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Issa ZF. Radiofrequency lesion formation prediction with contact force versus local impedance. Curr Opin Cardiol 2024; 39:6-14. [PMID: 37820074 DOI: 10.1097/hco.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Safe and effective radiofrequency (RF) myocardial ablation requires real-time monitoring of lesion formation. Here, we review conventional and novel approaches proposed to guide titration of RF energy application. RECENT FINDINGS Conventional monitoring modalities, such as ablation electrode temperature, generator impedance, and tissue electrophysiological properties have been of limited value in predicting efficacy and safety of ablation. Therefore, several input-driven indices have been proposed to improve the quality and durability of RF ablation lesion while maintaining safety. These metrics predominantly incorporate RF power output, duration of RF application, and firmness and stability of electrode-tissue contact. More recently, novel catheters have enabled measuring local impedance at the catheter-tissue interface, which has been found valuable for real-time monitoring of RF lesion formation. SUMMARY It is likely that using the combination of multiple metrics would be required to improve the quality and safety of RF lesions, but further investigation is still required.
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Affiliation(s)
- Ziad F Issa
- Prairie Heart Institute, Springfield, Illinois, USA
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2
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Kobza R, Hilfiker G, Rissotto S, Mahida S, Grebmer C, Duru F, Pürerfellner H, Berte B. Performance and safety of temperature- and flow-controlled radiofrequency ablation for ventricular arrhythmia. Europace 2023; 26:euad372. [PMID: 38193796 PMCID: PMC10775682 DOI: 10.1093/europace/euad372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS High-power ablation is effective for ventricular arrhythmia ablation; however, it increases the risk of steam pops. The aim of this study was to define the safety and efficacy of QMODE ablation in the ventricle and the risk of steam pop. METHODS AND RESULTS Consecutive patients undergoing ventricular ablation using QDOT were included in a prospective single-centre registry. Procedural data, complications, and follow-up were systematically analysed and compared with a historical ventricular tachycardia (VT) and premature ventricular complexes (PVC) cohort ablated using STSF. QMODE (≤50 W) ablation was performed in 107 patients [age 62 ± 13 years; 76% male; VT (n = 41); PVC (n = 66)]. A total of 2456 applications were analysed [power: 45.9 ± 5.0 W with minimal power titration (90% > 95% max power); duration 26 ± 8 s; impedance drop 9.4 ± 4.7 Ω; ablation index: 569 ± 163; mean-max temperature 44.3 ± 2.6°C]. Ventricular tachycardia ablation was associated with shorter radiofrequency (RF) time and a trend towards shorter procedure times using QDOT (QDOT vs. STSF: 20.1 ± 14.7 vs. 31 ± 17 min; P = 0.002, 151 ± 59 vs. 172 ± 48 min; P = 0.06). Complications, VT recurrence, and mortality rates were comparable (QDOT vs. STSF: 2% vs. 2%; P = 0.9, 24% vs. 27%; P = 0.82, and 2% vs. 4%; P = 0.67). Five audible steam pops (0.02%) occurred. Premature ventricular complex ablation was associated with comparable RF and procedure times (QDOT vs. STSF: 4.8 ± 4.6 vs. 3.9 ± 3.1 min; P = 0.25 and 96.1 ± 31.9 vs. 94.6 ± 24.7 min; P = 0.75). Complication and PVC recurrence were also comparable (QDOT vs. STSF: 0% vs. 3%; P = 0.17 and 19% vs. 22%; P = 0.71). CONCLUSION Ventricular ablation using QMODE ≤ 50 W is safe and effective for both VT and PVC ablation and is associated with a low risk for steam pop.
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Affiliation(s)
- Richard Kobza
- Heart Center, Luzerner Kantonsspital, Zentralstrasse 1, Lucerne 6004, Switzerland
| | - Gabriela Hilfiker
- Heart Center, Luzerner Kantonsspital, Zentralstrasse 1, Lucerne 6004, Switzerland
| | | | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Christian Grebmer
- Heart Center, Luzerner Kantonsspital, Zentralstrasse 1, Lucerne 6004, Switzerland
| | - Firat Duru
- Cardiology Department, University Hospital Zürich, Zürich, Switzerland
| | | | - Benjamin Berte
- Heart Center, Luzerner Kantonsspital, Zentralstrasse 1, Lucerne 6004, Switzerland
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Schillaci V, Arestia A, Maddaluno F, Shopova G, Agresta A, Salito A, Stabile G, Marano G, Bottaro G, Malacrida M, Solimene F. Combining contact force and local impedance to treat idiopathic premature ventricular contractions from the outflow tracts: impact of ablation strategy on outcomes. J Interv Card Electrophysiol 2023; 66:2011-2020. [PMID: 36964415 DOI: 10.1007/s10840-023-01528-6] [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: 01/23/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Contact force (CF)-sensing catheters have not proved superior to standard catheters in the ablation of premature ventricular contractions (PVCs) from the right and left ventricular outflow tract (RVOT, LVOT). In this context, the utility of measuring local impedance (LI) is not known. We aimed to ascertain whether the use of a catheter combining LI and CF information was associated with superior outcomes in comparison with other catheter technologies. METHODS We compared three groups of 40 propensity-matched patients with PVCs from the OTs, ablated by means of different catheter technologies: a CF-plus LI-featured catheter, an LI-featured catheter, and a standard irrigated catheter. RESULTS The CF + LI group displayed a significantly lower risk of PVC recurrence than the standard ablation group (HR, 0.22; 95%CI, 0.07-0.71; p = 0.01). In the CF + LI group, LI drop and RF time were the only predictors of successful lesions (OR = 1.19, CI: 1.13-1.26, p < 0.001; OR = 1.06 CI: 1.01-1.07, p = 0.044, respectively). In the coronary cusps, unlike the RVOT/LVOT region, CF was not associated with LI drop (p = 0.48), and RF duration showed a linear relationship with LI drop (p < 0.001). CONCLUSIONS The use of ablation catheters that combine CF and LI information is associated with increased success in the RF ablation of PVCs from the OTs. LI drop is the most important predictor of effective lesions, but its behavior depends on the ablation site: in the coronary cusps, unlike the RVOT/LVOT region, longer RF application times are needed in order to achieve LI drops associated with successful outcomes. REGISTRY AND REGISTRATION NO. OF THE STUDY/TRIAL NCT03793998.
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Affiliation(s)
- Vincenzo Schillaci
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | - Alberto Arestia
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | | | - Gergana Shopova
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | | | - Armando Salito
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giovanni Marano
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | - Giuseppe Bottaro
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy
| | | | - Francesco Solimene
- Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy.
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Kellnar A, von Falkenhausen AS, Fichtner S, Sinner M, Estner HL, Lackermair K. Effects of contemporary hard- and software mapping and ablation features on acute and long-term success in premature ventricular complex ablation. Int J Cardiol 2023; 390:131269. [PMID: 37591414 DOI: 10.1016/j.ijcard.2023.131269] [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: 07/04/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Current standards of ablation of premature ventricular complexes (PVC) combine modern hard- and software mapping and ablation features like multielectrode mapping catheters (MEC), contact force (CF) guided ablation catheters and pattern matching filters (PMF). Benefits of these individual tools were described for selected patients with PVC, but data on combination of these features in the real world setting is sparse. METHODS Between 2015 and 2021 we retrospectively enrolled 172 consecutive patients undergoing PVC ablation in our center. The utilization of MEC, CF guided ablation catheters and PMF software was analyzed in terms of procedural data, acute and long-term success after 12 months. RESULTS Acute ablation success was reached in 71% of patients (n = 118) with an overall recurrence rate of 34% after 12 months. PMF software was used in 130 patients (78%), MEC in 131 patients (79%) and ablation was guided using CF in 99 patients (60%). PMF significantly reduced procedural duration and time of radiofrequency application (RF, 150 vs. 185 min, p 0.04 and 325 vs. 556 min, p 0.01). CF enabled significantly shorter radiation time (7.9 vs. 12.3 min, p 0.01), whereas MEC did not influence procedural data. Acute and long-term outcomes were not affected by these modern mapping and ablation features, yet, multivariable regression analysis revealed an underlying cardiomyopathy and the respective focus as independent predictors for recurrence. CONCLUSION Contemporary hard- and software mapping and ablation features could reduce procedural, radiation and RF time in PVC ablation. Furthermore, patient characteristics rather than technical factors alter outcome of this all-comer collective.
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Affiliation(s)
- Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | - Aenne S von Falkenhausen
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | | | - Moritz Sinner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J, Ling M, Kong Q, Maduray K, Zhao C, Zhong J. Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias. J Clin Med 2023; 12:jcm12093154. [PMID: 37176594 PMCID: PMC10179325 DOI: 10.3390/jcm12093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. METHODS AND RESULTS From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. CONCLUSIONS The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.
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Affiliation(s)
- Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Lujie Chang
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Bing Rong
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guanqi Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Mingying Ling
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qingyu Kong
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Cuifen Zhao
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China
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6
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Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Madaffari A, Seiler J, Mühl A, Tanner H, Roten L, Reichlin T. Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters. J Cardiovasc Electrophysiol 2023; 34:292-299. [PMID: 36490307 DOI: 10.1111/jce.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Impact of Contact Force-Sensing Catheters on Fluoroscopy Time in Interventional Electrophysiology: A European Survey. J Clin Med 2022; 11:jcm11051322. [PMID: 35268413 PMCID: PMC8911176 DOI: 10.3390/jcm11051322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
This multicenter European survey systematically evaluated the impact of using contact force-sensing catheters (CFSCs) on fluoroscopy and procedure time in interventional electrophysiology. Data from 25 participating centers were collected and analyzed, also considering important confounders. With the use of CFSCs, fluoroscopy time was reduced for right- and left-sided atrial ablations (median −6.4 to −9.6 min, p < 0.001 for both groups), whereas no such effect could be found for ventricular ablations. Moreover, the use of CFSCs was associated with an increase in procedure time for right-sided atrial and ventricular ablations (median +26.0 and +44.0 min, respectively, p < 0.001 for both groups), but not for left-sided atrial ablations. These findings were confirmed independent of career level and operator volume, except for very highly experienced electrophysiologists, in whom the effect was blunted. In the subset of pulmonary vein isolations (PVIs), CFSCs were shown to reduce both fluoroscopy and procedure time. In conclusion, the use of CFSCs was associated with a reduced fluoroscopy time for atrial ablations and an increased procedure time for right atrial and ventricular ablations. These effects were virtually independent of the operator experience and caseload. When considering only PVIs as an important subset, CFSCs were shown to reduce both fluoroscopy and procedure time.
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Karkowski G, Kuniewicz M, Ząbek A, Koźluk E, Dębski M, Matusik PT, Lelakowski J. Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias. J Clin Med 2022; 11:jcm11030593. [PMID: 35160043 PMCID: PMC8836481 DOI: 10.3390/jcm11030593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/10/2022] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs). Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed. Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% (n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS (n = 1) and standard catheter (n = 2) ablations. Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.
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Affiliation(s)
- Grzegorz Karkowski
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
| | - Marcin Kuniewicz
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
| | - Edward Koźluk
- Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Maciej Dębski
- Department of Cardiology, Norfolk and Norwich University Hospital, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: ; Tel.: +48-12-614-2277
| | - Jacek Lelakowski
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
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Ábrahám P, Ambrus M, Herczeg S, Szegedi N, Nagy KV, Salló Z, Perge P, Osztheimer I, Széplaki G, Tahin T, Merkely B, Gellér L. Selection of an impedance- or magnetic field-based electro-anatomical mapping platform does not affect outcomes of outflow tract premature ventricular complex manual ablation. Heart Vessels 2022; 37:1769-1775. [PMID: 35554635 PMCID: PMC9399042 DOI: 10.1007/s00380-022-02081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/15/2022] [Indexed: 12/31/2022]
Abstract
Comparative data are virtually missing about the performance of different electro-anatomical mapping (EAM) system platforms on outflow tract (OT) premature ventricular complex (PVC) ablation outcomes with manual ablation catheters. We aimed to compare the acute success-, complication-, and long-term recurrence rates of impedance-based (IMP) and magnetic field-based (MAG) EAM platforms in manual OT PVC ablation. Single-centre, propensity score matched data of 39-39 patients ablated for OT PVCs in 2015-17 with IMP or MAG platforms were analysed. Acute success rate, peri-procedural complications, post-ablation daily PVC burden, and long-term recurrence rates were compared on intention-to-treat basis. Acute success rate was similar in the IMP and MAG group (77 vs. 82%, p = 0.78). There was a single case of femoral pseudo-aneurysm and no cardiac tamponade occurred. PVC burden fell significantly from baseline 24.0% [15.0-30.0%] to 3.3% [0.25-10.5%] (p < 0.001) post-ablation, with no difference between EAM platforms (IMP: 2.6% [0.5-12.0%] vs. MAG: 4.0% [2.0-6.5%]; p = 0.60). There was no significant difference in recurrence-free survival of the intention-to-treat cohort of the IMP and MAG groups (54 vs. 60%, p = 0.82, respectively) during 12 months of follow-up. Ablation with the aid of both impedance- and magnetic field-based EAM platforms can considerably reduce OT PVC burden and give similar acute- and long-term freedom from arrhythmia.
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Affiliation(s)
- Pál Ábrahám
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary.
| | - Mercédesz Ambrus
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Szilvia Herczeg
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Nándor Szegedi
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Klaudia Vivien Nagy
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Zoltán Salló
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Péter Perge
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - István Osztheimer
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gábor Széplaki
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
- Heart and Vascular Centre, Mater Private Hospital, Eccles St, Dublin 7, D07 WKW8, Ireland
- Royal College of Surgeons in Ireland, 23 St Stephen's Green, Dublin 2, D02 YN77, Ireland
| | - Tamás Tahin
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
| | - László Gellér
- Semmelweis University Heart and Vascular Centre, Városmajor u. 68, Budapest, 1122, Hungary
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10
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Rationale and study design for empirical additional lesions for premature ventricular complex from the outflow tract: a multi-center, prospective randomized trial (EASE-PVC study). J Interv Card Electrophysiol 2022; 65:725-729. [PMID: 35932444 PMCID: PMC9726665 DOI: 10.1007/s10840-022-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Late recurrence after ablation remains a significant issue in patients with premature ventricular complexes (PVCs) who undergo catheter ablation. In this study, we aimed to test the hypothesis that empirical additional ablation (EAA) would improve the long-term control of PVCs from outflow tracts (OT-PVCs) compared with the approach of limited single point ablation at the assumptive location. METHODS EASE-PVC study (ChiCTR2200055340) is a prospective multi-center, randomized, and controlled trial designed to assess the effectiveness and safety of empirical additional ablation in patients with OT-PVCs. After successful elimination of OT-PVCs, the patients will be randomized into two groups. In patients randomized to the EAA group, additional lesion applications at sites surrounding the successful ablation site will be delivered empirically. For patients randomized to the control group, no additional empiric ablation will be performed around the successful ablation site. The primary endpoint will be freedom from PVC recurrence at 3 months following ablation, without antiarrhythmic drug therapy. CONCLUSIONS The EASE-PVC study is designed to compare the effectiveness and safety of two different strategies for ablation in patients with OT-PVCs, namely empirical additional ablation strategy versus conventional single point ablation strategy. This prospective, multi-center, and randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to elucidate the superiority of empirical additional ablation for the long-term control of OT-PVCs compared with the traditional single point ablation strategy. CLINICAL TRIAL REGISTRATION Chinese Clinical Trials Registry Identifier: ChiCTR2200055340.
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