hirotsugu Sato
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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13
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Fukuda R, Nakahara S, Sato H, Nishiyama N, Hori Y, Taguchi I. Virtual and real assessment of a wide antral ablated region in atrial fibrillation patients using the hot balloon system. Clin Case Rep 2021; 9:1199-1201. [PMID: 33768810 PMCID: PMC7981672 DOI: 10.1002/ccr3.3730] [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: 11/05/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
The hot balloon system has become widely used for atrial fibrillation ablation and also has software for preoperative computer simulation. The computer model may be useful for predicting the extent of a wide planar ablation region in the left atrium.
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Affiliation(s)
- Reiko Fukuda
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
| | - Shiro Nakahara
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
| | - Hirotsugu Sato
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
| | - Naoki Nishiyama
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
| | - Yuichi Hori
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
| | - Isao Taguchi
- Department of CardiologyDokkyo Medical UniversitySaitama Medical Center SaitamaJapan
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14
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Chun JKR, Bordignon S, Last J, Mayer L, Tohoku S, Zanchi S, Bianchini L, Bologna F, Nagase T, Urbanek L, Chen S, Schmidt B. Cryoballoon Versus Laserballoon: Insights From the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009294. [PMID: 33417476 DOI: 10.1161/circep.120.009294] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF). METHODS Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications. RESULTS Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes; P<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes, P=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%, P=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group. CONCLUSIONS Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.
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Affiliation(s)
- Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.).,Medizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Germany (J.K.R.C.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Mayer
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
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