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Cespón-Fernández M, Della Rocca DG, Magnocavallo M, Betancur A, Lombardo I, Pannone L, Vetta G, Sorgente A, Polselli M, Audiat C, Del Monte A, Combes S, Marcon L, Overeinder I, Nakasone K, Mouram S, Mohanty S, Bianchi S, Almorad A, Sieira J, Bala G, Ströker E, Rossi P, Sarkozy A, Boveda S, Natale A, de Asmundis C, Chierchia GB. Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience. J Interv Card Electrophysiol 2025:10.1007/s10840-025-02021-y. [PMID: 40038209 DOI: 10.1007/s10840-025-02021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 02/12/2025] [Indexed: 03/06/2025]
Abstract
BACKGROUND Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system. METHODS Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations. RESULTS A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times. CONCLUSION The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.
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Affiliation(s)
| | - Domenico G Della Rocca
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium.
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, 78705, USA.
- Department of Cardiology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Andrés Betancur
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Ilenia Lombardo
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Marco Polselli
- Arrhythmology Unit, Hospital Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Charles Audiat
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Kazutaka Nakasone
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, 78705, USA
| | - Stefano Bianchi
- Arrhythmology Unit, Hospital Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Pietro Rossi
- Arrhythmology Unit, Hospital Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, 78705, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair-Ziekenhuis Brussel, Brussels, Belgium
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Stauffer N, Knecht S, Badertscher P, Krisai P, Hennings E, Serban T, Voellmin G, Osswald S, Sticherling C, Kühne M. Repeat catheter ablation after very late recurrence of atrial fibrillation after pulmonary vein isolation. Europace 2024; 26:euae096. [PMID: 38607938 PMCID: PMC11068271 DOI: 10.1093/europace/euae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
AIMS Atrial fibrillation (AF) recurs in about one-third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences (VLR) after more than 1 year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after VLR of AF after index CA. METHODS AND RESULTS We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation. Out of 1864 patients included in the registry, 426 patients undergoing a repeat ablation were included in the analysis (28% female, age 63 ± 9.8 years, 46% persistent AF). Two hundred and ninety-one patients (68%) were stratified in the ER group and 135 patients (32%) in the LR group. Pulmonary vein reconnections were a common finding in both groups, with 93% in the ER group compared to 86% in the LR group (P = 0.052). In the LR group, 40 of 135 patients (30%) had a recurrence of AF compared to 90 of 291 patients (31%) in the ER group (log-rank P = 0.72). CONCLUSION There was no association between the time to recurrence of AF after initial CA and the characteristics and outcomes of the repeat procedure.
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Affiliation(s)
- Niklas Stauffer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Elisa Hennings
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
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Knecht S, Zeljkovic I, Badertscher P, Krisai P, Spies F, Vognstrup J, Pavlovic N, Manola S, Osswald S, Kühne M, Sticherling C. Role of empirical isolation of the superior vena cava in patients with recurrence of atrial fibrillation after pulmonary vein isolation-a multi-center analysis. J Interv Card Electrophysiol 2023; 66:435-443. [PMID: 35980512 PMCID: PMC9977848 DOI: 10.1007/s10840-022-01314-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-pulmonary vein (PV) triggers play a role in the initiation of atrial fibrillation (AF), with the superior vena cava (SVC) being a common location. The aim of the current study was to investigate a strategy of empirical SVC isolation (SVCI) in addition to re-isolation of PV in patients with recurrence of AF after index PV isolation (PVI). METHODS We retrospectively analyzed consecutive patients from two centers with recurrence of AF after index PVI, undergoing a repeat ablation. Whereas only a re-isolation of the PV was intended in patients with reconnections of equal or more than two PV (PVI group), an additional SVCI was aimed for in patients with < 2 isolated PV in addition to the re-isolation of the PV (PVI + group). Analysis was performed as-treated and per-protocol. RESULTS Of the 344 patients included in the study (age 60 ± 10 years, 73% male, 66% paroxysmal AF), PVI only was performed in 269 patients (77%) and PVI plus SVCI (PVI +) in 75 patients (23%). Overall, freedom from AF/AT after repeat PVI was 80% (196 patients) in the PVI group and 73% in the PVI + group (p = 0.151). In multivariable Cox regression analysis, presence of persistent AF (HR 2.067 (95% CI 1.389-3.078), p < 0.001) and hypertension (HR 1.905 (95% CI 1.218-2.980), p = 0.005) were identified as only significant predictors of AF/AT recurrence. The per-protocol results did not differ from this observation. CONCLUSIONS A strategy of an empirical additional SVCI at repeat PVI ablation for recurrence of AF/AT does not improve outcome compared to a PVI only approach.
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Affiliation(s)
- Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Ivan Zeljkovic
- Department of Cardiology, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jan Vognstrup
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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Groin lymphorrhea after catheter ablation of atrial fibrillation: A case report. HeartRhythm Case Rep 2022; 9:178-180. [PMID: 36970391 PMCID: PMC10030298 DOI: 10.1016/j.hrcr.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Kühne M, Knecht S, Spies F, Aeschbacher S, Haaf P, Zellweger M, Schaer B, Osswald S, Sticherling C. Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion-The Simplify Cryo Study. Front Cardiovasc Med 2021; 8:664538. [PMID: 34124199 PMCID: PMC8187607 DOI: 10.3389/fcvm.2021.664538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion. Methods and Results: Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. After cMRI assessment, patients treated by PVI using a novel no-contrast (NC) protocol without routine contrast injections to demonstrate PV occlusion (NC group) were compared to patients undergoing PVI with contrast injections to demonstrate PV occlusion (standard group). One hundred patients with paroxysmal or persistent AF (age 61 ± 10 years, ejection fraction 59 ± 11%, left atrial volume index 37.2 ± 2.0 mL/m2) were studied. The NC protocol was feasible in 72 of 75 patients (96%). Total procedure time and fluoroscopy time were 64.0 ± 14.1 min and 11.0 ± 4.6 min in the NC group and 92.0 ± 25.3 min and 18.0 ± 6.0 min in the standard group, respectively (all p < 0.001). Dose area product was 368 ± 362 cGy*cm2 in the NC group compared to 1928 ± 1541 cGy*cm2 in the standard group (p < 0.001). Forty-five of 75 patients (60%) in the NC group and 16 of 25 patients (64%) in the standard group remained in stable sinus rhythm after a single PVI and a 1-year follow-up (p = 0.815). Conclusions: Performing CB ablation without using contrast injections to demonstrate PV occlusion was feasible, resulted in reduced radiation exposure, and increased the efficiency of the procedure.
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Affiliation(s)
- Michael Kühne
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
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6
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Teres C, Soto-Iglesias D, Penela D, Jáuregui B, Ordoñez A, Chauca A, Huguet M, Ramírez-Paesano C, Oller G, Jornet A, Palet J, Santana D, Panaro A, Maldonado G, de Leon G, Gualis B, Jimenez-Britez G, Evangelista A, Carballo J, Ortiz-Perez JT, Berruezo A. Left atrial wall thickness of the pulmonary vein reconnection sites during atrial fibrillation redo procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:824-834. [PMID: 33742716 DOI: 10.1111/pace.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial wall thickness (LAWT) has been related to pulmonary vein (PV) reconnections after atrial fibrillation (AF) ablation. The aim was to integrate 3D-LAWT maps in the navigation system and analyze the relationship with local reconnection sites during AF-redo procedures. METHODS Consecutive patients referred for AF-redo ablation were included. Procedure was performed using a single catheter technique. LAWT maps obtained from multidetector computerized tomography (MDCT) were imported into the navigation system. LAWT of the circumferential PV line, the reconnected segment and the reconnected point, were analyzed. RESULTS Sixty patients [44 (73%) male, age 61 ± 10 years] were included. All reconnected veins were isolated using a single catheter technique with 55 min (IQR 47-67) procedure time and 75 s (IQR 50-120) fluoroscopy time. Mean LAWT of the circumferential PV line was 1.46 ± 0.22 mm. The reconnected segment was thicker than the rest of segments of the circumferential PV line (2.05 + 0.86 vs. 1.47 + 0.76, p < .001 for the LPVs; 1.55 + 0.57 vs. 1.27 + 0.57, p < .001 for the RPVs). Mean reconnection point wall thickness (WT) was at the 82nd percentile of the circumferential line in the LPVs and at the 82nd percentile in the RPVs. CONCLUSION A single catheter technique is feasible and efficient for AF-redo procedures. Integrating the 3D-LAWT map into the navigation system allows a direct periprocedural estimation of the WT at any point of the LA. Reconnection points were more frequently present in thicker segments of the PV line. The use of 3D-LAWT maps can facilitate reconnection point identification during AF-redo ablation.
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | - Agustí Jornet
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Jordi Palet
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - David Santana
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | - Belen Gualis
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | - Julio Carballo
- Heart Institute, Teknon Medical Center, Barcelona, Spain
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