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Fujita S, Kabata E, Nishiyama M, Sakai T, Takeda Y, Yachi Y, Hatasaki K, Chikata A, Usuda K. Efficacy of High-Density Three-Dimensional Mapping for Verapamil-Sensitive Left Posterior Fascicular Ventricular Tachycardia in Pediatric Patients. Pediatr Cardiol 2024; 45:368-376. [PMID: 38071252 DOI: 10.1007/s00246-023-03352-1] [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: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 01/28/2024]
Abstract
In verapamil-sensitive left posterior fascicular ventricular tachycardia (LPF-VT), radiofrequency catheter ablation (RFA) is performed targeting mid-to-late diastolic potential (P1) and presystolic potential (P2) during tachycardia. This study included four patients who had undergone electrophysiological study (EPS) and pediatric patients with verapamil-sensitive LPF-VT who had undergone RFA using high-density three-dimensional (3D) mapping. The included patients were 11-14 years old. During EPS, right bundle branch block and superior configuration VT were induced in all patients. VT mapping was performed via the transseptal approach. P1 and P2 during VT were recorded in three of the four patients. All patients initially underwent RFA via the transseptal approach. In three patients, P1 during VT was targeted, and VT was terminated. The lesion size indices in which VT was terminated were 4.6, 4.6, and 4.7. For one patient whose P1 could not be recorded, linear ablation was performed perpendicularly in the area where P2 was recorded during VT. Among the three patients in whom VT was terminated, linear ablation was performed in two to eliminate the ventricular echo beats. In all patients, VT became uninducible in the acute phase and had not recurred 8-24 months after RFA. High-density 3D mapping with an HD Grid Mapping Catheter allows recording of P1 and P2 during VT and may improve the success rate of RFA in pediatric patients with verapamil-sensitive LPF-VT.
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Affiliation(s)
- Shuhei Fujita
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan.
| | - Eriko Kabata
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Mami Nishiyama
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Tomohide Sakai
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Yoshikatsu Takeda
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Yusuke Yachi
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Kiyoshi Hatasaki
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazuo Usuda
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
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Yamashita S, Mizukami A, Ono M, Hiroki J, Miyakuni S, Ueshima D, Matsumura A, Miyazaki S, Sasano T. Higher power achieves greater local impedance drop, shorter ablation time, and more transmural lesion formation in comparison to lower power in local impedance guided radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1869-1877. [PMID: 37529869 DOI: 10.1111/jce.16025] [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: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Since the local impedance (LI) of the ablation catheter reflects tissue characteristics, the efficacy of higher power (HP) compared to lower power (LP) in LI-guided ablation may differ from other index-guided ablations. OBJECTIVE This study aimed to assess the efficacy of HP ablation in LI-guided ablation of atrial fibrillation (AF). METHODS A prospective observational study was conducted, enrolling patients undergoing de novo ablation for AF. Pulmonary vein isolation was performed using point-by-point ablation with a RHYTHMIA HDxTM Mapping System and an open-irrigated ablation catheter with mini-electrodes (IntellaNav MIFI OI). Ablation was stopped when the LI drop reached 30 ohms, three seconds after the LI plateaued, or when ablation time reached 30 s. To balance the baseline differences, a unique method was used in which the power was changed between HP (45 W to anterior wall/40 W to posterior wall) and LP (35 W/30 W) alternately for each adjacent point. RESULTS A total of 551 ablations in 10 patients were analyzed (HP, n = 276; LP, n = 275). The maximum LI drop was significantly larger (HP: 28.3 ± 5.4 vs. LP: 24.8 ± 6.3 ohm), and the time to minimum LI was significantly shorter (HP: 15.0 ± 6.3 vs. LP: 19.3 ± 6.6 s) in the HP setting. The unipolar electrogram analysis of three patients revealed that the electrogram indicating transmural lesion formation was observed more frequently in the HP setting. CONCLUSION In LI-guided ablation, the HP could achieve a larger LI drop and shorter time to minimum LI, which may result in more transmural lesion formation compared to a LP setting.
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Affiliation(s)
- Shu Yamashita
- Department of Cardiology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Maki Ono
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Jiro Hiroki
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Shota Miyakuni
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Ueshima
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | | | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Conti S, Sabatino F, Fortunato F, Ferrara G, Cascino A, Sgarito G. High-Power Short-Duration Lesion Index-Guided Posterior Wall Isolation beyond Pulmonary Vein Isolation for Persistent Atrial Fibrillation. J Clin Med 2023; 12:5228. [PMID: 37629269 PMCID: PMC10455235 DOI: 10.3390/jcm12165228] [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: 05/08/2023] [Revised: 07/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Background: High-power short-duration (HPSD) radiofrequency (RF) ablation has been adopted to improve atrial fibrillation (AF) ablation. Although the role of HPSD is well-established in pulmonary vein isolation (PVI), fewer data have assessed the impact of HPSD when addressing extra-pulmonary veins (PVs) targets. Therefore, this study aims to determine the safety, effectiveness, and acute outcomes of HPSD lesion index (LSI)-guided posterior wall isolation (PWI) in addition to PVI as an initial strategy in persistent atrial fibrillation (Pe-AF). Methods: Consecutive patients who underwent ablation of Pe-AF in our center between August 2021 and January 2022 were retrospectively enrolled. All patients' ablation strategy was PVI plus PWI using HPSD LSI-guided isolation. RF parameters included 50 W targeting LSI values of ≥5 on the anterior part of the PVs and anterior roofline and ≥4 for the posterior PVs aspect, bottom line, and within the posterior wall (PW). We compared the LSI values with and without acute conduction gaps after the initial first-pass PWI. Left atrial mapping was performed with the EnSite X mapping system and a high-density multipolar Grid-shaped mapping catheter. We compared the procedural characteristics using HPSD (n = 35) vs. a control group (n = 46). Results: Thirty-five consecutive patients were included in the study. PWI on top of PVI was achieved in all cases in the HPSD group. First-pass PVI was achieved in 93.3% of PVs (n = 126/135). First-pass roofline block was obtained in most patients (n = 31, 88.5%), while first-pass block of the bottom line was only achieved in 51.4% (n = 18). There were no significant differences compared to the control group; first-pass PVI was achieved in 94.9% of PVs (n = 169/178), first-pass roofline block in 89.1%, and bottom-line in 45.6% of patients. To achieve complete PWI with HPSD, scattered RF applications within the PW were necessary. No electrical reconnection of the PW was found after adenosine administration and the waiting period. The procedure and RF times were significantly shorter in the HPSD group compared to the control group, with values of 116.2 ± 10.9 vs. 144.5 ± 11.3 min, and 19.8 ± 3.6 vs. 26.3 ± 6.4 min, respectively, p < 0.001. Fluoroscopy time was comparable between both groups. No procedural complications were observed. At the 12-month follow-up, 71.4% of patients remained free from AF, with no differences between the groups. Conclusions: HPSD LSI-guided PWI on top of PVI seems effective and safe. Compared to a control group, HPSD is associated with similar rates of first-pass PWI and PVI but with a shorter procedural and RF time.
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Affiliation(s)
- Sergio Conti
- Department of Electrophysiology, ARNAS Civico–Di Cristina–Benfratelli, 90127 Palermo, Italy
| | - Francesco Sabatino
- Department of Electrophysiology, ARNAS Civico–Di Cristina–Benfratelli, 90127 Palermo, Italy
| | - Fabrizio Fortunato
- Faculty of Medicine, Postgraduate School in Cardiology, University of Palermo, 90127 Palermo, Italy
| | - Giuliano Ferrara
- Department of Electrophysiology, ARNAS Civico–Di Cristina–Benfratelli, 90127 Palermo, Italy
| | - Antonio Cascino
- Department of Electrophysiology, ARNAS Civico–Di Cristina–Benfratelli, 90127 Palermo, Italy
| | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico–Di Cristina–Benfratelli, 90127 Palermo, Italy
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Takahara H, Kiuchi K, Fukuzawa K, Takami M, Izawa Y, Nakamura T, Nakasone K, Sonoda Y, Yamamoto K, Suzuki Y, Tani KI, Iwai H, Nakanishi Y, Shoda M, Murakami A, Yonehara S, Negi N, Somiya Y, Hirata KI. The impact of the procedural parameters on the lesion characteristics associated with AF recurrence: Late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) analysis. J Cardiovasc Electrophysiol 2023; 34:527-535. [PMID: 36598438 DOI: 10.1111/jce.15805] [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: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lesion gaps assessed by late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) are associated with the atrial fibrillation (AF) recurrence after pulmonary vein isolation. Animal studies have demonstrated that the catheter-contact force (CF), stability, and orientation are strongly associated with lesion formation. However, the impact of those procedural factors on the lesion characteristics associated with AF recurrence has not been well discussed. METHODS A total of 30 patients with paroxysmal AF who underwent catheter ablation were retrospectively enrolled. Radiofrequency (RF) applications were performed with 35 W for 30 s in a point-by-point fashion under esophageal temperature monitoring. The inter-lesion distance was 4 mm. The lesions were visualized by LGE-MRI 3 months postprocedure and assessed by the LGE volume (ml), gap number (GN), and average gap length (AGL [mm]). The gaps were defined as nonenhancement sites of >4 mm. The procedural factors including the catheter-CF, stability, and orientation were calculated on the NavX system. RESULTS Six (20%) of 30 patients had AF recurrences 12 months postablation. A univariate analysis demonstrated that the AGL was associated with AF recurrence (hazard ratio [HR]: 1.20, confidence interval [CI]: 1.03-1.42, p = .02). All AF recurrence were found in patients with an AGL of >7 mm. The catheter-CF and stability were associated with an AGL of >7 mm, but not the orientation (CF-HR: 0.62, CI: 0.39-0.97, p = .038; stability-HR: 0.8, CI: 0.66-0.98, p = .027). CONCLUSIONS RF ablation with a low CF and poor catheter stability has a potential risk of creating large lesion gaps associated with AF recurrence.
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Affiliation(s)
- Hiroyuki Takahara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazutaka Nakasone
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Sonoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Yamamoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuya Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Tani
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidehiro Iwai
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuhiko Shoda
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Murakami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shogo Yonehara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe, Japan
| | - Yuichiro Somiya
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Hohendanner F, Bock M, Keznickl-Pulst J, Furundzija V, Scholz S, Schöppenthau D, Hrytsyna Y, Falk V, Pieske B, Hindricks G, Potapov E, Gerds-Li JH. Mechanistic assessment and ablation of left ventricular assist device related ventricular tachycardia in patients with severe heart failure. Front Physiol 2023; 14:1086730. [PMID: 37123254 PMCID: PMC10130641 DOI: 10.3389/fphys.2023.1086730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Aims: Left-ventricular-assist-devices (lvad) are an established treatment for patients with severe heart failure with reduced ejection fraction (HF) and reduce mortality. However, HF patients have significant substrate for ventricular tachycardia (VT) and the lvad itself might be pro-arrhythmogenic. We investigated the mechanism of VT in lvad-patients in relation to the underlying etiology and provide in silico and ex-vivo data for ablation in these HF patients. Methods and Results: We retrospectively analyzed invasive electrophysiological (EP) studies of 17 patients with VT and lvad. The mechanism of VT was determined using electroanatomical, entrainment and activation time mapping. Ischemic cardiomyopathy was present in 70% of patients. VT originated from the lvad region in >30%. 1/6 patients with VT originating from the lvad region had episodes before lvad implantation, while 7/11 patients with VT originating from other regions had episodes before implantation. Number and time of radiofrequency (RF)-ablation lesions were not different between VTs originating from the lvad or other regions. Long-term freedom from VT was 50% upon ablation in patients with VT originating from the lvad region and 64% if ablation was conducted in other regions. To potentially preemptively mitigate lvad related VT in patients undergoing lvad implantation, we obtained in silico derived data and performed ex-vivo experiments targeting ventricular myocardium. Of the tested settings, application of 25 W for 30 s was safe and associated with optimal lesion characteristics. Conclusion: A significant percentage of patients with lvad undergoing VT ablation exhibit arrhythmia originating in close vicinity to the device and recurrence rates are high. Based on in silico and ex-vivo data, we propose individualized RF-ablation in selected patients at risk for/with lvad related VT.
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Affiliation(s)
- Felix Hohendanner
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- *Correspondence: Felix Hohendanner,
| | - Matthias Bock
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Vesna Furundzija
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Scholz
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Doreen Schöppenthau
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Yuriy Hrytsyna
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Herz, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - Volkmar Falk
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Herz, Thorax- und Gefäßchirurgie, Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Gerhard Hindricks
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Evgenij Potapov
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Jin-Hong Gerds-Li
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. Europace 2021; 24:874-886. [PMID: 34964469 DOI: 10.1093/europace/euab279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is an important alternative to antiarrhythmic drugs in the treatment of symptomatic atrial fibrillation. However, the inability to consistently achieve durable isolation of the pulmonary veins hampers the long-term efficacy of PVI procedures. The large number of factors involved in RF lesion formation and the complex interplay of these factors complicate reliable creation of durable and transmural ablation lesions. Various surrogate markers of ablation lesion formation have been proposed that may provide information on RF lesion completeness. Real-time assessment of these surrogates may aid in the creation of transmural ablation lesions, and therefore, holds potential to decrease the risk of PV reconnection and consequent post-PVI arrhythmia recurrence. Moreover, titration of energy delivery until lesions is transmural may prevent unnecessary ablation and subsequent adverse events. Whereas several surrogate markers of ablation lesion formation have been described over the past decades, a 'gold standard' is currently lacking. This review provides a state-of-the-art overview of ablation strategies that aim to enhance durability of RF-PVI, with special focus on real-time available surrogates of RF lesion formation in light of the biophysical basis of RF ablation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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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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8
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Proietti R, Lichelli L, Lellouche N, Dhanjal T. The challenge of optimising ablation lesions in catheter ablation of ventricular tachycardia. J Arrhythm 2021; 37:140-147. [PMID: 33664896 PMCID: PMC7896466 DOI: 10.1002/joa3.12489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 12/26/2022] Open
Abstract
Radiofrequency catheter ablation has become an established treatment for ventricular tachycardia. The exponential increase in procedures has provided further insights into mechanisms causing arrhythmias and identification of ablation targets with the development of new mapping strategies. Since the definition of criteria to identify myocardial dense scar, borderzone and normal myocardium, and the description of isolated late potentials, local abnormal ventricular activity and decrementing evoked potential mapping, substrate-guided ablation has progressively become the method of choice to guide procedures. Accordingly, a wide range of ablation strategies have been developed from scar homogenization to scar dechanneling or core isolation using increasingly complex and precise tools such as multipolar or omnipolar mapping catheters. Despite these advances long-term success rates for VT ablation have remained static and lower in nonischemic than ischemic heart disease because of the more patchy distribution of myocardial scar. Ablation aims to deliver an irreversible loss of cellular excitability by myocardial heating to a temperatures exceeding 50°C. Many indicators of ablation efficacy have been developed such as contact force, impedance drop, force-time integral and ablation index, mostly validated in atrial fibrillation ablation. In ventricular procedures there is limited data and ablation lesion parameters have been scarcely investigated. Since VT arrhythmia recurrence can be related to inadequate RF lesion formation, it seems reasonable to establish robust markers of ablation efficacy.
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Affiliation(s)
- Riccardo Proietti
- Department of CardiologyUniversity Hospital Coventry & Warwickshire NHS TrustCoventryUK
- Department of Cardiac, Thoracic, Vascular SciencesUniversity of PaduaPaduaItaly
| | - Luca Lichelli
- Department of Cardiac, Thoracic, Vascular SciencesUniversity of PaduaPaduaItaly
| | - Nicolas Lellouche
- Hopital Henri Mondor Albert ChenevierCreteilFrance
- Inserm U955University Paris Est Creteil Paris XIIParisFrance
| | - Tarvinder Dhanjal
- Department of CardiologyUniversity Hospital Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
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9
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Kurose J, Kiuchi K, Fukuzawa K, Takami M, Mori S, Suehiro H, Nagamatsu YI, Akita T, Takemoto M, Yatomi A, Nakamura T, Sakai J, Watanabe Y, Shimoyama S, Negi N, Kyotani K, Hirata KI. Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force-sensing catheter: Late-gadolinium enhancement magnetic resonance imaging assessment. J Cardiovasc Electrophysiol 2020; 31:2572-2581. [PMID: 32648326 DOI: 10.1111/jce.14664] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are characterized as a wider and more continuous than that after conventional radiofrequency catheter ablation (RFCA) without the contact force (CF)-sensing technology. However, the impact on the lesion characteristics of ablation with a CF-sensing catheter has not been well discussed. We sought to assess the lesions using late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) and to compare the differences between the two groups (CB group vs. RF group). METHODS A total of 30 consecutive patients who underwent PVI were enrolled (CB group, 18; RF group, 12). The RF applications were delivered with a target lesion size index (LSI) of 5. The PVI lesions were assessed by LGE-MRI 3 months after the PVI. The region around the PV was divided into eight segments: roof, anterior-superior, anterior carina, anterior inferior, bottom, posterior inferior, posterior carina, and posterior superior segment. The lesion width and visual gap of each segment were compared between the two groups. The visual gaps were defined as no-enhancement site of >4 mm. RESULTS The mean LSI was 4.7 ± 0.7. The lesion width was significantly wider but the visual gaps were more frequently documented at the bottom segment of right PV in the CBA group (lesion width: 8.1 ± 2.2 vs. 6.3 ± 2.2 mm; p = .032; visual gap at the bottom segment or right PV: 39% vs. 0%; p = .016). CONCLUSIONS The PVI lesion was wider after CBA, while the visual gaps were fewer after RFCA with a CF-sensing catheter.
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Affiliation(s)
- Jun Kurose
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideya Suehiro
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu-Ichi Nagamatsu
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomomi Akita
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Takemoto
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsusuke Yatomi
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Sakai
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Internal Medicine, Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinsuke Shimoyama
- Department of Internal Medicine, Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Katsusuke Kyotani
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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