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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [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: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation + ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
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Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
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Kreidieh O, Hunter TD, Goyal S, Varley AL, Thorne C, Osorio J, Silverstein J, Varosy P, Metzl M, Leyton-Mange J, Singh D, Rajendra A, Moretta A, Zei PC. Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL-AF registry. J Cardiovasc Electrophysiol 2024; 35:440-450. [PMID: 38282445 DOI: 10.1111/jce.16190] [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: 11/26/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION During atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long-term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI. METHODS We reviewed AFA procedures in a multicenter prospective registry of AFA (REAL-AF). A multivariate ordinal logistic regression, weighted by inverse proceduralist volume, was used to determine predictors of FPI. RESULTS A total of 2671 patients were included with 1806 achieving FPI in both vein sides, 702 achieving FPI in one, and 163 having no FPI. Individually, age, left atrial (LA) scar, higher power usage (50 W), greater posterior contact force, ablation index >350 posteriorly, Vizigo™ sheath utilization, nonstandard ventilation, and high operator volume (>6 monthly cases) were all related to improved odds of FPI. Conversely sleep apnea, elevated body mass index (BMI), diabetes mellitus, LA enlargement, antiarrhythmic drug use, and center's higher fluoroscopy use were related to reduced odds of FPI. Multivariate analysis showed that BMI > 30 (OR 0.78 [0.64-0.96]) and LA volume (OR per mL increase = 1.00 [0.99-1.00]) predicted lower odds of achieving FPI, whereas significant left atrial scarring (>20%) was related to higher rates of FPI. Procedurally, the use of high power (50 W) (OR 1.32 [1.05-1.65]), increasing force posteriorly (OR 2.03 [1.19-3.46]), and nonstandard ventilation (OR 1.26 [1.00-1.59]) predicted higher FPI rates. At a site level, high procedural volume (OR 1.89 [1.48-2.41]) and low fluoroscopy centers (OR 0.72 [0.61-0.84]) had higher rates of FPI. CONCLUSION FPI rates are affected by operator experience, patient comorbidities, and procedural strategies. These factors may be postulated to impact acute lesion formation.
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Affiliation(s)
- Omar Kreidieh
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tina D Hunter
- CTI Clinical Trial and Consulting, Covington, Kentucky, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | | | - Jose Osorio
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul Varosy
- Medicine-Cardiology, University of Colorado, Denver, Aurora, Colorado, USA
| | - Mark Metzl
- NorthShore University Health System, Bannockburn, Illinois, USA
| | | | - David Singh
- John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | | | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, Romero JE. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:2573-2583. [PMID: 37804258 DOI: 10.1016/j.jacep.2023.08.005] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. OBJECTIVES This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. METHODS Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. RESULTS A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. CONCLUSIONS There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
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Affiliation(s)
- Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA; Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Te
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Benjamin D'Souza
- Cardiac Arrythmia Program, Cardiology Service, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Mohit Rastogi
- Electrophysiology Department, Heart and Vascular Service, University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | | | - Laura C Ibanez
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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4
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Osorio J, Zei PC, Díaz JC, Varley AL, Morales GX, Silverstein JR, Oza SR, D'Souza B, Singh D, Moretta A, Metzl MD, Hoyos C, Matos CD, Rivera E, Magnano A, Salam T, Nazari J, Thorne C, Costea A, Thosani A, Rajendra A, Romero JE. High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:1543-1554. [PMID: 37294263 DOI: 10.1016/j.jacep.2023.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined. OBJECTIVES This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF). METHODS In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months. RESULTS A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications. CONCLUSIONS HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan C Díaz
- Cardiac Arrhythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Saumil R Oza
- Ascension Medical Group, St Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - David Singh
- The Queens Medical Center, Honolulu, Hawaii, USA
| | | | - Mark D Metzl
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefania Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tariq Salam
- MultiCare Pulse Heart Institute, Tacoma, Washington, USA
| | - Jose Nazari
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | | | - Alexandru Costea
- Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, UC Heart, Lung, and Vascular Institute, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Baden, Pennsylvania, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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5
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Rajendra A, Osorio J, Diaz JC, Hoyos C, Rivera E, Matos CD, Costea A, Varley AL, Thorne C, Hoskins M, Goyal S, Oza S, Magnano A, D'Souza B, Silverstein J, Metzl M, Zei PC, Romero JE. Performance of the REAL-AF Same-Day Discharge Protocol in Patients Undergoing Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1515-1526. [PMID: 37204358 DOI: 10.1016/j.jacep.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. OBJECTIVES The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m2), operators prospectively determined whether patients undergoing ablation of AF were candidates for SDD (SDD vs non-SDD groups). Successful SDD was achieved if the patient met the protocol discharge criteria. The primary efficacy endpoint was the success rate of SDD. The primary safety endpoints were readmission rates as well as acute and subacute complications. The secondary endpoints included procedural characteristics and freedom from all-atrial arrhythmias. RESULTS A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212). CONCLUSIONS In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071).
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Affiliation(s)
- Anil Rajendra
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Juan C Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Clinica Las Vegas, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefanía Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandru Costea
- Heart & Vascular Institute, The Christ Hospital Medical Center, Liberty Township, Ohio, USA
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Sandeep Goyal
- Piedmont Heart Institute Buckhead, Atlanta, Georgia, USA
| | - Saumil Oza
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Anthony Magnano
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Silverstein
- Electrophysiology Service, AHN Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark Metzl
- NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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AlKassas A, Fouda M, Fassini G, Sanhoury M. Pre-procedural high serum visfatin and tumor necrosis factor-α might predict recurrent atrial fibrillation after catheter ablation. Egypt Heart J 2023; 75:63. [PMID: 37466800 DOI: 10.1186/s43044-023-00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Many patients would require repeated ablation procedures owing to recurrent atrial fibrillation with its associated symptoms. Identifying those who are at risk of recurrent AF could assist us to develop preventive strategies and to properly select those who will benefit more from catheter ablation. Our aim is to study the role of preprocedural serum level of certain biomarkers in the prediction of AF recurrence after catheter ablation. RESULTS The present study included 117 patients: 26 patients with persistent and 91 patients with paroxysmal AF. Blood samples for estimation of serum levels of studied cytokines were obtained prior to the procedure. Pulmonary vein isolation was performed in all patients through point-by point radiofrequency ablation guided by 3D electroanatomical mapping system. Patients were followed for 12 months for AF recurrence. Forty-one (35%) patients developed AF recurrence. Those patients were significantly older, had significantly higher BMI, lower ejection fraction, and wider maximal left atrial diameter (LAD). Serum hs-CRP, IL-6, TNF-α, visfatin, and adiponectin levels were significantly higher compared to those who did not develop AF recurrence. Correlation analysis showed positive correlations between the incidence of RAF and patients' age, BMI, and maximum LAD and elevated cytokine levels and maximal LAD showed significant correlations with the type of AF and elevated serum TNF-α, visfatin, and adiponectin. Statistical analyses defined elevated serum levels of TNF-α, visfatin, and adiponectin as positive predictors for RAF, and automatic linear modeling analysis showed that elevated serum visfatin, TNF-α, and adiponectin can predict RAF by accuracy rates of 50%, 34%, and 16%, respectively. CONCLUSIONS RAF is most probably an outcome of the interplay between patients' clinical data, obesity, and inflammation. Pre-procedural estimation of serum levels of visfatin and TNF-α might determine patients with probability for RAF.
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Affiliation(s)
- Amr AlKassas
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Fouda
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | - Mohamed Sanhoury
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy. J Interv Card Electrophysiol 2023; 66:381-388. [PMID: 35947317 PMCID: PMC9977702 DOI: 10.1007/s10840-022-01332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Advances in technology and workflows have facilitated substantial reductions in fluoroscopy utilization and procedure times for atrial fibrillation (AF) ablations. A recently available steerable sheath, visualizable on a 3D electroanatomical map (EAM), may further simplify low/zero fluoroscopy ablation workflows by facilitating understanding of the relative positions of the catheter and sheath. The objective of this study was to demonstrate feasibility, safety, procedural efficiency, and clinical effectiveness of incorporating the new visualizable sheath into a low-fluoroscopy workflow. METHODS Consecutive de novo paroxysmal AF procedures were performed with a porous tip contact force catheter at a high-volume site between January 2018 and May 2019. Procedures performed with and without the VIZIGO™ EAM-visualizable sheath (Vizigo) were compared. All ablations employed the same standardized low-fluoroscopy workflow. Statistical analyses employed stabilized inverse probability of treatment weights (IPTW) to balance cohorts by operator and key patient characteristics. RESULTS Cohorts of 142 Vizigo and 173 non-Vizigo patients were similar at baseline. Use of the Vizigo sheath was associated with approximately 10% improvement in catheter stability (p = 0.0005), 16% reduction in radiofrequency time (p < 0.0001), and 7% fewer ablations that used fluoroscopy (p = 0.0030). There was one cardiac tamponade in each cohort and no deaths, atrioesophageal fistulas, or strokes. Single-procedure freedom from atrial arrhythmia recurrence through 12 months was similar between cohorts (p = 0.9556). CONCLUSIONS Use of a 3D EAM-visualizable sheath resulted in improved catheter stability, reduced radiofrequency time, and more procedures performed without fluoroscopy, without compromise to safety or effectiveness.
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8
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Silverstein J, Varosy PD, Godfrey B, Cooper C, Varley A, Rajendra A, Morales G, Osorio J. Designing an Efficient and Quality-focused Integrated Atrial Fibrillation Care Center. J Innov Card Rhythm Manag 2022; 13:5196-5201. [PMID: 36605293 PMCID: PMC9635571 DOI: 10.19102/icrm.2022.13107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/02/2022] [Indexed: 12/03/2022] Open
Abstract
Atrial fibrillation (AF) represents a significant health care burden in the United States that will continue to increase as the population ages; thus, the introduction of cost-effective strategies to limit this burden is critical. The establishment of dedicated electrophysiology programs focusing on AF care within hospitals can improve patient care while providing added financial benefits for institutions if properly planned and delivered. This paper explains how to develop an efficient and quality-focused AF ablation program as part of a larger AF center of excellence by highlighting the experience of a single center and demonstrating how the same principles were adopted to implement a similar program at another institution.
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Affiliation(s)
- Joshua Silverstein
- Mount Carmel Health System, Columbus, OH, USA,Allegheny Health Network, Pittsburgh, PA, USA,Address correspondence to: Joshua Silverstein, MD, FHRS, Allegheny Health Network, 320 E North Ave, Pittsburgh, PA 15212, USA. ,
| | - Paul D. Varosy
- VA Eastern Colorado Health Care System and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Allyson Varley
- Heart Rhythm Clinical and Research Solution, Innovation Depot, Birmingham, AL, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, AL, USA
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, AL, USA,Heart Rhythm Clinical and Research Solution, Innovation Depot, Birmingham, AL, USA
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9
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Kreidieh O, Varley AL, Romero J, Singh D, Silverstein J, Thosani A, Varosy P, Hebsur S, Godfrey BE, Schrappe G, Justice L, Zei PC, Osorio J. Practice Patterns of Operators Participating in the Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) Registry. J Interv Card Electrophysiol 2022; 65:429-440. [PMID: 35438393 DOI: 10.1007/s10840-022-01205-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) is a multicenter prospective registry of atrial fibrillation (AF) ablation. We sought to describe the baseline workflows of REAL-AF operators. METHODS REAL-AF enrolls high volume minimum fluoroscopy radiofrequency ablators. A 150 item questionnaire was administered to participating operators. Responses were analyzed using standard methods. RESULTS Forty-two respondents had a mean 178.2 ± 89.2 yearly AF ablations, with 42.4 ± 11.9% being paroxysmal (PAF). Most operators performed ablation with uninterrupted or minimally interrupted anticoagulation (66.7% and 28.6%). Left atrial appendage (LAA) thrombus was most commonly ruled out with transesophageal echocardiography (33.3% and 42.9% for PAF and persistent AF). Consistent with registry design, radiofrequency energy (92.1% ± 18.8% of cases) and zero fluoroscopy ablation (73.8% goal 0 fluoroscopy) were common. The majority of operators relied on index-guided ablation (90.5%); Mean Visitag surpoint targets were higher anteriorly vs posteriorly (508.3 ± 49.8 vs 392.3 ± 37.0, p < 0.01), but power was similar. There was considerable heterogeneity related to gaps in current knowledge, such as lesion delivery targets and sites of extra-pulmonary vein ablation (most common was the posterior wall followed by the roof). Peri-procedural risk factor management of obesity, hypertension, and sleep apnea was common. There was a mean of 3.0 ± 1.2 follow-up visits at 12 months. CONCLUSIONS REAL-AF operators were high volume low fluoroscopy "real world" operators with good follow-up and adherence to known best-practices. There was disagreement related to knowledge gaps in guidelines.
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Affiliation(s)
- Omar Kreidieh
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA.
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Jorge Romero
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA
| | - David Singh
- Division of Cardiology, Queen's Medical Center, Honolulu, HI, USA
| | | | | | - Paul Varosy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Shrinivas Hebsur
- Michigan Heart and Vascular Institute, St Mary Mercy Hospital, Livonia, MI, USA
| | | | - Gunther Schrappe
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Linda Justice
- Heart Rhythm Clinical and Research Solutions, Birmingham, AL, USA
| | - Paul C Zei
- Brigham And Women's Hospital, Harvard Medical School, 44 Washington Street, Boston, MA, 02115, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview Health, Birmingham, AL, USA
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