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Urbanek L, Chen S, Bordignon S, Tohoku S, Bologna F, Schulte-Hahn B, Chun KJ, Schmidt B. Unexpected large device related thrombus at 12 months follow-up after left atrial appendage closure. Pacing Clin Electrophysiol 2022; 45:1383-1384. [PMID: 35821363 DOI: 10.1111/pace.14562] [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: 05/01/2022] [Revised: 06/19/2022] [Accepted: 07/01/2022] [Indexed: 01/20/2023]
Abstract
An 89-year-old woman underwent left atrial appendage (LAA) closure (LAAC) in our hospital because of recurrent gastrointestinal bleedings. The first transesophageal echocardiography (TEE) follow-up at six weeks revealed a complete sealing of the LAA and no device related thrombus. In a TEE follow-up at one year after the LAA closure, a large device related thrombus (6 × 3 cm) was found. Treated with oral anticoagulation (apixaban) the thrombus showed a partial resolution one year later.
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Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | | | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | | | | | - Kr Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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2
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Tohoku S, Chun KRJ, Bordignon S, Chen S, Schaack D, Urbanek L, Ebrahimi R, Hirokami J, Bologna F, Schmidt B. Findings from repeat ablation using high-density mapping after pulmonary vein isolation with pulsed field ablation. Europace 2022; 25:433-440. [PMID: 36427201 PMCID: PMC9935020 DOI: 10.1093/europace/euac211] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS Pulsed-field ablation (PFA) can offer a novel perspective for atrial fibrillation (AF) ablation. We aimed to characterize the incidence of pulmonary vein (PV) reconnection, types of recurrent atrial tachyarrhythmia (ATa) and lesion quality after PFA-guided PV isolation (PVI). METHODS AND RESULTS Patients undergoing second ablation for recurrent ATa following the initial PVI using the pentaspline PFA catheter were investigated. The rate of PV reconnection, the features of recurrent ATa, and the amount of isolated posterior wall (PW) surface area (ISAPW%) (ratio of the isolated- to total surface area on PW) were analyzed. RESULTS Among 360 patients treated with PFA, 25 patients (paroxysmal AF, n = 19) with 99 PVs underwent a second procedure 6.1 ± 4.0 months after the initial procedure. The rate of PV reconnection was 9.1% (9 PVs). Patients presented with atrial tachycardia (AT) (n = 16), AF (n = 8) and typical atrial flutter (n = 1). The mechanism of all but one AT was macro-reentry. The critical isthmus was found to be linked to the initial lesion set at the left atrial (LA) PW in eight patients and linked to pre-existing substrate at the LA anterior wall in four patients. One AT had a focal origin at the septum. In three patients, AT were unmappable. Mean ISAPW% was 72.7 ± 19.0%. CONCLUSION We revealed a remarkable low reconnection rate with a large antral lesion at the PW after pentaspline PFA catheter-guided PVI. However, macro-reentrant AT with a critical isthmus at the LAPW linked to the PVI lesion set was commonly observed.
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany,Die Sektion Medizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany,Die Sektion Medizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Boris Schmidt
- *Corresponding author. Tel: +49 69 9450280; Fax: +49 69 945028119. E-mail address:
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3
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Pansera F, Bordignon S, Bologna F, Tohoku S, Chen S, Urbanek L, Schmidt B, Chun KRJ. Catheter ablation induced phrenic nerve palsy by pulsed field ablation—completely impossible? A case series. Eur Heart J Case Rep 2022; 6:ytac361. [PMID: 36128440 PMCID: PMC9477201 DOI: 10.1093/ehjcr/ytac361] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
Background Pulsed field ablation (PFA) is a new feasible and safe method for the ablative treatment of cardiac arrhythmias, such as atrial fibrillation (AF). Through the use of electric fields, it causes pore-like openings in the cell’s wall, leading to cell death. The most appealing characteristic of this new technique is its selectivity for cardiomyocytes and consequently its low risk of collateral damage to extracardiac tissues. We present three cases of a PFA-induced transient phrenic nerve (PN) injury documented during pulmonary vein isolation (PVI). Case summaries Three patients aged 55–81 years underwent PFA for symptomatic AF. Cases 1 and 3 were affected by paroxysmal AF without evidence of structural heart disease. Case 2 had persistent AF and ischaemic cardiomyopathy with preserved ejection fraction. We observed a transient right hemidiaphragm palsy during the delivery of impulses in the right superior pulmonary vein (Cases 1 and 2) and in the right inferior pulmonary vein (Case 3). The palsy lasted <1 min and was followed by spontaneous full recovery in all cases. Discussion Transient PN dysfunction can be observed following PFA in AF ablation. According to our initial experience, a full recovery of the PN function can be expected within seconds. We hypothesize a hyperpolarization of neuronal cells or a depletion of acetylcholine in the motoric endplate to explain this event. Further studies are required to understand the exact pathophysiological mechanism.
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Affiliation(s)
- Francesco Pansera
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Stefano Bordignon
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Fabrizio Bologna
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Shota Tohoku
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Shaojie Chen
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Lukas Urbanek
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Boris Schmidt
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Kyoung-Ryul Julian Chun
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
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Scarica C, Pontemezzo E, Admitable C, Bologna F, Bosio Y, Fasano E, Gregori O, Manniello D, Miceli A, Pace S, Patruno M, Gujiarro Ponce P, Barberi S, Monaco A. P-098 Male age does not affect sperm motility rate after thawing and laboratory outcomes of transnational oocyte donation programs. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.094] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can outcomes of transnational egg donation treatments, which involves the shipping of cryopreserved partner semen, be affected by advanced paternal age?
Summary answer
Male age does not affect percentage of motile spermatozoa after thawing. Advanced paternal age does not affect IVF laboratory outcomes of transnational egg donation treatments
What is known already
Studies on advanced paternal age are limited and a clear definition of advanced paternal age is still missing. The separation between advanced paternal and maternal age effects is hampered by the collinearity of maternal age with paternal age, since older males are often associated with older women. Many studies have focused on egg donation treatments, to overcome this problem. However, these studies reported conflicting results, such as a putative effect of advanced paternal age on ICSI outcomes, while some others not. This study analyzes paternal age in transnational egg donation program, which involves the shipping of cryopreserved partner semen
Study design, size, duration
A multicentric retrospective cohort study involving 101 couples and 327 blastocysts was performed from June 2018 up to December 2021. Two Italian IVF centers involved a Spanish center to perform a transnational fresh oocyte donation program. The aim of the study was to analyze the putative effect of male age on (i) semen parameters, (ii) fertilization rate and (iii) blastocyst rate.
Participants/materials, setting, methods
Donations of both male and female gametes were excluded. We performed sperm cryopreservation of the male partner of the recruited couples. Frozen samples were shipped with a authorized courier, which certified the safety of the whole procedure. The day of donor’s egg retrieval, semen samples were thawed and ICSI was performed on fresh donated oocytes. Resulted blastocysts were vitrified and shipped to the centers where the frozen embryo transfers in the recipient patients were performed.
Main results and the role of chance
The mean of male partners age was 42.6 ± 6.5 (min 26- max 63). Overall fertilization rate was 81.6% (686/840), and blastocyst rate was 47.6% (327/686). Male age was analyzed as a continuous variable and divided into five groups calculated for 5-year intervals. No differences in terms of fertilization rates nor blastocysts rates were found (85.3% and 43.7% for <35-years; 84.7% and 54.0% for 36-39-years; 79.7% and 44.2% for 40-44-years; 89.6 and 48.1% for 45-49-years; 74.5% and 56.5 for >50-years). Although advanced paternal age has been correlated to the decrease of most of sperm parameters, in the present study we found that only progressive rapid motility was significantly affected by advanced paternal age (coefficient -0.261 , P = 0.009). To evaluate the predictive value of advanced paternal age and sperm parameters on fertilization and blastocysts formation, we performed a multiple linear regression analysis. We found that sperm parameters and male age in our sample are not predictive of the number of fertilized oocytes nor the number of obtained blastocysts. Importantly for the setting of the study, the percentage of progressive motile sperm at the thawing was not influenced by paternal age.
Limitations, reasons for caution
The main limitation of the study is the small sample size, which might mask the paternal age effect on the sperm parameters, as the volume, which tend to decrease in the classes of age, but did not reached the statistical significance. The multicentric nature of the study represent a strength
Wider implications of the findings
The discomfort for couples that need oocyte donation in countries where there is a low availability of egg donors is often underestimated. This study demonstrate that, independently of male age, the shipping of frozen sperm and the ICSI of freshly donated oocytes represent a valid option for these couples.
Trial registration number
not applicable
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Affiliation(s)
- C Scarica
- European Hospital, New Fertility Group Reproductive Medicine Center , Rome, Italy
| | - E Pontemezzo
- European Hospital, New Fertility Group Reproductive Medicine Center , Rome, Italy
| | - C Admitable
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - F Bologna
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - Y Bosio
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - E Fasano
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - O Gregori
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - D Manniello
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - A Miceli
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - S Pace
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - M Patruno
- Promea SpA, Affidea Group- Reproductive Medicine and Genetics , Turin, Italy
| | - P Gujiarro Ponce
- Amnios in Vitro Project, Assisted Reproduction Clinic , Madrid, Spain
| | - S Barberi
- Amnios in Vitro Project, Assisted Reproduction Clinic , Madrid, Spain
| | - A Monaco
- European Hospital, New Fertility Group Reproductive Medicine Center , Rome, Italy
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Schmidt B, Bordignon S, Tohoku S, Chen S, Bologna F, Urbanek L, Pansera F, Ernst M, Chun KRJ. 5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation. Circ Arrhythm Electrophysiol 2022; 15:e010817. [PMID: 35617232 DOI: 10.1161/circep.121.010817] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology. METHODS All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. In the validation phase (n=25), device electrogram quality was compared with a circular mapping catheter to assess pulmonary vein isolation and esophageal temperature monitoring was used. In the streamline phase (n=166), a single-catheter approach was implemented. Postprocedural cerebral magnetic resonance imaging was performed in 53 patients. In 52 patients, esophageal endoscopy was performed at day 1 after the procedure. Follow-up was performed using 72 hours Holter ECGs. RESULTS On a pulmonary vein basis, pulmonary vein isolation rate was 100% including a single shot isolation rate of 99.5%. The electrogram information of the pulsed field ablation catheter and the circular mapping catheter were 100% congruent. Neither esophageal temperature rises nor esophageal thermal injury were observed. Two minor strokes occurred, presumable due to air embolism during catheter exchanges through the large bore sheath (13.8 F ID). In the streamline phase, reduced procedure times (46±14 versus 38±13 minutes, P=0.004), no further strokes and a low incidence of silent cerebral injury (10/53 patients; 19%) were noted. During short-term follow-up, 17/191 patients (9%) had a atrial tachyarrhythmia recurrence. CONCLUSIONS The pulsed field ablation device allows for simple and safe simple single shot pulmonary vein isolation using standard sedation protocols. Procedural speed and efficacy are remarkable and streamlining measures have added safety.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie (B.S.), Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Francesco Pansera
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Matthias Ernst
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
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6
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Tohoku S, Schmidt B, Bordignon S, Chen S, Bologna F, Julian Chun KR. Initial clinical experience of pulmonary vein isolation using the ultra-low temperature cryoablation catheter for patients with atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1371-1379. [PMID: 35488736 DOI: 10.1111/jce.15519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The iCLAS ultra-low temperature cryoablation (ULTC) system has recently brought to the market. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation in atrial fibrillation (AF) ablation. The use of an esophageal warming balloon is recommended when using the system to reduce the potential for collateral esophageal injury. OBJECTIVE To describe the initial clinical experience when using ULTC in the AF treatment without general anesthesia (GA). METHODS Consecutive patients undergoing AF ablation using ULTC under deep sedation without GA were enrolled. We assessed the procedural data focusing on "single-shot isolation" defined as successful pulmonary vein (PV) isolation after the first application. Esophagogastroduodenoscopy was systematically performed the day after ablation. RESULTS A total of 27 AF patients (67% paroxysmal AF) were analyzed. One-hundred-four out of 106 PVs (98.1%) were isolated solely using ULTC. The mean procedure time was 79 ± 30 min. The mean number of applications per PV was 2.6 ± 1.0. Single-shot isolation was achieved in 57 PVs (54%) varying across PVs from left superior- to inferior PVs (40-64%). Single procedure six-month recurrence free rate was 84%. No major complication (cerebrovascular event, pericardial effusion/tamponade, esophageal damage on esophagogastroduodenoscopy) occurred. A single transient phrenic nerve palsy occurred during the right superior PV ablation which had recovered by the 3-month follow up appointment. CONCLUSIONS AF ablation using the novel ULTC system seemed feasible without GA and enabled >50% single-shot isolation rate. The promising safety profile has to be confirmed in large-scaled studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | | | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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7
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Urbanek L, Bordignon S, Chen S, Bologna F, Thohoku S, Dincher M, Schulte-Hahn B, Schmidt B, Julian Chun KR. Impact of Body Mass Index on Cryoablation of atrial fibrillation: Patient characteristics, procedural data and long-term outcomes. J Cardiovasc Electrophysiol 2022; 33:1106-1115. [PMID: 35355367 DOI: 10.1111/jce.15478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/03/2022] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ablation of atrial fibrillation in the context of obesity can be challenging. We sought to evaluate the role of cryoballoon pulmonary vein isolation (CB-PVI) in obese patients with symptomatic atrial fibrillation (AF). METHODS Patients with a BMI≥25 kg/m2 and symptomatic AF who underwent CB-PVI were retrospectively enrolled. Three groups were defined (G1: BMI of 25-29 kg/m2 ; G2: BMI of 30-34 kg/m2 ; G3: BMI≥35 kg/m2 ). RESULTS 600 patients were included (59% male; 66±11 years old); 337, 149, 114 were assigned to G1, G2 and G3, respectively. Acute procedural success was recorded in 99,7% of patients. Procedural and fluoroscopy time were comparable but radiation dose was significantly higher in G3. Procedural complications were 3% in G1, 5,4% in G2 and 8,8% in G3 (p=0,01). The overall freedom from AF after 1-year was 77%. G3 had a significantly worse 1-year success rate compared to G1 and G2 (G3:66,5% vs. G1:78,4%; p=0,015 and vs. G2:82,5%; p=0,008) with a reduced 1-year success in paroxysmal AF (G1:84,0%; G2:86,3% and G3:69,6%) but not in persistent AF (G1:68,7%; G2:77,4% and G3:62,1%). G3 showed similar success rates irrespective of AF form (PAF 69,6% vs. persAF 62,1%; p=0,501). CONCLUSION Cryoballoon ablation in obese patients can be effective with an acceptable safety profile, 77% of patients were in stable SR at one year. Severe obese patients (BMI≥35) showed reduced procedural safety and 1-year success rate. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Shota Thohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Matthias Dincher
- Johannes Gutenberg University Mainz, Gutenberg School of Management and Economics, Jakob-Welder-Weg 9, 55128, Mainz, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
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8
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Tohoku S, Schmidt B, Bordignon S, Chen S, Bologna F, Urbanek L, Pansera F, Chun KJ. Pulsed Field Ablation for Persistent Superior Vena Cava: New Solution for an Old Problem. JACC Case Rep 2022; 4:301-305. [PMID: 35257107 PMCID: PMC8897151 DOI: 10.1016/j.jaccas.2022.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
Persistent left superior vena cava (PLSVC) is a known arrhythmogenesis site in patients with atrial fibrillation. However, the optimal PLSVC isolation approach has remained unclear because of the potential risk of complications. The current study reports 2 cases of successful electrical PLSVC isolation using pulsed field ablation. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
- Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
- Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Francesco Pansera
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K.R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
- Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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Tohoku S, Bordignon S, Bologna F, Chen S, Urbanek L, Operhalski F, Chun KJ, Schmidt B. Laser balloon in pulmonary vein isolation for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2021; 18:1083-1091. [PMID: 34618626 DOI: 10.1080/17434440.2021.1990754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Visually guided laser balloon (LB) catheter has been an established modality dedicated for pulmonary vein (PV) isolation in patients with atrial fibrillation. The newly updated version of this novel device has technically evolved recent years. AREAS COVERED This review will summarize the contemporary technical evolution of LB catheter. Available efficacy outcomes and the historical change of ablation style will be evaluated. Furthermore, the future perspectives for clinical practice are discussed. EXPERT COMMENTARY The initial LB ablation system provided comparable clinical results in PV isolation with other technologies, but with a unique strategical concept enabling the direct visualization of the tissue to cauterize. With multigenerational development, the LB catheter has been equipped with more compliant balloon for favorable PV occlusion and a robotically motor driven continuous ablation mode (RAPID mode). These technical innovations changed the concept of the ablation strategy using LB catheter as 'point-by-point' into 'single-shot' fashion. The remaining tasks are further improvements such as equipping with real-time recording system of intracardiac electrogram, durable structured balloon and the instrument for visualizing the cauterization area in a 360-degree panoramic view, which includes potential possibilities to develop this novel device to the more optimal device for PV isolation.
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Affiliation(s)
- Shota Tohoku
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Stefano Bordignon
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Fabrizio Bologna
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Shaojie Chen
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Lukas Urbanek
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Kr Julian Chun
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
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Schmidt B, Chen S, Tohoku S, Bordignon S, Bologna F, Chun KRJ. Single shot electroporation of premature ventricular contractions from the right ventricular outflow tract. Europace 2021; 24:597. [PMID: 34536008 DOI: 10.1093/europace/euab212] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
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11
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Bordignon S, Chen S, Bologna F, Thohoku S, Urbanek L, Willems F, Zanchi S, Bianchini L, Trolese L, Konstantinou A, Fuernkranz A, Schmidt B, Chun JKR. Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures- the Frankfurt approach. Europace 2021; 23:868-877. [PMID: 33458770 DOI: 10.1093/europace/euaa406] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/02/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2). METHODS AND RESULTS Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, and safety issues were systematically collected. The 28 mm CB2 was used in combination with an inner lumen spiral catheter, a luminal oesophageal temperature (LET) probe was used with a cut-off of 15°C, the phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration was mainly set at 240 s with a bonus application in case of delayed time-to-isolation (TTI > 75 s). A total of 1017 CB2 procedures were analysed (58% male, 66 ± 12 years old, 70% with PAF). 3964 PVs were identified, 99.8% PVs isolated using solely the 28 mm CB. Mean procedure time was 69 ± 25 min, TTI during the first application was recorded in 77% of PVs after a mean of 48 ± 31 s. We recorded 0.2% cardiac tamponade, 4.8% PN injury (1.6% of PN palsy), and 19% of LET < 15°C. Among 725 patients with follow-up data, 84% with PAF and 75% with persAF were in stable SR at 1 year. Shorter freezing duration and longer TTI were procedural predictors for recurrence. CONCLUSION Cryoballoon procedures are fast and associated with a benign safety profile. Shorter TTI and longer freeze durations are associated with sinus rhythm during follow-up.
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Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shota Thohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | | | - Luca Trolese
- Herzzentrum Uniklinik Freiburg, Freiburg, Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
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12
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Bianchini L, Bordignon S, Chen S, Zanchi S, Tohoku S, Bologna F, Tondo C, Schmidt B, Chun KRJ. Increased procedural safety of cryoballoon pulmonary vein isolation with a double 120 s freeze protocol. Pacing Clin Electrophysiol 2021; 44:1371-1379. [PMID: 34152640 DOI: 10.1111/pace.14299] [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] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/22/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently a double 120 s freeze cryoballoon (CB) pulmonary vein isolation (PVI) protocol proved to be non inferior to a double 240 s freeze protocol in terms of atrial fibrillation (AF) recurrences. We hypothesized that this approach could also result in an increased procedure safety. METHODS Eighty consecutive patients treated with a double 120 s freeze protocol (Group CB120) were compared with 80 previous consecutive patients treated with a single 240 s freeze protocol (Group CB240). Procedures were performed with a temperature probe to monitor the luminal esophageal temperature (LET), using a cut off for cryoenergy interruption of 15°C. During ablation at the septal pulmonary veins (PVs), the phrenic nerve (PN) function was monitored by pacing. RESULTS In CB120 and CB240 the rate of single shot isolation was similar in all PVs. Time to isolation was not different between the two groups. Mean minimal esophageal temperature was lower in LSPV and LIPV of the CB240 group. A total of 4/80 patients (5%) of the CB120 group experienced a PN injury, but no persistent form was recorded; 11/80 patients (14%) of the CB240 group experienced a PN injury, three in a persistent form (p = .10). A LET <15°C was recorded in 3/80 patients (4%) in the CB120 group and in 16/80 patients (20%) in the CB240 group (p < .01). Composite rate of energy-related safety events (LET <15°C and PN injury) was significantly lower in the CB120 (34% vs. 9%, p < .01). CONCLUSIONS Safety of second generation CB PVI can be increased using a double 120 s freeze protocol.
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Affiliation(s)
- Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
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13
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Chen S, Zanchi S, Bordignon S, Bianchini L, Tohoku S, Bologna F, Chun KRJ, Schmidt B. Ablation Index guided high power (50W) short duration for anterior line and roof line ablation: feasibility, procedural data and lesion analysis. Europace 2021. [DOI: 10.1093/europace/euab116.068] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objectives
To evaluate the feasibility, procedural data, and lesion characteristics of anterior line (AL) and roof line (RL) ablation by using ablation index (AI) guided high-power(50W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI).
Methods
35 consecutive patients with macro-reentrant left atrial tachycardia (LAT) or substrate at LA anterior wall or roof after previous PVI were enrolled. Ablation power was set to 50W, targeting AI 500 for AL and 400 for RL. First-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into 3(caudal, middle and cranial) segments to analyze the location of conduction gaps in non-FPB patients.
Results
A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them respectively. In non-FPB group, the most frequent gap location along the AL was the middle third. Final block of AL was achieved in 97%, and block of RL was achieved in 100%. The RF ablation time was short (2,9 ± 0,8 min for AL and 46,2 ± 15,6 sec for RL). For AL, female gender was significantly more frequent in FPB than in non-FPB patients(p 0,028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 sec vs 161 ± 41 sec; p = 0,02). No procedural complications occurred.
Conclusion
AI guided high-power(50W) ablation appears to be a feasible, effective and fast technique for AL and RL ablation.
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Affiliation(s)
- S Chen
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Zanchi
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Bordignon
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - L Bianchini
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Tohoku
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - F Bologna
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - KRJ Chun
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
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Bordignon S, Tohoku S, Chen S, Bologna F, Throm C, Urbanek L, Hilbert M, Chun KRJ, Schmidt B. First insight into a novel irrigated radiofrequency ablation balloon. Europace 2021. [DOI: 10.1093/europace/euab116.092] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A novel irrigated RF balloon (RFB) for pulmonary vein isolation (PVI) was recently released in selected centers . It is a 28 mm open irrigated balloon with 10 unipolar electrodes on its surface to deploy a circular ostial lesion set around the PVs. An inner lumen spiral catheter allows for real time PVI visualization during the ablation.
Methods
Data from consecutive RFB procedures were collected and analysed. After a single transseptal puncture and selective PV angiograms a 3D map of the left atrium was acquired. Sequential PVI was performed using the RFB: each application lasted 60 seconds, the posterior electrodes were identified to stop the energy delivery after 20 seconds. Real time to isolation data were acquired. A 3D bipolar remap was finally performed to observe the level of isolation. A temperature probe was used to monitor the local esophageal temperature (LET) with a cut off of 39°C. Acute procedural data and complication were collected. Endoscopy was scheduled the day after procedure.
Results
Data from 10 consecutive RFB procedures were analyzed: 6/10 patients were male, 67 ± 9 years old, 8/10 with history of paroxysmal AF. A total of 36 PVs were targeted and isolated with the RFB, with a mean of 7,3 ± 4,0 applications per patient and 2,0 ± 1,2 applications per PV. First pass "single shot" isolation was achieved in 22/36 (61%), time to isolation during the first application was observed in 29/36 (80%) PVs, but an acute reconnection was observed in 10/29 (35%) isolated PVs. Mean time to sustained isolation was 13 ± 5 sec., mean time to non-sustained isolation was significantly longer (29 ± 17 sec; p = 0,001). Procedure time was 57 ± 16 min., left atrial dwell time 50 ± 14 min, ablation phase time 29 ± 14 min and fluoroscopy time was 10 ± 4 minutes. An esophageal temperature above 39°C was recorded in 2/36 PVs. No phrenic nerve palsy was recorded. 7/10 patients underwent endoscopy and no thermal lesions were detected. No other complications were recorded.
Conclusion
The novel irrigated RFB seems to allow an effective, safe and fast pulmonary vein isolation. More studies are needed to optimize energy dosing to possibly increase the rate of durable single shot PVI.
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Affiliation(s)
- S Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - C Throm
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - L Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - M Hilbert
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
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15
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Zanchi S, Bianchini L, Bordignon S, Tohoku S, Chen S, Bologna F, Tondo C, Schmidt B, Chun JKR. [Typical atrial flutter catheter ablation complicated by right coronary artery spasm and occlusion. Case report and review of the literature]. G Ital Cardiol (Rome) 2021; 22:244-249. [PMID: 33687378 DOI: 10.1714/3557.35345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Right coronary artery lesion is an uncommon and serious complication of typical atrial flutter ablation. We report a case of right coronary artery occlusion during atrial flutter ablation managed with percutaneous coronary intervention, combined with a review of the literature, in order to obtain pathogenetic and epidemiological information about this complication.
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Affiliation(s)
- Simone Zanchi
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania - Centro Cardiologico Monzino, IRCCS, Università degli Studi, Milano
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania - Centro Cardiologico Monzino, IRCCS, Università degli Studi, Milano
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Università degli Studi, Milano
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Francoforte sul Meno, Germania
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Zanchi S, Chen S, Bordignon S, Bianchini L, Tohoku S, Bologna F, Tondo C, Chun KRJ, Schmidt B. Ablation Index-guided high-power (50 W) short-duration for left atrial anterior and roofline ablation: Feasibility, procedural data, and lesion analysis (AI High-Power Linear Ablation). J Cardiovasc Electrophysiol 2021; 32:984-993. [PMID: 33634549 DOI: 10.1111/jce.14973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/11/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the feasibility, procedural data, and lesion characteristics of the anterior line (AL) and roofline (RL) ablation by using ablation index (AI)-guided high power (50 W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI). METHODS Data from 35 consecutive patients with macro-reentrant left atrial tachycardia or substrate at the left atrium anterior wall or roof after previous PVI were collected. Ablation power was set to 50 W, targeting AI 500 for AL and 400 for RL. The first-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into three (caudal, middle, and cranial) segments to analyze the location of conduction gaps in non-FPB patients. RESULTS A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them, respectively. In the non-FPB group, the most frequent gap location along the AL was the middle third. The final block of AL was achieved in 97%, and the block of RL was achieved in 100%. The radiofrequency (RF) ablation time was short (2.9 ± 0.8 min for AL and 46.2 ± 15.6 s for RL). For AL, the female gender was significantly more frequent in FPB than in non-FPB patients (p = .028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 s vs. 161 ± 41 s; p = .02). No procedural complications occurred. CONCLUSION AI-guided high-power (50 W) ablation appears to be a feasible, effective, and fast technique for AL and RL ablation.
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Affiliation(s)
- Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
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Chun JKR, Bordignon S, Last J, Mayer L, Tohoku S, Zanchi S, Bianchini L, Bologna F, Nagase T, Urbanek L, Chen S, Schmidt B. Cryoballoon Versus Laserballoon: Insights From the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009294. [PMID: 33417476 DOI: 10.1161/circep.120.009294] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF). METHODS Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications. RESULTS Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes; P<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes, P=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%, P=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group. CONCLUSIONS Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.
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Affiliation(s)
- Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.).,Medizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Germany (J.K.R.C.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Mayer
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
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18
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Urbanek L, Chen S, Bordignon S, Tsianakas N, Bologna F, Chun K, Schmidt B. Impact of body mass index on atrial fibrillation ablation using cryoballoon: procedural data and clinical outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0420] [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: 11/12/2022] Open
Abstract
Abstract
Background
The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported.
Purpose
To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB.
Methods
Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) >75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT).
Results
Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p<0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p<0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%).
Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded.
Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF.
Conclusions
Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - N Tsianakas
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - K.R.J Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
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Konstantinou A, Bordignon S, Tohoku T, Chen S, Bologna F, Tsianakas N, Urbanek L, Trolesse L, Lindhoff-Last E, Schmidt B, Chun K. Real world experience from 1000 patients. Preprocedural DOAC interruption impacts detectable DOAC serum levels but not adverse events after catheter ablation of atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0583] [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
Direct oral anticoagulation (DOAC) therapy represents the standard of care in patients with atrial fibrillation (AF) and increased stroke risk. In a real world setting withholding DOAC medication before elective AF ablation is considered to reduce procedural bleeding risks. The aim of this study was to determine the individual DOAC level prior to the ablation procedure, to identify predisposing factors affecting traceable DOAC levels and to screen for associated severe adverse events.
Methods
Between September 2016 and March 2019 blood samples were obtained from patients on DOAC before an elective AF ablation. Per institutional standard all patients have been instructed to pause DOAC medication prior ablation for one or two doses depending on the patient profile and type of medication. The time interval between ablation and last DOAC intake was calculated in hours. Patient characteristics, procedural data and in-hospital complications were noted from all patients.
Results
A total of 1000 patients (60% male, age: 68y, GFR 83.25: BMI: 28, CHADSVASC score 3) undergoing AF ablation were included. Two groups were defined. Group A (n=416, 41.6%): patients treated with “single pill” DOAC (Rivaroxaban (n=288, 28.8%) and Edoxaban (n=128, 12.8%)). Group B (n=584, 58.4%): patients treated with twice a day DOAC (Apixaban (n=505, 50.5%) and Dabigatran (n=79, 7.9%)). The only difference in patient characteristics was an increased prior bleeding history in group B. The DOAC pause was significantly longer in group A (mean 40h) compared to group B (mean 32h), p=0.026. In a total of 217 patients (21.7%) DOAC levels where traceable prior to AF ablation. Traceable DOAC levels were significantly more common in group B (n=144/584, 24.7%) compared to group A (n=73/416, 17.5%). Adverse events occurred in 5.7% of patients (0.4% stroke, 0.3% tamponade, 2.5% hematoma, 1.9% AV-fistel, 0.7% pseudoaneurysma). T-Test analysis showed no significant difference in the occurrence of adverse events between both groups.
Conclusion
Despite of interrupting DOACs before an elective AF ablation therapeutic substance levels can be detected in >20% of patients. The rate of adverse events was not different between “single pill” vs. twice a day DOAC intake.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Konstantinou
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - S Bordignon
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - T Tohoku
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - S Chen
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - F Bologna
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - N Tsianakas
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - L Urbanek
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - L Trolesse
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - E Lindhoff-Last
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - K.R.J Chun
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
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20
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Zender N, Weise FK, Bordignon S, Herrmann E, Konstantinou A, Bologna F, Nagase T, Chen S, Chun KRJ, Schmidt B. Thromboembolism after electrical isolation of the left atrial appendage: a new indication for interventional closure? Europace 2020; 21:1502-1508. [PMID: 31230078 DOI: 10.1093/europace/euz161] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/23/2019] [Accepted: 05/14/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Left atrial appendage electrical isolation (LAAI) may improve the rhythm outcome in selected patients with atrial fibrillation (AF). Controversy exists if LAAI is associated with an increased rate of thromboembolic complications. We sought to assess the feasibility, efficacy, and safety of interventional left atrial appendage closure (LAAC) in comparison to oral anticoagulation (OAC) after electrical LAAI. METHODS AND RESULTS Weeks after index LAAI using the cryoballoon or a linear maze like ablation strategy patients' left atrial appendage was invasively remapped. In case of persistent LAAI, LAAC was performed. Patients who refused invasive remapping continued OAC. The primary endpoint was composed of any stroke or systemic embolism (SE) and the occurrence of intracardiac thrombus. Secondary endpoints included stroke/SE, major bleeding, and all-cause death. Of 166 patients (51% female; mean age 70 ± 8 years; mean CHAD2S2VASc score 3.4 ± 1.8) after LAAI, 94 patients received LAAC (LAAC group) and 72 continued OAC (no LAAC). After LAAC, 83% of patients received dual antiplatelet therapy for 6 weeks and aspirin thereafter. During a mean follow-up of 778 ± 630 days, 5 and 11 primary endpoint events were observed in the LAAC and no LAAC group, respectively [hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.10-0.75; P = 0.010]. The calculated annual thromboembolic event rates were 6.9% (no LAAC) and 2.3% (LAAC), respectively. Left atrial appendage closure significantly reduced the incidence of stroke and SE (HR 0.31, CI 0.1-0.98; P = 0.04). CONCLUSION After electrical LAAI for rhythm control in AF patients, interventional LAAC was associated with fewer thromboembolic complications when compared with OAC.
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Affiliation(s)
- Niklas Zender
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Felix K Weise
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Kyoung Ryul Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, D Frankfurt am Main, Germany
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Tsianakas N, Bordignon S, Bologna F, Tohoku S, Chen S, Konstantinou A, Chun KRJ, Schmidt B. Holter ECG diagnosis of nicotine-spray induced ventricular fibrillation. An unusual case of Prinzmetal variant angina. J Electrocardiol 2020; 63:17-20. [PMID: 33022429 DOI: 10.1016/j.jelectrocard.2020.09.004] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
We report on an interesting case of resuscitated sudden cardiac death (SDC) in a 51-year-old with hypertension and positive family history for SDC. The patient was resuscitated and an emergency angiogram ruled out coronary artery disease. Cardio-MRT ruled structural disease or infection. Holter and telemetry monitoring revealed premature ventricular complexes and transient ST-changes followed by anginaepisodes in correlation with the use of the nicotine-replacement-spray. The patient was urged to quit smoking and smoking-substitutes. Medical therapy with calcium-channelblocker and a long acting nitrate was administered. One-month follow up reported no arrhythmic or angina events.
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Affiliation(s)
- N Tsianakas
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany.
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - S Tohoku
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - A Konstantinou
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
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22
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Zanchi S, Bianchini L, Bordignon S, Bologna F, Tohoku S, Chen S, Chun JKR, Schmidt B. Left atrial appendage (LAA) electrical isolation by Maze‐like catheter substrate modification in presence of LAA‐occluder device: A case report. Clin Case Rep 2020; 8:2021-2024. [PMID: 33088543 PMCID: PMC7562897 DOI: 10.1002/ccr3.3069] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/12/2020] [Accepted: 05/30/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Simone Zanchi
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Julian K. R. Chun
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Agaplesion Markus‐Krankenhaus Frankfurt am Main Germany
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23
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Tohoku S, Chen S, Last J, Bordignon S, Bologna F, Trolese L, Zanchi S, Bianchini L, Schmidt B, Chun KRJ. Phrenic nerve injury in atrial fibrillation ablation using balloon catheters: Incidence, characteristics, and clinical recovery course. J Cardiovasc Electrophysiol 2020; 31:1932-1941. [DOI: 10.1111/jce.14567] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/12/2020] [Indexed: 08/29/2023]
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
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24
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Chen S, Schmidt B, Bordignon S, Tohoku S, Urbanek L, Plank K, Willems F, Throm C, Konstantinou A, Hilbert M, Zanchi S, Bianchini L, Bologna F, Tsianakas N, Kreuzer C, Nagase T, Perrotta L, Last J, Chun KRJ. Cryoballoon pulmonary vein isolation in treating atrial fibrillation using different freeze protocols: The “ICE‐T 4 minutes vs 3 minutes” propensity‐matched study (Frankfurt ICE‐T 4 vs. 3). J Cardiovasc Electrophysiol 2020; 31:1923-1931. [DOI: 10.1111/jce.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Christina Throm
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Max Hilbert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Claudia Kreuzer
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Medizinische Klinik II, Kardiologie/Angiologie/IntensivmedizinUniversitätsklinikum Schleswig‐Holstein, Universität zu Lübeck Lübeck Germany
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Chen S, Schmidt B, Bordignon S, Bologna F, Lindhoff-Last E, Chun KRJ. Thrombus Formation in Isolated Left Atrial Appendage After Multiple Atrial Fibrillation Ablations Despite Oral Anticoagulation Followed by Percutaneous Appendage Closure. JACC Clin Electrophysiol 2020; 5:398-400. [PMID: 30898245 DOI: 10.1016/j.jacep.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Edelgard Lindhoff-Last
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
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Chen S, Schmidt B, Bordignon S, Bologna F, Chun KRJ. Short tip–more function? Atrial fibrillation ablation using the novel third-generation cryoballoon in resected pulmonary vein. Int J Arrhythm 2019. [DOI: 10.1186/s42444-019-0006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patients who had previous pulmonary surgery undergoing pulmonary vein isolation (PVI) were seldom reported.
Case presentation
We describe an AF ablation using the novel short-tip third-generation cryoballoon in a patient with resected pulmonary vein. All pulmonary veins were successfully isolated without complication. The short-tip third-generation cryoballoon shows advantageous profile in PVI for AF patients with previous pulmonary surgery.
Conclusions
This report indicates that for AF patient who had previous resected PV surgery, the short-tip CB 3 provides an ideal device option for real-time PVI.
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Bordignon S, Bologna F, Chen S, Konstantinou A, Tsianakas N, Tohoku S, Trolese L, Chun KJ, Schmidt B. Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report. J Cardiovasc Electrophysiol 2019; 30:2858-2863. [PMID: 31638713 DOI: 10.1111/jce.14246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/02/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a left atrial appendage thrombus (LAAT) despite oral anticoagulation (OAC) are at high risk of thromboembolism (TE) and a relevant proportion of LAAT do not resolve under continued OAC. Left atrial appendage closure (LAAC) in the presence of LAAT was anecdotally described as a therapeutic option to prevent TE in the patients. OBJECTIVE To describe the feasibility of LAAC despite LAAT in consecutive patients. METHODS We searched the LAAC database of our center to identify patients in whom a LAAC was performed despite evidence of a thrombus in the LAA. All procedures were performed under transesophageal echocardiography guidance, no angiographies were performed to avoid LAAT dislocation. An Amulet Occluder device was preferred to allow proximal implantation and sealing of the LAA. RESULTS Nine patients were identified. The mean age was 68.1 ± 10.7 years, four were female, mean CHADSVASC and HASBLED were 3.6 ± 1.7 and 3.0 ± 1.0. Eight of nine patients were on OAC, one patient was under lone aspirin therapy because of bleeding. The mean distance between the LAAT and the estimated landing zone was 18 ± 6 mm, the minimal distance was 11 mm. The mean landing zone was 21 ± 3 mm, devices with a mean size of 25 ± 4 mm were chosen for implantation. All implantation succeeded, only two patients required an intraprocedural replacement. No procedural complication nor short term thromboembolic complication during a follow up of 138 ± 149 days were recorded. CONCLUSION In the presented series a percutaneous LAAC despite a LAAT resulted to be feasible and safe.
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Affiliation(s)
- Stefano Bordignon
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Fabrizio Bologna
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shaoje Chen
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Athanasios Konstantinou
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Nikolaos Tsianakas
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shota Tohoku
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Luca Trolese
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Kr Julian Chun
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Medizinische Klinik III, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
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Chun JKR, Bordignon S, Chen S, Tohoku S, Bologna F, Urbanek L, Schmidt BH. Current Status of Atrial Fibrillation Ablation with Balloon Strategy. Korean Circ J 2019; 49:991-1001. [PMID: 31646768 PMCID: PMC6813157 DOI: 10.4070/kcj.2019.0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023] Open
Abstract
Catheter ablation of atrial fibrillation (AF) has been established worldwide and is recommended for symptomatic paroxysmal AF patients according to international guidelines. Importantly, the cornerstone of any AF ablation represents pulmonary vein isolation (PVI). Traditional radiofrequency (RF) point by point ablation within a 3D electroanatomic left atrial (LA) map requires profound understanding of LA anatomy and electrophysiology. This ablation strategy can be highly efficient and safe if performed in experienced hands and centers. However, procedural complexity causes a long learning curve and has limited its wide spread utilization. In contrast, balloon based PVI ablation strategies are based on an anatomic principle. Currently, two balloon types (cryoballoon and laserballoon) have been adopted to clinical routine. Both balloons are positioned at the target PV and circumferential energy ablation is enabled. This simplified anatomic approach facilitates reaching the procedural endpoint of PVI and demonstrated less operator dependency. Therefore, balloon PVI appears to be associated with improved procedural reproducibility and safety. Importantly, large scale randomized trials proved non-inferiority of balloon guided AF ablation (cryothermal and laser energy) vs. experienced operators using traditional “gold standard” RF ablation in paroxysmal and persistent AF. Ongoing technological refinements of both balloons as well as the introduction of novel energy dosing strategies and ablation targets may potentially impact the current way of ablating AF in future. This review will summarize current clinical experience of contemporary balloon devices and will look into future developments.
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Affiliation(s)
- Julian Kyoung Ryul Chun
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Stefano Bordignon
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shaojie Chen
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Heinrich Schmidt
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Chen S, Schmidt B, Bordignon S, Urbanek L, Tohoku S, Bologna F, Angelkov L, Garvanski I, Tsianakas N, Konstantinou A, Trolese L, Weise F, Perrotta L, Chun KRJ. Ablation index‐guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study. J Cardiovasc Electrophysiol 2019; 30:2724-2731. [DOI: 10.1111/jce.14219] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Lazar Angelkov
- Department of Cardiology and ElectrophysiologyAcibadem City Clinic Cardiovascular CenterSofia Bulgaria
| | - Iskren Garvanski
- Department of Cardiology and ElectrophysiologyAcibadem City Clinic Cardiovascular CenterSofia Bulgaria
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Felix Weise
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Chun KRJ. P1921Impact of cryoballoon freeze duration on long-term durability of pulmonary vein isolation in atrial fibrillation: insights from Re-mapping procedures (the ICE Re-map study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0668] [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: 11/12/2022] Open
Abstract
Abstract
Background
Second-generation cryoballoon (CB2) represents a powerful pulmonary vein isolation (PVI) tool. Recently, the randomized time-to-effect guided (ICE-T) CB2 strategy targeting a 240s single freeze demonstrated fast and efficient PVI. To further optimize safety and efficacy, a shortened 3min freeze duration has been suggested but PVI durability remains unclear.
Methods
Between May 2013 and December 2017 all CB2 ablations followed the ICE-T concept (target-freeze: 240s or 180s). Patients undergoing a second procedure for arrhythmia recurrence were analyzed. Two groups were defined based on the index freeze duration (group 240s vs. group 180s). In all repeat procedures a 3D left-atrial map was obtained. Durability of PVI and localization of conduction gaps were compared.
Results
A total of 106/788 (13%) patients underwent a second procedure (group 240s: 80/604 vs. group 180s: 26/184) after a mean of 377 days. There was no difference regarding PV occlusion and time-to-isolation in the index procedure between two groups. No major complications occurred. During the second procedure significantly more patients demonstrated durable isolation of all PVs in group 240 (61% vs 35%, p=0.02) along with a significantly increased rate of PVI durability (88% vs. 69%, per vein, p<0.001). Left sided PVs did significantly benefit from 240s freezes (reconnection LSPV: 6% vs 27%, p=0.004, LIPV: 14 vs. 39%, p=0.006).
Conclusions
The ICE-T strategy is associated with a high rate of durable PVI in patients with arrhythmia recurrence. Target freeze duration of 240s vs. 180s is associated with significantly increased lesion durability, particularly at left sided PVs, without increasing complications.
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Affiliation(s)
- S Chen
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - L Perrotta
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Chun KJ. Impact of Cryoballoon Freeze Duration on Long-Term Durability of Pulmonary Vein Isolation. JACC Clin Electrophysiol 2019; 5:551-559. [DOI: 10.1016/j.jacep.2019.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023]
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Nagase T, Bordignon S, Perrotta L, Bologna F, Tsianakas N, Chen S, Konstantinou A, Chun JK, Schmidt B. Analysis of procedural data of pulmonary vein isolation for atrial fibrillation with the second‐generation laser balloon. Pacing Clin Electrophysiol 2019; 42:837-845. [DOI: 10.1111/pace.13692] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/16/2019] [Accepted: 04/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Takahiko Nagase
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Julian K.R. Chun
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum BethanienAgaplesion Markuskrankenhaus Medizinische Klinik III Frankfurt am Main Germany
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Bordignon S, Chen S, Perrotta L, Bologna F, Nagase T, Konstantinou A, Weise F, Fuernkranz A, Schmidt B, Chun JKR. Durability of cryoballoon left atrial appendage isolation: Acute and invasive remapping electrophysiological findings. Pacing Clin Electrophysiol 2019; 42:646-654. [DOI: 10.1111/pace.13690] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Felix Weise
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
| | - Julian K. R. Chun
- Cardioangiologisches Centrum BethanienAgaplesion Markus‐Krankenhaus Frankfurt am Main Germany
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KJ. Durable cryoballoon-based left atrial appendage isolation: Catheter maneuver, occlusion grade, contact force, and time to isolation. J Cardiovasc Electrophysiol 2019; 30:1278-1279. [PMID: 30868679 DOI: 10.1111/jce.13895] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shaojie Chen
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Kr Julian Chun
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Left appendage isolation plus left appendage occlusion on top of pulmonary vein isolation, a therapeutic option for a PVI nonresponder with persistent atrial fibrillation? J Cardiovasc Electrophysiol 2019; 30:1177-1178. [DOI: 10.1111/jce.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol). J Cardiovasc Electrophysiol 2019; 30:272-283. [DOI: 10.1111/jce.13818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/11/2018] [Accepted: 11/28/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
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Chen S, Chun KRJ, Bordignon S, Weise FK, Nagase T, Perrotta L, Bologna F, Schmidt B. Left atrial appendage occlusion using LAmbre Amulet and Watchman in atrial fibrillation. J Cardiol 2018; 73:299-306. [PMID: 30583991 DOI: 10.1016/j.jjcc.2018.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/11/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) has been suggested as an alternative to anticoagulation in non-valvular atrial fibrillation (AF). The present study aimed to compare a LAmbre LAA occluder system [Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen, China] with the most investigated Amulet (St. Jude Medical Inc., St. Paul, MN, USA) and Watchman (Boston Scientific, Plymouth, MN, USA) devices in terms of peri-procedural and short-term outcomes. METHODS This is a prospective observational study. RESULTS Overall, 140 patients (50 female, mean age 76.2±8.4 years) were consecutively enrolled. Mean CHA2DS2-VASc score was 3.8±1.5, and mean HAS-BLED score was 3.9±1.1. Baseline clinical characteristics were comparable between the three groups (LAmbre, n=30; Amulet, n=74; Watchman, n=36); the LAmbre group had significantly more patients with complicated LAA morphology (p=0.006). The implant success rate was 100% in LAmbre, 99% in Amulet, and 100% in Watchman group (p=0.638). The number of device repositions was not significantly different between groups (0.7±1.1 in LAmbre, 1.0±2.0 in Amulet, and 1.4±1.8 in Watchman group, p=0.345). Fluoroscopic and procedural times were similar between groups. Major peri-procedural adverse events did not differ between groups (0% vs. 0% vs. 2.8%, p=0.233). Six months' follow-up showed good device stability and patients' clinical condition in all groups. CONCLUSION LAmbre, Amulet, and Watchman exhibit remarkable implant success rate, low risk of peri-procedural adverse events, and good clinical outcomes.
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Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - K R Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Felix K Weise
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
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Nagase T, Bordignon S, Perrotta L, Bologna F, Tsianakas N, Chen S, Konstantinou A, Chun JK, Schmidt B. HEartLight guided - PUre Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate: HEURECA Study. Pacing Clin Electrophysiol 2018; 42:22-30. [DOI: 10.1111/pace.13552] [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] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/23/2018] [Accepted: 11/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Takahiko Nagase
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Julian K.R. Chun
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien; Agaplesion Markuskrankenhaus; Medizinische Klinik III Frankfurt am Main Germany
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Nagase T, Bordignon S, Perrotta L, Bologna F, Weise FK, Konstantinou A, Kato R, Schmidt B, Chun JKR. Low Risk of Pulmonary Vein Stenosis After Contemporary Atrial Fibrillation Ablation ― Lessons From Repeat Procedures After Radiofrequency Current, Cryoballoon, and Laser Balloon ―. Circ J 2018; 82:1558-1565. [DOI: 10.1253/circj.cj-17-1324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takahiko Nagase
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | - Stefano Bordignon
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | - Laura Perrotta
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | - Fabrizio Bologna
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | - Felix K. Weise
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | | | - Ritsushi Kato
- Department of Cardiology, International Medical Center, Saitama Medical University
| | - Boris Schmidt
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
| | - Julian K. R. Chun
- Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III
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Chen S, Schmidt B, Bordignon S, Bologna F, Perrotta L, Nagase T, Chun KRJ. Atrial fibrillation ablation using cryoballoon technology: Recent advances and practical techniques. J Cardiovasc Electrophysiol 2018; 29:932-943. [PMID: 29663562 DOI: 10.1111/jce.13607] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 01/17/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) affects 1-2% of the population, and its prevalence is estimated to double in the next 50 years as the population ages. AF results in impaired patients' life quality, deteriorated cardiac function, and even increased mortality. Antiarrhythmic drugs frequently fail to restore sinus rhythm. Catheter ablation is a valuable treatment approach for AF, even as a first-line therapy strategy in selected patients. Effective electrical pulmonary vein isolation (PVI) is the cornerstone of all AF ablation strategies. Use of radiofrequency (RF) catheter in combination of a three-dimensional electroanatomical mapping system is the most established ablation approach. However, catheter ablation of AF is challenging even sometimes for experienced operators. To facilitate catheter ablation of AF without compromising the durability of the pulmonary vein isolation, "single shot" ablation devices have been developed; of them, cryoballoon ablation, is by far the most widely investigated. In this report, we review the current knowledge of AF and discuss the recent evidence in catheter ablation of AF, particularly cryoballoon ablation. Moreover, we review relevant data from the literature as well as our own experience and summarize the key procedural practical techniques in PVI using cryoballoon technology, aiming to shorten the learning curve of the ablation technique and to contribute further to reduction of the disease burden.
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Affiliation(s)
- Shaojie Chen
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Weise FK, Bordignon S, Perrotta L, Konstantinou A, Bologna F, Nagase T, Chen S, Chun KJ, Schmidt B. Short-term dual antiplatelet therapy after interventional left atrial appendage closure with different devices. EUROINTERVENTION 2018; 13:e2138-e2146. [DOI: 10.4244/eij-d-17-00901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Konstantinou A, Bordignon S, Hilbert M, Bologna F, Tsianakas N, Nagase T, Chen S, Perrotta L, Weise FK, Lindhoff-Last E, Schmidt B, Chun KRJ. P384Plasma level of DOACS in patients undergoing catheter ablation for atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.195] [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)
- A Konstantinou
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - S Bordignon
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - M Hilbert
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - F Bologna
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - N Tsianakas
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - T Nagase
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - S Chen
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - L Perrotta
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - F K Weise
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - E Lindhoff-Last
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
| | - KRJ Chun
- Cardiology Centre Bethanien (CCB), Cardiology, Frankfurt am Main, Germany
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Chen S, Schmidt B, Bordignon S, Bologna F, Nagase T, Tsianakas N, Perrotta L, Chun KRJ. P393Feasibility of Percutaneous Left Atrial Appendage Closure using a novel LAmbre occluder in patients with atrial fibrillation, initial results from a prospective cohort registry study. Europace 2018. [DOI: 10.1093/europace/euy015.204] [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)
- S Chen
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - S Bordignon
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - F Bologna
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - T Nagase
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - N Tsianakas
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - L Perrotta
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - KRJ Chun
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
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Chen S, Chun KRJ, Perrotta L, Bologna F, Nagase T, Tsianakas N, Bordignon S, Schmidt B. P936Catheter based Left Atrial Appendage Occluder implantation using a novel LAmbre system vs. Amulet and Watchman Device in atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.537] [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)
- S Chen
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - KRJ Chun
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - L Perrotta
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - F Bologna
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - T Nagase
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - N Tsianakas
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - S Bordignon
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
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Bordignon S, Hibert M, Nagase T, Chen S, Bologna F, Perrotta L, Weise FK, Konstantinou A, Schmidt B, Chun KRJ. P349Catheter ablation of AF recurrences after PVI: only Re-PVI or further substrate modification? A retrospective long term follow up analysis. Europace 2018. [DOI: 10.1093/europace/euy015.160] [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)
- S Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - M Hibert
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - T Nagase
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - L Perrotta
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - F K Weise
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - A Konstantinou
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
| | - KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt a.M., Germany
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Chen S, Schmidt B, Bordignon S, Bologna F, Nagase T, Perrotta L, Julian Chun KR. Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins. Arrhythm Electrophysiol Rev 2018; 7:11-17. [PMID: 29686870 DOI: 10.15420/aer.2018;1;2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 02/07/2023] Open
Abstract
Catheter ablation is the most effective treatment option for patients suffering from symptomatic atrial fibrillation. Electrical isolation of the pulmonary veins is the procedural cornerstone. Point-by-point radiofrequency current energy ablation in combination with a 3D electro-anatomical mapping system is the established approach to ablation. In contrast, cryoballoon ablation uses a single-shot approach to facilitate pulmonary vein isolation. However, fixed cryoballoon diameters (28 mm or 23 mm) and non-balloon compliance can lead to technical difficulties in isolating variable pulmonary vein anatomies. This review focuses on key procedural aspects and illustrates practical techniques in cryoballoon pulmonary vein isolation to shorten the learning curve without compromising safety and efficacy. It has a special emphasis on inferior pulmonary veins.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
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Chen S, Schmidt B, Bordignon S, Bologna F, Nagase T, Tsianakas N, Perrotta L, Chun KRJ. Feasibility of percutaneous left atrial appendage closure using a novel LAmbre occluder in patients with atrial fibrillation: Initial results from a prospective cohort registry study. J Cardiovasc Electrophysiol 2017; 29:291-297. [PMID: 29149516 DOI: 10.1111/jce.13385] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 10/05/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The LAmbre™ occluder is a novel device for percutaneous left atrial appendage closure (LAAC). The presented study aimed to report the initial experience in implantation of the novel LAmbre for LAAC in patients with nonvalvular AF. METHODS We conducted a prospective, observational, cohort registry study to evaluate the feasibility of percutaneous LAAC using the LAmbre system. RESULTS Thirty patients (15 female, mean age 77.6 ± 8.9 years) who had high risks of stroke and contraindications for oral anticoagulation were prospectively enrolled in this registry study. The mean CHA2DS2-VaSc was 3.9 ± 1.5, and the mean HAS-BLED score was 4.1 ± 1.0. Twenty (66.7%) patients had chicken-wing LAA morphology. The implant success rate was 100%. The mean fluoroscopic time and procedure time were 3.5 ± 1.9 and 29.0 ± 10.1 minutes, respectively. No significant procedure-related complications were observed during in-hospital and acute clinical follow-up. CONCLUSION In this preliminary study, the LAmbre occluder showed an excellent implant success rate, favorable implant property, and very low incidence of complications. Larger sample, randomized studies are further warranted.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien Frankfurt Am Main, Medizinische Klinik III, Markuskrankenhaus, Frankfurt Am Main, Germany
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Bordignon S, Perrotta L, Dugo D, Bologna F, Nagase T, Fuernkranz A, Chun KJ, Schmidt B. Cover Image, Volume 28, Issue 9. J Cardiovasc Electrophysiol 2017. [DOI: 10.1111/jce.13339] [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: 12/01/2022]
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Bordignon S, Perrotta L, Dugo D, Bologna F, Nagase T, Fuernkranz A, Chun KJ, Schmidt B. Electrical isolation of the left atrial appendage by Maze-like catheter substrate modification: A reproducible strategy for pulmonary vein isolation nonresponders? J Cardiovasc Electrophysiol 2017. [DOI: 10.1111/jce.13276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Daniela Dugo
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Alexander Fuernkranz
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - K.R. Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus; Wilhelm-Epstein Frankfurt/M; Germany
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Perrotta L, Dugo D, Bordignon S, Nagase T, Bologna F, Schmidt B, Chun JKR. P895Individualized Cryoballoon Energy pulmonary vein isolation guided by real time PV recordings: the ICE T concept in a single centre experience. Europace 2017. [DOI: 10.1093/ehjci/eux151.077] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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