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Tzeis S, Kojic D, Manola S, Brusich S, Pernat A, Asvestas D, Xenos T, Tomovic M, Cubranic Z, Rauber M, Pavlovic N. Ablation of residual potentials along the circumferential line reduces acute reconnection in patients undergoing pulmonary vein isolation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Acute pulmonary vein (PV) reconnection is frequently encountered in patients with atrial fibrillation (AF) subjected to PV isolation (PVI).
Purpose
In this prospective, multicenter, randomized study, we investigated whether the identification and ablation of sites along the circumferential line with specific electrogram criteria indicative of nontrasmurality, after initial achievement of PVI, reduces acute PV reconnection rate.
Methods
Patients referred for AF ablation at five European centers were enrolled. PVI with antral circumferential isolation of ipsilateral PVs was performed using a contact force sensing ablation catheter delivering 35–40W at the anterior/superior and 30W at the posterior wall with target ablation index of 550 at the anterior wall/roof and 400 at the posterior/inferior segments. Following PVI, mapping with the ablation catheter was performed to identify residual potentials (RP) along the ablation line, defined as bipolar amplitude ≥0.2 mV or 0.1–0.19 mV combined with negative component of the unipolar electrogram as recorded by the 3D mapping system. Ipsilateral PV sets with RPs were randomized to either no further ablation (Group B) or to additional ablation of RPs (Group C). The primary study endpoint was defined as spontaneous or adenosine-mediated recovery of conduction after 30-minute waiting period which was also evaluated in ipsilateral PV sets without residual potentials (Group A).
Results
In total, 109 patients (59.3±10.6 years, 47% hypertension, 9.3% diabetes, left atrial diameter 39.1±4.6mm) were enrolled in the study. After initial isolation of 194 PV pairs, 98 PV pairs had no RPs (Group A) while the remaining 96 with RPs were randomized to either Group B or C (48 PV pairs each). The number of sites with RPs did not differ between groups B and C (4.1±2.5 vs 4.7±3.2, p=0.27). The occurrence of the primary endpoint in Group A was 7.1%. Ablation of residual potentials resulted in significant reduction of spontaneous or adenosine mediated reconnection (14.6% vs 47.9%, p<0.001).
Conclusion
Following initial PVI achievement, ablation of RPs along the antral circumferential line reduces spontaneous or adenosine-mediated acute PV reconnection rate in patients undergoing first-time AF ablation. Therefore, scanning of the PVI line in search of weak links with specific electrogram criteria indicative of nontrasmurality, and subsequent deployment of bonus lesions, could represent a convenient and practical way to reduce acute PV reconnection. Further studies are required to assess long term effects on AF recurrence rates.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tzeis
- Mitera Hospital , Athens , Greece
| | - D Kojic
- Cardiovascular Institute Dedinje , Belgrade , Serbia
| | - S Manola
- University Hospital Dubrava , Zagreb , Croatia
| | - S Brusich
- University of Rijeka, Department of Cardiovascular Medicine , Rijeka , Croatia
| | - A Pernat
- University Medical Centre of Ljubljana, Cardiology Department , Ljubljana , Slovenia
| | | | - T Xenos
- Mitera Hospital , Athens , Greece
| | - M Tomovic
- Cardiovascular Institute Dedinje , Belgrade , Serbia
| | - Z Cubranic
- University of Rijeka, Department of Cardiovascular Medicine , Rijeka , Croatia
| | - M Rauber
- University Medical Centre of Ljubljana, Cardiology Department , Ljubljana , Slovenia
| | - N Pavlovic
- University Hospital Dubrava , Zagreb , Croatia
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Sakellaropoulou A, Asvestas D, Bazoukis G, Saplaouras A, Giannakakis G, Letsas K, Efremidis M, Sideris A. P907Atrial septum dissection following transseptal puncture for left atrial ablation: an underestimated complication. Europace 2018. [DOI: 10.1093/europace/euy015.508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - G Giannakakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
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Vlachos K, Letsas K, Asvestas D, Bazoukis G, Saplaouras A, Martin R, Kalafateli M, Lioni L, Georgopoulos S, Karamichalakis N, Sakellaropoulou A, Kolokathis AM, Valkanas K, Sideris A, Efremidis M. P931Low voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - R Martin
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - M Kalafateli
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - L Lioni
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - N Karamichalakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A M Kolokathis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Valkanas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
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Vlachos K, Letsas K, Saplaouras A, Bazoukis G, Asvestas D, Giannakakis G, Martin R, Sakellaropoulou A, Kolokathis AM, Valkanas K, Georgopoulos S, Karamichalakis N, Geladari E, Efremidis M, Sideris A. P1174Targeted ablation of specific electrogram patterns in low voltage areas after pulmonary vein antral isolation in persistent AF: termination to an organized rhythm reduces AF recurrence. Europace 2018. [DOI: 10.1093/europace/euy015.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Giannakakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - R Martin
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A M Kolokathis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Valkanas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - N Karamichalakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - E Geladari
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
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Asvestas D, Letsas K, Bazoukis G, Saplaouras A, Goga C, Sakellaropoulou A, Vlachos K, Georgopoulos S, Sideris A, Efremidis M. P828Quantitative assessment of left atrial fibrosis in patients with paroxysmal atrial fibrillation using high density Confidense mapping. Europace 2018. [DOI: 10.1093/europace/euy015.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - C Goga
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
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Letsas KP, Xydonas S, Karamichalakis N, Efremidis M, Manolatos D, Bazoukis G, Asvestas D, Vlachos K, Georgopoulos S, Saplaouras A, Winter J, Sideris A. Intermuscular implantation technique for subcutaneous cardioverter-defibrillators. Herz 2018; 44:541-545. [PMID: 29468258 DOI: 10.1007/s00059-018-4688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/02/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The conventional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation has been associated with pocket complications. The aim of this study was to evaluate the efficacy and safety of an alternative intermuscular technique for S‑ICD implantation. METHODS S-ICDs were implanted in ten consecutive patients (ten males, mean age: 46.8 ± 14.7 years). The pocket for the pulse generator was made above the serratus anterior muscular fascia and beneath the latissimus dorsi muscle by detaching the fibrous tissue between the muscles. Electrode implantation was performed using the three- (n = 4) or the two-incision technique (n = 6). RESULTS All S‑ICDs were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, apart from one patient with Brugada syndrome who needed device repositioning more dorsally. During a mean follow-up of 16.5 ± 7.3 months, no major complications requiring surgical repair were encountered, while patients demonstrated high levels of comfort and satisfaction with the cosmetic result. One patient experienced an inappropriate shock due to noise detection, which was resolved after reprogramming to a different sensing vector. CONCLUSION The intermuscular technique is a safe and efficacious approach for S‑ICD implantation. This technique could lead to fewer pocket-related complications and better cosmetic results.
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Affiliation(s)
- K P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Xydonas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - N Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - M Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - D Manolatos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - G Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece.
| | - D Asvestas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - K Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - A Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - J Winter
- Division of Cardiac Surgery, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - A Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
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Bazoukis G, Letsas KP, Vlachos K, Asvestas D, Saplaouras A, Karamichalakis N, Georgopoulos S, Lioni L, Kolokathis A, Sakellaropoulou A, Sideris A, Efremidis M. P368New oral anticoagulants compared to acenocoumarol for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation. Europace 2017. [DOI: 10.1093/ehjci/eux141.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Efremidis M, Letsas K, Giannopoulos G, Lioni L, Vlachos K, Asvestas D, Karlis D, Kareliotis V, Geladari H, Sideris A, Deftereos S. Early pulmonary vein reconnection as a predictor of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace 2015; 17:741-6. [DOI: 10.1093/europace/euu216] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/15/2014] [Indexed: 11/14/2022] Open
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