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Singleton MJ, Osorio J. Intracardiac echocardiography, electroanatomical mapping, and the obsolescence of fluoroscopy for catheter ablation procedures. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01799-7. [PMID: 38575796 DOI: 10.1007/s10840-024-01799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Matthew J Singleton
- Department of Cardiovascular Medicine, WellSpan York Hospital, 1001 S. George St, York, PA, 17403, USA.
| | - Jose Osorio
- HCA FL Miami Electrophysiology - Cardiovascular Group, 3683 South Miami Ave, Suite 500, Miami, FL, USA
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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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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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Zang X, Zhao Z, Chen K, Song W, Ma J, Zhou Y, Liang E, Fu H, Wang X, Zhao Y, Zhang R. Evaluation of the Efficacy of Sacubitril/Valsartan on Radiofrequency Ablation in Patients with Hypertension and Persistent Atrial Fibrillation. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07493-6. [PMID: 37676586 DOI: 10.1007/s10557-023-07493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate whether the effect of radiofrequency ablation can be improved by using sacubitril/valsartan (S/V) to control blood pressure in hypertensive patients with persistent atrial fibrillation. METHODS A total of 63 and 67 hypertension patients with persistent atrial fibrillation were enrolled in an S/V group and ACEI/ARB group, respectively. All patients underwent radiofrequency catheter ablation (RFCA). The blood pressure of the two groups was controlled within the range of 100-140 mmHg (high pressure) and 60-90 mmHg (low pressure). The clinical outcomes of the two groups were observed after 12 months of follow-up. RESULTS No significant differences in blood pressure were observed between the S/V and ACEI/ARB groups. In addition, the recurrence rate of atrial fibrillation between the two groups was not different. The left atrial diameter was an independent predictor of recurrence (HR = 1.063, P = 0.008). However, in the heart failure subgroup, the recurrence rate of S/V was significantly lower than that of the ACEI/ARB group (P = 0.005), and Cox regression analysis showed that the recurrence risk of atrial fibrillation of the S/V group was 0.302 lower than that of the ACEI/ARB group. NT-proBNP, LVEF, and LAD were significantly improved in hypertension patients with heart failure when comparing cases before and at the end of follow-up. CONCLUSIONS S/V is better than ACEI/ARB in reducing the recurrence of persistent atrial fibrillation in patients with hypertension and heart failure after RFCA.
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Affiliation(s)
- Xiaobiao Zang
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Zhihan Zhao
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Ke Chen
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Weifeng Song
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Jifang Ma
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - You Zhou
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Erpeng Liang
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Haixia Fu
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Xianqing Wang
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China
| | - Yonghui Zhao
- Department of Cardiology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China.
| | - Rongfeng Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Risk and benefit of extrapulmonary vein ablation in atrial fibrillation. Curr Opin Cardiol 2023; 38:1-5. [PMID: 36598443 DOI: 10.1097/hco.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the recent development, benefit, and safety of extrapulmonary vein ablation for atrial fibrillation. RECENT FINDING Studies have shown that extrapulmonary vein ablation can help maintain normal sinus rhythm for patients with persistent atrial fibrillation. As prior strategies targeting anatomical lines and triggers are well utilized, novel techniques for substrate mapping have been rapidly developing. These strategies are well tolerated and could be chosen based on patients' conditions and physicians' experience. SUMMARY Extrapulmonary vein ablation could be safely and effectively performed for patients with atrial fibrillation. It provides further consolidation of normal sinus rhythm.
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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Zei PC. The wall of unintended consequences: is the main benefit of posterior LA wall isolation simply more durable pulmonary vein isolation? J Cardiovasc Electrophysiol 2022; 33:1665-1666. [PMID: 35589553 DOI: 10.1111/jce.15552] [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: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Medicine is rife with therapies originally developed for a specific purpose, yet after some time, the true benefit is determined to lie elsewhere - examples of the "law of unintended consequences". This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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