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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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Zhang R, Chu H, Liu S, Yang B, Han B, Xiao X, Ma C, Sun Y, Yin X, Xia Y, Gao L. Catheter ablation of atrial fibrillation using FireMagic TrueForce ablation catheter: The TRUEFORCE trial. Pacing Clin Electrophysiol 2023; 46:986-993. [PMID: 37334721 DOI: 10.1111/pace.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The use of contact force (CF) sensing catheters has provided a revolutionary improvement in catheter ablation (CA) of atrial fibrillation (AF) in the past decade. However, the success rate of CA for AF remains limited, and some complications still occur. METHODS The TRUEFORCE trial (Catheter Ablation of Atrial Fibrillation using FireMagic TrueForce Ablation Catheter) is a multicenter, prospective, single-arm objective performance criteria study of AF patients who underwent their first CA procedure using FireMagic TrueForce ablation catheter. RESULTS A total of 120 patients (118 with paroxysmal AF) were included in this study, and 112 patients included in the per-protocol analysis. Pulmonary vein isolation (PVI) was achieved in 100% of the patients, with procedure and fluoroscopy time of 146.63 ± 40.51 min and 12.89 ± 5.59 min, respectively. Freedom from recurrent atrial arrhythmia after ablation was present 81.25% (95% confidence interval [CI]: 72.78%-88.00%) of patients. No severe adverse events (death, stroke/transient ischemic attack [TIA], esophageal fistula, myocardial infarction, thromboembolism, or pulmonary vein stenosis) were detected during the follow-up. Four (4/115, 3.33%) adverse events were documented, including one abdominal discomfort, one femoral artery hematoma, one coughing up blood, and one postoperative palpitation and insomnia. CONCLUSIONS This study demonstrated the clinical feasibility of FireMagic force-sensing ablation catheter in CA of AF, with a satisfactory short- and long-term efficacy and safety.
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Affiliation(s)
- Rongfeng Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huimin Chu
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai, China
| | - Bing Yang
- Department of Cardiology, Dongfang Hospital Affiliated to Tongji University, Shanghai, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Xianjie Xiao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chengming Ma
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuanjun Sun
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Gu K, Yan S, Wu X. Influence of pulsating intracardiac blood flow on radiofrequency catheter ablation outcomes in an anatomy-based atrium model. Int J Hyperthermia 2022; 39:1064-1077. [PMID: 35993225 DOI: 10.1080/02656736.2022.2108149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Highly consistent cardiac ablation outcomes through radiofrequency catheter ablation (RFCA) under pulsatile and constant flow profiles (PP&CP) of intracardiac blood were previously indicated by computer modeling, with simplified geometry and lossless receipt of inflow for ablation catheters. This study aimed to further investigate the effects of intracardiac blood pulsatility in an anatomy-based atrium model. METHODS Four pulmonary veins were blood inflows at 10 mm Hg. The mitral valve was the outflow, with PP based on pulsatile velocity curve from clinical measurements, and CP was obtained by averaging the velocity curve under PP over an ablation time of 30 s. A numerical comparison between ablation results under PP and CP, without experimental validation, was performed. RESULTS Temperature fluctuations persisted in mid-myocardium, and most clearly in blood and endocardium under PP. At a constant power of 20 W, marked differences in ablation outcome between PP and CP occurred in the middle of unilateral pulmonary veins and the posterior wall of the left atrium (LA) where the blood velocities were significantly decreased under CP. The mid-myocardial, blood and endocardial temperatures, as well as the effective lesion volume at the former position, were decreased by 4.1%, 15%, 13.6%, and 13.8%, respectively under PP. The extents for the latter position were 11%, 22%, 22.5%, and 55.6%, respectively. CONCLUSION Intracardiac flow pulsatility causes a greater reduction in blood and endocardial temperatures at ablation sites away from the main bloodstream, effective cooling of which is more likely to rely on blood velocities approaching peak PP values.
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Affiliation(s)
- Kaihao Gu
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xiaomei Wu
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China.,Academy for Engineering and Technology, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai, China.,Shanghai Engineering Research Centre of Assistive Devices, Shanghai, China.,Yiwu Research Institute of Fudan University, Yiwu, China
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Effectiveness and Safety of High-Power Radiofrequency Ablation Guided by Ablation Index for the Treatment of Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5609764. [PMID: 35991126 PMCID: PMC9391153 DOI: 10.1155/2022/5609764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Background To investigate the efficacy and safety of ablation index- (AI-) guided high-power radiofrequency ablation in the treatment of atrial fibrillation (AF). Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50 W, 40 W, and 30 W; AI = 500). And a total of 100 consecutive patients with paroxysmal AF undergoing pulmonary vein isolation (PVI) were included. The patients were divided into two groups (n = 50 for each) as follows: control group, treated with conventional power (30 W) ablation mode; and study group, treated with high power (40 W) radiofrequency ablation mode. All groups were treated with the same AI value guided the ablation (target AI = 400/500 on posterior/anterior wall, respectively). Acute pulmonary vein (PV) reconnection was assessed post adenosine administration 20 minutes after ablation. Subsequently, pathological observation of porcine heart lesions and necrotic tissue was performed. Additionally, statistical analyses were carried out on patients' baseline clinical characteristics, surgical data, and total RF energy. Results In swine ventricular endocardial RF applications, compared with 40 W and 30 W, the use of 50 W was associated with shallower tissue lesion depth (p < 0.001) and greater lesion maximum diameter (p < 0.001). Compared with 40 W and 30 W, tissue necrosis caused by 50 W was the deepest and largest (p < 0.001). In pulmonary vein isolation (PVI), there was no significant difference in baseline data between the study group and control group (p > 0.05). In patients with paroxysmal atrial fibrillation, the procedure time in the high-power group was significantly shortened (p < 0.001). The ablation time was significantly shorter (p < 0.001). Compared with control group, RF energy per point and acute pulmonary vein (PV) reconnection were lower (p < 0.001), and first-pass PVI was higher (p < 0.01) in study group. There were no significant differences in complications and sinus rhythm maintenance at 12 months between the two groups (p > 0.05). Conclusions Compared with conventional (30 W) PVI, AI-guided high-power (40 W) was safe and associated with shorter procedure time and reduced acute PV reconnection.
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Liu Z, Liu LF, Liu XQ, Liu J, Wang YX, Liu Y, Liu XP, Yang XC, Chen ML. Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation. Front Cardiovasc Med 2022; 9:949918. [PMID: 35990990 PMCID: PMC9387669 DOI: 10.3389/fcvm.2022.949918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ablation in a milder AI-targeting setting are unknown. The goal of this study was to explore the efficacy and safety of HP-AI-guided ablation in a milder AI-targeting setting. Methods Patients who underwent pulmonary vein isolation (PVI) for AI-guided atrial fibrillation ablation in our center were enrolled and divided into 2 groups according to the ablation power used. In the HP-AI group, the ablation power was over 45 W, while the low power-AI group was ablated with <35 W power. The targeted AIs were 450–500 in the anterior wall and 350–400 in the posterior wall. The efficacy outcome was expressed as the single-procedure atrial arrhythmia-free survival between 91 days and 1 year. Safety outcomes included severe adverse events (SAEs), including symptomatic pulmonary vein (PV) stenosis, atrioesophagal fistula, cardiac tamponade, stroke, thromboembolism events, myocardial infarction, and major bleeding. Results A total of 134 patients were enrolled, of whom 74 underwent PVI using HP-AI, while 60 received low power-AI ablation. After a mean follow-up time of 7.4 months, 22 (16.4%) patients showed arrhythmia recurrence: 5 (6.8%) patients in the HP-AI group and 17 (28.3%) patients in the low power-AI group. The HP-AI group showed a significantly higher arrhythmia-free survival than the low power-AI group (p = 0.011). Two patients in the low power-AI group and 1 patient in the HP-AI group developed an SAE (p = NS). Compared with the low power-AI group, the HP-AI group demonstrated a higher PV first-pass isolation rate, shorter ablation time, and fewer patients with anatomical leakages and sites of unreached AI. Conclusion In a milder AI setting, HP-AI ablation might result in significantly higher arrhythmia-free survival than low power-AI ablation and a similar safety profile.
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Gasimova NZ, Nechepurenko AA, Kropotkin EB, Ivanitsky EA, Kolunin GV, Shavshin DA, Antolic B, Artyukhina EA, Abdrakhmanov AS, Korolev KS, Lebedev DS, Mikhaylov EN. Performance of the ablation index during pulmonary vein isolation: periprocedural data from a multicenter registry. J Interv Card Electrophysiol 2022; 65:167-177. [PMID: 35575867 PMCID: PMC9109667 DOI: 10.1007/s10840-022-01242-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study aimed to assess the achievement of target ablation index (AI) values and their impact on first-pass pulmonary vein isolation (FPI) as well as to identify FPI predictors. METHODS Atrial fibrillation (AF) ablation was performed according to the local practice, and target AIs were evaluated. The actual AI was calculated as the median value of all ablation points for the anterior and posterior left atrial (LA) walls. RESULTS A total of 450 patients from nine centers were enrolled. Patients with first-time ablation (n = 408) were divided into the FPI and non-FPI groups. In the FPI group, a higher median target AI was reported for both the anterior and posterior LA walls than those in the non-FPI group. A higher actual AI was observed for the anterior LA wall in the FPI group. The actual AI was equal to or higher than the target AI for the posterior, anterior, and both LA walls in 54%, 47%, and 35% (n = 158) cases, respectively. Parameters such as hypertension, stroke, ablation power, actual AI value on the anterior wall, target AI values on both LA walls, AI achievement on the posterior wall, carina ablation, and operator experience were all associated with FPI in a univariate logistic regression model; only carina ablation was an independent predictor of FPI. CONCLUSIONS According to our multicenter study, FPI and a target AI were not achieved in a significant proportion of AF ablation procedures. Higher actual and target AI values were associated with FPI, but only carina ablation can independently predict FPI.
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Affiliation(s)
- Nigar Z Gasimova
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia.
| | - Anatoly A Nechepurenko
- Federal Center of Cardiovascular Surgery, 4 Pokrovskaya Roscha str, 414011, Astrakhan, Russia
| | - Evgeny B Kropotkin
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Eduard A Ivanitsky
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Grigorii V Kolunin
- Tyumen Cardiology Research Center, 111 Melnikayte str, 625026, Tyumen, Russia
| | - Dmitry A Shavshin
- Federal Center of High Medical Technologies, 4a Kaliningradskoe highway, 238312, Kaliningrad, Russia
| | - Bor Antolic
- University Medical Center, 7 Zaloska cesta, 1000, Lyublyana, Slovenia
| | - Elena A Artyukhina
- Vishnevskiy National Medical Research Center of Surgery, 27 Bolshaya Serpukhovskaya str, 117997, Moscow, Russia
| | - Ayan S Abdrakhmanov
- National Research Cardiac Surgery Center, 38 Turan ave, 010000, Nur-Sultan, Kazakhstan
| | - Konstantin S Korolev
- Saint-Petersburg Pediatric University, 2 Litovskaya str, 194100, Saint-Petersburg, Russia
| | - Dmitry S Lebedev
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
| | - Evgeny N Mikhaylov
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
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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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