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Valeriano C, Buytaert D, Fabbricatore D, De Schouwer K, Addeo L, De Braekeleer L, Geelen P, De Potter T. High efficiency single-catheter workflow for radiofrequency atrial fibrillation ablation in the QDOT catheter era. J Interv Card Electrophysiol 2024; 67:817-826. [PMID: 38092999 DOI: 10.1007/s10840-023-01709-3] [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: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 06/12/2024]
Abstract
BACKGROUND High-power short-duration (HPSD) ablation may improve the consistency and efficiency of pulmonary vein isolation (PVI). The novel QDOT Micro™ catheter (Biosense Webster, Inc.) with temperature feedback and microelectrodes aims to enhance PVI efficiency and safety. This study wants to evaluate the feasibility, safety, and efficiency of a standardized single-catheter workflow for PVI using QDOT (Q-FLOW). METHODS The Q-FLOW includes single transeptal access, radiofrequency encircling of the PVs using a power of 50 W in a temperature/flow-controlled mode, and validation of the circles with microelectrodes. A 1:1 propensity-matched cohort of patients treated with conventional power-controlled ablation using a circular mapping catheter (CMC-FLOW) was used to compare procedural and clinical outcomes. RESULTS A total of 150 consecutive atrial fibrillation patients (paroxysmal 67%, persistent 33%) were included. First-pass isolation rate was 86%. Procedural time, X-ray time, and dose were significantly lower for the Q-FLOW vs the CMC-FLOW (67.2 ± 17.9 vs 88.3 ± 19.2 min, P < 0.001; 3.0 ± 1.9 vs 5.0 ± 2.4 min, P < 0.001; 4.3 ± 1.9 vs 6.4 ± 2.3 Gycm2, P < 0.001). Complications were numerically but not significantly lower in the Q-FLOW group (2 [1.3%] vs 7 [4.7%], P = 0.091). There was no difference in arrhythmia recurrence at 12 months (atrial arrhythmia-free survival rate, 87.5% vs 84.4%, P = 0.565). CONCLUSION A streamlined single-catheter workflow for PVI using QDOT was feasible and safe, resulting in a high rate of first-pass isolation and a low complication rate. The Q-FLOW further improved the efficiency of PVI compared to the standard CMC-FLOW, without difference in the 12-month outcome.
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Affiliation(s)
- Chiara Valeriano
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Dimitri Buytaert
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Koen De Schouwer
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Lucio Addeo
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Lisa De Braekeleer
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Peter Geelen
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium
| | - Tom De Potter
- Cardiovascular Center Aalst, Arrhythmia Unit, OLV Hospital, Aalst, Belgium.
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Ferro EG, Reynolds MR, Xu J, Song Y, Cohen DJ, Wadhera RK, d'Avila A, Zimetbaum PJ, Yeh RW, Kramer DB. Outcomes of Atrial Fibrillation Ablation Among Older Adults in the United States: A Nationwide Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00271-8. [PMID: 38795100 DOI: 10.1016/j.jacep.2024.03.032] [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: 02/15/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is increasingly recommended as first-line therapy for atrial fibrillation. Recent data suggest growing PVI volumes but rising complication rates, although comprehensive real-world outcomes including both inpatient and outpatient encounters remain unclear. OBJECTIVES The purpose of this study was to evaluate patient characteristics, population rates, and 30-day outcomes of PVI in a nationwide sample of U.S. adults aged >65 years. METHODS First-time PVIs were identified among U.S. Medicare fee-for-service beneficiaries using Current Procedural Terminology procedural codes. Comorbidities were ascertained using International Classification of Diseases-10th Revision diagnosis codes associated with each procedural claim. Outcomes included periprocedural complications, all-cause hospitalizations, and mortality at 30 days. RESULTS From January 2017 through December 2021, a total of 227,133 patients underwent PVI (mean age 72.5 years, 42% women, 92.7% White) with an increasing comorbidity burden over time. PVI volume increased from 83.8 (2017) to 111.6 per 100,000 patient-years (2021), which was driven by outpatient procedures (87.8% of all PVIs). Concurrently, there was a significant decrease in complication rates (3.9% in 2017 vs 3.1% in 2021; P < 0.001) and hospitalizations (8.8% vs 7.0%; P < 0.001), with no significant change in mortality (0.4%; P = 0.08). The most common periprocedural complications were bleeding (1.8%), pericardial effusion (1.4%), and vascular access damage (0.8%). CONCLUSIONS The use of PVI has steadily increased among older patients in contemporary U.S. clinical practice; yet, cumulative complication and hospitalization rates at 30 days have decreased over time, with stably low rates of short-term mortality despite rising comorbidity burden among treated patients. These data may reassure patients and providers on the safety of PVI as an increasingly common first-line procedure for atrial fibrillation.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jiaman Xu
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David J Cohen
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andre d'Avila
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Saglietto A, Turturiello D, Viveros D, Bellido A, Alderete J, Zaraket F, Franco-Ocaña P, Huguet M, Cámara Ó, Vătășescu R, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial. Europace 2024; 26:euae087. [PMID: 38652090 PMCID: PMC11036893 DOI: 10.1093/europace/euae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). METHODS AND RESULTS Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). CONCLUSION LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.
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Affiliation(s)
- Giulio Falasconi
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Saglietto
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Turturiello
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Fatima Zaraket
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Paula Franco-Ocaña
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | | | - Radu Vătășescu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
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Penela D, Chauca A, Fernández-Armenta J, Pavón R, Benito B, Acosta J, Lozano JM, Falasconi G, San Antonio R, Soto-Iglesias D, Martí-Almor J, Ordoñez A, Bellido A, Carreño JM, Matiello M, Cano L, Pedrote A, Viveros D, Alderete J, Francia P, Algarra-Cullell M, Silva E, Meca-Santamaria J, Franco P, Cappato R, Berruezo A. Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures-the SIMPLE study. J Interv Card Electrophysiol 2023; 66:1979-1988. [PMID: 36877415 DOI: 10.1007/s10840-023-01511-1] [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: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation. METHODS In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms. RESULTS 128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71). CONCLUSIONS The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Ricardo Pavón
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Maria Matiello
- Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Lucas Cano
- Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza, Rome, Italy
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain.
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Zhang R, Chu H, Liu S, Yang B, Han B, Xiao X, Ma C, Sun Y, Yin X, Xia Y, Gao L. Catheter ablation of atrial fibrillation using FireMagic TrueForce ablation catheter: The TRUEFORCE trial. Pacing Clin Electrophysiol 2023; 46:986-993. [PMID: 37334721 DOI: 10.1111/pace.14751] [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: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The use of contact force (CF) sensing catheters has provided a revolutionary improvement in catheter ablation (CA) of atrial fibrillation (AF) in the past decade. However, the success rate of CA for AF remains limited, and some complications still occur. METHODS The TRUEFORCE trial (Catheter Ablation of Atrial Fibrillation using FireMagic TrueForce Ablation Catheter) is a multicenter, prospective, single-arm objective performance criteria study of AF patients who underwent their first CA procedure using FireMagic TrueForce ablation catheter. RESULTS A total of 120 patients (118 with paroxysmal AF) were included in this study, and 112 patients included in the per-protocol analysis. Pulmonary vein isolation (PVI) was achieved in 100% of the patients, with procedure and fluoroscopy time of 146.63 ± 40.51 min and 12.89 ± 5.59 min, respectively. Freedom from recurrent atrial arrhythmia after ablation was present 81.25% (95% confidence interval [CI]: 72.78%-88.00%) of patients. No severe adverse events (death, stroke/transient ischemic attack [TIA], esophageal fistula, myocardial infarction, thromboembolism, or pulmonary vein stenosis) were detected during the follow-up. Four (4/115, 3.33%) adverse events were documented, including one abdominal discomfort, one femoral artery hematoma, one coughing up blood, and one postoperative palpitation and insomnia. CONCLUSIONS This study demonstrated the clinical feasibility of FireMagic force-sensing ablation catheter in CA of AF, with a satisfactory short- and long-term efficacy and safety.
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Affiliation(s)
- Rongfeng Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huimin Chu
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai, China
| | - Bing Yang
- Department of Cardiology, Dongfang Hospital Affiliated to Tongji University, Shanghai, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Xianjie Xiao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chengming Ma
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuanjun Sun
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Calvert P, Kollias G, Pürerfellner H, Narasimhan C, Osorio J, Lip GYH, Gupta D. Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review. Europace 2023; 25:euad151. [PMID: 37306314 PMCID: PMC10259069 DOI: 10.1093/europace/euad151] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Atrial fibrillation is associated with neurocognitive comorbidities such as stroke and dementia. Evidence suggests that rhythm control-especially if implemented early-may reduce the risk of cognitive decline. Catheter ablation is highly efficacious for restoring sinus rhythm in the setting of atrial fibrillation; however, ablation within the left atrium has been shown to result in MRI-detected silent cerebral lesions. In this state-of-the-art review article, we discuss the balance of risk between left atrial ablation and rhythm control. We highlight suggestions to lower the risk, as well as the evidence behind newer forms of ablation such as very high power short duration radiofrequency ablation and pulsed field ablation.
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Affiliation(s)
- Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
| | | | | | - Calambur Narasimhan
- Department of Cardiac Electrophysiology, AIG Hospitals, 1-66/AIG/2 to 5, Mindspace Road, Gachibowli Hyderabad, Telangana 500032, India
| | - Jose Osorio
- Grandview Medical Center, Arrhythmia Institute at Grandview, 3686 Grandview Parkway Suite 720, Birmingham, AL 35243, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
- Danish Centre for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
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7
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Saglietto A, Jauregui B, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Gaspardone C, San Antonio R, Huguet M, Cámara Ó, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation. Europace 2023; 25:euad118. [PMID: 37125968 PMCID: PMC10228614 DOI: 10.1093/europace/euad118] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
AIMS Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. METHODS AND RESULTS Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50-67), fluoroscopy time was 43 s (IQR 20-71), and radiofrequency (RF) time was 16.5 min (IQR 14.3-18.4). The median AI tailored to the local LAWT was 387 (IQR 360-410) for the anterior wall and 335 (IQR 300-375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. CONCLUSION In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).
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Affiliation(s)
- Giulio Falasconi
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Diego Penela
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Cheryl Teres
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Beatriz Jauregui
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Daniel Viveros
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Aldo Bellido
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Julia Meca-Santamaria
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Paula Franco
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Carlo Gaspardone
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Óscar Cámara
- Department of Information and Communication Technologies, Pompeu Fabra University, C/Tànger 122-140, 08018 Barcelona, Spain
| | - José-Tomás Ortiz-Pérez
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
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8
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Radiofrequency ablation of atrial fibrillation using a single catheter approach: time to lose the halo. J Interv Card Electrophysiol 2023; 66:249-252. [PMID: 36070030 DOI: 10.1007/s10840-022-01353-3] [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: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
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9
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High-power short-duration ablation index-guided pulmonary vein isolation protocol using a single catheter. J Interv Card Electrophysiol 2022; 65:633-642. [PMID: 35596105 PMCID: PMC9726791 DOI: 10.1007/s10840-022-01226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) is the most commonly performed electrophysiological procedure. To improve healthcare utilization, we aimed to compare the efficacy, efficiency, and safety of a minimalistic, streamlined single catheter ablation approach using a high-power short-duration ablation index-guided protocol (HPSD) vs. a control single-catheter protocol (SP). METHODS Pulmonary vein isolation (PVI) with a single transseptal puncture without a multipolar mapping catheter was performed in 91 patients. Left atrial mapping was performed with the ablation catheter, only. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD (n = 34) vs. a control (n = 57) ablation protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month blanking period. RESULTS Using the HPSD protocol the median procedure and RF ablation time were significantly shorter compared to the SP, 84 (IQR 76-100) vs. 118 min (IQR 104-141) and 1036 (898-1184) vs. 1949s (IQR 1693-2261), respectively, p < .001 for all. First-pass PVI was achieved using the HPSD protocol in 88% and using the SP in 87% of patients, p = 1.0. No procedural complications were observed. High-sensitivity cardiac troponin levels were significantly higher in patients using the HPSD protocol compared to the SP. At 12 months follow-up, 87% patients remained free from AF with no differences between groups. CONCLUSIONS A minimalistic, HPSD ablation index-guided PVI with a single-catheter approach is very efficient, safe, and associated with excellent clinical outcomes at 1 year.
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10
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Effectiveness and Safety of High-Power Radiofrequency Ablation Guided by Ablation Index for the Treatment of Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5609764. [PMID: 35991126 PMCID: PMC9391153 DOI: 10.1155/2022/5609764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Background To investigate the efficacy and safety of ablation index- (AI-) guided high-power radiofrequency ablation in the treatment of atrial fibrillation (AF). Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50 W, 40 W, and 30 W; AI = 500). And a total of 100 consecutive patients with paroxysmal AF undergoing pulmonary vein isolation (PVI) were included. The patients were divided into two groups (n = 50 for each) as follows: control group, treated with conventional power (30 W) ablation mode; and study group, treated with high power (40 W) radiofrequency ablation mode. All groups were treated with the same AI value guided the ablation (target AI = 400/500 on posterior/anterior wall, respectively). Acute pulmonary vein (PV) reconnection was assessed post adenosine administration 20 minutes after ablation. Subsequently, pathological observation of porcine heart lesions and necrotic tissue was performed. Additionally, statistical analyses were carried out on patients' baseline clinical characteristics, surgical data, and total RF energy. Results In swine ventricular endocardial RF applications, compared with 40 W and 30 W, the use of 50 W was associated with shallower tissue lesion depth (p < 0.001) and greater lesion maximum diameter (p < 0.001). Compared with 40 W and 30 W, tissue necrosis caused by 50 W was the deepest and largest (p < 0.001). In pulmonary vein isolation (PVI), there was no significant difference in baseline data between the study group and control group (p > 0.05). In patients with paroxysmal atrial fibrillation, the procedure time in the high-power group was significantly shortened (p < 0.001). The ablation time was significantly shorter (p < 0.001). Compared with control group, RF energy per point and acute pulmonary vein (PV) reconnection were lower (p < 0.001), and first-pass PVI was higher (p < 0.01) in study group. There were no significant differences in complications and sinus rhythm maintenance at 12 months between the two groups (p > 0.05). Conclusions Compared with conventional (30 W) PVI, AI-guided high-power (40 W) was safe and associated with shorter procedure time and reduced acute PV reconnection.
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11
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Schlögl S, Schlögl KS, Bengel P, Bergau L, Haarmann H, Rasenack E, Hasenfuss G, Zabel M. Impact of open-irrigated radiofrequency catheter with contact force measurement on the efficacy and safety of atrial fibrillation ablation: a single-center direct comparison. J Interv Card Electrophysiol 2022; 65:685-693. [PMID: 35907108 PMCID: PMC9726666 DOI: 10.1007/s10840-022-01316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In atrial fibrillation (AF) patients, catheter ablation of pulmonary veins (PVI) is the most effective therapeutic option to maintain sinus rhythm. To improve successful PVI, contact force-sensing (CF) catheters became routinely available. Previous studies did not clearly show superior clinical efficacy in comparison with non-CF catheters. METHODS We investigated consecutive patients, who underwent index PVI for AF at our hospital between 2012 and 2018. Three hundred and fifty-four patients were ablated without CF. After availability of CF catheters in 2016, 317 patients were ablated using CF. In case of crossover between the groups, follow-up was censored. The primary endpoint was any documented atrial tachycardia (AT) or atrial fibrillation > 30 s after a 3-month blanking period. Secondary endpoints were procedural characteristics and periprocedural complications. RESULTS There was no significant difference between the groups at baseline except hyperlipidemia. After 365 days of follow-up, 67% of patients in the CF group remained free from AF/AT recurrence compared to 59% in non-CF group (P = 0.038). In multivariable Cox regression analysis, non-CF ablation was an independent risk factor for AF recurrence besides age and persistent AF. Total fluoroscopy time (15 ± 7.6 vs. 28 ± 15.9 min) and total procedure time (114 ± 29.6 vs. 136 ± 38.5 min) were significantly lower for CF-guided PVI (P < 0.001). Complication rates did not differ between groups (P = 0.661). CONCLUSIONS In our study, the AT/AF recurrence rate and pulmonary vein reconnection rate is lower after CF PVI with a similar complication rate but lower total procedure time and total fluoroscopy time compared to non-CF PVI.
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Affiliation(s)
- Simon Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Klaudia Stella Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Philipp Bengel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Leonard Bergau
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Helge Haarmann
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Eva Rasenack
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuss
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Markus Zabel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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12
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A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:629-639. [PMID: 34757547 DOI: 10.1007/s10840-021-01086-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)-guided zero-fluoroscopy approach (ZFA) for RFA. METHODS Consecutive patients (n = 111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure. RESULTS ZFA success was achieved in 80 (72%) procedures. BMI > 35 kg/m2 resulted in the only independent predictor of ZFA failure (OR = 6.10, 95% CI 1.15-46.49, p = 0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63 s, p < 0.001), total emitted fluoroscopy dose (0.2 vs. 6.0 mGy, p < 0.001), dose area product (0.04 vs. 1.4 Gy*cm2, p < 0.001), and effective dose (0.8 vs. 27.2 mSv*100, p < 0.001). Complete pulmonary vein isolation was achieved in all procedures. No difference was observed between the groups in in-hospital complication rate (0.9% vs. 1.8%, p = 0.99). CONCLUSIONS This is the largest study proving procedural feasibility, safety, and efficacy of TEE-guided AF-ablation with a complete or near-complete avoidance of radiological exposure, without using intracardiac echocardiography.
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13
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Sebag FA, Simeon E, Miled M, Jorrot P, Villejoubert O, Darondel JM, Hamon D, Lellouche N, Mignot N. Single-catheter simplified stepwise approach to persistent atrial fibrillation ablation: A feasibility study. Arch Cardiovasc Dis 2021; 114:707-714. [PMID: 34620575 DOI: 10.1016/j.acvd.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary vein isolation. AIM To evaluate the feasibility of this approach to performing persistent atrial fibrillation ablation, including pulmonary vein isolation and atrial lines, if needed. METHODS We prospectively included 159 consecutive patients referred to our centre for a first persistent atrial fibrillation ablation between January 2018 and December 2018. All patients underwent pulmonary vein isolation. If the patient was still in atrial fibrillation (spontaneously or inducible), we subsequently performed a stepwise approach, including roof line, anterior mitral line, posterior box lesion and cavotricuspid isthmus line. Finally, if patient remained in atrial fibrillation at the end of the procedure, a synchronized direct-current cardioversion was applied to restore sinus rhythm. RESULTS At baseline, 54 patients were in sinus rhythm and underwent pulmonary vein isolation. For patients in atrial fibrillation, after pulmonary vein isolation and ablation of additional lines, if needed, 18 patients were converted to atrial tachycardia and one directly to sinus rhythm; 96 were still in atrial fibrillation and underwent direct-current cardioversion. After a mean follow-up of 17±6 months, 57 patients (36%) experienced atrial arrhythmia recurrence. No deaths, tamponades or phrenic nerve injuries were observed following the procedure. The main mode of arrhythmia recurrence was atrial fibrillation in 75% of cases and atrial tachycardia in 25% of cases. CONCLUSION A single-catheter approach, including pulmonary vein isolation and atrial lines, is feasible and safe in patients undergoing persistent atrial fibrillation ablation, with an acceptable success rate of 64% at mid-term follow-up.
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Affiliation(s)
- Frédéric A Sebag
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - Edouard Simeon
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Manel Miled
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Pierre Jorrot
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Olivier Villejoubert
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Jean-Marc Darondel
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - David Hamon
- Service de Cardiologie, Hôpital Henri Mondor, 94000 Créteil, France
| | | | - Nicolas Mignot
- Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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14
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Teres C, Soto-Iglesias D, Penela D, Jáuregui B, Ordoñez A, Chauca A, Carreño JM, Scherer C, San Antonio R, Huguet M, Roque A, Ramírez C, Oller G, Jornet A, Palet J, Santana D, Panaro A, Maldonado G, de Leon G, Jiménez G, Evangelista A, Carballo J, Ortíz-Pérez JT, Berruezo A. Personalized paroxysmal atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: the 'Ablate by-LAW' single-centre study-a pilot study. Europace 2021; 24:390-399. [PMID: 34480548 DOI: 10.1093/europace/euab216] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine if adapting the ablation index (AI) to the left atrial wall thickness (LAWT), which is a determinant of lesion transmurality, is feasible, effective, and safe during paroxysmal atrial fibrillation (PAF) ablation. METHODS AND RESULTS Consecutive patients referred for PAF first ablation. Left atrial wall thickness three-dimensional maps were obtained from multidetector computed tomography and integrated into the CARTO navigation system. Left atrial wall thickness was categorized into 1 mm layers and AI was titrated to the LAWT. The ablation line was personalized to avoid thicker regions. Primary endpoints were acute efficacy and safety, and freedom from atrial fibrillation (AF) recurrences. Follow-up (FU) was scheduled at 1, 3, 6, and every 6 months thereafter. Ninety patients [60 (67%) male, age 58 ± 13 years] were included. Mean LAWT was 1.25 ± 0.62 mm. Mean AI was 366 ± 26 on the right pulmonary veins with a first-pass isolation in 84 (93%) patients and 380 ± 42 on the left pulmonary veins with first-pass in 87 (97%). Procedure time was 59 min (49-66); radiofrequency (RF) time 14 min (12.5-16); and fluoroscopy time 0.7 min (0.5-1.4). No major complication occurred. Eighty-four out of 90 (93.3%) patients were free of recurrence after a mean FU of 16 ± 4 months. CONCLUSION Personalized AF ablation, adapting the AI to LAWT allowed pulmonary vein isolation with low RF delivery, fluoroscopy, and procedure time while obtaining a high rate of first-pass isolation, in this patient population. Freedom from AF recurrences was as high as in more demanding ablation protocols. A multicentre trial is ongoing to evaluate reproducibility of these results.
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Albert Roque
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Carlos Ramírez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Guillermo Oller
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Agustí Jornet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jordi Palet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Santana
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alejandro Panaro
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Giuliana Maldonado
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo de Leon
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo Jiménez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Arturo Evangelista
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Julio Carballo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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15
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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: 19] [Impact Index Per Article: 6.3] [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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16
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Hasebe H, Yoshida K, Nogami A, Furuyashiki Y, Hanaki Y, Baba M, Ieda M. A simple pacing maneuver to unmask an epicardial connection involving the right-sided pulmonary veins. J Cardiovasc Electrophysiol 2020; 32:287-296. [PMID: 33305884 DOI: 10.1111/jce.14835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION An epicardial connection (EC) between the right-sided pulmonary venous (PV) carina and right atrium (RA) is one of the mechanisms for which carinal ablation is required for right-sided PV isolation. The purpose of the study was to devise a simple pacing maneuver to differentiate an EC from a residual conduction gap on the antral ablation line during radiofrequency catheter ablation. METHODS AND RESULTS This study included 133 consecutive patients. After one round of ablation, electrograms at the posterior antrum outside the ablation line were recorded during sinus rhythm (SR) and coronary sinus (CS) pacing, and intervals between the antral and PV potentials were measured in each rhythm. The ΔintervalSR-CS was calculated as the difference between the interval during SR and that during CS pacing. Presence of an EC was confirmed by observation of a RA posterior wall breakthrough during right-sided PV pacing, which was then targeted for ablation. Patients with nonachievement of first-pass isolation (N = 35) and with PV reconnection during the procedure (N = 9) were classified into the EC-group (N = 20) and gap-group (N=24), respectively. The prevalence of carina breakthrough during SR was higher in the EC-group than the gap-group (18 [95%] vs. 1 [4%] patients, p < .0001). The ΔintervalSR-CS was larger in the EC-group versus gap-group (71 [interquartile range, 57-97] vs. 6 [2-9] ms, p < .0001). In all patients with an EC, RA ablation resulted in delay (32 [20-40] ms) (N = 15) or elimination of PV potentials (N = 5). CONCLUSION An EC can be efficiently discriminated from a conduction gap by a simple pacing maneuver.
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Affiliation(s)
- Hideyuki Hasebe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Yuichi Hanaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Masako Baba
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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17
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Sebag FA, Simeon É, Moubarak G, Zhao A, Villejoubert O, Darondel JM, Vedrenne G, Lepillier A, Jorrot P, Mouhoub Y, Bouzeman A, Hamon D, Lellouche N, Mignot N. Definition of success criteria for ablation of typical right atrial flutter with a single-catheter approach: A pilot study. Arch Cardiovasc Dis 2020; 113:791-796. [PMID: 33051170 DOI: 10.1016/j.acvd.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The success rate of cavotricuspid isthmus ablation to treat right common flutter is high (up to 95%), but needs bidirectional block confirmation, requiring two or three catheters. AIM To describe a new pacing technique using a single catheter to ablate and confirm cavotricuspid isthmus block with differential PR interval measurements. METHODS We included 61 patients from five centres, who were referred for cavotricuspid isthmus ablation. All patients had cavotricuspid isthmus ablation, and the cavotricuspid isthmus block was confirmed by differential pacing using two or three catheters. The new method consisted of measuring the PR interval on the surface electrocardiogram using pacing from the tip of the ablation catheter on the lateral side (lateral delay) and the septal side (coronary sinus ostium) of the cavotricuspid isthmus line (difference=delta PR interval), before and after cavotricuspid isthmus ablation. We analysed the value of the delta PR interval in predicting bidirectional cavotricuspid isthmus block as confirmed by standard methods. RESULTS Among our patient population (mean age 63±12 years), 39 patients were ablated during sinus rhythm, and 22 during common flutter. Cavotricuspid isthmus block was achieved in all patients but one. Lateral delay and delta PR interval increased significantly after validation of cavotricuspid isthmus block (257±42 vs. 318±50ms and 32±23 vs. 96±22ms, respectively; P<0.0001). A delta PR interval cut-off of ≥70ms had 100% sensitivity and specificity to predict bidirectional cavotricuspid isthmus block. CONCLUSIONS A single-catheter ablation approach to performing cavotricuspid isthmus line based on surface electrocardiogram PR interval measurement is feasible. After ablation, cavotricuspid isthmus block was systematically obtained when the delta PR interval was>70ms.
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Affiliation(s)
- Frédéric A Sebag
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
| | - Édouard Simeon
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Ghassan Moubarak
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Alexandre Zhao
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | | | - Jean-Marc Darondel
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | | | | | - Pierre Jorrot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Yamina Mouhoub
- Service de cardiologie, hôpital Saint-Joseph, 75014 Paris, France
| | | | - David Hamon
- Service de cardiologie, hôpital Henri-Mondor, 94010 Créteil, France
| | | | - Nicolas Mignot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
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Virk SA, Ariyaratnam J, Bennett RG, Kumar S. Updated systematic review and meta-analysis of the impact of contact force sensing on the safety and efficacy of atrial fibrillation ablation: discrepancy between observational studies and randomized control trial data. Europace 2020; 21:239-249. [PMID: 30544134 DOI: 10.1093/europace/euy266] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Despite widespread adoption of contact force (CF) sensing technology in atrial fibrillation (AF) ablation, randomized data suggests lack of improvement in clinical outcomes. We aimed to assess the safety and efficacy of CF-guided vs. non CF-guided AF ablation. Methods and results Electronic databases were searched for randomized controlled trials (RCTs) and controlled observational studies (OS) comparing outcomes of AF ablation performed with vs. without CF guidance. The primary efficacy endpoint was freedom from AF at follow-up. The primary safety endpoint was major peri-procedural complications. Secondary endpoints included procedural, fluoroscopy, and ablation duration. Subgroup analyses were performed by AF type and study design. Nine RCTs (n = 903) and 26 OS (n = 8919) were included. Overall, CF guidance was associated with improved freedom from AF [relative risk (RR) 1.10; 95% confidence interval (CI) 1.02-1.18], and reduced total procedure duration [mean difference (MD) 15.33 min; 95% CI 6.98-23.68], ablation duration (MD 3.07 min; 95% CI 0.29-5.84), and fluoroscopy duration (MD 5.72 min; 95% CI 2.51-8.92). When restricted to RCTs however, CF guidance neither improved freedom from AF (RR 1.03; 95% CI 0.95-1.11), independent of AF type, nor did it reduce procedural, fluoroscopy, or ablation duration. Contact force guidance did not reduce the incidence of major peri-procedural complications (RR 0.89; 95% CI 0.64-1.24). Conclusion Meta-analysis of randomized data demonstrated that CF guidance does not improve the safety or efficacy of AF ablation, despite initial observational data showing dramatic improvement. Rigorous evaluation in randomized trials is needed before widespread adoption of new technologies.
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Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | | | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia
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Du Z, Hu F, Wu L, Zheng L, Ding L, Liang E, Chen G, Yao Y. Single transseptal puncture technique and contact force catheter: A simplified ablation strategy for paroxysmal atrial fibrillation. Exp Ther Med 2020; 20:2611-2616. [PMID: 32793307 PMCID: PMC7418501 DOI: 10.3892/etm.2020.9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/01/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to evaluate the safety and efficacy of an optimized single transseptal puncture technique and contact force sensing atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) strategy within a clinical setting. Fast anatomic mapping and contact force sensing ablation was applied to patients with paroxysmal AF (PAF) ablation between September 2014 and December 2016 using a single trans-septal sheath. Pulmonary vein isolation (PVI) and linear ablation were performed in PAF individually with a 10-20 g contact force with minimal fluoroscopy. Stimulation with 10 mA outputs on the lesions without capture was used as endpoint. A total of 419 consecutive patients who underwent first-time RFCA were enrolled in the current study, and acute PVI was achieved in all patients. The average procedure time was 74.5±9.7 min, with an average ablation time of 27.3±7.8 min. The average fluoroscopy time was 4.7±3.3 min and the average radiation dose was 24.3±25.2 mGy. At a mean follow-up time of 14.5 ± 4.1 months, sinus rhythm was maintained at 85.0%. Cardiac tamponade occurred in one case. The results indicated that this simplified technique was a simple, safe and effective approach for PAF ablation therapy.
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Affiliation(s)
- Zhongpeng Du
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Feng Hu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lingmin Wu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Ligang Ding
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Erpeng Liang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Gang Chen
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
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Chin SH, O'Brien J, Epicoco G, Peddinti P, Gupta A, Modi S, Waktare J, Snowdon R, Gupta D. The feasibility and effectiveness of a streamlined single-catheter approach for radiofrequency atrial fibrillation ablation. J Arrhythm 2020; 36:685-691. [PMID: 32782640 PMCID: PMC7411237 DOI: 10.1002/joa3.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol. METHODS A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre- and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block. RESULTS The CMC-free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148 ± 32 minutes, ablation time of 27.5 ± 5.7 minutes, and fluoroscopy time of 7.8 ± 1.0 minutes. First-pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF. The CMC-free approach resulted in a cost saving of £47,190. CONCLUSION A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, and is associated with excellent clinical outcomes at 1 year.
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Affiliation(s)
- Shui Hao Chin
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Jim O'Brien
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Gianluca Epicoco
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | | | | | - Simon Modi
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Johan Waktare
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Richard Snowdon
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Dhiraj Gupta
- Institute of Cardiovascular Medicine and ScienceDepartment of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
- School of MedicineUniversity of LiverpoolLiverpoolUK
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Comparing rates of atrioesophageal fistula with contact force-sensing and non-contact force-sensing catheters: analysis of post-market safety surveillance data. J Interv Card Electrophysiol 2019; 59:49-55. [PMID: 31758505 PMCID: PMC7508752 DOI: 10.1007/s10840-019-00653-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/27/2019] [Indexed: 10/28/2022]
Abstract
PURPOSE There is limited data on the specific incidence of serious adverse events, such as atrioesophageal fistula (AEF), associated with either contact force (CF) or non-CF ablation catheters. Since the actual number of procedures performed with each type of catheter is unknown, making direct comparisons is difficult. The purpose of this study was to assess the incidence of AEF associated with the use of CF and non-CF catheters. Additionally, we aimed to understand the workflow present in confirmed AEF cases voluntarily provided by physicians. METHODS The number of AEFs for 2014-2017 associated with each type of catheter was extracted from an ablation device manufacturer's complaint database. Proprietary device sales data, a proxy for the total number of procedures, were used as the denominator to calculate the incidence rates. Additional survey and workflow data were systematically reviewed. RESULTS Both CF and non-CF ablation catheters have comparably low incidence of AEF (0.006 ± 0.003% and 0.005 ± 0.003%, respectively, p = 0.69). CF catheters are the catheter of choice for left atrium (LA) procedures which pose the greatest risk for AEF injury. Retrospective analysis of seven AEF cases demonstrated that high power and force and long RF duration were delivered on the posterior wall of the left atrium in all cases. CONCLUSIONS CF and non-CF ablation catheters were found to have similar AEF incidence, despite CF catheters being the catheter of choice for LA procedures. More investigation is needed to understand the range of parameters which may create risk for AEF.
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Pambrun T, Durand C, Constantin M, Masse A, Marra C, Meillet V, Haïssaguerre M, Jaïs P, Bortone A. High-Power (40-50 W) Radiofrequency Ablation Guided by Unipolar Signal Modification for Pulmonary Vein Isolation: Experimental Findings and Clinical Results. Circ Arrhythm Electrophysiol 2019; 12:e007304. [PMID: 31164003 DOI: 10.1161/circep.119.007304] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although proposed to facilitate pulmonary vein isolation (PVI), high-power ablation may favor extracardiac damage. Negative component abolition of the unipolar signal reflects lesion transmurality. The present study sought to evaluate the safety and efficacy of high-power ablation using unipolar signal modification as a local end point. Methods High power and standard power were compared in 4 swine and 100 consecutive patients referred for PVI. The first 50 patients were included in the control group (25-30 W) and the last 50 patients in the study group (40-50 W). Atrial radiofrequency applications were stopped 2 s (study group and swine) or 5 s (control group) after unipolar signal modification. Ventricular radiofrequency applications of 500 J (25 W·20 s versus 50 W·10 s) were performed at the swine epicardium. Results Swine gross necropsy did not show any extracardiac damage related to atrial lesions. At equal energy of 500 J, 50 W lesions were deeper (3±0.9 versus 2.6±1.1 mm; P=0.03) and wider (6.2±2 versus 5±2.3 mm; P=0.006) than 25 W lesions. No complications occurred during the clinical study, whatever the power output used for PVI. For a similar sinus rhythm maintenance at 12 months (90% versus 88%; P=0.75), the study group displayed higher first-pass PVI (92% versus 73%; P<0.001), lower acute pulmonary vein reconnection (2% versus 17%; P<0.001), reduced procedure time (73.1±18.2 versus 107.4±21.2 min; P<0.001), and ablation time (13±2.9 versus 30.3±8.8 min; P<0.001). Conclusions High-power PVI guided by unipolar signal modification safely decreases procedural burden while ensuring robust 12-month outcomes.
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Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Cyril Durand
- Département de Rythmologie, Infirmerie Protestante, Lyon, France (C.D.)
| | - Marion Constantin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Alexandre Masse
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Céline Marra
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Valentin Meillet
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.)
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Yoshida K, Baba M, Shinoda Y, Harunari T, Tsumagari Y, Koda N, Hayashi K, Yaguchi T, Watabe H, Hasebe H, Aonuma K, Takeyasu N, Nogami A, Ieda M. Epicardial connection between the right-sided pulmonary venous carina and the right atrium in patients with atrial fibrillation: A possible mechanism for preclusion of pulmonary vein isolation without carina ablation. Heart Rhythm 2019; 16:671-678. [DOI: 10.1016/j.hrthm.2018.11.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 11/30/2022]
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Pambrun T, Denis A, Duchateau J, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Derval N. MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL-PLAN case series. J Cardiovasc Electrophysiol 2018; 30:7-15. [PMID: 30461121 DOI: 10.1111/jce.13797] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/10/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Beyond pulmonary veins (PV) isolation, the ablation strategy for persistent atrial fibrillation (AF) remains controversial. Substrate ablation may provide a high termination rate but at the cost of impaired atrial physiology and recurrent complex re-entries. To overcome these pitfalls, we investigated a new lesion set based on important anatomical considerations. METHODS AND RESULTS The case series included 10 consecutive patients with persistent AF. Three atrial structures were successively targeted: (1) coronary sinus and vein of Marshall (CS-VOM) musculature elimination; (2) PVs isolation; and (3) anatomical isthmuses block. The lesion set completion was the procedural endpoint. Step 1: VOM ethanol infusion was feasible in all cases (mean time of 33.4 ± 9.4 minutes), mean radiofrequency (RF) time for CS-VOM bundles was 14.4 ± 6.9 minutes. Step 2: mean RF time for PV isolation was 27.7 ± 9.3 minutes. Step 3: mean RF time for mitral, roof, and cavotricuspid lines was 5.7 ± 2.3, 8.1 ± 4.3, and 5.9 ± 1.9 minutes, respectively. The lesion set was achieved in all patients. Mean procedure time was 270 ± 29.9 minutes. AF termination and noninducibility were, respectively, obtained in 50% and 90% of the patients. After a 6-month follow-up, all patients were free from arrhythmia recurrence. CONCLUSION The present case series reports a new ablation strategy systematically targeting anatomical structures previously identified as possibly involved in the fibrillatory process and the recurrent tachycardias. The resulting lesion set provides good short-term outcomes. Although promising, these preliminary results need to be confirmed in the larger prospective study.
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Affiliation(s)
- Thomas Pambrun
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
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Gabriels J, Beldner S, Donnelly J, Willner J, Epstein LM, Patel A. Escape mapping to achieve bidirectional block: A case series. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:470-473. [DOI: 10.1111/pace.13551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/16/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- James Gabriels
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Stuart Beldner
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Joseph Donnelly
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Jonathan Willner
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Laurence M. Epstein
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
| | - Apoor Patel
- Department of ElectrophysiologyNorth Shore University HospitalNorthwell Health Manhasset NY USA
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Deng H, Shantsila A, Xue Y, Potpara TS, Bai Y, Zhan X, Fang X, Liao H, Wei W, Wu S, Lip GYH. Using the MB-LATER score for predicting arrhythmia outcome after catheter ablation for atrial fibrillation: The Guangzhou atrial fibrillation project. Int J Clin Pract 2018; 72:e13247. [PMID: 30144238 DOI: 10.1111/ijcp.13247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Several clinical scoring systems have been derived to predict the arrhythmia outcome of catheter ablation (CA) for atrial fibrillation (AF) but which is better is not clear. Simple clinical risk scores (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following CA and the simple MB-LATER score has recently been described. We compare the predictive ability of seven existing clinical scoring systems (HATCH, CHADS2 , CHA2 DS2 -VASc, BASE-AF2 , APPLE, CAAP-AF, and MB-LATER) in a Chinese cohort of AF patients undergoing CA. METHODS AND RESULTS 1410 patients (mean age 57.2 ± 11.6 years; 68% male) with AF undergoing CA during 2011-2015 were enrolled in final analysis. Symptoms, 12 lead ECG and Holter ECGs were recorded before discharge, and at 1, 3, 6 months, and every 6 months thereafter to detect the arrhythmia relapse. During a mean 20.7 ± 8.8-month follow-up, recurrence occurred in 365 patients(25.9%). All tested scores were predictors of AF recurrence with areas under the curve (AUCs) of 0.58, 0.57, 0.57, 0.75, 0.74, 0.71, and 0.73 respectively (all P < 0.01). Compared to all other scores, the MB-LATER score showed improved reclassification (NRI range 30%-82.6%, P < 0.01) and discrimination indexes (IDI range 2.6%-18.6%, all P < 0.01) in predicting AF recurrence. CONCLUSION Based on net reclassification and discrimination analysis, the MB-LATER score performed best for predicting AF recurrent postablation, in a large "all comers" Chinese cohort. This simple clinical risk score (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following catheter ablation.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Alena Shantsila
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ying Bai
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wei
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gregory Y H Lip
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Du X, Chu H, Ye P, He B, Xu H, Jiang S, Lin M, Lin R, Liu J, Wang B, Feng M, Yu Y, Chen X. Combination of left atrial appendage closure and catheter ablation in a single procedure for patients with atrial fibrillation: Multicenter experience. J Formos Med Assoc 2018; 118:891-897. [PMID: 30482569 DOI: 10.1016/j.jfma.2018.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Experience in procedures combining left atrial appendage (LAA) closure (LAAC) and catheter ablation (CA) was scarce in Chinese nonvalvular atrial fibrillation (AF) patients with high risks for stroke and bleeding. We aimed to investigate the efficacy and safety of the combination therapy with LAAC and AF CA in a single procedure based on the multicenter data and medium-term follow-up results. METHODS A total of 122 AF patients with a mean CHA2DS2-VASc score of 4.3 ± 1.4 and HAS-BLED score of 3.3 ± 1.0 were enrolled. The Watchman (n = 83) devices were implanted either before or after AF ablations in the same procedure, while the Amplatzer Cardiac Plug (ACP, n = 39) devices were implanted immediately after CA. AF recurrence and transesophageal echocardiography results were evaluated. RESULTS All devices were successfully implanted and acute complete LAA occlusions were achieved in 115 (94.3%) of patients. Neither acute nor chronic peri-device leaks greater than 5 mm were detected. Oral anticoagulation was held in all patients but two with asymptomatic device-related thrombi, which were resolved after prolonged anticoagulation. AF-free success rate without antiarrhythmic drugs was 76.2% after a mean follow-up of 11.5 ± 6.8 months. No serious complications were observed during the follow-up. CONCLUSION The combination therapy with LAAC and AF ablation in a single procedure was efficacious and safe in the Chinese symptomatic AF population with high risk for stroke and bleeding.
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Affiliation(s)
- Xianfeng Du
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Huimin Chu
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China.
| | - Ping Ye
- The Central Hospital of Wuhan, Wuhan, 325000, China
| | - Bin He
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Huaiqin Xu
- The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Shubin Jiang
- The Hospital of Traditional Chinese Medicine of the Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumchi, 830000, China
| | - Miao Lin
- Wenzhou Central Hospital, Wenzhou, 325000, China
| | - Rong Lin
- Quanzhou First Hospital, Fujian Medical University, Quanzhou, 362002, China
| | - Jing Liu
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Binhao Wang
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Mingjun Feng
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Yibo Yu
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
| | - Xiaomin Chen
- Ningbo First Hospital, Zhejiang University, Ningbo, 315010, China
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Deng H, Bai Y, Shantsila A, Fauchier L, Potpara TS, Lip GYH. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clin Res Cardiol 2017; 106:813-823. [PMID: 28560516 PMCID: PMC5613037 DOI: 10.1007/s00392-017-1123-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 11/01/2022]
Abstract
Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation. Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Ying Bai
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Beijing Tongren Hospital, Capital University, Beijing, China
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK.
- School of Medicine, Belgrade University, Belgrade, Serbia.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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29
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Han X, Li J. Catheter Ablation of Atrial Fibrillation: Where Are We? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Winkle RA, Mead RH. Thought leaders saving money: One catheter at a time. Heart Rhythm 2016; 14:339-340. [PMID: 28007542 DOI: 10.1016/j.hrthm.2016.12.030] [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: 12/14/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, Palo Alto Medical Foundation, Sutter Health, E. Palo Alto, California.
| | - R Hardwin Mead
- Silicon Valley Cardiology, Palo Alto Medical Foundation, Sutter Health, E. Palo Alto, California
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