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Tohoku S, Bordignon S, Schaack D, Hirokami J, Urbanek L, Urbani A, Kheir J, Schmidt B, Chun KRJ. Initial real-world data on catheter ablation in patients with persistent atrial fibrillation using the novel lattice-tip focal pulsed-field ablation catheter. Europace 2024; 26:euae129. [PMID: 38916275 PMCID: PMC11197047 DOI: 10.1093/europace/euae129] [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: 03/14/2024] [Accepted: 05/07/2024] [Indexed: 06/26/2024] Open
Abstract
AIMS Technological advancements have contributed to the enhanced precision and lesion flexibility in pulsed-field ablation (PFA) by integrating a three-dimensional mapping system combined with a point-by-point ablation strategy. Data regarding the feasibility of this technology remain limited to some clinical trials. This study aims to elucidate initial real-world data on catheter ablation utilizing a lattice-tip focal PFA/radiofrequency ablation (RFA) catheter in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS Consecutive patients who underwent catheter ablation for persistent AF via the lattice-tip PFA/RFA catheter were enrolled. We evaluated acute procedural data including periprocedural data as well as the clinical follow-up within a 90-day blanking period. In total, 28 patients with persistent AF underwent AF ablation either under general anaesthesia (n = 6) or deep sedation (n = 22). In all patients, pulmonary vein isolation was successfully achieved. Additional linear ablations were conducted in 21 patients (78%) with a combination of successful anterior line (n = 13, 46%) and roof line (n = 19, 68%). The median procedural and fluoroscopic times were 97 (interquartile range, IQR: 80-114) min and 8.5 (IQR: 7.2-9.5) min, respectively. A total of 27 patients (96%) were interviewed during the follow-up within the blanking period, and early recurrent AF was documented in four patients (15%) including one case of recurrent AF during the hospital stay. Neither major nor minor procedural complication occurred. CONCLUSION In terms of real-world data, our data confirmed AF ablation feasibility utilizing the lattice-tip focal PFA/RFA catheter in patients with persistent AF.
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein der Universität zu Lübeck, Ratzeburger Allee 16023538 Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Andrea Urbani
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Joseph Kheir
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Kyoung-Ryul Julian Chun
- Cardioangiologisches Centrum Bethanien Med. Klinik III, Markuskrankenhaus, Department of Cardiology, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein der Universität zu Lübeck, Ratzeburger Allee 16023538 Lübeck, Germany
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2
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Anter E, Mansour M, Nair DG, Sharma D, Taigen TL, Neuzil P, Kiehl EL, Kautzner J, Osorio J, Mountantonakis S, Natale A, Hummel JD, Amin AK, Siddiqui UR, Harlev D, Hultz P, Liu S, Onal B, Tarakji KG, Reddy VY. Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nat Med 2024:10.1038/s41591-024-03022-6. [PMID: 38760584 DOI: 10.1038/s41591-024-03022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
Clinical outcomes of catheter ablation for atrial fibrillation (AF) are suboptimal due, in part, to challenges in achieving durable lesions. Although focal point-by-point ablation allows for the creation of any required lesion set, this strategy necessitates the generation of contiguous lesions without gaps. A large-tip catheter, capable of creating wide-footprint ablation lesions, may increase ablation effectiveness and efficiency. In a randomized, single-blind, non-inferiority trial, 420 patients with persistent AF underwent ablation using a large-tip catheter with dual pulsed field and radiofrequency energies versus ablation using a conventional radiofrequency ablation system. The primary composite effectiveness endpoint was evaluated through 1 year and included freedom from acute procedural failure and repeat ablation at any time, plus arrhythmia recurrence, drug initiation or escalation or cardioversion after a 3-month blanking period. The primary safety endpoint was freedom from a composite of serious procedure-related or device-related adverse events. The primary effectiveness endpoint was observed for 73.8% and 65.8% of patients in the investigational and control arms, respectively (P < 0.0001 for non-inferiority). Major procedural or device-related complications occurred in three patients in the investigational arm and in two patients in the control arm (P < 0.0001 for non-inferiority). In a secondary analysis, procedural times were shorter in the investigational arm as compared to the control arm (P < 0.0001). These results demonstrate non-inferior safety and effectiveness of the dual-energy catheter for the treatment of persistent AF. Future large-scale studies are needed to gather real-world evidence on the impact of the focal dual-energy lattice catheter on the broader population of patients with AF. ClinicalTrials.gov identifier: NCT05120193 .
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Affiliation(s)
- Elad Anter
- Shamir Medical Center, Be'er Ya'Akov, Israel.
| | | | - Devi G Nair
- St. Bernards Medical Center & Arrhythmia Research Group, Jonesboro, AR, USA
| | | | | | | | | | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, TX, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - John D Hummel
- Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Anish K Amin
- Riverside Methodist Hospital, Upper Arlington, OH, USA
| | | | | | | | | | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, USA
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3
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Tonko JB, Lambiase P. Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias. Curr Cardiol Rep 2024; 26:269-282. [PMID: 38700597 PMCID: PMC11136806 DOI: 10.1007/s11886-024-02048-z] [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] [Accepted: 03/19/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Percutaneous radiofrequency (RF) catheter ablation is an established strategy to prevent ventricular tachycardia (VT) recurrence and ICD shocks. Yet delivery of durable lesion sets by means of traditional unipolar radiofrequency ablation remains challenging, and left ventricular transmurality is rarely achieved. Failure to ablate and eliminate functionally relevant areas is particularly common in deep intramyocardial substrates, e.g. septal VT and cardiomyopathies. Here, we aim to give a practical-orientated overview of advanced and emerging RF ablation technologies to target these complex VT substrates. We summarize recent evidence in support of these technologies and share experiences from a tertiary VT centre to highlight important "hands-on" considerations for operators new to advanced RF ablation strategies. RECENT FINDINGS A number of innovative and modified radiofrequency ablation approaches have been proposed to increase energy delivery to the myocardium and maximize RF lesion dimensions and depth. These include measures of impedance modulation, combinations of simultaneous unipolar ablations or true bipolar ablation, intramyocardial RF delivery via wires or extendable RF needles and investigational linear or spherical catheter designs. Recent new clinical evidence for the efficacy and safety of these investigational technologies and strategies merits a re-evaluation of their role and clinic application for percutaneous VT ablations. Complexity of substrates targeted with percutaneous VT ablation is increasing and requires detailed preprocedural imaging to characterize the substrate to inform the procedural approach and selection of ablation technology. Depending on local experience, options for additional and/or complementary interventional treatments should be considered upfront in challenging substrates to improve the success rates of index procedures. Advanced RF technologies available for clinical VT ablations include impedance modulation via hypotonic irrigation or additional dispersive patches and simultaneous unipolar as well as true bipolar ablation. Promising investigational RF technologies involve an extendable needle RF catheter, intramyocardial RF delivery over intentionally perforated wires as well as a variety of innovative ablation catheter designs including multipolar linear, spherical and partially insulated ablation catheters.
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Affiliation(s)
- J B Tonko
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK.
- Bartholomew s Hospital, W Smithfield, London, UK.
| | - P Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK
- Bartholomew s Hospital, W Smithfield, London, UK
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4
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Suga K, Kato H, Akita S, Sakurai T, Ota R, Okada T, Murakami H, Kada K, Tsuboi N, Yanagisawa S, Inden Y, Murohara T. Optimal ablation settings of TactiFlex SE laser-cut irrigated-tip catheter: comparison with ThermoCool SmartTouch SurroundFlow porous irrigated-tip catheter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01797-9. [PMID: 38573538 DOI: 10.1007/s10840-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The TactiFlex SE catheter (TFSE, Abbott) with a contact force (CF) sensor and a laser-cut irrigated-tip has recently become available but lacks a lesion quality marker. This study aimed to explore distinctions in lesion characteristics between the TFSE and the ThermoCool SmartTouch SurroundFlow catheter (STSF, Biosense Webster), which utilizes a porous irrigated tip, and to assess the most effective application settings for the TFSE. METHODS Lesions were generated using varying settings of radiofrequency power (30-50 W), CF (10-20 g), application duration (10-40 s), and catheter orientation (perpendicular or parallel) in an ex vivo porcine model. Comparative analysis between the TFSE and STSF was conducted for lesion characteristics and incidence of steam pops using predictive models in regression analyses. RESULTS Among 720 applications, the TFSE exhibited a significantly lower incidence of steam pops compared to the STSF (0.6% vs. 36.8%, P < 0.001). Moreover, coefficients of determination (R2) for the TFSE were higher than those for the STSF concerning lesion depth (0.710 vs. 0.541) and volume (0.723 vs. 0.618). The lesion size generated with the TFSE was notably smaller than that with the STSF under identical application settings. Additionally, to achieve a lesion depth ≥ 4.0 mm, the TFSE required an application duration 8-12 s longer than the STSF under similar settings. CONCLUSIONS The TFSE demonstrated a lower incidence of steam pops and superior predictability in lesion size compared to the STSF. However, the TFSE necessitated a longer application duration than the STSF to achieve an adequate lesion size.
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Affiliation(s)
- Kazumasa Suga
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shigeki Akita
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Taku Sakurai
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Ryusuke Ota
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Takuya Okada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hisashi Murakami
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Kenji Kada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Naoya Tsuboi
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
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5
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Kuroda M, Takeo A, Kobayashi H, Kuji R, Mori H, Tsutsui K, Fukunaga M, Nagashima M, Korai K, Ando K, Hiroshima K. Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model. J Interv Card Electrophysiol 2024; 67:589-597. [PMID: 37691083 DOI: 10.1007/s10840-023-01633-6] [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: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Lesion formation during catheter ablation is influenced by the power, contact force (CF), time, and catheter stability. However, the influence of the irrigation effects on lesion formation remains unknown. METHODS An ex vivo experiment using conductive gel was performed. Using three different catheter designs (TactiFlex ™ SE [TF], IntellaNav MiFi ™ OI [MiFi], QDOT MICRO™ [QDOT]), a cross-sectional analysis of the lesion size and surface lesion type of 10g/40W lesions with a combination of various ablation times was performed in protocol 1. A longitudinal analysis (combination of various powers [30, 40, and 50W] and various ablation times with a 10g setting) was performed to investigate the influence of the auto-regulated irrigation system (QDOT) on lesion formation in protocol 2. RESULTS The lesion formation with the QDOT catheter tended to create larger ablation lesions, while that with the TF catheter created smaller lesions than the other catheters. The lesion surface characteristics were divided into two patterns: ring (MiFi catheter and QDOT) and crescent (TF) patterns. The auto-regulated irrigation system did not influence the lesion formation, and the relationship between the lesion formation and RF energy exhibited similar changes regardless of the ablation power setting. CONCLUSION The lesion formation and lesion surface characteristics differed among the different irrigation tip designs. An auto-regulated irrigation system did not affect the lesion creation or surface lesion characteristics. Care should be given to the inter-product differences in the lesion characteristics during RF catheter ablation, partly due to the irrigation flow control and tip design.
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Affiliation(s)
- Maiko Kuroda
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Ayaka Takeo
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Kobayashi
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Rei Kuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hitoshi Mori
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Kenta Tsutsui
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michio Nagashima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kengo Korai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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6
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Yavin HD, Higuchi K, Younis A, Anter E. Lattice-tip catheter for single-shot pulmonary vein isolation with pulsed field ablation. J Interv Card Electrophysiol 2023; 66:1741-1748. [PMID: 36441424 DOI: 10.1007/s10840-022-01414-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A compressible lattice-tip catheter designed for focal ablation using radiofrequency or pulsed-field energies has been recently described. The objective of this study is to describe a new lattice catheter designed for single-shot pulmonary vein isolation (PVI). METHODS This 8F catheter consists of a compressible lattice tip that is delivered over the wire and is expandable up to 34 mm (SpherePVI™, Affera Inc.). Pulsed field ablation (PFA) was applied from 6 elements using a biphasic waveform of microsecond scale (± 1.3-2.0 kV, 5 s per application). In 12 swine, the superior vena cava (SVC) and right superior pulmonary vein (RSPV) were targeted for isolation. Animals were survived for 12-24 h (n = 6) or 3 weeks (n = 6) for evaluation of short and long-term safety and efficacy parameters. PVI was evaluated immediately after ablation and at the terminal procedure. Ablation-related microbubbles were examined using intracardiac echocardiography and phrenic nerve function by pacing. The tissue was examined by histopathology. RESULTS In all 12 animals, PFA resulted in successful acute isolation of the SVC and RSPV using 2.8 ± 1.1 and 3.2 ± 1.2 applications per vein, respectively. After a survival period of 23 ± 5.9 days, all targeted veins remained isolated, and the level of isolation persisted without significant regression or expansion. In one animal, SVC isolation at the level of the right atrial appendage resulted in sinus node arrest. PFA did not affect phrenic nerve function, and it was associated with a few isolated bubbles formation. CONCLUSIONS In this pre-clinical study, a new expandable lattice catheter designed for single-shot PVI was able to achieve rapid and durable isolation.
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Affiliation(s)
- Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Shamir Medical Center, Be'er Ya'akov, Israel.
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7
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Marashly Q, Najjar SN, Hahn J, Rector GJ, Khawaja M, Chelu MG. Innovations in ventricular tachycardia ablation. J Interv Card Electrophysiol 2023; 66:1499-1518. [PMID: 35879516 DOI: 10.1007/s10840-022-01311-z] [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: 02/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.
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Affiliation(s)
- Qussay Marashly
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Salim N Najjar
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Joshua Hahn
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Graham J Rector
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Muzamil Khawaja
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, USA.
- Texas Heart Institute, Houston, USA.
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8
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Shu T, Shen C, Chen X, Yu F. Two severe complications post-percutaneous intramyocardial septal radiofrequency ablation in a patient with failed alcohol septal ablation: pulseless electrical activity cardiac arrest and pericardial tamponade-a case report. Eur Heart J Case Rep 2023; 7:ytad371. [PMID: 37637089 PMCID: PMC10456200 DOI: 10.1093/ehjcr/ytad371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023]
Abstract
Background Alcohol septal ablation (ASA) can be recommended for patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). Recently, percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) was reported as a safe and effective treatment for HOCM. Case summary We present a case report of pulseless electrical activity (PEA), cardiac arrest, and pericardial tamponade occurring post-PIMSRA. We performed PIMSRA for the patient with HOCM after failed ASA. Two hours post-PIMSRA, transthoracic echocardiography (TTE) revealed that the hypokinetic basal intraventricular septal (IVS) thickness increased with aggravation of systolic anterior motion of the mitral valve. After the occurrence of subsequent PEA cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was provided. With sinus rhythm restoration and blood pressure stabilization after ECMO removal, the patient had pericardial tamponade on Day 3 post-PIMSRA. After excluding apparent myocardial perforation and draining haemorrhagic effusion under TTE guidance, her symptoms and haemodynamic status improved. She was asymptomatic at her one-year follow-up. The left ventricular outflow tract gradient (LVOTG) at rest and the thickness of the basal IVS reduced to 5 mmHg and 12 mm, respectively. Discussion We assumed that the main causes of PEA cardiac arrest and pericardial tamponade in our case were ablation-related tissue oedema at the basal IVS and blood leakage possibly related to puncture haemorrhage, respectively. While waiting for myocardial oedema to resolve, ECMO was applied as a bridge-to-recovery therapeutic approach. Pericardiocentesis is a strategy for the emergency drainage of pericardial effusion. It is essential to distinguish life-threatening complications with TTE for management planning post-PIMSRA.
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Affiliation(s)
- Tian Shu
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Caijie Shen
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Xiaomin Chen
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Fei Yu
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang, China
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9
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Kawano D, Mori H, Tsutsui K, Fukaya H, Tanaka N, Narita M, Sasaki W, Matsumoto K, Ikeda Y, Arai T, Nakano S, Kato R. Time dependency in the radiofrequency lesion formation for a local impedance guided catheter in an ex vivo experimental model. J Arrhythm 2022; 38:1080-1087. [DOI: 10.1002/joa3.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daisuke Kawano
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Hitoshi Mori
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Kenta Tsutsui
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Naomichi Tanaka
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Masataka Narita
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Wataru Sasaki
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Yoshifumi Ikeda
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Takahide Arai
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Shintaro Nakano
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Ritsushi Kato
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
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10
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The impact of a modified anaesthetic protocol on animal survival and the characteristics of ventricular arrhythmias in the course of acute myocardial infarction in a domestic pig model. J Vet Res 2022; 66:435-447. [PMID: 36349138 PMCID: PMC9597936 DOI: 10.2478/jvetres-2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Acute myocardial infarction (MI) is one of the most common causes of death in humans in highly developed countries. Among its most frequent complications affecting the patient’s prognosis are cardiac arrhythmias: ventricular tachycardia (VT) and ventricular fibrillation (VF).
Material and Methods
The study aimed to characterise arrhythmias in 19 pigs subjected to experimentally induced MI obtained by occlusion of the proximal left anterior descending (LAD) coronary artery using an angioplasty balloon. The anaesthetic protocol was modified to reduce mortality by including procedures stabilising haemodynamic disorders which develop during episodes of ischaemia and arrhythmia. During 30 min of experimentally induced ischaemia, the heart rhythm was recorded using a 12-lead ECG. The time, frequency, and type of arrhythmias were analysed.
Results
Ventricular arrhythmias were found in 94.74% of the treated pigs. The most common were ventricular premature complexes, reported in 88.89% of pigs with arrhythmia. Ventricular tachycardia was recorded in 66.67% and ventricular fibrillation in 50% of pigs with arrhythmias.
Conclusion
Myocardial infarction due to proximal LAD occlusion is characterised by a high incidence of ventricular arrhythmias, especially VT and VF. Because of the high survival rate, this MI porcine model may serve as a model for research on acute ischaemic ventricular arrhythmias in humans. Additionally, it reduces the total number of animals required for testing while yielding meaningful results, which is in line with the 3R principle.
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11
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Impact of tip design and thermocouple location on the efficacy and safety of radiofrequency application. J Interv Card Electrophysiol 2022; 66:885-896. [PMID: 35451737 DOI: 10.1007/s10840-022-01219-8] [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: 12/04/2021] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The FlexAbility™ SE catheter has a laser-cut 8Fr 4-mm flexible tip irrigated through laser-cut kerfs with a thermocouple 0.3 mm from the distal end. The TactiCath™ SE catheter has an 8Fr 3.5-mm tip and 6-irrigation port with a thermocouple 2.67 mm proximal to the tip. We investigated the impact of these differences on the efficacy and safety of radiofrequency (RF) applications. METHODS RF applications at a range of powers (20 W, 30 W, and 40 W), contact forces (5 g, 15 g, and 25 g), and durations (10-60 s) using perpendicular/parallel catheter orientation were performed in excised porcine hearts. Lesion characteristics and incidence of steam pops were compared. RESULTS A total of 540 lesions were examined. The FlexAbility™ SE catheter produced smaller lesion depths (4.0 mm vs. 4.4 mm, p = 0.014 at 20 W; 4.6 mm vs. 5.6 mm, p = 0.015 at 30 W), surface areas (22.7mm2 vs. 29.2mm2 at 20 W, p = 0.005; 23.2mm2 vs. 28.7mm2, p = 0.009 at 30 W), and volumes (126.1mm3 vs. 175.1mm3, p = 0.018 at 20 W; 183.2mm3 vs. 304.3mm3, p = 0.002 at 30 W) with perpendicular catheter placement. However, no differences were observed with parallel catheter placement. Steam-pops were significantly less frequently observed with the FlexAbility™ SE catheter (4% vs. 22%, p < 0.001) irrespective of catheter direction to the tissue. Multivariate analysis showed that use of the TactiCath™ SE catheter, power ≥ 40 W, contact force ≥ 25 g, RF duration > 30 s, parallel angle, and impedance drop ≥ 20Ω were significantly associated with occurrence of steam-pops. CONCLUSIONS The FlexAbility™ SE catheter reduced the risk of steam-pops but produced smaller lesions with perpendicular catheter placement compared to the TactiCath™ SE catheter.
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Masnok K, Watanabe N. Catheter contact area strongly correlates with lesion area in radiofrequency cardiac ablation: an ex vivo porcine heart study. J Interv Card Electrophysiol 2022; 63:561-572. [PMID: 34499311 PMCID: PMC9151538 DOI: 10.1007/s10840-021-01054-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Our previous study confirmed that not only force but also the catheter contact angle substantially impacted the contact area and its morphology. Therefore, in this study, we aimed to further investigate the relationship between the catheter contact area and the dimensions of the ablation lesion area as a function of catheter contact angle and force in radiofrequency catheter ablation. METHODS The radiofrequency catheter ablation test was performed for 5 contact angles and 8 contact forces at a fixed ablation time of 30 s. The initial impedance was 92.5 ± 2.5 Ω, the temperature during ablation was 30 °C, and the power was 30 W. The irrigation rate during ablation was set to 17 mL/min. Each experiment was repeated 6 times. RESULTS The catheter contact area showed a strong correlation with the ablation lesion area (r = 0.8507). When the contact area was increased, the lesion area also increased linearly in a monotonic manner. The relationships between catheter contact force and ablation lesion area and between catheter contact force and ablation lesion depth are logarithmic functions in which increased contact force was associated with increased lesion area and depth. The catheter contact angle is also an important determinant of the lesion area. The lesion area progressively increased when the contact angle was decreased. In contrast, the lesion depth progressively increased when the contact angle was increased. CONCLUSIONS The catheter contact area was strongly correlated with the ablation lesion area. Additionally, catheter contact force and contact angle significantly impacted the dimensions of the lesion in radiofrequency catheter ablation procedures.
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Affiliation(s)
- Kriengsak Masnok
- Biofluid Science and Engineering Laboratory, Functional Control Systems, Graduate School of Engineering and Science, Shibaura Institute of Technology, Room-102, 6th Building, Omiya-Campus, 307 Fukasaku, Minuma-Ku, Saitama-City, Saitama, 337-8570, Japan
| | - Nobuo Watanabe
- Biofluid Science and Engineering Laboratory, Functional Control Systems, Graduate School of Engineering and Science, Shibaura Institute of Technology, Room-102, 6th Building, Omiya-Campus, 307 Fukasaku, Minuma-Ku, Saitama-City, Saitama, 337-8570, Japan.
- Department of Bio-Science and Engineering, College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan.
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Reddy SA, Nethercott SL, Khialani BV, Virdee MS. Pulmonary vein isolation for atrial fibrillation: Does ablation technique influence outcome? Indian Heart J 2021; 73:718-724. [PMID: 34743897 PMCID: PMC8642637 DOI: 10.1016/j.ihj.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon ('single-shot' techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM). OBJECTIVE Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at Royal Papworth Hospital (RPH). METHOD Retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. RESULTS Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p < 0.05). Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups. CONCLUSIONS PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding.
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Affiliation(s)
- S A Reddy
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | | | - B V Khialani
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
| | - M S Virdee
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
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14
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Yavin HD, Higuchi K, Sroubek J, Younis A, Zilberman I, Anter E. Pulsed-Field Ablation in Ventricular Myocardium Using a Focal Catheter: The Impact of Application Repetition on Lesion Dimensions. Circ Arrhythm Electrophysiol 2021; 14:e010375. [PMID: 34459210 DOI: 10.1161/circep.121.010375] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Israel Zilberman
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
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15
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Sharif ZI, Heist EK. Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation. J Innov Card Rhythm Manag 2021; 12:4507-4518. [PMID: 34035983 PMCID: PMC8139307 DOI: 10.19102/icrm.2021.120505] [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: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 11/06/2022] Open
Abstract
Radiofrequency ablation (RFA) remains a highly effective therapy in the management of paroxysmal atrial fibrillation (PAF) and is an important therapeutic option in the management of persistent atrial fibrillation (PeAF) when clinically indicated. Lesion size is influenced by many parameters, which include those related to energy application (RFA power, temperature, and time), delivery mechanism (electrode size, orientation, and contact force), and the environment (blood flow and local tissue contact, stability, and local impedance). Successful durable RFA is dependent on achieving lesions that are reliably transmural and contiguous, whilst also avoiding injury to the surrounding structures. This review focuses on the variables that can be adjusted in connection with RFA to achieve long-lasting lesions that enable patients to derive the maximum sustained benefit from pulmonary vein isolation and additional lesion sets if utilized.
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Affiliation(s)
- Zain I Sharif
- Clinical Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - E Kevin Heist
- Clinical Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, MA, USA
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16
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Yavin H, Brem E, Zilberman I, Shapira-Daniels A, Datta K, Govari A, Altmann A, Anic A, Wazni O, Anter E. Circular Multielectrode Pulsed Field Ablation Catheter Lasso Pulsed Field Ablation: Lesion Characteristics, Durability, and Effect on Neighboring Structures. Circ Arrhythm Electrophysiol 2021; 14:e009229. [PMID: 33417475 DOI: 10.1161/circep.120.009229] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a nonthermal energy with potential safety advantages over radiofrequency ablation. This study investigated a novel PFA system-a circular multielectrode catheter (PFA lasso) and a multichannel generator designed to work with Carto 3 mapping system. METHODS A 7.5F bidirectional circular catheter with 10 electrodes and variable expansion was designed for PFA (biphasic, 1800 Volts). This study included a total of 16 swine used to investigate the following 3 experimental aims: Aim 1 examined the feasibility to create a right atrial ablation line of block from the superior vena cava to the inferior vena cava. Aim 2 examined the effect of PFA on lesion maturation including durability after a 30-day survival period. Aim 3 examined the effect of high-intensity PFA (10 applications) on esophageal and phrenic nerve tissue in comparison to normal intensity radiofrequency ablation (1-2 applications). Histopathologic analysis of all cardiac, esophageal, and phrenic nerve tissue was performed. RESULTS Acute line of block was achieved in 12/12 swine (100%) and required a total PFA time of 14 seconds (interquartile range [IQR], 9-24.5) per line. Ablation line durability after 28±3 days was maintained in 11/12 (91.7%) swine. PFA resulted in transmural lesions in 179/183 (97.8%) sections and a median lesion width of 14.2 mm. High-intensity PFA (9 [IQR, 8-14] application) had no effect on the esophagus while standard intensity radiofrequency ablation (1.5 [IQR, 1-2] applications) resulted in deep esophageal tissue injury involving the muscularis propria and adventitia layers. High-intensity PFA (16 [IQR, 10-28] applications) has no effect on phrenic nerve function and structure while standard dose radiofrequency ablation (1.5 [IQR, 1-2] applications) resulted in acute phrenic nerve paralysis. CONCLUSIONS In this preclinical model, a multielectrode circular catheter and multichannel generator produced durable atrial lesions with lower vulnerability to esophageal or phrenic nerve damage.
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Affiliation(s)
- Hagai Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
| | - Erez Brem
- Research and Development Division, Biosense Webster, Johnson and Johnson, Irwindale, CA (E.B., K.D.)
| | - Israel Zilberman
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.)
| | - Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.S.-D.)
| | - Keshava Datta
- Research and Development Division, Biosense Webster, Johnson and Johnson, Irwindale, CA (E.B., K.D.)
| | - Assaf Govari
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.)
| | - Andres Altmann
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.).,University Clinical Hospital Split, Croatia (A.A.)
| | | | - Oussama Wazni
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
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17
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Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol 2020; 18:210-225. [PMID: 33051613 DOI: 10.1038/s41569-020-00451-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation for atrial fibrillation (AF) has emerged as an important rhythm-control strategy and is by far the most common cardiac ablation procedure performed worldwide. Current guidelines recommend the procedure in symptomatic patients with paroxysmal or persistent AF who are refractory or intolerant to antiarrhythmic drugs. The procedure might also be considered as a first-line approach in selected asymptomatic patients. Data from large registries indicate that AF ablation might reduce mortality and the risk of heart failure and stroke, but evidence from randomized controlled trials is mixed. Pulmonary vein isolation using point-by-point radiofrequency or with the cryoballoon remains the cornerstone technique in AF ablation. Additional atrial ablation can be performed in patients with persistent AF, but its benefits are largely unproven. Technological advances in the past decade have focused on achieving durable vein isolation, reducing procedure duration and improving safety. Numerous exciting new technologies are in various stages of development. In this Review, we discuss the relevant data to support the recommended and evolving indications for catheter ablation of AF, describe the different ablation techniques, and highlight the latest advances in technology that aim to improve its safety and efficacy. We also discuss lifestyle modification strategies to improve ablation outcomes.
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Affiliation(s)
- Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ahmed M Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
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18
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Yavin HD, Leshem E, Shapira-Daniels A, Sroubek J, Barkagan M, Haffajee CI, Cooper JM, Anter E. Impact of High-Power Short-Duration Radiofrequency Ablation on Long-Term Lesion Durability for Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:973-985. [DOI: 10.1016/j.jacep.2020.04.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/20/2023]
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19
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Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with considerable morbidity and mortality. Electrically isolating the pulmonary veins from the left atrium by catheter ablation is superior to antiarrhythmic drug therapy for maintaining sinus rhythm, but its success varies depending on multiple factors, including arrhythmic burden. Although procedural outcomes have improved over the years, further gains are limited by a seemingly zero-sum relationship between effectiveness and safety, which is largely a product of the available technologies. Current energies used to create contiguous, transmural, and durable atrial lesions can result in serious complications if they reach the esophagus or phrenic nerve, for instance—structures that can be adjacent to the atrial myocardium, often within millimeters of the energy source. Consequently, high rates of pulmonary vein-left atrium reconnections are consistently seen in clinical studies and in clinical practice as operators appropriately forgo ablation effectiveness to protect patients from harm. However, as ablative technologies evolve to circumvent this stalemate, safer, and more effective pulmonary vein isolation seems increasingly realistic. Furthermore, the innovative nature of these technologies raises the prospect of markedly improved procedural efficiency, which could increase patient comfort, reduce operator occupational injuries, and enhance the use of health resources—all of which are increasingly important considerations particularly as the demand for catheter ablation for atrial fibrillation continues to rise. We herein review 3 promising candidate ablation technologies with the potential to revolutionize the management of patients with atrial fibrillation: electroporation (pulsed-field ablation), expandable lattice-tip radiofrequency ablation/electroporation, and ultra-low temperature cryoablation.
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Affiliation(s)
- F. Daniel Ramirez
- From the University of Bordeaux, CHU Bordeaux, Bordeaux-Pessac, France (F.D.R., M.H., P.J.)
- IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030 (F.D.R., M.H., P.J.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R.)
- Homolka Hospital, Prague, Czech Republic (V.Y.R.)
| | | | - Mélèze Hocini
- From the University of Bordeaux, CHU Bordeaux, Bordeaux-Pessac, France (F.D.R., M.H., P.J.)
- IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030 (F.D.R., M.H., P.J.)
| | - Pierre Jaïs
- From the University of Bordeaux, CHU Bordeaux, Bordeaux-Pessac, France (F.D.R., M.H., P.J.)
- IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030 (F.D.R., M.H., P.J.)
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20
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Aryana A. Novel and Emerging Tools and Technologies in Cardiac Electrophysiology: What's on the Horizon in 2020? J Innov Card Rhythm Manag 2020; 10:3944-3948. [PMID: 32494410 PMCID: PMC7252821 DOI: 10.19102/icrm.2019.101206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
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21
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Yavin H, Shapira-Daniels A, Barkagan M, Sroubek J, Shim D, Melidone R, Anter E. Pulsed Field Ablation Using a Lattice Electrode for Focal Energy Delivery: Biophysical Characterization, Lesion Durability, and Safety Evaluation. Circ Arrhythm Electrophysiol 2020; 13:e008580. [PMID: 32372696 PMCID: PMC7338046 DOI: 10.1161/circep.120.008580] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a nonthermal energy that may provide safety advantages over radiofrequency ablation (RFA). One-shot PFA catheters have been developed for pulmonary vein isolation, but they do not permit flexible lesion sets. This study investigated a novel lattice-tip catheter designed for focal RFA or PFA ablation. METHODS The effects of PFA (biphasic, 24 amperes) were investigated in 25 swine using a lattice-tip catheter and system (Affera Inc). Step 1 (n=14) examined the feasibility to create atrial line of block and described its acute effects on the phrenic nerve and esophagus. Step 2 (n=7) examined the subacute effects of PFA on block durability, phrenic nerve, and esophagus ≥2 weeks. Step 3 compared the effects of PFA and RFA on the esophagus using a mechanical deviation model approximating the esophagus to the right atrium (n=4) and by direct ablation within its lumen (n=4). The effects of endocardial PFA and RFA on the phrenic nerve were also compared (n=10). Histological analysis was performed. RESULTS PFA produced acute block in 100% of lines, achieved with 2.1 (1.3-3.2) applications/cm line. Histological analysis following (35 [18-37]) days showed 100% transmurality (thickness range 0.4-3.4 mm) with a lesion width of 19.4 (10.9-27.4 mm). PFA selectively affected cardiomyocytes but spared blood vessels and nervous tissue. PFA applied from the posterior atria (23 [21-25] applications) to the approximated esophagus (6 [4.5-14] mm) produced transmural lesions without esophageal injury. PFA (16.5 [15-18] applications) applied inside the esophageal lumen produced mild edema compared with RFA (13 [12-14] applications) which produced epithelial ulcerations. PFA resulted in no or transient stunning of the phrenic nerve (<5 minutes) without histological changes while RFA produced paralysis. CONCLUSIONS PFA using a lattice-tip ablation catheter for focal ablation produced durable atrial lesions and showed lower vulnerability to esophageal or phrenic nerve damage compared with RFA.
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Affiliation(s)
- Hagai Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Michael Barkagan
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Jakub Sroubek
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - David Shim
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | | | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
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Reddy VY, Anter E, Rackauskas G, Peichl P, Koruth JS, Petru J, Funasako M, Minami K, Natale A, Jais P, Nakagawa H, Marinskis G, Aidietis A, Kautzner J, Neuzil P. Lattice-Tip Focal Ablation Catheter That Toggles Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e008718. [DOI: 10.1161/circep.120.008718] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters have been shown capable of performing pulmonary vein isolation, but not flexible lesion sets such as linear lesions. A novel lattice-tip ablation catheter with a compressible 9-mm nitinol tip is able to deliver either focal radiofrequency ablation or PFA lesions, each in 2 to 5 s.
Methods:
In a 3-center, single-arm, first-in-human trial, the 7.5F lattice catheter was used with a custom mapping system to treat paroxysmal or persistent atrial fibrillation. Toggling between energy sources, point-by-point pulmonary vein encirclement was performed using biphasic PFA posteriorly and either temperature-controlled irrigated radiofrequency ablation or PFA anteriorly (RF/PF or PF/PF, respectively). Linear lesions were created using either PFA or radiofrequency ablation.
Results:
The 76-patient cohort included 55 paroxysmal and 21 persistent atrial fibrillation patients undergoing either RF/PF (40 patients) or PF/PF (36 patients) ablation. The pulmonary vein isolation therapy duration time (transpiring from first to last lesion) was 22.6±8.3 min/patient, with a mean of 50.1 RF/PF lesions/patient. Linear lesions included 14 mitral (4 RF/2 RF+PF/8 PF), 34 left atrium roof (12 RF/22 PF), and 44 cavotricuspid isthmus (36 RF/8 PF) lines, with therapy duration times of 5.1±3.5, 1.8±2.3, and 2.4±2.1 min/patient, respectively. All lesion sets were acutely successful, using 4.7±3.5 minutes of fluoroscopy. There were no device-related complications, including no strokes. Postprocedure esophagogastroduodenoscopy revealed minor mucosal thermal injury in 2 of 36 RF/PF and 0 of 24 PF/PF patients. Postprocedure brain magnetic resonance imaging revealed diffusion-weighted imaging+/fluid-attenuated inversion recovery- and diffusion-weighted imaging+/fluid-attenuated inversion recovery+ asymptomatic lesions in 5 and 3 of 51 patients, respectively.
Conclusions:
A novel lattice-tip catheter could safely and rapidly ablate atrial fibrillation using either a combined RF/PF approach (capitalizing on the safety of PFA and the years of experience with radiofrequency energy) or an entirely PF approach.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT04141007 and NCT04194307.
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Affiliation(s)
- Vivek Y. Reddy
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., M.F., K.M., P.N.)
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., J.S.K.)
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (E.A., H.N.)
| | - Gediminas Rackauskas
- Centre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Lithuania (G.R., G.M., A.A.)
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.)
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., J.S.K.)
| | | | - Moritoshi Funasako
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., M.F., K.M., P.N.)
| | - Kentaro Minami
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., M.F., K.M., P.N.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (A.N.)
| | - Pierre Jais
- University of Bordeaux, CHU Bordeaux, IHU LIRYC ANR-10-IAHU-04, France (P.J.)
| | - Hiroshi Nakagawa
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (E.A., H.N.)
| | - Germanas Marinskis
- Centre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Lithuania (G.R., G.M., A.A.)
| | - Audrius Aidietis
- Centre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Lithuania (G.R., G.M., A.A.)
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.)
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., M.F., K.M., P.N.)
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Reddy VY, Neužil P, Peichl P, Rackauskas G, Anter E, Petru J, Funasako M, Minami K, Aidietis A, Marinskis G, Natale A, Nakagawa H, Jackman WM, Kautzner J. A Lattice-Tip Temperature-Controlled Radiofrequency Ablation Catheter. JACC Clin Electrophysiol 2020; 6:623-635. [DOI: 10.1016/j.jacep.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
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24
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Koruth JS, Kuroki K, Kawamura I, Stoffregen WC, Dukkipati SR, Neuzil P, Reddy VY. Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions: A Preclinical Assessment of Safety and Durability. Circ Arrhythm Electrophysiol 2020; 13:e008716. [PMID: 32370542 DOI: 10.1161/circep.120.008716] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus. METHODS Two cohorts of 6 swine were treated with pulsed fields at low dose (PFLD) and high dose (PFHD) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PFLD), 6 mitral (PFHD), and 6 roof lines (radiofrequency+PFHD). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PFHD and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology. RESULTS Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PFLD to 100% with PFHD (P=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PFHD sections had higher transmurality rates than PFLD (98.3% versus 88.1%; P=0.03) despite greater mean thickness (2.5 versus 1.3 mm; P<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PFHD sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections. CONCLUSIONS The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.
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Affiliation(s)
- Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Kenji Kuroki
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Petr Neuzil
- Homolka Hospital, Prague, Czech Republic (P.N., V.Y.R.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.).,Homolka Hospital, Prague, Czech Republic (P.N., V.Y.R.)
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25
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Jaïs P, Ramirez FD. A Bigger Thermal Footprint. JACC Clin Electrophysiol 2020; 6:520-522. [DOI: 10.1016/j.jacep.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/25/2022]
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26
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Koruth JS, Kuroki K, Iwasawa J, Batul SA, Turagam MK, Dukkipati SR, Reddy VY. Feasibility, safety, and durability of porcine atrial ablation using a lattice-tip temperature-controlled radiofrequency ablation catheter. J Cardiovasc Electrophysiol 2020; 31:1323-1331. [PMID: 32250501 DOI: 10.1111/jce.14473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using standard radiofrequency (RF) catheters is limited by incomplete contiguity and prolonged procedural times. A novel, 9-mm lattice-tip irrigated RF catheter can create wide lesions rapidly in swine atria. METHODS In five swine, temperature limited (75°C) irrigated RF for 5 seconds/ablation was selected, to isolate seven pulmonary veins (PVs; five right superior and two inferior commons) and create five right atrial lines. After 4 weeks, repeat mapping and additional ablation to create atrial isthmus lesions were performed. The chronic lesions were submitted for histology. This was compared with right superior PVI data using standard 3.5-mm irrigated tip ablation in six swine. RESULTS All targeted PVs (seven of seven, 100%) were acutely isolated. Durable isolation was observed in all six of six PVs treated with 5-second applications, but not in one PV inadvertently treated with 4-second applications. For the durably isolated PVs, the mean lesion count/PV and total RF time/PV was 16.3 ± 5.2 applications and 81.3 ± 25.9 seconds for the right superior and 14.5 ± 0.7 applications and 71.1 ± 5.5 seconds for the inferior common PV. Right atrial linear ablation was performed with a lesion count of 12 ± 2.3 applications and RF times of 59.5 ± 12.5 seconds. Cavotricuspid and mitral isthmus linear ablations were transmural along their entire length. All 53 of 53 (100%) sections were transmural on histology. CONCLUSION Rapid and durable PVI and linear atrial ablation is feasible with this novel 9-mm lattice-tip catheter.
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Affiliation(s)
- Jacob S Koruth
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenji Kuroki
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jin Iwasawa
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Syed A Batul
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohit K Turagam
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas R Dukkipati
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
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A Lattice-Tip Temperature-Controlled Radiofrequency Ablation Catheter for Wide Thermal Lesions: First-in-Human Experience With Atrial Fibrillation. JACC Clin Electrophysiol 2020; 6:507-519. [PMID: 32439034 DOI: 10.1016/j.jacep.2019.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and acute performance of the lattice tip for the treatment of atrial flutter and fibrillation (AF). BACKGROUND A novel catheter using an expandable lattice structure with a wide thermal footprint incorporating multiple surface thermocouples/mini-electrodes has been designed for high-resolution mapping and high-current, temperature-controlled radiofrequency ablation (RFA). METHODS Patients with typical right atrial flutter or AF were prospectively enrolled in a single-arm study at 3 centers. Patients with atrial flutter underwent cavotricuspid isthmus (CTI) ablation. Patients with paroxysmal AF underwent pulmonary vein isolation (PVI) and CTI if desired, and for patients with persistent AF, mitral isthmus and left atrial roof lines were also permitted. Mapping was performed with the lattice (Sphere-9) catheter and a novel compatible electroanatomic mapping system (Prism-1). RFA was performed in a point-by-point fashion (Tmax, 73°C to 80°C; range 2 to 7 s). Patients were followed for 3 months. RESULTS A total of 71 patients underwent ablation: 65 PVI (38% with persistent AF) and 22 mitral isthmus, 24 roof, and 48 CTI lines. PVI was achieved in 64 of 65 (98.5%) by using the lattice alone and required a mean of 2.7 ± 0.70 RFA min. Mitral block was achieved in 100% by using 11.5 ± 10.7 applications and 1.0 ± 0.92 RFA min; only 1 patient required adjunctive epicardial coronary sinus ablation. Roof line and CTI block were achieved in 95.8% and 100% of patients, using 4.9 ± 1.9 and 5.9 ± 3.1 applications for 0.4 ± 0.16 and 0.5 ± 0.24 RFA min, respectively. At 3 months, there were no deaths, strokes, tamponade, or atrioesophageal fistula. CONCLUSIONS This first-in-human study demonstrated clinical feasibility and safety for rapid high-current, temperature-controlled point-by-point PVI and linear ablation.
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28
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Haines DE. Can an Expanding Lattice Electrode Catheter Expand Our Success in Catheter Ablation? Circ Arrhythm Electrophysiol 2019; 12:e007306. [PMID: 30943763 DOI: 10.1161/circep.119.007306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David E Haines
- Heart Rhythm Center, Beaumont Health, Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
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Terricabras M, Piccini JP, Verma A. Ablation of persistent atrial fibrillation: Challenges and solutions. J Cardiovasc Electrophysiol 2019; 31:1809-1821. [PMID: 31828883 DOI: 10.1111/jce.14311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 12/25/2022]
Abstract
Catheter ablation is commonly used for treatment of persistent atrial fibrillation (AF). Pulmonary vein isolation (PVI) is still the cornerstone for the procedure, however, outcomes are consistently lower compared to paroxysmal AF. It is hypothesized that it could be due to lack of durable lesions or the presence of non-PV targets that remain after PVI. Numerous advances in ablation catheter technologies and mapping systems may potentially achieve lower recurrence rates in the future. Ongoing research is required to discover the best technique for persistent AF ablation. The purpose of this review is to describe the new, developing technologies that may improve the outcome of this procedure in the persistent AF population.
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Affiliation(s)
- Maria Terricabras
- Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
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Sandhu A, Nguyen DT. Forging ahead: Update on radiofrequency ablation technology and techniques. J Cardiovasc Electrophysiol 2019; 31:360-369. [DOI: 10.1111/jce.14317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Amneet Sandhu
- Section of Cardiology, Division of Cardiology, Section of Electrophysiology and Denver VA Medical CenterUniversity of ColoradoAurora Colorado
| | - Duy T. Nguyen
- Section of Electrophysiology, Division of CardiologyStanford UniversityPalo Alto California
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Shapira-Daniels A, Barkagan M, Yavin H, Sroubek J, Reddy VY, Neuzil P, Anter E. Novel Irrigated Temperature-Controlled Lattice Ablation Catheter for Ventricular Ablation: A Preclinical Multimodality Biophysical Characterization. Circ Arrhythm Electrophysiol 2019; 12:e007661. [PMID: 31707809 DOI: 10.1161/circep.119.007661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular tachycardia ablation is often limited by insufficient lesion creation. A novel radiofrequency catheter with an expandable lattice electrode has a larger surface area capable of delivering higher currents at a lower density to potentially increase lesion dimensions without overheating. METHODS This 8F bidirectional irrigated catheter (Sphere-9, Affera Inc) has a 9 mm spherical lattice tip ("lattice") with an effective surface area 10-fold larger than standard linear catheters. Nine surface thermocouples provide temperature feedback to a proprietary high-current generator operating in a temperature-controlled mode. Ex vivo phase: in 11 bovine hearts, unipolar ablation at 30, 60, and 120 seconds was compared between the lattice (Tmax60°C) and a standard linear irrigated-tip catheter (40 W) at contact force of 10 g. In 5 porcine hearts, bipolar ablation was compared between the catheters (Tmax60°C versus 40 W; 60 seconds). In vivo phase: in 9 swine, ventricular ablation at Tmax60°C versus 40 W was performed for 60 seconds. In addition, direct tissue temperature at 3- and 7-mm tissue depth was measured in a thigh muscle preparation. RESULTS Ex vivo: lattice produced deeper lesions at 30, 60, and 120 seconds application duration (6.7±1.3 versus 4.8±1.2 mm; 8.3±1.4 versus 5.4±0.8 mm; 10.0±1.6 versus 6.1±1.6 mm, respectively, P≤0.001 for all). Bipolar lesions were deeper (15.8±4.1 versus 10.5±1.4 mm, P<0.001) and more likely to be transmural (80% versus 0%, P=0.002). In vivo: lattice produced deeper lesions (10.5±1.4 versus 6.5±0.8 mm, P≤0.001). Tissue temperature at 7 mm was higher with the lattice (+15.1±2.4°C; P<0.001). The steam-pop occurrence was lower with the lattice (total: 4% versus 18%, P=0.02; in vivo 0% versus 14.2%, P=0.13). CONCLUSIONS This novel radiofrequency system produces larger ventricular lesions compared with standard irrigated catheters and at a lower risk of tissue overheating. This may improve the efficacy of ventricular tachycardia ablation procedures while reducing the number of applications and procedural duration.
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Affiliation(s)
- Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.)
| | - Michael Barkagan
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.)
| | - Hagai Yavin
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.)
| | - Jakub Sroubek
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.)
| | - Vivek Y Reddy
- Helmsley Center for Electrophysiology, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (V.Y.R.).,Department of Cardiology, Hamolka Hospital, Prague, Czech Republic (V.Y.R., P.N.)
| | - Petr Neuzil
- Department of Cardiology, Hamolka Hospital, Prague, Czech Republic (V.Y.R., P.N.)
| | - Elad Anter
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.)
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