1
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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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Calvert P, Koniari I, Mills MT, Ashrafi R, Snowdon R, Gupta D, Luther V. Lesion metrics and 12-month outcomes of very-high power short duration radiofrequency ablation (90W/4 s) under mild conscious sedation. J Cardiovasc Electrophysiol 2024; 35:1165-1173. [PMID: 38571287 DOI: 10.1111/jce.16269] [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: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is often performed under general anaesthesia (GA) or deep sedation. Anaesthetic availability is limited in many centers, and deep sedation is prohibited in some countries without anaesthetic support. Very high-power short duration (vHPSD-90W/4 s) PVI using the Q-Dot catheter is generally well tolerated under mild conscious sedation (MCS) though an understanding of catheter stability and long-term effectiveness is lacking. We analyzed lesion metrics and 12-month freedom from atrial arrythmia with this approach. METHODS Our approach to radiofrequency (RF) PVI under MCS is standardized and includes a single catheter approach with a steerable sheath. We identified patients undergoing Q-Dot RF PVI between March 2021 and December 2022 in our center, comparing those undergoing vHPSD ablation under MCS (90W/MCS) against those undergoing 50 W ablation under GA (50 W/GA) up to 12 months of follow-up. Data were extracted from clinical records and the CARTO system. RESULTS Eighty-three patients met our inclusion criteria (51 90W/MCS; 32 50 W/GA). Despite shorter ablation times (353 vs. 886 s; p < .001), the 90 W/MCS group received more lesions (median 87 vs. 58, p < .001), resulting in similar procedure times (149.3 vs. 149.1 min; p = .981). PVI was achieved in all cases, and first pass isolation rates were similar (left wide antral circumferential ablation [WACA] 82.4% vs. 87.5%, p = .758; right WACA 74.5% vs. 78.1%, p = .796; 90 W/MCS vs. 50 W/GA respectively). Analysis of 6647 ablation lesions found similar mean impedance drops (10.0 ± 1.9 Ω vs. 10.0 ± 2.2 Ω; p = .989) and mean contact force (14.6 ± 2.0 g vs. 15.1 ± 1.6 g; p = .248). Only median 2.5% of lesions in the 90 W/MCS cohort failed to achieve ≥ 5 Ω drop. In the 90 W/MCS group, there were no procedural related complications, and 12-month freedom from atrial arrhythmia was observed in 78.4%. CONCLUSION vHPSD PVI is feasible under MCS, with encouraging acute and long-term procedural outcomes. This provides a compelling option for centers with limited anaesthetic support.
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Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Dhiraj Gupta
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Vishal Luther
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [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: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
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Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
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Baumgartner A, Martinek M, Derndorfer M, Kollias G, Ammann P, Pürerfellner H, Seidl S. Pulmonary Vein Isolation for Atrial Fibrillation: Comparison of a Very High-Power Very Short-Duration (vHPvSD) Ablation Protocol versus a Hybrid Ablation Approach-Procedural and Mid-Term Outcome Data. J Clin Med 2024; 13:2879. [PMID: 38792421 PMCID: PMC11121963 DOI: 10.3390/jcm13102879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is a standard-of-care treatment in the rhythm control strategy of symptomatic atrial fibrillation (AF). Ablation protocols, varying in the power and duration of energy delivery, have changed rapidly in recent years. Very high-power very short-duration ablation (vHPvSD) is expected to shorten procedural times compared to conventional ablation approaches. However, the existing data suggest that this might come at the cost of lower first-pass isolation rates, a predictor of poor ablation long-term outcomes. This study aims to compare a vHPvSD protocol to a hybrid strategy, in which the power and duration of the energy transfer are adapted depending on the anatomical location. Methods: We retrospectively analyzed procedural and outcome data from 93 patients (55 vHPvSD vs. 38 hybrid) scheduled for de novo pulmonary vein isolation. A vHPvSD ablation protocol (90 Watt (W), 4 s) was compared to a hybrid protocol using vHPvSD on the posterior wall and 50 W HPSD (high-power short-duration) ablation guided by the Ablation Index along the remaining spots. Results: Ablation times were significantly shorter in the vHPvSD cohort (5.4 min. vs. 14.2 min, p < 0.001), thus resulting in a significant reduction in the overall procedural duration (91 min vs. 106 min, p = 0.003). The non-significant slightly higher first-pass isolation rates in the vHPvSD cohort (85% vs. 76%, p = 0.262) did not affect freedom from AF 6 months after the procedure (83% vs. 87%, p = 0.622). Conclusions: vHPvSD helps in shortening the PVI procedural duration, thus neither affecting first-pass isolation rates nor freedom from atrial tachyarrhythmia recurrence at 6 months after the index procedure.
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Affiliation(s)
| | - Martin Martinek
- Department of Cardiology, Ordensklinikum Linz GmbH, 4020 Linz, Austria; (M.M.); (M.D.); (G.K.); (H.P.)
| | - Michael Derndorfer
- Department of Cardiology, Ordensklinikum Linz GmbH, 4020 Linz, Austria; (M.M.); (M.D.); (G.K.); (H.P.)
| | - Georgios Kollias
- Department of Cardiology, Ordensklinikum Linz GmbH, 4020 Linz, Austria; (M.M.); (M.D.); (G.K.); (H.P.)
| | - Peter Ammann
- Department of Cardiology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz GmbH, 4020 Linz, Austria; (M.M.); (M.D.); (G.K.); (H.P.)
| | - Sebastian Seidl
- Department of Cardiology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland;
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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:S1547-5271(24)00261-3. [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] [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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Wang Y, Lai HL, Chen Q, Liu H, Liu QM, Huang WB, Tao Y, Xiong Q, Zhou N, Zhao C, Qiu J, Xu Z, Wang DW. Application of a circular-shaped pulsed field ablation catheter with magnetic sensors for pulmonary vein isolation: a multi-centre clinical study report. Europace 2024; 26:euae068. [PMID: 38584395 PMCID: PMC10999647 DOI: 10.1093/europace/euae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/24/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS A few studies have reported the effect and safety of pulsed field ablation (PFA) catheters for ablating atrial fibrillation (AF), which were mainly based on basket-shaped or flower-shaped designs. However, the clinical application of a circular-shaped multi-electrode catheter with magnetic sensors is very limited. To study the efficacy and safety of a PFA system in patients with paroxysmal AF using a circular-shaped multi-electrode catheter equipped with magnetic sensors for pulmonary vein isolation (PVI). METHODS AND RESULTS A novel proprietary bipolar PFA system was used for PVI, which utilized a circular-shaped multi-electrode catheter with magnetic sensors and allowed for three-dimensional model reconstruction, mapping, and ablation in one map. To evaluate the efficacy, efficiency, and safety of this PFA system, a prospective, multi-centre, single-armed, pre-market clinical study was performed. From July 2021 to December 2022, 151 patients with paroxysmal AF were included and underwent PVI. The study examined procedure time, immediate success rate, procedural success rate at 12 months, and relevant complications. In all 151 patients, all the pulmonary veins were acutely isolated using the studied system. Pulsed field ablation delivery was 78.4 ± 41.8 times and 31.3 ± 16.7 ms per patient. Skin-to-skin procedure time was 74.2 ± 29.8 min, and fluoroscopy time was 13.1 ± 7.6 min. The initial 11 (7.2%) cases underwent procedures with deep sedation anaesthesia, and the following cases underwent local anaesthesia. In the initial 11 cases, 4 cases (36.4%) presented transient vagal responses, and the rest were all successfully preventatively treated with atropine injection and rapid fluid infusion. No severe complications were found during or after the procedure. During follow-up, 3 cases experienced atrial flutter, and 11 cases had AF recurrence. The estimated 12-month Kaplan-Meier of freedom from arrhythmia was 88.4%. CONCLUSION The PFA system, comprised of a circular PFA catheter with magnetic sensors, could rapidly achieve PVI under three-dimensional guidance and demonstrated excellent safety with comparable effects.
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Affiliation(s)
- Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
| | - Heng Li Lai
- Division of Cardiology, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Qi Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Liu
- Division of Cardiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qi Ming Liu
- Division of Cardiology, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Wei Bin Huang
- Division of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yu Tao
- Division of Cardiology, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Qingmei Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
| | - Ziqin Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, 430030 Wuhan, China
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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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Boga M, Orbán G, Perge P, Salló Z, Tanai E, Ferencz AB, Tóth P, Komlósi F, Osztheimer I, Nagy KV, Merkely B, Gellér L, Szegedi N. Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation. J Clin Med 2024; 13:1960. [PMID: 38610727 PMCID: PMC11012634 DOI: 10.3390/jcm13071960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (M.B.); (G.O.)
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Zeng L, Chen S, Zeng R, Hu H, Yang Q, Cui K, Chen Q, Fu H, Pu X. CLOSE protocol versus lower ablation index value for paroxysmal atrial fibrillation: A randomized noninferior clinical trial. J Cardiovasc Electrophysiol 2024; 35:469-477. [PMID: 38282257 DOI: 10.1111/jce.16194] [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: 10/12/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The optimized ablation index (AI) value for catheter ablation of atrial fibrillation (AF) remains to be defined. We aimed to compare the efficacy and safety of CLOSE protocol and lower AI protocol in paroxysmal AF. METHODS AND RESULTS Patients with symptomatic, drug-resistant paroxysmal AF for first ablation were prospectively enrolled from September 2020 to January 2022. The patients were randomly divided into CLOSE group (AI ≥ 550 for anterior/roof segments and ≥400 for posterior/inferior segments) and lower AI group (AI ≥ 450 for anterior/roof segments and ≥350 for posterior/inferior segments). First-pass isolation, acute pulmonary vein (PV) reconnections, 1-year arrhythmia recurrence, and major complications were assessed. Of the 270 enrolled patients, 238 completed 1-year follow-up (118 in CLOSE group and 120 in lower AI group). First-pass isolation in left PVs was higher in CLOSE group (71.2% vs. 53.3%, p = .005). Acute PV reconnections were comparable between groups (9.3% vs. 14.2%, p = .246). At 1 year, 86.4% in CLOSE group versus 81.7% in lower AI group were free from atrial arrhythmia (log rank p = .334). The proportion difference was -4.8% (95% CI: -14.1% to 4.6%), and p = .475 for noninferiority. Stroke occurred in four patients of lower AI group, and no cardiac tamponade, atrioesophageal fistula, major bleeding or death occurred post procedure. CONCLUSION For patients with paroxysmal AF and treated by AI-guided PV ablation, lower AI is not noninferior to CLOSE protocol.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyong Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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10
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Kreidieh O, Hunter TD, Goyal S, Varley AL, Thorne C, Osorio J, Silverstein J, Varosy P, Metzl M, Leyton-Mange J, Singh D, Rajendra A, Moretta A, Zei PC. Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL-AF registry. J Cardiovasc Electrophysiol 2024; 35:440-450. [PMID: 38282445 DOI: 10.1111/jce.16190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION During atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long-term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI. METHODS We reviewed AFA procedures in a multicenter prospective registry of AFA (REAL-AF). A multivariate ordinal logistic regression, weighted by inverse proceduralist volume, was used to determine predictors of FPI. RESULTS A total of 2671 patients were included with 1806 achieving FPI in both vein sides, 702 achieving FPI in one, and 163 having no FPI. Individually, age, left atrial (LA) scar, higher power usage (50 W), greater posterior contact force, ablation index >350 posteriorly, Vizigo™ sheath utilization, nonstandard ventilation, and high operator volume (>6 monthly cases) were all related to improved odds of FPI. Conversely sleep apnea, elevated body mass index (BMI), diabetes mellitus, LA enlargement, antiarrhythmic drug use, and center's higher fluoroscopy use were related to reduced odds of FPI. Multivariate analysis showed that BMI > 30 (OR 0.78 [0.64-0.96]) and LA volume (OR per mL increase = 1.00 [0.99-1.00]) predicted lower odds of achieving FPI, whereas significant left atrial scarring (>20%) was related to higher rates of FPI. Procedurally, the use of high power (50 W) (OR 1.32 [1.05-1.65]), increasing force posteriorly (OR 2.03 [1.19-3.46]), and nonstandard ventilation (OR 1.26 [1.00-1.59]) predicted higher FPI rates. At a site level, high procedural volume (OR 1.89 [1.48-2.41]) and low fluoroscopy centers (OR 0.72 [0.61-0.84]) had higher rates of FPI. CONCLUSION FPI rates are affected by operator experience, patient comorbidities, and procedural strategies. These factors may be postulated to impact acute lesion formation.
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Affiliation(s)
- Omar Kreidieh
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tina D Hunter
- CTI Clinical Trial and Consulting, Covington, Kentucky, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | | | - Jose Osorio
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul Varosy
- Medicine-Cardiology, University of Colorado, Denver, Aurora, Colorado, USA
| | - Mark Metzl
- NorthShore University Health System, Bannockburn, Illinois, USA
| | | | - David Singh
- John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Zhao Y, Yuan X, Xie Y, Yin X, Liu Y, Sun Y, Gong Y, Liu J, Chen F. Association of Preablation Plasma Corin Levels With Atrial Fibrillation Recurrence After Catheter Ablation: A Prospective Observational Study. J Am Heart Assoc 2024; 13:e031928. [PMID: 38214265 PMCID: PMC10926783 DOI: 10.1161/jaha.123.031928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND We assessed the impact of pre- and postprocedural plasma corin levels on the recurrence of atrial fibrillation (AF) after catheter ablation (CA). METHODS AND RESULTS This prospective, single-center, observational study included patients undergoing their first CA of AF. Corin was measured before and 1 day after CA. The primary end point was recurrent AF between 3 and 12 months after ablation. From April 2019 through May 2021, we analyzed 616 patients with AF (59.09% men) with a mean age of 62.86±9.42 years. Overall, 153 patients (24.84%) experienced recurrent AF. In the recurrence group, the pre- and postprocedure corin concentrations were 539.14 (329.24-702.08) and 607.37 (364.50-753.80) pg/mL, respectively, which were significantly higher than the nonrecurrence group's respective concentrations of 369.05 (186.36-489.28) and 489.12 (315.66-629.05) pg/mL (both P<0.0001). A multivariate Cox regression analysis with confounders found that elevated preablation corin levels were significantly associated with an increased risk of AF recurrence after CA. Receiver operating characteristic curve analysis identified that a preablation corin threshold of >494.85 pg/mL predicted AF recurrence at 1 year. An increase of 1 SD in corin concentrations before CA (264.94 pg/mL) increased the risk of recurrent AF by 54.3% after adjusting for confounding variables (hazard ratio, 1.465 [95% CI, 1.282-1.655]; P<0.0001). CONCLUSIONS Plasma corin levels at baseline is a valuable predictor of AF recurrence after CA, independent of established conventional risk factors. Risk stratification before ablation for AF may be useful in selecting treatment regimens for patients.
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Affiliation(s)
- Yichang Zhao
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Xiaoyang Yuan
- Department of Laboratory MedicineThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yunpeng Xie
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Xiaomeng Yin
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Ying Liu
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuanjun Sun
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yue Gong
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Jinqiu Liu
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Feifei Chen
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
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12
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Badertscher P, Knecht S. Pedal to the metal: is vHPSD RF ablation now reaching its full potential? J Interv Card Electrophysiol 2024; 67:21-23. [PMID: 37382824 DOI: 10.1007/s10840-023-01599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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13
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Okamatsu H, Okumura K, Onishi F, Yoshimura A, Negishi K, Tanaka Y, Tsurugi T, Nakao K, Sakamoto T, Koyama J. Predictors of pulmonary vein non-reconnection in the second procedure after ablation index-guided pulmonary vein isolation for atrial fibrillation and its impact on the outcome. J Cardiovasc Electrophysiol 2023; 34:2452-2460. [PMID: 37787003 DOI: 10.1111/jce.16084] [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: 08/03/2023] [Revised: 09/04/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Although first-pass isolation (FPI) of the pulmonary vein (PV) has been suggested as a marker for PV isolation (PVI) durability, it has not been confirmed. Non-PV atrial fibrillation (AF) triggers were the main target in patients without PV reconnection in the second ablation procedure, but the outcome was unclear. We aimed to validate FPI as a marker of PVI durability and evaluate the outcome after the second procedure in patients without PV reconnection by comparing it to those with reconnection. METHODS Among the 2087 patients undergoing the first ablation index-guided radiofrequency AF ablation, 309 with atrial tachyarrhythmias (ATs) recurrence and undergoing the second procedure were studied. Clinical characteristics and outcomes were compared between the patients without PV reconnection (PV non-reconnection group, n = 142) and with reconnection (PV reconnection group, n = 167). RESULTS FPI in both PV sides in the first ablation procedure was significantly more frequent in the PV non-reconnection group (77.5%) than in the PV reconnection group (45.5%) (p < .001). Multivariate logistic regression analysis revealed that FPI (odds ratio, 3.71 [95% confidence interval, 2.23-6.19], p < .001) was the only predictor of PV non-reconnection. Radiofrequency applications for non-PV AF triggers were more frequently performed in the PV non-reconnection group (40.8% vs. 24.6%, respectively, p < .001). Kaplan-Meier analysis revealed that AT recurrence-free rate was significantly lower in the PV non-reconnection group (1-year recurrence-free rate, 62.7% vs. 75.4%, respectively; p = .01 by log-rank test). CONCLUSION FPI was the only independent predictor of PV non-reconnection. Despite aggressive ablation for non-PV triggers, AT recurrence was more frequent in patients with PV non-reconnection.
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Affiliation(s)
- Hideharu Okamatsu
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Fumitaka Onishi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Akino Yoshimura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kodai Negishi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yasuaki Tanaka
- Division of Cardiology, Saiseikai Misumi Hospital, Kumamoto, Japan
| | - Takuo Tsurugi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Junjiro Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
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14
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, Romero JE. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:2573-2583. [PMID: 37804258 DOI: 10.1016/j.jacep.2023.08.005] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. OBJECTIVES This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. METHODS Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. RESULTS A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. CONCLUSIONS There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
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Affiliation(s)
- Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA; Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Te
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Benjamin D'Souza
- Cardiac Arrythmia Program, Cardiology Service, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Mohit Rastogi
- Electrophysiology Department, Heart and Vascular Service, University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | | | - Laura C Ibanez
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Osorio J, Zei PC, Díaz JC, Varley AL, Morales GX, Silverstein JR, Oza SR, D'Souza B, Singh D, Moretta A, Metzl MD, Hoyos C, Matos CD, Rivera E, Magnano A, Salam T, Nazari J, Thorne C, Costea A, Thosani A, Rajendra A, Romero JE. High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:1543-1554. [PMID: 37294263 DOI: 10.1016/j.jacep.2023.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined. OBJECTIVES This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF). METHODS In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months. RESULTS A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications. CONCLUSIONS HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan C Díaz
- Cardiac Arrhythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Saumil R Oza
- Ascension Medical Group, St Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - David Singh
- The Queens Medical Center, Honolulu, Hawaii, USA
| | | | - Mark D Metzl
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefania Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tariq Salam
- MultiCare Pulse Heart Institute, Tacoma, Washington, USA
| | - Jose Nazari
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | | | - Alexandru Costea
- Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, UC Heart, Lung, and Vascular Institute, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Baden, Pennsylvania, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Cai C, Wang J, Niu HX, Chu JM, Hua W, Zhang S, Yao Y. Clinical outcome of lesion size index-guided high-power radiofrequency catheter ablation for pulmonary vein isolation in patients with atrial fibrillation: 2-year follow-up. J Cardiovasc Electrophysiol 2023; 34:546-555. [PMID: 36640429 DOI: 10.1111/jce.15809] [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: 08/31/2022] [Revised: 12/03/2022] [Accepted: 01/04/2023] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The long-term efficacy of high-power (50 W) ablation guided by lesion size index (LSI-guided HP) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains undetermined. Our study sought to assess the clinical efficacy of LSI-guided HP ablation for PVI in patients with AF and explore the potential predictors associated with clinical outcomes. METHODS We consecutively included 186 patients with AF who underwent LSI-guided HP (50 W) ablation at Fuwai Hospital from June 2019 to October 2021. The target LSI values of 4.5-5.5 and 4.0-4.5 at the anterior and posterior walls, respectively, were used in our study. The baseline clinical characteristics, procedural and ablation data, and clinical outcomes were evaluated. The independent potential predictors associated with AF recurrence were further evaluated. RESULTS The incidence rate of first-pass PVI was 83.9% (156/186). A total of 11 883 lesions were analyzed, and compared with posterior walls of pulmonary veins, anterior walls had significantly lower mean contact force (8.2 ± 3.0 vs. 8.3 ± 2.3 g, p = .015), longer mean radiofrequency duration (16.9 ± 7.2 vs. 12.9 ± 4.5 s, p < .001) and higher mean LSI (4.8 ± 0.2 vs. 4.4 ± 0.2, p < .001). The overall incidence of periprocedural complications was 3.7%, and steam pops without pericardial effusion occurred in three patients (1.6%). During a mean follow-up of 24.0 ± 8.4 months, the overall AF recurrence-free survival was 87.1% after a single procedure. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than those with persistent AF (91.2% vs. 80.8%, log-rank p = .034). Higher LSI (HR 0.50, p < .001) and paroxysmal AF (HR 0.39, p = .029) were significantly associated with decreased AF recurrence. By receiver operating characteristic analysis, the LSI of 4.7 and 4.3 for the anterior and posterior walls of the PVs had the highest predictive value for AF recurrence, respectively. CONCLUSION LSI-guided HP (50 W) ablation for PVI was an efficient and safe strategy and led to favorable single-procedure 2-year AF recurrence-free survival in patients with AF. Higher LSI and paroxysmal AF were independent predictors of decreased 2-year AF recurrence. The LSI of 4.7 for the anterior wall and 4.3 for the posterior wall of the PVs were the best cutoff values for predicting AF recurrence after LSI-guided HP ablation.
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Affiliation(s)
- Chi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Xia Niu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Min Chu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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O'Neill L, El Haddad M, Berte B, Kobza R, Hilfiker G, Scherr D, Manninger M, Wijnmaalen AP, Trines SA, Wielandts JY, Gillis K, Lycke M, De Becker B, Tavernier R, Le Polain De Waroux JB, Knecht S, Duytschaever M. Very High-Power Ablation for Contiguous Pulmonary Vein Isolation: Results From the Randomized POWER PLUS Trial. JACC Clin Electrophysiol 2022; 9:511-522. [PMID: 36752467 DOI: 10.1016/j.jacep.2022.10.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Very high-power, short-duration (90-W/4-second) ablation for pulmonary vein isolation (PVI) may reduce procedural times. However, shorter applications with higher power may impact lesion quality. OBJECTIVES In this multicenter, randomized controlled trial, we compared procedural efficiency, efficacy, and safety of PVI using 90-W/4-second ablation to 35/50-W ablation. METHODS Patients with paroxysmal or persistent atrial fibrillation undergoing first-time PVI were randomized to pulmonary vein encirclement with contiguous applications using very high-power, short-duration applications (90 W over 4 seconds) or 35/50-W applications (titrated up to ablation index >550 anteriorly and >400 posteriorly). Prospective endpoints were procedural efficiency (procedure time and first-pass isolation), safety (including esophageal endoscopic evaluation), and 6-month effectiveness using repetitive Holter monitoring. RESULTS One hundred eighty patients were randomized, 90 to the 90-W group (mean age: 64.2 ± 8.9 years) and 90 to the 35/50-W group (mean age: 62.3 ± 10.8 years). Procedural time was shorter in the 90-W group vs the 35/50-W group (70 [interquartile range: 60-80] vs 75 [interquartile range: 65-88.3] minutes; P = 0.009). A nonsignificant trend towards lower rates of first-pass isolation was seen in the 90-W group (83.9% vs 90%; P = 0.0852). No major complications were observed in both groups with esophageal injury occurring in 1 patient per group. At 6 months, 17% of patients in the 90-W group vs 15% in the 35/50-W group experienced recurrent arrhythmia (P = 0.681). CONCLUSIONS Contiguous ablation using very high-power, short-duration applications results in a significant but modest reduction in procedure time with similar safety and 6-month efficacy vs a conventional approach. A hybrid approach combining both ablation modalities might be the most optimal strategy. (POWER PLUS [Very High Power Ablation in Patients With Atrial Fibrillation Schedule for a First Pulmonary Vein Isolation]; NCT04784013).
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Affiliation(s)
- Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium; Luzerner Kantonsspital, Luzern, Switzerland
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Kris Gillis
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
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Huang L, Gao M, Lai Y, Guo Q, Li S, Li C, Liu N, Wang W, Liu X, Zuo S, Guo X, Zhao X, Jiang C, Sang C, Tang R, Long D, Du X, Dong J, Ma CS. The adjunctive effect for left pulmonary vein isolation of vein of Marshall ethanol infusion in persistent atrial fibrillation. Europace 2022; 25:441-449. [PMID: 36504017 PMCID: PMC9935035 DOI: 10.1093/europace/euac219] [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: 07/29/2022] [Accepted: 10/23/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study sought to assess the effect of ethanol infusion into the vein of Marshall (EIVOM) on the acute success of left pulmonary vein (LPV) isolation in persistent atrial fibrillation (PeAF). METHODS AND RESULTS A total of 313 patients with drug-resistant PeAF were enrolled (135 in Group 1 and 178 in Group 2). In Group 1, EIVOM was firstly performed, followed by radiofrequency ablation (RFA) including bilateral pulmonary vein isolation (PVI) and linear ablation at roofline, cavotricuspid isthmus, and mitral isthmus (MI). In Group 2, PVI and linear ablations were completed with RFA. First-pass isolation of the LPV was achieved in 119 (88.1%) and 132 (74.2%) patients in Groups 1 and 2, respectively (P = 0.002). The rate of acute pulmonary vein reconnection (PVR) was significantly lower in Group 1 (9.6% vs. 22.5%, P = 0.003). About half of acute PVR occurred in the carina with or without EIVOM. CONCLUSION EIVOM is effective in achieving a higher first-pass isolation and a lower acute PVR of LPV in PeAF.
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Affiliation(s)
- Lihong Huang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Mingyang Gao
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Yiwei Lai
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Qi Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Songnan Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Changyi Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Nian Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Xiaoxia Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Song Zuo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Xin Zhao
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Caihua Sang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Ribo Tang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Deyong Long
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Xin Du
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Rd, Chaoyang District, 100029 Beijing, China
| | - Chang-sheng Ma
- Corresponding author. Fax: 86-10-84005361. E-mail address:
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19
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Rordorf R, Iacopino S, Verlato R, Arena G, Tondo C, Molon G, Manfrin M, Rovaris G, Perego GB, Sciarra L, Mantica M, Sacchi R, Pieragnoli P. Role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01430-7. [DOI: 10.1007/s10840-022-01430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
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20
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Salló Z, Perge P, Balogi B, Orbán G, Piros K, Herczeg S, Nagy KV, Osztheimer I, Ábrahám P, Merkely B, Gellér L, Szegedi N. Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:935705. [PMID: 35872909 PMCID: PMC9300971 DOI: 10.3389/fcvm.2022.935705] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHigh-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.MethodsOne hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).ResultsBilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001).ConclusionOur prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.
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21
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Boussoussou M, Szilveszter B, Vattay B, Kolossváry M, Vecsey-Nagy M, Salló Z, Orbán G, Péter P, Katalin P, Vivien NK, István O, Maurovich-Horvat P, Merkely B, Gellér L, Szegedi N. The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation. Int J Cardiovasc Imaging 2022; 38:1601-1611. [PMID: 35138472 PMCID: PMC11142952 DOI: 10.1007/s10554-022-02533-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
Abstract
Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHA2DS2-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.
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Affiliation(s)
- Melinda Boussoussou
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary.
| | - Bálint Szilveszter
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Borbála Vattay
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Márton Kolossváry
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Milán Vecsey-Nagy
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Zoltán Salló
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Gábor Orbán
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Perge Péter
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Piros Katalin
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Nagy Klaudia Vivien
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Osztheimer István
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | | | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - László Gellér
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
| | - Nándor Szegedi
- Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary
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22
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Skeete J, Sharma PS, Kenigsberg D, Pietrasik G, Osman AF, Ravi V, Du‐Fay‐de‐Lavallaz JM, Post Z, Wasserlauf J, Larsen TR, Krishnan K, Trohman R, Huang HD. Wide area circumferential ablation for pulmonary vein isolation using radiofrequency versus laser balloon ablation. J Arrhythm 2022; 38:336-345. [PMID: 35785385 PMCID: PMC9237344 DOI: 10.1002/joa3.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/27/2022] [Accepted: 04/15/2022] [Indexed: 12/22/2022] Open
Abstract
Background Persistent atrial fibrillation (AF) is associated with high recurrence rates of AF and atypical atrial flutters or tachycardia (AFT) postablation. Laser balloon (LB) ablation of the pulmonary vein (PV) ostia has similar efficacy as radiofrequency wide area circumferential ablation (RF‐WACA); however, an approach of LB wide area circumferential ablation (LB‐WACA) may further improve success rates. Objective To evaluate freedom from atrial tachyarrhythmia (AFT/AF) recurrence postablation using RF‐WACA versus LB‐WACA in persistent AF patients. Methods This was a retrospective multicenter study. Patients were followed for up to 24 months via office visits, Holter, and/or device monitoring. The primary endpoint was freedom from AFT/AF after a single ablation procedure. Secondary endpoints included freedom from AF, freedom from AFT, first‐pass isolation of all PVs, and procedural complications. Results Two hundred and four patients were studied (LB‐WACA: n = 103; RF‐WACA: n = 101). Patients’ baseline characteristics were similar except patients in the RF‐WACA group were older (64 vs. 68, p = .03). First‐pass isolation was achieved more often during LBA (LB‐WACA: 88% vs. RF‐WACA 75%; p = .04). Procedure (p = .36), LA dwell (p = .41), and fluoroscopy (p = .44) time were similar. The mean follow‐up was 506 ± 279 days. Sixty‐six patients had arrhythmic events including 24 AFT and 59 AF recurrences. LB‐WACA group had higher arrhythmia‐free survival (p = .009) after single ablation procedures. In the multivariate Cox regression model, RF‐WACA was associated with a higher recurrence of AFT compared with LB‐WACA (Adjusted HR 3.16 [95% CI: 1.13–8.83]; p = .03). Conclusions LB‐WACA was associated with higher freedom from atrial arrhythmias mostly driven by the lower occurrence of AFT compared with RF‐WACA.
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Affiliation(s)
- Jamario Skeete
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | | | - David Kenigsberg
- Florida Heart Rhythm Specialists Westside Medical Center Fort Lauderdale Florida USA
| | | | - Ahmed F. Osman
- Florida Heart Rhythm Specialists Westside Medical Center Fort Lauderdale Florida USA
| | - Venkatesh Ravi
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | | | - Zoe Post
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | | | - Timothy R. Larsen
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | - Kousik Krishnan
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | - Richard Trohman
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
| | - Henry D. Huang
- Division of Cardiology Rush University Medical Center Chicago Illinois USA
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Gupta D, Calvert P. Very High Power Very Short Duration Ablation for Atrial Fibrillation: with great power comes great responsibility. J Cardiovasc Electrophysiol 2022; 33:928-931. [PMID: 35233877 DOI: 10.1111/jce.15432] [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: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
For all the advances This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Liverpool, UK
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Liverpool, UK
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24
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Okamatsu H, Okumura K, Kaneko S, Negishi K, Hayashi K, Tsurugi T, Tanaka Y, Nakao K, Sakamoto T, Koyama J. Ablation Index-Guided High-Power Radiofrequency Application Shortens the Procedure Time With Similar Outcomes to Conventional Power Application in Atrial Fibrillation Ablation. Circ Rep 2021; 3:559-568. [PMID: 34703933 PMCID: PMC8492404 DOI: 10.1253/circrep.cr-21-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background:
The impact of high-power radiofrequency (RF) application in ablation index (AI)-guided atrial fibrillation (AF) ablation has not been elucidated. Methods and Results:
We investigated 1,333 patients undergoing first AF ablation (median age 68 years; interquartile range [IQR] 61–73 years). The first 301 patients underwent AI-guided conventional power RF application (CP group), whereas the following 1,032 patients underwent high-power RF application (HP group). The minimum AI target values were 400, 360, and 260 at the left atrial anterior wall, posterior wall, and esophagus, respectively. RF power in the CP group was 30–40, 20–25, and 20 W at the anterior wall, posterior wall, and esophagus, respectively, compared with 50, 40, and 25, respectively, in the HP group. Procedure time was shorter in the HP than CP group (median 153 [IQR 129–190] vs. 180 (IQR 152–229) min; P<0.0001). The percentage of first-pass pulmonary vein isolation (69% vs. 73%; P=0.07) and all procedure-related complications (2.0% vs. 3.4%; P=0.19) was similar. Kaplan-Meier analysis showed similar recurrence-free survival (RFS) for all AF types. Respective 1-year RFS in the CP and HP groups was 82% and 87% in paroxysmal AF, 78% and 82% in persistent AF, and 59% and 58% in long-standing persistent AF. Conclusions:
In AI-guided AF ablation, high-power RF application shortens the procedure time without increasing complications and with similar outcomes.
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Affiliation(s)
- Hideharu Okamatsu
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Shozo Kaneko
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Kodai Negishi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Katsuhide Hayashi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Takuo Tsurugi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Yasuaki Tanaka
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
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25
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Katić J, Anić A, Brešković T, Jurišić Z. Higher than recommended lesion size index target values for pulmonary vein isolation result in better clinical outcomes in paroxysmal atrial fibrillation patients. J Interv Card Electrophysiol 2021; 64:463-468. [PMID: 34453647 DOI: 10.1007/s10840-021-01053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Catheter ablation is a cornerstone of the therapy for paroxysmal atrial fibrillation. The importance of effective lesion size formation during pulmonary vein isolation is gauged through conduction recovery and recurrence of arrhythmia. Therefore, the lesion size index (LSI) is designed to utilize traditional intraprocedural parameters and predict procedural success. The impact of the optimal LSI index and the respective segments of the pulmonary veins has not been commonly evaluated. We aimed to assess whether higher and targeted LSI on the different segments of pulmonary veins could actually lead to better clinical outcomes of paroxysmal atrial fibrillation ablation. METHODS Retrospective analyses of drug-refractory paroxysmal atrial fibrillation patients who underwent first catheter ablation were conducted. Targeted LSI of 6.5 at the anterior wall and 5.2 at the posterior wall, roof, and floor of the pulmonary vein was applied. The primary endpoint was defined as arrhythmias recurrence assessed by routine electrocardiograms and 24-h ambulatory electrocardiographic monitoring at 3, 6, and 12 months post-ablation. RESULTS Among the included 39 patients, the single-procedure 12-month freedom from arrhythmias was reached in 92.3% of patients. Interestingly, there was no tendency towards an increased number of adverse effects using a higher LSI index. CONCLUSIONS Atrial fibrillation ablation guided by targeted LSI value showed efficiency on the freedom from arrhythmias during 1-year follow-up period without harmful effects.
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Affiliation(s)
- Josip Katić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia.
| | - Ante Anić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Toni Brešković
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Zrinka Jurišić
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
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26
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[Pulmonary vein isolation using radiofrequency ablation]. Herzschrittmacherther Elektrophysiol 2021; 32:395-405. [PMID: 34309747 DOI: 10.1007/s00399-021-00794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Catheter ablation represents the primary treatment for most arrhythmias. The effectiveness of catheter ablation for the treatment of atrial fibrillation is superior to drug therapy. Therefore, catheter ablation has been established as an increasingly common procedure in clinical routine. In this context, the electrical isolation of the pulmonary veins (PVI) constitutes the cornerstone of the interventional therapy of paroxysmal and persistent atrial fibrillation. This article describes the procedure of pulmonary vein isolation utilizing radiofrequency point-by-point ablation. It shall be a practical guide for the staff in the electrophysiological laboratory. This article continues a series of manuscripts focusing on interventional electrophysiology topics in the course of EP (electrophysiology) training.This article describes the procedure of pulmonary vein isolation utilizing radiofrequency point-by-point ablation. It shall be a practical guide for the staff in the electrophysiological laboratory. This article continues a series of manuscripts dealing with topics of interventional electrophysiology in the course of EP training.
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