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Dhruva SS, Zhang S, Chen J, Noseworthy PA, Doshi AA, Agboola KM, Herrin J, Jiang G, Yu Y, Cafri G, Farr KC, Mbwana MS, Ross JS, Coplan PM, Drozda JP. Using real-world data from health systems to evaluate the safety and effectiveness of a catheter to treat ischemic ventricular tachycardia. J Interv Card Electrophysiol 2023; 66:1817-1825. [PMID: 36738387 DOI: 10.1007/s10840-023-01496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The ThermoCool STSF catheter is used for ablation of ischemic ventricular tachycardia (VT) in routine clinical practice, although outcomes have not been studied and the catheter does not have Food and Drug Administration (FDA) approval for this indication. We used real-world health system data to evaluate its safety and effectiveness for this indication. METHODS Among patients undergoing ischemic VT ablation with the ThermoCool STSF catheter pooled across two health systems (Mercy Health and Mayo Clinic), the primary safety composite outcome of death, thromboembolic events, and procedural complications within 7 days was compared to a performance goal of 15%, which is twice the expected proportion of the primary composite safety outcome based on prior studies. The exploratory effectiveness outcome of rehospitalization for VT or heart failure or repeat VT ablation at up to 1 year was averaged across health systems among patients treated with the ThermoCool STSF vs. ST catheters. RESULTS Seventy total patients received ablation for ischemic VT using the ThermoCool STSF catheter. The primary safety composite outcome occurred in 3/70 (4.3%; 90% CI, 1.2-10.7%) patients, meeting the pre-specified performance goal, p = 0.0045. At 1 year, the effectiveness outcome risk difference (STSF-ST) at Mercy was - 0.4% (90% CI: - 25.2%, 24.3%) and at Mayo Clinic was 12.6% (90% CI: - 13.0%, 38.4%); the average risk difference across both institutions was 5.8% (90% CI: - 12.0, 23.7). CONCLUSIONS The ThermoCool STSF catheter was safe and appeared effective for ischemic VT ablation, supporting continued use of the catheter and informing possible FDA label expansion. Health system data hold promise for real-world safety and effectiveness evaluation of cardiovascular devices.
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Affiliation(s)
- Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco School of Medicine, 4150 Clement St, Building 203, 111C, San Francisco, CA, 94121, USA.
| | - Shumin Zhang
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | | | | | | | - Kolade M Agboola
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Guoqian Jiang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Yue Yu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Guy Cafri
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Mwanatumu S Mbwana
- National Evaluation System for Health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium, Arlington, VA, USA
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Paul M Coplan
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
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Li J, Zhou G, Li X, Huang S, Lin H, Lin S, Tan L, Chen W, Huang X, Wang Y. Comparisons of procedural characteristics and clinical outcomes between SMARTTOUCH SURROUNDFLOW catheter and other catheters for atrial fibrillation radiofrequency catheter ablation: a systematic literature review. BMJ Open 2023; 13:e075579. [PMID: 37848300 PMCID: PMC10582897 DOI: 10.1136/bmjopen-2023-075579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND SMARTTOUCH SURROUNDFLOW (STSF) catheter is the new generation of SMARTTOUCH (ST) catheter with an upgraded irrigation system for radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF). METHODS This systematic literature review searched the major English and Chinese bibliographic databases from 2016 to 2022 for any original clinical studies assessing the STSF catheter for RFCA in AF patients. Meta-analysis with a random effects model was used for evidence synthesis. RESULTS Pooled outcomes from 19 included studies indicated that STSF catheter was associated with a significantly shorter procedure time (weighted mean difference (WMD): -17.4 min, p<0.001), shorter ablation time (WMD: -6.6 min, p<0.001) and lower catheter irrigation fluid volume (WMD: -492.7 mL, p<0.001) than ST catheter. Pooled outcomes from four included studies with paroxysmal AF patients reported that using the STSF catheter for RFCA was associated with a significantly shorter ablation time (WMD: -5.7 min, p<0.001) and a lower risk of 1-year postablation arrhythmia recurrence (rate ratio: 0.504, p<0.001) than the SURROUNDFLOW (SF) catheter. Significant reductions in procedure time and ablation time associated with the STSF catheter were also reported in the other four studies using non-ST/SF catheters as the control. Overall complications of STSF catheter and control catheters were comparable. CONCLUSIONS Using the STSF catheter was superior to using the ST catheter to conduct RFCA for AF by significantly reducing procedure time, ablation time, fluoroscopy time and irrigation fluid volume. The superiority of the STSF catheter over the SF catheter and other non-ST/SF catheters for RFCA needs further confirmation.
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Affiliation(s)
- Jianyong Li
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Guifang Zhou
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Xinzhong Li
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Senlin Huang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Hairuo Lin
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Shaopeng Lin
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Liang Tan
- Changsha Normin Health Technology Ltd, Changsha, China
| | - Wendong Chen
- Normin Health Consulting Ltd, Mississauga, Ontario, Canada
- THETA Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Xiaobo Huang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Yuegang Wang
- Department of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
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Costea A, Haile B, Barone A, Schenthal M, Romanowicz K, Rajsheker S, Boo LM, Hunter TD. Porous tip radiofrequency ablation catheter reduced heart failure‐related complications and healthcare resource utilization in paroxysmal atrial fibrillation patients. J Arrhythm 2023. [DOI: 10.1002/joa3.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Alexandru Costea
- Internal Medicine Department University of Cincinnati Cincinnati Ohio USA
| | - Bereket Haile
- College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Adam Barone
- Heritage College of Osteopathic Medicine Ohio University Athens Ohio USA
| | - Maddie Schenthal
- Department of Biology Bellarmine University Louisville Kentucky USA
| | | | - Srinivas Rajsheker
- Internal Medicine Department University of Cincinnati Cincinnati Ohio USA
| | - Lee Ming Boo
- Clinical Science and External Research, Biosense Webster, Inc. Irvine California USA
| | - Tina D. Hunter
- Real World Evidence, CTI Clinical Trial & Consulting Covington Kentucky USA
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Alvarez CK, Zweibel S, Stangle A, Panza G, May T, Marieb M. Anesthetic Considerations in the Electrophysiology Laboratory: A Comprehensive Review. J Cardiothorac Vasc Anesth 2023; 37:96-111. [PMID: 36357307 DOI: 10.1053/j.jvca.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Catheter ablation procedures for arrhythmias or implantation and/or extraction of cardiac pacemakers can present many clinical challenges. It is imperative that there is clear communication and understanding between the anesthesiologist and electrophysiologist during the perioperative period regarding the mode of ventilation, hemodynamic considerations, and various procedural complications. This article provides a comprehensive narrative review of the anesthetic techniques and considerations for catheter ablation procedures, ventilatory modes using techniques such as high-frequency jet ventilation, and strategies such as esophageal deviation and luminal temperature monitoring to decrease the risk of esophageal injury during catheter ablation. Various hemodynamic considerations, such as the intraprocedural triaging of cardiac tamponade and fluid administration during catheter ablation, also are discussed. Finally, this review briefly highlights the early research findings on pulse-field ablation, a new and evolving ablation modality.
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Affiliation(s)
- Chikezie K Alvarez
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT.
| | - Steven Zweibel
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Alexander Stangle
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Gregory Panza
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Thomas May
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Mark Marieb
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; Griffin Hospital, Derby, CT
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Fekri P, Khodashenas H, Lachapelle K, Cecere R, Zadeh M, Dargahi J. Y-Net: A Deep Convolutional Architecture for 3D Estimation of Contact Forces in Intracardiac Catheters. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3148439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Osorio J, Hunter TD, Rajendra A, Zei P, Silverstein J, Morales G. Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 2021; 32:1814-1821. [PMID: 33825242 DOI: 10.1111/jce.15028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter-tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1-year clinical success after PAF ablation, including first pass isolation. METHODS Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide-area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10-20 s. Radiofrequency energy was set at 40-45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. RESULTS A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90-day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). CONCLUSION In a real-world setting, first pass isolation was highly predictive of 12-month clinical success after CF-guided ablation in a PAF population.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Tina D Hunter
- CTI Clinical Trial & Consulting Services, Covington, Kentucky, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul Zei
- Brigham And Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chen CF, Gao XF, Liu MJ, Jin CL, Xu YZ. Safety and efficacy of the ThermoCool SmartTouch SurroundFlow catheter for atrial fibrillation ablation: A meta-analysis. Clin Cardiol 2019; 43:267-274. [PMID: 31743474 PMCID: PMC7068067 DOI: 10.1002/clc.23297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
Background The ThermoCool Smarttouch Surroundflow catheter (STSFc) is an advanced catheter, which integrating contact force sensing and surroundflow technology. However, comparative data between STSFc and contact force sensing catheter (Thermocool SmartTouch catheter [STc]) are limited. Hypothesis We thought that STSFc might bring more clinical benefits. The aim of this meta‐analysis was to compare the safety and efficiency between the STSFc and the STc for treatment of atrial fibrillation (AF). Methods The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies comparing STSFc and STc. Results Four trials involving 727 patients were included in the study. Pool‐analyses demonstrated that, as compared STc ablation, STSFc ablation was more beneficial in terms of procedural times (standard mean difference [SMD]: −0.22; 95% confidence interval [CI], −0.37 to −0.07, P = .005) and irrigation fluid volume (SMD: −1.94; 95% CI, −2.65 to −1.22, P < .0001). There was no significant difference between STSFc and STc (risk ratio [RR]: 1.02; 95% CI: 0.86 to 1.21, P = .79) for free from AF. Evidence of complications were low and similar for both groups (RR: 0.83; 95% CI: 0.19‐3.55, P = .80). Additionally, patients administered STSFc ablation tended to have shorter fluoroscopic times (SMD: −0.20; 95% CI, −0.63‐0.23, P = .21). Conclusions STSFc ablation was associated with reducing procedural times and irrigation fluid volume. Further, STSFc ablation tended to shorten fluoroscopic times. Therefore, STSFc ablation would be a better choice for AF patients especially in patients with heart failure.
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Affiliation(s)
- Chao-Feng Chen
- Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Xiao-Fei Gao
- Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Mei-Jun Liu
- Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Chao-Lun Jin
- Nanjing Medical University, Hangzhou City, Zhejiang Province, China
| | - Yi-Zhou Xu
- Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
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