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Nair D, Martinek M, Colley BJ, Sundaram S, Hariharan R, Morales G, Sommer P, Healy S, Siddiqui U, Gibson D, Chapman K, Sarver A, Lo M. Safety and effectiveness of the first contact force ablation catheter with a flexible tip. Heart Rhythm O2 2023; 4:784-793. [PMID: 38204461 PMCID: PMC10774658 DOI: 10.1016/j.hroo.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Catheter ablation is an established therapy for paroxysmal atrial fibrillation (PAF). The TactiFlex Ablation Catheter, Sensor Enabled (TactiFlex SE) is a next-generation radiofrequency ablation catheter incorporating fiber optics-based contact force-sensing technology with a flexible, laser-cut tip. Objective The study sought to evaluate the safety and effectiveness of the TactiFlex SE ablation catheter for treatment of drug-refractory PAF. Methods The TactiFlex AF investigational device exemption was a prospective, nonrandomized, multicenter clinical study. Enrollment began on June 26, 2020 and completed June 18, 2021. Subjects with PAF underwent de novo pulmonary vein isolation and, if indicated, ablation for typical atrial flutter. Subjects were followed for 12 months. Results Of the 355 subjects enrolled at 37 sites worldwide, 334 underwent ablation with the TactiFlex SE catheter. The Kaplan-Meier estimate of 12-month freedom from AF/atrial flutter (AFL)/atrial tachycardia recurrence was 72.9% (95% confidence interval [CI] 95% CI 67.2%-77.8%) and clinical success was 83.6% (95% CI 95% CI 78.1%-87.2%). As-treated analyses compared subjects treated at high power (left atrium time-averaged power setting 40-50 W; n = 222) vs low power (<40 W; n = 97). The Kaplan-Meier estimate of 12-month freedom from AF/AFL/atrial tachycardia recurrence was 76.4% (95% CI 69.3%-82.0%) and clinical success was 83.9% (95% CI 77.5%-88.6%) in the high-power group compared with 66.8% (95% CI 56.1%-75.5%) and 80.7% (95% CI 70.8%- 87.5%), respectively, in the low-power group. The primary safety event rate in all treated subjects was 4.3%; 4.1% in the HP group and 5.2% in the LP group (P = .7671). Conclusion TactiFlex SE is safe and effective for treatment of drug-refractory PAF and concomitant AFL and enables more efficient procedures than previous generation catheters.
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Affiliation(s)
- Devi Nair
- St. Bernard’s Medical Center, Jonesboro, Arkansas
| | - Martin Martinek
- Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | - Sri Sundaram
- South Denver Cardiology Associates PC, Denver, Colorado
| | - Ramesh Hariharan
- University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | | | | | - Monica Lo
- Arkanasas Heart Hospital, Little Rock, Arkansas
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Thomas KL, Al-Khatib SM, Kosinski AS, Sears SF, Allen LaPointe NM, Jackson LR, Matlock DD, Haithcock D, Colley BJ, Hirsh DS, Peterson ED. Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical Trial. Ann Intern Med 2023; 176:615-623. [PMID: 37011387 PMCID: PMC10354526 DOI: 10.7326/m22-2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Racial disparities in implantable cardioverter-defibrillator (ICD) implantation are multifactorial and are partly explained by higher refusal rates. OBJECTIVE To assess the effectiveness of a video decision support tool for Black patients eligible for an ICD. DESIGN Multicenter, randomized clinical trial conducted between September 2016 and April 2020. (ClinicalTrials.gov: NCT02819973). SETTING Fourteen academic and community-based electrophysiology clinics in the United States. PARTICIPANTS Black adults with heart failure who were eligible for a primary prevention ICD. INTERVENTION An encounter-based video decision support tool or usual care. MEASUREMENTS The primary outcome was the decision regarding ICD implantation. Additional outcomes included patient knowledge, decisional conflict, ICD implantation within 90 days, the effect of racial concordance on outcomes, and the time patients spent with clinicians. RESULTS Of the 330 randomly assigned patients, 311 contributed data for the primary outcome. Among those randomly assigned to the video group, assent to ICD implantation was 58.6% compared with 59.4% in the usual care group (difference, -0.8 percentage point [95% CI, -13.2 to 11.1 percentage points]). Compared with usual care, participants in the video group had a higher mean knowledge score (difference, 0.7 [CI, 0.2 to 1.1]) and a similar decisional conflict score (difference, -2.6 [CI, -5.7 to 0.4]). The ICD implantation rate within 90 days was 65.7%, with no differences by intervention. Participants randomly assigned to the video group spent less time with their clinician than those in the usual care group (mean, 22.1 vs. 27.0 minutes; difference, -4.9 minutes [CI, -9.4 to -0.3 minutes]). Racial concordance between video and study participants did not affect study outcomes. LIMITATION The Centers for Medicare & Medicaid Services implemented a requirement for shared decision making for ICD implantation during the study. CONCLUSION A video-based decision support tool increased patient knowledge but did not increase assent to ICD implantation. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Kevin L Thomas
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | - Sana M Al-Khatib
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | | | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina (S.F.S.)
| | - Nancy M Allen LaPointe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (N.M.A.L.)
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina (L.R.J.)
| | - Daniel D Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado (D.D.M.)
| | | | | | - David S Hirsh
- Department of Medicine, Emory University, Atlanta, Georgia (D.S.H.)
| | - Eric D Peterson
- Department of Medicine, University of Texas Southwestern, Dallas, Texas (E.D.P.)
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Lo M, Nair D, Mansour M, Calkins H, Reddy VY, Colley BJ, Tanaka-Esposito C, Sundaram S, DeLurgio DB, Sanders P, Khatib S, Bernard M, Olson N, Gibson D, Miller A, Li J, Natale A. Contact force catheter ablation for the treatment of persistent atrial fibrillation: Results from the PERSIST-END study. J Cardiovasc Electrophysiol 2023; 34:279-290. [PMID: 36352771 DOI: 10.1111/jce.15742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Use of a novel magnetic sensor enabled optical contact force ablation catheter has been established to be safe and effective for treatment of symptomatic drug-refractory paroxysmal atrial fibrillation (AF) but has yet to be demonstrated in the persistent AF (PersAF) population. METHODS PERSIST-END was a multicenter, prospective, nonrandomized, investigational study designed to demonstrate the safety and effectiveness of TactiCath™ Ablation Catheter, Sensor Enabled™(SE) (TactiCath SE) for use in the treatment of subjects with documented PersAF refractory or intolerant to at least one Class I/III AAD. The ablation strategy included pulmonary vein isolation and additional targets at physician discretion. Follow-up through 15-months, including a 3-month blanking period and 3-month therapy consolidation period, was performed with cardiac event and Holter monitoring. Primary safety, primary effectiveness, clinical success, and quality of life (QOL) endpoints were analyzed. RESULTS Of 224 subjects enrolled at 21 investigational sites in the United States and Australia, 223 underwent ablation with the investigational catheter. The primary safety event rate was 3.1% (seven events in seven subjects). The Kaplan-Meier estimate of freedom from AF/atrial flutter/atrial tachycardia recurrence at 15-months was 61.6% and clinical success at 15 months was 89.8%. Subject QOL significantly improved following ablation as assessed via AFEQT (31.6 point increase, p < .0001) and EQ-5D-5L (10.7 point increase, p < .0001) and was met with a 53% reduction in all cause cardiovascular healthcare utilization. CONCLUSION The sensor-enabled force-sensing catheter is safe and effective for the treatment of drug refractory recurrent symptomatic PersAF, reducing arrhythmia recurrence while improving QOL and healthcare utilization.
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Affiliation(s)
- Monica Lo
- Arkansas Heart Hospital, Little Rock, Arkansas, USA
| | - Devi Nair
- St. Bernards Medical Center, Jonesboro, Arkansas, USA
| | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hugh Calkins
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Sri Sundaram
- South Denver Cardiology Associates, Littleton, Colorado, USA
| | | | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, Louisiana, USA
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Hsu JC, Darden D, Glover BM, Colley BJ, Steinberg C, Thibault B, Jewell C, Bernard M, Tabereaux PB, Siddiqui U, Li J, Horvath EE, Cooper D, Lin D. Performance and acute procedural outcomes of the EnSite Precision™ cardiac mapping system for electrophysiology mapping and ablation procedures: results from the EnSite Precision™ observational study. J Interv Card Electrophysiol 2022; 65:141-151. [PMID: 35536500 PMCID: PMC9550718 DOI: 10.1007/s10840-022-01239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Background The EnSite Precision™ cardiac mapping system (Abbott) is a catheter navigation and mapping system capable of displaying the three-dimensional (3D) position of conventional and sensor-enabled electrophysiology catheters, as well as displaying cardiac electrical activity as waveform traces and dynamic 3D maps of cardiac chambers. The EnSite Precision™ Observational Study (NCT-03260244) was designed to quantify and characterize the use of the EnSite Precision™ cardiac mapping system for mapping and ablation of cardiac arrhythmias in a real-world environment and evaluate procedural outcomes. Methods A total of 1065 patients were enrolled at 38 centers in the USA and Canada between 2017 and 2018 and were followed for 12 months post procedure for arrhythmia recurrence, medication use, and quality-of-life changes. Eligible subjects were adults undergoing a cardiac electrophysiology mapping and radiofrequency ablation procedure using the EnSite Precision™ System. Results A final cohort of 925 patients (64.3 years of age, 30.2% female) were analyzed. The primary procedural indication was atrial flutter in 48.1% (445/925), atrial fibrillation in 46.5% (430/925), and other arrhythmias in 5% (50/925). Electroanatomic mapping was performed in 81.5% (754/925) of patients. Mapping was stable throughout 79.8% (738/925) of procedures with initial mapping time of 8.6 min (IQR 4.7–15.0). Average mapping efficiency created with AutoMap or TurboMap was 164.9 ± 365.7 used points per minute. Median number of mapping points collected and used was 1752.5 and 811.0, respectively. Only 335/925 (36.2%) required editing and 66.0% (221/335) of these patients required editing of less than 10 points. Fluoroscopy was utilized in most cases (n = 811/925, 87.4%) with fluoroscopy time of 11.0 min (IQR 6.0–18.0). Overall median procedure time was 101.0 min (IQR 59.0–152.0). Acute procedural success was high for both atrial fibrillation (n = 422/430, 98.1%) and atrial flutter (n = 434/445, 97.5%). Conclusion In a real-world study analysis, use of the EnSite Precision™ mapping system was associated with high procedural stability, short mapping times, high point density requiring infrequent editing, low fluoroscopy time, and high prevalence of acute procedural success. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01239-4.
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Affiliation(s)
- Jonathan C Hsu
- University of California San Diego, 4952 Medical Center Dr, ACTRI Bldg, 3rd Floor, Room 3E-313, MC7411, La Jolla, CA, 92037, USA.
| | - Douglas Darden
- University of California San Diego, 4952 Medical Center Dr, ACTRI Bldg, 3rd Floor, Room 3E-313, MC7411, La Jolla, CA, 92037, USA
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie Et Pneumologie de Québec (IUCPQ-UL), Laval University, Quebec, Canada
| | | | - Coty Jewell
- Oklahoma Heart Hospital South, Oklahoma City, OK, USA
| | | | | | | | - Jingyun Li
- Abbott Laboratories, Zephyrhills, FL, USA
| | | | - Daniel Cooper
- Washington University School of Medicine, St. Louis, MO, USA
| | - David Lin
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Lo MY, Mansour M, Nair DG, Calkins H, Reddy VY, Judson Colley B, Tanaka-Esposito C, Khatib S, Sundaram S, Gibson DN, DeLurgio D, Sanders P, Miller A, Li J, Natale A. B-PO03-082 ABLATION OF PERSISTENT ATRIAL FIBRILLATION USING A NOVEL CONTACT FORCE CATHETER: PRIMARY RESULTS OF THE PERSIST-END STUDY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kautzner J, Albenque JP, Natale A, Maddox W, Cuoco F, Neuzil P, Poty H, Getman MK, Liu S, Starek Z, Dukkipati SR, Colley BJ, Al-Ahmad A, Sidney DS, McElderry HT. A Novel Temperature-Controlled Radiofrequency Catheter Ablation System Used to Treat Patients With Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:352-363. [PMID: 33516712 DOI: 10.1016/j.jacep.2020.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES DIAMOND-AF (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation) was a prospective, multicenter, noninferiority, randomized trial that compared the safety and effectiveness of the DTA system versus those of a force-sensing RF ablation system (control) for the treatment of patients with drug-refractory, recurrent, symptomatic paroxysmal atrial fibrillation (AF). BACKGROUND Irrigated radiofrequency (RF) ablation catheters lose tissue temperature acuity, which is vital in assessing lesion formation. DiamondTemp Ablation (DTA) was designed to re-establish accurate tissue temperature measurements during ablation. METHODS A total of 482 patients with paroxysmal AF were randomized (239 DTA, 243 control) to undergo pulmonary vein isolation and were followed up at 23 sites. Patients were screened for disease progression, cardiac characteristics, and prior interventions. Primary endpoints were effectiveness (freedom from atrial arrhythmia recurrence) and safety (composite of procedure- and device-related serious adverse events). RESULTS The primary safety event rate was 3.3% in the DTA group versus 6.6% in the control group (p < 0.001 vs. 6.5% noninferiority margin). Primary effectiveness was met in 79.1% of DTA subjects and 75.7% of control subjects (p < 0.001 vs. -12.5% noninferiority margin). Secondary endpoint analysis found that off-drug effectiveness favored DTA compared with the control (142 [59.4%] vs. 120 [49.4%], respectively; p = 0.03). Total RF time and individual RF ablation duration were significantly shorter with less saline infused through the DTA catheter (p < 0.001). Both arms saw clinically meaningful improvements in quality of life at 12 months. CONCLUSIONS Safety and efficacy of the DTA system proved noninferior to force-sensing RF ablation in a paroxysmal AF population. Efficiencies were observed using DTA with shorter total RF times, individual RF ablation durations, and less saline infusion. (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation; NCT03334630).
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Affiliation(s)
- Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - William Maddox
- University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Frank Cuoco
- Trident Medical Center, Charleston, South Carolina, USA
| | | | - Herve Poty
- Clinique du Tonkin, Valleurbanne, France
| | | | - Shufeng Liu
- Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Zdenek Starek
- St. Anne's University Hospital, Brno, Czech Republic
| | | | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
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8
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Abstract
Whereas a number of surveys have documented oral disease preventive behaviors and associated factors, little is known about public knowledge and beliefs about dental sealants. In this study, factors associated with the presence of sealants were studied in first and second graders residing in Columbia, SC. From a sample of 1,119 children, 88 were found clinically to have sealants; 508 did not have, but needed them. Parents of the sealant children (n = 87) and of a random sample of the no-sealant children (n = 289) were interviewed by telephone to obtain information regarding (1) factors related to parents' inclination to obtain sealants for their children, (2) ability of the family to obtain oral disease preventive services, and (3) the influence of others in the family's decision-making efforts. Analysis of 16 factors thought to be related to sealant presence revealed that parents were more likely to obtain dental sealants for their children if dentists or their staffs recommended them, if the parents were knowledgeable about dental sealants, if the parents were more highly educated, and if the parents had dental insurance coverage. Parents were less likely to obtain dental sealants for their children if they heard about them from mass media. The latter finding is unexpected and may have been influenced by conflicting or negative opinion expressed by some dental practitioners through mass media or other channels of communication.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R H Selwitz
- Epidemiology and Oral Disease Prevention Program, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20816
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