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For: Naniwadekar A, Dukkipati SR. High-power short-duration ablation of atrial fibrillation: A contemporary review. Pacing Clin Electrophysiol 2021;44:528-540. [PMID: 33438279 DOI: 10.1111/pace.14167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 12/27/2020] [Accepted: 01/10/2021] [Indexed: 01/15/2023]

For:	Naniwadekar A, Dukkipati SR. High-power short-duration ablation of atrial fibrillation: A contemporary review. Pacing Clin Electrophysiol 2021;44:528-540. [PMID: 33438279 DOI: 10.1111/pace.14167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 12/27/2020] [Accepted: 01/10/2021] [Indexed: 01/15/2023]

Number

Cited by Other Article(s)

Pierucci N, Mariani MV, Laviola D, Silvetti G, Cipollone P, Vernile A, Trivigno S, La Fazia VM, Piro A, Miraldi F, Vizza CD, Lavalle C. Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications. J Clin Med 2024;13:2980. [PMID: 38792520 PMCID: PMC11121906 DOI: 10.3390/jcm13102980] [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: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open

Abstract

Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA's ability to achieve pulmonary vein isolation-a cornerstone of AF treatment-rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA's effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols.

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Affiliation(s)

Nicola Pierucci Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Marco Valerio Mariani Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Domenico Laviola Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Giacomo Silvetti Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Pietro Cipollone Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Antonio Vernile Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Sara Trivigno Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Vincenzo Mirco La Fazia Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX 78705, USA;
Agostino Piro Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Fabio Miraldi Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Carmine Dario Vizza Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
Carlo Lavalle Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)

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De Potter TJR, De Becker B, Duytschaever M. Durable pulmonary vein isolation with optimized high-power and very high-power short-duration temperature-controlled ablation: A step-by-step guide. J Cardiovasc Electrophysiol 2024;35:886-894. [PMID: 38433316 DOI: 10.1111/jce.16217] [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: 11/09/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]

Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Hirata S, Kurokawa S, Okumura Y. Where is the gap after a 90 W/4 s very-high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness. J Arrhythm 2024;40:256-266. [PMID: 38586851 PMCID: PMC10995583 DOI: 10.1002/joa3.13009] [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: 09/06/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open

Joza J, Nair GM, Birnie DH, Nery PB, Redpath CJ, Sarrazin JF, Champagne J, Bernick J, Wells GA, Essebag V. High-power short-duration versus low-power long-duration ablation for pulmonary vein isolation: A substudy of the AWARE randomized controlled trial. J Cardiovasc Electrophysiol 2024;35:136-145. [PMID: 37990448 DOI: 10.1111/jce.16123] [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: 08/31/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]

Abstract

INTRODUCTION

Pulmonary vein isolations (PVI) are being performed using a high-power, short-duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low-power, long-duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF).

METHODS

Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1-year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14-day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RRa ) and mean difference (MDa ) estimates.

RESULTS

Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RRa 0.77 (95% confidence interval [CI]) 0.55-1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RRa 1.59 [95% CI 0.77-3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RRa 3.95 [95% CI 1.00-15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MDa 97.5 min [95% CI 84.8-110.4)]; p < .0001) with no difference in adjudicated serious adverse events.

CONCLUSIONS

An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy.

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Osorio J, Maccioni S, Sharma R, Patel L, Spin P, Natale A. QDOT MICRO™ versus THERMOCOOL^® SMARTTOUCH™ and THERMOCOOL SMARTTOUCH^® Surround Flow in radiofrequency ablation of paroxysmal atrial fibrillation. J Comp Eff Res 2023;12:e230005. [PMID: 37584396 PMCID: PMC10690395 DOI: 10.57264/cer-2023-0005] [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: 01/17/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open

Di Cori A, Parollo M, Gentile F, Pistelli L, Vitale C, Della Volpe S, Giannotti Santoro M, Mazzocchetti L, De Lucia R, Canu A, Barletta V, Grifoni G, Segreti L, Bongiorni MG, Zucchelli G. Short and Long-Term Outcomes of Lesion Index-Guided High-Power Short-Duration Approach for Atrial Fibrillation Ablation. J Clin Med 2023;12:4986. [PMID: 37568387 PMCID: PMC10420312 DOI: 10.3390/jcm12154986] [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: 06/14/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open

Affiliation(s)

Andrea Di Cori Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Matteo Parollo Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Francesco Gentile Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Lorenzo Pistelli Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.) Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital “G. Martino”, University of Messina, 98168 Messina, Italy
Carlo Vitale Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Salvatore Della Volpe Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Mario Giannotti Santoro Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Lorenzo Mazzocchetti Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Raffaele De Lucia Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Antonio Canu Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Valentina Barletta Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Gino Grifoni Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Luca Segreti Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Maria Grazia Bongiorni Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)
Giulio Zucchelli Second Division of Cardiology, Cardiac-Toracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy; (A.D.C.); (F.G.); (L.P.); (C.V.); (S.D.V.); (M.G.S.); (L.M.); (R.D.L.); (A.C.); (V.B.); (G.G.); (L.S.); (M.G.B.); (G.Z.)

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Tokavanich N, Prasitlumkum N, Kewcharoen J, Chokesuwattanaskul R, Phannajit J, Cheungpasitporn W, Akoum N, Ranjan R, Bunch TJ, Navaravong L. Network meta-analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023;34:869-879. [PMID: 36691892 DOI: 10.1111/jce.15831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]

Abstract

BACKGROUND

High-power short-duration (HPSD) atrial fibrillation (AF) ablation with a power of 40-50 W was proved to be safe and effective. Very high-power short-duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation.

METHODS

A literature search for studies that reported AF ablation outcomes, including short-term freedom from atrial arrhythmia, first-pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random-effects model of network meta-analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes.

RESULTS

A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2-1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78-2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5-8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61-8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques.

CONCLUSION

vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.

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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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Radiofrequency ablation using the second-generation temperature-controlled diamond tip system in paroxysmal and persistent atrial fibrillation: results from FASTR-AF. J Interv Card Electrophysiol 2023;66:343-351. [PMID: 35581464 DOI: 10.1007/s10840-022-01234-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]

Osorio J, Hussein AA, Delaughter MC, Monir G, Natale A, Dukkipati S, Oza S, Daoud E, Di Biase L, Mansour M, Fishel R, Valderrabano M, Ellenbogen K. Very High-Power Short-Duration, Temperature-Controlled Radiofrequency Ablation in Paroxysmal Atrial Fibrillation: The Prospective Multicenter Q-FFICIENCY Trial. JACC Clin Electrophysiol 2022;9:468-480. [PMID: 36752484 DOI: 10.1016/j.jacep.2022.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 01/20/2023]

Abstract

BACKGROUND

QDOT MICRO (QDM) is a novel contact force-sensing catheter optimized for temperature-controlled radiofrequency (RF) ablation. The very high-power short-duration (vHPSD) algorithm modulates power, maintaining target temperature during 90 W ablations for ≤4 seconds.

OBJECTIVES

This study aims to evaluate safety and 12-month effectiveness of the QDM catheter in paroxysmal atrial fibrillation (AF) ablation using the vHPSD mode combined with conventional-power temperature-controlled (CPTC) mode.

METHODS

In this prospective, multicenter, nonrandomized study, patients with drug-refractory, symptomatic paroxysmal AF underwent pulmonary vein (PV) isolation with QDM catheter with vHPSD as primary ablation mode, with optional use of the CPTC mode (25 to 50 W) for PV touch-up or non-PV ablation. The primary safety endpoint was incidence of primary adverse events within ≤7 days of ablation. The primary effectiveness endpoint was freedom from documented atrial tachyarrhythmia recurrence and acute procedural, repeat ablation, and antiarrhythmic drug failure.

RESULTS

Of 191 enrolled participants, 166 had the catheter inserted, received RF ablation, and met eligibility criteria. Median procedural, RF application for ablating PVs, and fluoroscopy times were 132.0, 8.0, and 9.1 minutes, respectively. The primary adverse event rate was 3.6%. Imaging conducted in a subset of participants (n = 40) at 3 months did not show moderate or severe PV stenosis. The Kaplan-Meier estimated 12-month rate for primary effectiveness success was 76.7%; freedom from atrial tachyarrhythmia recurrence was 82.1%; clinical success (freedom from symptomatic recurrence) was 86.0%; and freedom from repeat ablation was 92.1%.

CONCLUSIONS

Temperature-controlled paroxysmal AF ablation with the novel QDM catheter in vHPSD mode (90 W, ≤4 seconds), alone or with CPTC mode (25 to 50 W), is highly efficient and effective without compromising safety. (Evaluation of QDOT MICRO Catheter for Pulmonary Vein Isolation in Subjects With Paroxysmal Atrial Fibrillation [Q-FFICIENCY]; NCT03775512.).

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Safe and effective delivery of high-power, short-duration radiofrequency ablation lesions with a flexible-tip ablation catheter. Heart Rhythm O2 2022;4:42-50. [PMID: 36713045 PMCID: PMC9877396 DOI: 10.1016/j.hroo.2022.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open

Nyuta E, Takemoto M, Sakai T, Antoku Y, Mito T, Umemoto S, Fujiwara M, Takegami K, Takiguchi T, Nakahara M, Koga T, Tsuchihashi T. Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation. Circ J 2022;86:1219-1228. [PMID: 35786692 DOI: 10.1253/circj.cj-22-0182] [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] [Indexed: 11/09/2022]

Cai C, Wang J, Niu HX, Chu JM, Hua W, Zhang S, Yao Y. Optimal Lesion Size Index for Pulmonary Vein Isolation in High-Power Radiofrequency Catheter Ablation of Atrial Fibrillation. Front Cardiovasc Med 2022;9:869254. [PMID: 35463774 PMCID: PMC9021528 DOI: 10.3389/fcvm.2022.869254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open

Abstract

Background

Although both high-power (HP) ablation and lesion size index (LSI) are novel approaches to make effective lesions during pulmonary vein isolation (PVI) for atrial fibrillation (AF), the optimal LSI in HP ablation for PVI is still unclear. Our study sought to explore the association between LSI and acute conduction gap formation and investigate the optimal LSI in HP ablation for PVI.

Methods

A total of 105 consecutive patients with AF who underwent HP ablation guided by LSI (LSI-guided HP) for PVI in our institute between June 2019 and July 2020 were retrospectively enrolled. Each ipsilateral PV circle was subdivided into four segments, and ablation power was set to 50 W with target LSI values at 5.0 and 4.0 for anterior and posterior walls, respectively. We compared the LSI values with and without acute conduction gaps after the initial first-pass PVI.

Results

PVI was achieved in all patients, and the incidence of first-pass PVI was 78.1% (82/105). A total of 6,842 lesion sites were analyzed, and the acute conduction gaps were observed in 23 patients (21.9%) with 45 (0.7%) lesion points. The gap formation was significantly associated with lower LSI (3.9 ± 0.4 vs. 4.6 ± 0.4, p < 0.001), lower force-time integral (82.6 ± 24.6 vs. 120.9 ± 40.4 gs, p < 0.001), lower mean contact force (5.7 ± 2.4 vs. 8.5 ± 2.8 g, p < 0.001), shorter ablation duration (10.5 ± 3.6 vs. 15.4 ± 6.4 s, p < 0.001), lower mean temperature (34.4 ± 1.4 vs. 35.6 ± 2.6°C, p < 0.001), and longer interlesion distance (4.4 ± 0.3 vs. 4.3 ± 0.4 mm, p = 0.031). As per the receiver operating characteristic analysis, the LSI had the highest predictive value for gap formation in all PVs segments, with a cutoff of 4.35 for effective ablation (sensitivity 80.0%; specificity 75.4%, areas under the curve: 0.87). The LSI of 4.55 and 3.95 had the highest predictive value for gap formation for the anterior and posterior segments of PVs, respectively.

Conclusion

Using LSI-guided HP ablation for PVI, more than 4.35 of LSI for all PVs segments showed the best predictive value to avoid gap formation for achieving effective first-pass PVI. The LSI of 4.55 for the anterior wall and 3.95 for the posterior wall were the best cutoff values for predicting gap formation, respectively.

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Kreidieh O, Varley AL, Romero J, Singh D, Silverstein J, Thosani A, Varosy P, Hebsur S, Godfrey BE, Schrappe G, Justice L, Zei PC, Osorio J. Practice Patterns of Operators Participating in the Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) Registry. J Interv Card Electrophysiol 2022;65:429-440. [PMID: 35438393 DOI: 10.1007/s10840-022-01205-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]

Li JH, Xie HY, Sun Q, Guo XG, Chen YQ, Cao ZJ, Ma J. Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins. Front Cardiovasc Med 2022;8:794834. [PMID: 35087882 PMCID: PMC8787139 DOI: 10.3389/fcvm.2021.794834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open