1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024; 21:e31-e149. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Solimene F, Maggio R, De Sanctis V, Escande W, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Ferraro A, Mantica M, Zucchelli G, Dell'Era G, Mascia G, Ricci Maga R, Pandozi C, Rossi P, Scaglione M, Zingarini G, Garnier F, Loricchio ML, Pelargonio G, Lepillier A. Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from an international multicenter clinical setting. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01849-0. [PMID: 38972960 DOI: 10.1007/s10840-024-01849-0] [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: 01/30/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). OBJECTIVE We report the outcomes of our acute and long-term clinical evaluation of CF-LI-guided PVI in consecutive AF ablation cases from an international multicenter clinical setting. METHODS Three hundred twenty-four consecutive patients from 20 European centers undergoing RF catheter ablation with the Stablepoint™ catheter were enrolled in the CHARISMA registry. Of these, 275 had a minimum follow-up of 1 year and were included in the primary analysis. RESULTS The mean procedure duration was 115 ± 47 min, and the mean fluoroscopy time was 9.9 ± 6 min. At the end of the procedures, all PVs had been successfully isolated in all study patients. Minor complications were reported in 12 patients (4.4%). At 1 year, 36 (13.1%) patients had had an AF recurrence, and freedom from antiarrhythmic drugs and AF recurrence was achieved in 228 (82.9%) patients. The recurrence rate was higher in patients with persistent AF (21/116, 18.1%) than in those with paroxysmal AF (15/159, 9.4%; p = 0.0459). On multivariate logistic analysis adjusted for baseline confounders, only time > 6 months from first diagnosis of AF to ablation (HR = 2.93, 95%CI 1.03 to 8.36, p = 0.0459) was independently associated with recurrences. CONCLUSION An ablation strategy for PVI guided by CF-LI technology proved safe and effective and resulted in a low recurrence rate of AF over 1-year follow-up, irrespective of the underlying AF type. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice. (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.
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Affiliation(s)
- Franscesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Ruggero Maggio
- Laboratorio Di Elettrofisiologia, Infermi Hospital, 29, Rivoli, Italy.
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute E Della Scienza Di Torino" Hospital, University of Turin, Turin, Italy
| | - Anna Ferraro
- Laboratorio Di Elettrofisiologia, Infermi Hospital, 29, Rivoli, Italy
| | | | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell'Era
- Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | | | | | | | - Pietro Rossi
- Fatebenefratelli Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
| | | | | | | | | | - Gemma Pelargonio
- Istituto Di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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4
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Schiavone M, Solimene F, Moltrasio M, Casella M, Bianchi S, Iacopino S, Rossillo A, Schillaci V, Fassini G, Compagnucci P, Salito A, Rossi P, Filannino P, Maggio R, Themistoklakis S, Pandozi C, Caprioglio F, Malacrida M, Russo AD, Tondo C. Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:1101-1111. [PMID: 38519418 DOI: 10.1111/jce.16246] [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: 12/20/2023] [Revised: 02/17/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Limited data exist on pulsed-field ablation (PFA) in patients with persistent atrial fibrillation (PeAF) undergoing left atrial posterior wall isolation (LAPWI). METHODS The Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA) prospective registry included consecutive patients referred for PeAF catheter ablation at 9 Italian centers, treated with the FARAPULSETM-PFA system. The primary efficacy and safety study endpoints were the acute LAPWI rate, freedom from arrhythmic recurrences and the incidence of major periprocedural complications. Patients undergoing pulmonary vein isolation (PVI) alone, PWI + LAPWI and redo procedures were compared. RESULTS Among 249 patients, 21.7% had long-standing PeAF, 79.5% were male; mean age was 63 ± 9 years. LAPWI was performed in 57.6% of cases, with 15.3% being redo procedures. Median skin-to-skin times (PVI-only 68 [60-90] vs. PVI + LAPWI 70 [59-88] mins) did not differ between groups. 45.8% LAPWI cases were approached with a 3D-mapping system, and 37.3% with intracardiac echocardiography. LAPWI was achieved in all patients by means of PFA alone, in 88.8% cases at first pass. LAPWI was validated either by an Ultrahigh-density mapping system or by recording electrical activity + pacing maneuvers. No major complications occurred, while 2.4% minor complications were detected. During a median follow-up of 273 [191-379] days, 41 patients (16.5%) experienced an arrhythmic recurrence after the 90-day blanking period, with a mean time to recurrence of 223 ± 100 days and no differences among ablation strategies. CONCLUSION LAPWI with PFA demonstrates feasibility, rapidity, and safety in real-world practice, offering a viable alternative for PeAF patients. LAPWI is achievable even with a fluoroscopy-only method and does not significantly extend overall procedural times.
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Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Solimene
- Montevergine Clinic, Mercogliano, Avellino, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Michela Casella
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Stefano Bianchi
- Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | | | | | | | - Gaetano Fassini
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | | | - Pietro Rossi
- Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | | | | | | | | | | | | | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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5
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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6
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Lepillier A, Maggio R, De Sanctis V, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Segreti L, Dell’Era G, Garnier F, Mascia G, Pandozi C, Dello Russo A, Scaglione M, Cosaro G, Ferraro A, Paziaud O, Maglia G, Solimene F. Insight into contact force local impedance technology for predicting effective pulmonary vein isolation. Front Cardiovasc Med 2023; 10:1169037. [PMID: 37476572 PMCID: PMC10354239 DOI: 10.3389/fcvm.2023.1169037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created. Objective We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry. Methods A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included. Results In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, p < 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, p < 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was >21 Ω at anterior sites and >18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (r = 0.14, 95% CI: 0.13-0.16, p < 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (-0.22, -0.23 to -0.20, p < 0.0001 for CF; -0.27, -0.29 to -0.26, p < 0.0001 for LI drop). Conclusion An LI drop >21 Ω at anterior sites and >18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT. Clinical trial registration http://clinicaltrials.gov/, identifier: NCT03793998.
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Affiliation(s)
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell’Era
- Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy
| | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | - Francesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
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7
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Orbán G, Salló Z, Perge P, Ábrahám P, Piros K, Nagy KV, Osztheimer I, Merkely B, Gellér L, Szegedi N. Characteristics of Very High-Power, Short-Duration Radiofrequency Applications. Front Cardiovasc Med 2022; 9:941434. [PMID: 35911564 PMCID: PMC9326019 DOI: 10.3389/fcvm.2022.941434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Pulmonary vein isolation is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). The very high-power, short-duration (vHPSD) radiofrequency (RF) ablation is a novel technology that favors resistive heating while decreasing the role of conductive heating. Our study aimed to evaluate the correlations between contact force (CF), power, impedance drop (ID), and temperature; and to assess their role in lesion formation with the vHPSD technique. Methods Consecutive patients who underwent initial point-by-point RF catheter ablation for AF were enrolled in the study. The vHPSD ablation was performed applying 90 W for 4 s with an 8 ml/min irrigation rate. Results Data from 85 patients [median age 65 (59–71) years, 34% female] were collected. The median procedure time, left atrial dwelling time, and fluoroscopy time were 70 (60–90) min, 49 (42–58) min, and 7 (5–11) min, respectively. The median RF time was 312 (237-365) sec. No steam pop nor major complications occurred. A total of 6,551 vHPSD RF points were analyzed. The median of CF, maximum temperature, and ID were 14 (10–21) g, 47.6 (45.1–50.4) °C, and 8 (6–10) Ohms, respectively. CF correlated significantly with the maximum temperature (p < 0.0001). A CF of 5 g and above was associated with a significantly higher temperature compared to those lesions with a CF below 5 grams (p < 0.0001). Bilateral first-pass isolation rate was 84%. The 6-month AF-recurrence rate was 7%. Conclusion The maximum temperature and CF significantly correlate with each other during vHPSD applications. A CF ≥ 5 g leads to better tissue heating and thus might be more likely to result in good lesion formation, although this clinical study was unable to assess actual lesion sizes.
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8
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Requirement of larger local impedance reduction for successful lesion formation at carinal area during pulmonary vein isolation. J Interv Card Electrophysiol 2022; 65:509-518. [PMID: 35794439 DOI: 10.1007/s10840-022-01282-1] [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: 03/25/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Local impedance (LI) measurement from an ablation catheter is useful in predicting lesion size and acute success of pulmonary vein isolation (PVI). The LI variation can be described by absolute LI drop (ΔLID) or ΔLID/initial LI (%LID). We evaluated the utility of these parameters in predicting acute lesion durability during PVI using a novel catheter capable of measuring both LI and contact force (CF). METHODS PVI with a targeted CF, power, and duration was performed in 23 consecutive patients with paroxysmal atrial fibrillation. LI was blinded to operators during ablation. Parameters for each RF application were collected and compared for acute successful lesions and gaps. RESULTS A total of 1633 RF applications including 97 (5.9%) gap lesions were analyzed. Successful lesions were more frequently observed at non-carinal sites and those with higher contact force, FTI, initial LI, and larger variation of LI and generator impedance (GI). Multivariate analysis demonstrated that absolute GI drop (ΔGID) [OR 1.09 (1.04-1.15), p < 0.001], ΔLID [1.12 (1.09-1.16), p < 0.001], ΔGID/initial GI (%GID) [OR 1.04 (1.01-1.07), p = 0.01], and %LID [OR 1.15 (1.12-1.28), p < 0.001] were significantly associated with successful lesions, and carinal site [OR 0.15(0.09-0.24), p < 0.001] was significantly related to gaps. Both ΔLID and %LID equally predicted the acute durability of lesions during PVI. ΔLID ≥ 24Ω and %LID ≥ 15% at the carina, and ΔLID ≥ 21Ω and %LID ≥ 14% at non-carinal sites significantly predicted acute successful lesions with negative predictive values of 93-99%. CONCLUSIONS Both ΔLID and %LID were equally useful in predicting acute successful lesions during PVI. Larger cut-off values should be applied to carinal sites.
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9
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Solimene F, Stabile G, Segreti L, Malacrida M, Schillaci V, Rossi P, Bongiorni MG, Shopova G, Cauti FM, Zucchelli G, Arestia A, Bianchi S, Di Cori A, Maddaluno F, De Simone A, Garcia-Bolao I. Targeted ablation of residual pulmonary vein potentials in atrial fibrillation ablation through ultra-high-density mapping: insights from the CHARISMA registry. J Cardiovasc Electrophysiol 2022; 33:1414-1424. [PMID: 35524404 DOI: 10.1111/jce.15527] [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: 09/07/2021] [Revised: 04/02/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (RAP) within the antral scar by means of an ultra-high density mapping (UHDM) system. METHODS We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity. The LumipointTM (Boston Scientific) map-analysis tool was used sequentially on each PV component. The ablation endpoint was PV isolation (PVI) and electrical quiescence in the antral region. RESULTS Fifty-eight cases of AF ablation were analyzed. A total of 86 PVGs in 34 (58.6%) patients and 44 RAPs in 34 patients (58.6%) were found. In 16 (27.6%) cases, we found at least one RAP in patients with complete absence of PV conduction. RAPs showed a lower mean voltage than PVG (0.3±0.2mV vs 0.7±0.5mV, p<0.0001), whereas the mean number of EGM peaks was higher (8.4±1.4 vs 3.2±1.5, p<0.0001). The percentage of patients in whom RAPs were detected through LumipointTM was higher than through propagation map analysis (58.6% vs 36.2%, p=0.025). Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study patients. During a mean follow-up of 453±133 days, 6 patients (10.3%) suffered an AF/AT recurrence. CONCLUSION Local vulnerabilities in antral lesion sets were easily discernible by means of the UHDM system in both de novo and redo patients when no PV conduction was present. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/Identifier: NCT03793998 This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Anthea Hospital, Bari, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maurizio Malacrida
- Boston Scientific, Milan, Italy.,Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Pietro Rossi
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Filippo Maria Cauti
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Stefano Bianchi
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Maddaluno
- Boston Scientific, Milan, Italy.,Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Ignacio Garcia-Bolao
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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10
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Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:595-604. [PMID: 35589172 DOI: 10.1016/j.jacep.2022.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures. BACKGROUND A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure. METHODS Fifty-eight patients who had undergone LI-blinded de novo PVI returned for a 3-month mapping procedure. PVI ablation circles were divided into 16 anatomic segments for classification (durable block or gap), and the median LI drop within segments with an interlesion distance of ≤6 mm was compared. A total of 51 data sets met the criteria for segmental analysis of LI performance. RESULTS At the 3-month procedure, PV connection was confirmed in at least 1 PV segment in 35 of the included patients. LI drop outperformed generator impedance drop as a predictor of durable conduction block (area under the receiver-operating characteristic curve: 0.79 vs 0.68; P = 0.003). Optimal LI drops were identified by left atrial region (anterior/superior: 16.9 Ω [sensitivity: 69.1%; specificity: 85.0%; positive predictive value for durable conduction block: 97.7%]; posterior/inferior:14.2 Ω [sensitivity: 73.8%; specificity: 78.3%; positive predictive value: 96.9%]). Starting LI before radiofrequency (RF) application was significantly different among healthy, gap, and mature scar tissue and was also a contributing factor to achieving an optimal LI drop (85.2% of RF applications with a starting LI of ≥110 Ω achieved the optimal regional drop or greater). CONCLUSIONS LI drop is predictive of durable PV segment isolation. Preablation starting LI is associated with the magnitude of LI drop. These findings suggest that a regional approach to RF ablation guided by LI combined with careful interlesion distance control may be beneficial in patients with paroxysmal atrial fibrillation (Electrical Coupling Information From the Rhythmia HDx System and DirectSense Technology in Subjects With Paroxysmal Atrial Fibrillation [LOCALIZE]; NCT03232645).
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11
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Solimene F, Stabile G, Ramos P, Segreti L, Cauti FM, De Sanctis V, Maggio R, Ramos-Maqueda J, Mont L, Schillaci V, Malacrida M, Garcia-Bolao I. Improved procedural workflow for catheter ablation of paroxysmal AF with high-density mapping system and advanced technology: Rationale and study design of a multicenter international study. Clin Cardiol 2022; 45:597-604. [PMID: 35446440 PMCID: PMC9175242 DOI: 10.1002/clc.23806] [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: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. METHODS The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single-arm, international post-market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post-ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post-ablation to proactively detect and manage any recurrences within the 90-day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post-ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. DISCUSSION The DELETE AF trial will provide additional knowledge on long-term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at ClinicalTrials.gov (NCT05005143).
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Affiliation(s)
| | | | - Pablo Ramos
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | | | - Javier Ramos-Maqueda
- Department of Cardiology, Section for Electrophysiology, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
| | - Lluis Mont
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Ignacio Garcia-Bolao
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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12
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Ducceschi V, Zingarini G, Nigro G, Brasca FMA, Malacrida M, Carbone A, Lavalle C, Maglia G, Infusino T, Aloia A, Nicolis D, Auricchio C, Uccello A, Notaristefano F, Rago A, Botto GL, Esposito L. Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter. Pacing Clin Electrophysiol 2022; 45:612-618. [PMID: 35383979 DOI: 10.1111/pace.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. METHODS RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. RESULTS 392 point-by-point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4±12Ω prior to ablation and 92.0±11Ω after ablation (p<0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8±6Ω vs 8.7±4Ω; RedV: 17.2±6Ω vs 7.8±5Ω; UPC: 19.6±6Ω vs 10.1±5Ω, all p<0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure-related adverse events were reported. CONCLUSIONS A LI-guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | - Antonio Aloia
- Division of Cardiology, Presidio Ospedaliero di Vallo della Lucania, Italy
| | | | | | | | | | - Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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13
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Solimene F, De Sanctis V, Maggio R, Malacrida M, Segreti L, Anselmino M, Schillaci V, Mantica M, Scaglione M, Dello Russo A, Cauti FM, Zingarini G, Pandozi C, Cavaiani M, Ferraro A, Maglia G, Stabile G. When local impedance meets contact force: preliminary experience from the CHARISMA registry. J Interv Card Electrophysiol 2022; 63:749-758. [PMID: 35322330 PMCID: PMC9151535 DOI: 10.1007/s10840-022-01163-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have emerged as a viable real-time indicator of tissue characteristics and the consequent durability of the lesions created. We investigated the impact of catheter-tissue contact force (CF) on LI behavior during pulmonary vein isolation (PVI). METHODS Forty-five consecutive patients of the CHARISMA registry undergoing de novo AF radiofrequency (RF) catheter ablation with a novel open-irrigated-tip catheter endowed with CF and LI measurement capabilities (Stablepoint™ catheter, Boston Scientific) were included. RESULTS A total of 2895 point-by-point RF applications were analyzed (RF delivery time (DT) = 8.7±4s, CF = 13 ±±8 g, LI drop = 23 ±±7 Ω). All PVs were successfully isolated in an overall procedure time of 118 ±±34 min (fluoroscopy time = 13 ±±8 min). The magnitude of LI drop weakly correlated with CF (r = 0.13, 95% confidence interval (CI): 0.09 to 0.16, p < 0.0001), whereas both CF and LI drop inversely correlated with DT (r = -0.26, 95%CI: -0.29 to -0.22, p < 0.0001 for CF; r = -0.36, 95%CI: -0.39 to -0.33, p < 0.0001 for LI). For each 10 g of CF, LI drop markedly increased from 22.4 ± 7 Ω to 24.0 ± 8 Ω at 5 to 25 g CF intervals (5-14 g of CF vs 15-24 g of CF, p < 0.0001), whereas it showed smooth transition over 25 g (24.8 ± 7Ω at ≥ 25 g CF intervals, p = 0.0606 vs 15-24 g of CF). No major complications occurred during the procedures or within 30 days. CONCLUSIONS CF significantly affects LI drop and probable consequent lesion formation during RF PVI. The benefit of higher contact (> 25 g) between the catheter and the tissue appears to have less impact on LI drop. TRIAL REGISTRATION Catheter Ablation of Arrhythmias With High Density Mapping System in the Real World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.
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Affiliation(s)
| | - Valerio De Sanctis
- Department of Cardiac Electrophysiology and Pacing, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | | | | | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Massimo Mantica
- Department of Cardiac Electrophysiology and Pacing, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Giuseppe Stabile
- Clinica Montevergine, Avellino, Mercogliano, Italy
- Anthea Hospital, Bari, Italy
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14
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Yasumoto K, Egami Y, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. The correlation between local impedance drop and catheter contact in clinical pulmonary vein isolation use. Pacing Clin Electrophysiol 2022; 45:984-992. [PMID: 35363376 DOI: 10.1111/pace.14500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local impedance (LI) drop during radiofrequency (RF) application is monitored to assess the lesion formation. Recently, a novel ablation catheter has been introduced to clinical setting, which is capable of monitoring LI and catheter contact parameters including contact force (CF) and contact angle (CA). This study aimed to clarify the correlation between LI drop and catheter contact parameters. METHODS AND RESULTS This prospective study included 15 paroxysmal atrial fibrillation (AF) patients who underwent initial pulmonary vein isolation (PVI). First-pass encircling point-by-point PV ablation was performed by using a 4.5-mm irrigated ablation catheter, with monitoring LI, CF, and CA. RF energy was applied for 30 sec at each site with 30W. Stable ablation points were analyzed to examine the correlation between LI drop and catheter contact parameters. Among 903 ablation points, 499 stable ablation points (55.2%) were analyzed. CA showed good correlation with LI drop (ρ = 0.418, P<0.001). Maximum CF, minimum CF, average CF, and initial CF all showed weak correlation with LI drop (ρ = 0.201, P<0.001; ρ = 0.224, P<0.001; ρ = 0.258, P<0.001; and ρ = 0.212, P<0.001, respectively). Multivariate analysis demonstrated that CA was an independent factor of LI drop among the catheter contact parameters (β = 0.139, 95%CI = 0.111-0.167, P<0.001). The LI drop in the blocked segments was significantly higher than that in the electrical conduction gap segments (27.3 ± 9.8 Ω vs. 19.6 ± 6.4 Ω, P<0.001) CONCLUSION: In clinical PVI use, both CF and CA were correlated with LI drop. More parallel CA could induce higher LI drop, which may lead to effective lesion formation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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15
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Chu GS, Calvert P, Futyma P, Ding WY, Snowdon R, Gupta D. Local impedance for the optimization of radiofrequency lesion delivery: A review of bench and clinical data. J Cardiovasc Electrophysiol 2021; 33:389-400. [PMID: 34921465 DOI: 10.1111/jce.15335] [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: 08/25/2021] [Revised: 11/11/2021] [Accepted: 12/05/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Radiofrequency catheter ablation is a cornerstone of treatment for many cardiac arrhythmias. Progression in three-dimensional mapping and contact-force sensing technologies have improved our capability to achieve success, but challenges still remain. METHODS In this article, we discuss the importance of overall circuit impedance in radiofrequency lesion formation. This is followed by a review of the literature regarding recently developed "local impedance" technology and its current and future potential applications and limitations, in the context of established surrogate markers currently used to infer effective ablation. RESULTS We discuss the role of local impedance in assessing myocardial substrate, as well as its role in clinical studies of ablation. We also discuss safety considerations, limitations and ongoing research. CONCLUSION Local impedance is a novel tool which has the potential to tailor ablation in a manner distinct from other established metrics.
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Affiliation(s)
- Gavin S Chu
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Research Unit, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Piotr Futyma
- Department of Cardiology, Medical College of the University of Rzeszów, St. Joseph's Heart Rhythm Center, Rzeszów, Poland, Rzeszów, Poland
| | - Wern Yew Ding
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Research Unit, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Richard Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Research Unit, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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16
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Solimene F, Giannotti Santoro M, Stabile G, Malacrida M, De Simone A, Pandozi C, Pelargonio G, Rossi P, Battaglia A, Pecora D, Bongiorni MG, Zucchelli G, Stocco C, Arestia A, Iuliano S, Russo M, Narducci ML, Segreti L. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2031-2040. [PMID: 34606098 DOI: 10.1111/pace.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An early, comprehensive rhythm-control therapy is needed in order to treat atrial fibrillation (AF) effectively and to improve ablation outcomes. METHODS A total of 153 consecutive patients from the CHARISMA registry undergoing AF ablation at eight centers were included. Patients with de novo PVI were classified as having undergone early treatment (ET) if the procedure was performed within 6 months after the first AF episode, and as having undergone delayed treatment (DT) if ablation was performed over 6 months after the first AF episode. RESULTS One-hundred fifty-three patients were enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF). The time from the first AF episode to the ablation procedure was 1034 ± 1483 days. The ET group comprised 36 patients (25.3%), the DT group 60 (39.2%) and Redo cases were 57 (37.3%). During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/AT recurrence. More DT patients than ET patients suffered recurrences (15.7% vs. 2.2%, p = 0.0452) and the time to AT/AF recurrence was shorter in the group of patients who received an ablation treatment after 6 months (HR = 6.19, 95% CI: 1.7 to 21.9; p = 0.0474). On multivariate Cox analysis, only hypertension (HR = 4.86, 95% CI: 1.6 to 14.98, p = 0.0062) was independently associated with recurrences. Beyond the hypertension risk factor, ET was associated with a low risk of recurrence; recurrence rate ranged from 0% (ET patients without hypertension) to 25.0% (DT patients with hypertension). CONCLUSIONS An early rhythm-control ablation therapy in the absence of common risk factors was associated with the lowest rate of recurrences.
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Affiliation(s)
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Anthea Hospital, Bari, Italy
| | | | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Iuliano
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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17
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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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18
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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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19
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Hashimoto K, Tsuzuki I, Seki Y, Ibe S, Yamashita T, Miyama H, Fujisawa T, Katsumata Y, Kimura T, Fukuda K, Takatsuki S. Change in the local impedance and electrograms recorded by a micro-electrode tip catheter during initial atrial fibrillation ablation. J Arrhythm 2021; 37:566-573. [PMID: 34141009 PMCID: PMC8207389 DOI: 10.1002/joa3.12535] [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: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A novel measurement of the local impedance (LI) and electrograms recorded from micro-electrodes on catheter tip has been developed. However, the data during pulmonary vein (PV) ablation is not sufficient. We aimed to investigate the utility of this measurement during initial atrial fibrillation (AF) ablation. METHODS We investigated 111 representative radiofrequency applications in 7 AF patients without a history of prior ablation (6 males, age 68 [65-72] years, 2 persistent AF). The ablation strategy was PV isolation for paroxysmal AF and single ring box isolation for persistent AF, using MiFi catheter. The correlation of the generator impedance (GI) drop and LI drop after radiofrequency applications and the predictive value of the initial LI elevation before radiofrequency applications for LI drop were analyzed. Also, the LI and GI drop were investigated according to the location of RF applications. RESULTS The LI drop was higher than GI drop (23.7 [16.4-35.7] and 9.0 [6.0-12.0]; P < .01). There were correlations between the initial LI elevation and LI drop (R 2 = 0.466, P < .01) and between the LI and GI drop (R 2 = 0.263, P < .01). The LI drops significantly differed according to the different anatomical localizations by the Kruskal-Wallis test, although the GI drops did not differ (P < .01 and P = .49, respectively). CONCLUSION LI drop was associated with initial LI elevation and was larger than GI drop. LI drop was different according to locations, although GI drop was not. These findings might indicate that LI drop would be a more sensitive marker for lesion formation than GI drop.
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Affiliation(s)
- Kenji Hashimoto
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Ippei Tsuzuki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Yuta Seki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Susumu Ibe
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | | | - Hiroshi Miyama
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Taishi Fujisawa
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | | | - Takehiro Kimura
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Keiichi Fukuda
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Seiji Takatsuki
- Department of CardiologyKeio University School of MedicineTokyoJapan
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20
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Solimene F, Giannotti Santoro M, De Simone A, Malacrida M, Stabile G, Pandozi C, Pelargonio G, Cauti FM, Scaglione M, Pecora D, Bongiorni MG, Arestia A, Grimaldi G, Russo M, Narducci ML, Segreti L. Pulmonary vein isolation in atrial fibrillation patients guided by a novel local impedance algorithm: 1-year outcome from the CHARISMA study. J Cardiovasc Electrophysiol 2021; 32:1540-1548. [PMID: 33851484 DOI: 10.1111/jce.15041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have recently emerged as a viable real-time indicator of tissue characteristics and durability of the lesions created. We report the outcomes of acute and long-term clinical evaluation of the new DirectSense algorithm in AF ablation. METHODS Consecutive patients undergoing AF ablation were included in the CHARISMA registry. RF delivery was guided by the DirectSense algorithm, which records the magnitude and time-course of the impedance drop. The ablation endpoint was pulmonary vein isolation (PVI), as assessed by the entrance and exit block. RESULTS 3556 point-by-point first-pass RF applications of >10 s duration were analyzed in 153 patients (mean age=59 ± 10 years, 70% men, 61% paroxysmal AF, 39% persistent AF). The mean baseline LI was 105 ± 15 Ω before ablation and 92 ± 12 Ω after ablation (p < .0001). Both absolute drops in LI and the time to LI drop (LI drop/τ) were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8 Ω vs 6 ± 4 Ω, p < .0001 for LI; 0.73 [0.41-1.25] Ω/s vs. 0.35[0.22-0.59 Ω/s, p < .0001 for LI drop/τ). No major complications occurred during or after the procedures. All PVs had been successfully isolated. During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/atrial tachycardia recurrence after the 90-day blanking period. CONCLUSION The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective and resulted in a very low rate of AF recurrence over 1-year follow-up.
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Affiliation(s)
- Francesco Solimene
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | | | - Giuseppe Stabile
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy.,Department of Electrophysiology, Anthea Hospital, Bari, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | - Marco Scaglione
- Department of Electrophysiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Arestia
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Gabriella Grimaldi
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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21
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Iacopino S, Filannino P, Artale P, Placentino F, Pesce F, Petretta A. Antral lesion characterization of a new cryoballoon ablation system in terms of local impedance drop: The first reported case. HeartRhythm Case Rep 2021; 7:182-185. [PMID: 33786317 PMCID: PMC7987902 DOI: 10.1016/j.hrcr.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Paolo Artale
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Francesca Pesce
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Petretta
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
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22
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Miyazaki S, Hasegawa K, Mukai M, Aoyama D, Nodera M, Yamaguchi J, Shiomi Y, Tama N, Ikeda H, Ishida K, Uzui H, Tada H. Superior vena cava isolation using a novel ablation catheter incorporating local impedance monitoring. J Interv Card Electrophysiol 2021; 64:291-300. [PMID: 33755817 DOI: 10.1007/s10840-021-00980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A novel technology able to measure the local impedance (LI) during radiofrequency ablation has become available for clinical use. We investigated the change in the LI characteristics during superior vena cava isolations (SVCIs) using a novel catheter equipped with mini-electrodes. METHODS Twenty paroxysmal atrial fibrillation patients (68 ± 9 years; 14 males) underwent an SVCI by targeting breakthroughs. Subsequently, dormant conduction provoked by adenosine triphosphate (ATP) was evaluated. RESULTS Electrical SVCIs were successfully achieved in all with 7.2 ± 3.0 radiofrequency applications (RFA) without any complications. The procedure and fluoroscopic times were 13.1 ± 8.1 and 2.8 ± 2.3 min. No ablation was required at the anteroseptal SVC in 19 (95.0%) patients. The baseline LI and generator impedance (GI) were 125 ± 23 and 105 ± 14Ω. LI drops during RFA were significantly greater than GI drops (17 ± 12 vs. 4 ± 4Ω, p < 0.001). The correlation between the LI drops and GI drops was relatively high (R = 0.69, p < 0.001). LI drops were highest at the septal SVC and lowest at the lateral followed by antero-lateral SVC. The baseline electrogram amplitude between the mini-electrodes and tip-ring electrodes was 1.2 ± 1.4 and 0.8 ± 0.6 mV. The mini-electrode amplitude is more sharply attenuated with a greater magnitude than the tip-ring amplitude (p < 0.001). ATP-provoked dormant conduction was exposed in 10/17 (58.8%) patients and antero-lateral SVC gap locations in 7. Antero-lateral SVC LI drops were similar between patients with and without dormancy. CONCLUSIONS The LI drop magnitude during RFA significantly differed among the SVC segments. Antero-lateral SVC ATP-provoked dormant conduction was often exposed, and additional applications are recommended following the isolation for a robust SVCI.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Junya Yamaguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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