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Mhanna M, Beran A, Al‐Abdouh A, Sajdeya O, Barbarawi M, Alsaiqali M, Jabri A, Al‐Aaraj A, Alharbi A, Chacko P. Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta‐analysis. J Arrhythm 2022; 38:570-579. [PMID: 35936032 PMCID: PMC9347204 DOI: 10.1002/joa3.12742] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Catheter placement and stability are well‐known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter–tissue contact. The purpose of this systematic review and meta‐analysis is to see if employing a SS influences procedure outcome. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow‐up. The secondary outcomes were the procedure‐related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random‐effects model. Results A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09–1.29; p < .001). Both techniques had similar rate for procedural‐related complication (RR: 1.09, 95% CI 0.50–2.39; p = .83). The SS strategy had a shorter procedure time (MD −10.6 [min], 95% CI −20.97, −0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group. Conclusions The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine University of Toledo Toledo Ohio USA
| | - Azizullah Beran
- Department of Internal Medicine University of Toledo Toledo Ohio USA
| | - Ahmad Al‐Abdouh
- Department of Internal Medicine University of Kentucky Lexington Kentucky USA
| | - Omar Sajdeya
- Department of Internal Medicine University of Toledo Toledo Ohio USA
| | - Mahmoud Barbarawi
- Department of Cardiovascular Medicine University of Connecticut Farmington Connecticut USA
| | - Mahmoud Alsaiqali
- Department of Internal Medicine State University of New York Downstate Medical Center Brooklyn New York USA
| | - Ahmad Jabri
- Department of Cardiology Case Western Reserve University/MetroHealth Medical Center Cleveland Ohio USA
| | - Ahmad Al‐Aaraj
- Department of Cardiology James Cook University Hospital Middlesbrough UK
| | | | - Paul Chacko
- Department of Cardiovascular Medicine University of Toledo Toledo Ohio USA
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Reddy SA, Nethercott SL, Khialani BV, Grace AA, Martin CA. Management of arrhythmias in pulmonary hypertension. J Interv Card Electrophysiol 2021; 62:219-229. [DOI: 10.1007/s10840-021-00988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
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van de Sande WWPJ, Ali A, Radaelli G. Design and Evaluation of a Passive Constant Force Mechanism for a Cardiac Ablation Catheter. J Med Device 2020. [DOI: 10.1115/1.4048911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Contact force management has been proven to have a positive effect on the outcome of cardiac ablation procedures. However, no method exists that allows maintaining a constant contact force within a required and effective range. This work aims to develop and evaluate such a constant force mechanism for use in an ablation catheter. A passive constant force mechanism was designed based on a tape loop. The tape loop consists of two tapered springs that work in parallel. A finite element analysis was carried out to verify the behavior and performance of the design. A design based on requirements for a constant force ablation tip showed an average force of about 7.8×10−2 N±8×10−3 N over 20 mm in simulation. A scaled prototype was built and evaluated to prove the validity of the concept; this prototype provides an average force of 1.3×10−1 N±1.6×10−2 N over 35 mm. The mechanism allows for controlled delivery of contact force within a desired and effective range. Based on these findings, it can be concluded that the approach is successful but needs to be optimized for future applications. Being able to control the delivery of contact force in a constant range may increase the effectivity of cardiac ablation procedures and improve clinical outcomes.
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Affiliation(s)
- Werner W. P. J. van de Sande
- Department of Precision and Microsystems Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands
| | - Awaz Ali
- Department of BioMechanical Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands
| | - Giuseppe Radaelli
- Department of Precision and Microsystems Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands
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Pedersoli F, Hitpass L, Isfort P, Zimmermann M, Schulze-Hagen M, Gombert A, Kuhl CK, Bruners P, Keil S. Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years' Experience. Vasc Endovascular Surg 2020; 55:158-163. [PMID: 33213286 DOI: 10.1177/1538574420975264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. METHODS A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). RESULTS 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). CONCLUSION Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
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5
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Kyriakopoulou M, Strisciuglio T, El Haddad M, De Pooter J, Almorad A, Van Beeumen K, Unger P, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study. Europace 2019; 21:1185-1192. [DOI: 10.1093/europace/euz115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/02/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We sought to evaluate the efficacy and the safety of a simple technique for stabilizing the ablation catheter during anterior pulmonary vein (PV) encirclement in patients ablated for paroxysmal atrial fibrillation. This consisted of bending the ablation catheter in the left atrium, creating a loop that was cautiously advanced together with the long sheath at the ostium and then within the left superior PV. The curve was then progressively released to reach a stable contact with the anterior part of the left PVs.
Methods and results
Eighty consecutive patients (age 64 ± 11 years, left atrial diameter 43 ± 8 mm) undergoing ‘CLOSE’-guided PV isolation were prospectively randomized into two groups depending on whether the loop technique was used or not. When using the loop technique, the encirclement of the left PVs was shorter [20 min (interquartile range, IQR 17–24) vs. 26 min (IQR 18–33), P < 0.01] with a high rate of first pass isolation [(100%) vs. (97%), P = 0.9] and adenosine proof isolation [(93%) vs. (95%), P = 0.67]. Most specifically, at the anterior part of the left PVs, there were less dislocations [0 (IQR 0–0) vs. 1 (IQR 0–4), P < 0.001], radiofrequency duration was shorter (272 ± 85 s vs. 378 ± 122 s, P < 0.001), force-time integral was higher [524 gs (IQR 427–687) vs. 398 gs (IQR 354–451), P < 0.001], average contact force was higher [20 g (IQR 13–27) vs. 11g (IQR 9–16), P < 0.001], and impedance drop was higher [12 Ω (IQR 9–19) vs. 10 Ω (IQR 7–14), P < 0.001].
Conclusion
This study describes a simple technique to facilitate catheter stability at the anterior part of the left PVs, resulting in more efficient left PV encirclement without compromising safety.
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Affiliation(s)
- Maria Kyriakopoulou
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Alexandre Almorad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Katarina Van Beeumen
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | | | - Yves Vandekerckhove
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
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Chautems C, Lyttle S, Boehler Q, Nelson BJ. Design and Evaluation of a Steerable Magnetic Sheath for Cardiac Ablations. IEEE Robot Autom Lett 2018. [DOI: 10.1109/lra.2018.2809546] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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7
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Narui R, Yamane T, Tokuda M, Ikewaki H, Okajima E, Sato H, Oseto H, Isogai R, Tokutake K, Yokoyama K, Kato M, Ito K, Tanigawa SI, Yamashita S, Inada K, Matsuo S, Miyanaga S, Sugimoto K, Yoshimura M. Atrial fibrillation diagnosed by a medical checkup is associated with a poor outcome of catheter ablation. Heart Vessels 2018; 33:770-776. [PMID: 29357093 DOI: 10.1007/s00380-017-1115-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF), especially asymptomatic cases, is often detected by medical checkups. We investigated the outcome of AF ablation in cases detected by medical checkups. We reviewed the data of 735 patients with AF (56 ± 10 years, paroxysmal: 441 patients) who underwent initial catheter ablation. All patients were divided into two groups based on their AF being diagnosed either by a medical checkup (group M) or not (group NM). AF was diagnosed by medical checkups in 263 (36%) patients. In Group M, the age was younger, time from the diagnosis to ablation shorter, left atrium dimension larger, and left ventricular ejection fraction lower than in Group NM. Male gender, persistent AF, and asymptomatic AF were more frequently seen in Group M than in Group NM. A mean of 13 ± 11 months after the initial ablation procedure, AF recurrence was more frequently observed in group M compared to group NM (P = 0.018). While the AF recurrence rate was similar in both groups in persistent AF patients (P = 0.87), it was more frequently observed in Group M than in Group NM in paroxysmal AF patients (P = 0.005). AF diagnosed by medical checkups was often associated with a worse outcome of catheter ablation, especially in paroxysmal AF patients.
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Affiliation(s)
- Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hirotsugu Ikewaki
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Eri Okajima
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hidenori Sato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hirotsuna Oseto
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Ito
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shin-Ichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoru Miyanaga
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Sugimoto
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Knecht S, Burch F, Reichlin T, Spies F, Mühl A, Altmann D, Ammann P, Schaer B, Osswald S, Sticherling C, Kühne M. First clinical experience of a dedicated irrigated-tip radiofrequency ablation catheter for the ablation of cavotricuspid isthmus-dependent atrial flutter. Clin Res Cardiol 2017; 107:281-286. [PMID: 29204691 DOI: 10.1007/s00392-017-1180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Different types of irrigated-tip ablation catheters are available for ablation of atrial flutter (AFL). The aim of this study was to compare an established with a novel dedicated Gold irrigated-tip catheter for ablation of AFL. METHODS AND RESULTS We compared consecutive patients undergoing ablation of AFL using a standard 3.5 mm irrigated-tip platinum-iridium (Pt-Ir) catheter (Thermocool, TC-group) and a 3.5 mm irrigated gold-tip catheter (Gold-group) specifically designed for cavotricuspid isthmus ablation (CTI). The primary endpoint was acute efficacy (net RF time) to achieve block across the CTI. Secondary endpoints included procedure time, fluoroscopy duration, complications, and recurrence of AFL.153 patients (age 68 ± 11 years, 74% male) were included. Net RF time to achieve CTI block was not different between the TC-group (793 ± 503 s) and the Gold-group (706 ± 422 s; p = 0.406). Total procedure time was not significantly different between the TC-group (70 ± 26 min) and the Gold-group (70 ± 27 min; p = 0.769). A significant difference between the groups was identified for the fluoroscopy duration (TC-group: 934 ± 537 s, Gold-group: 596 ± 362 s, p < 0.001). There were no major complications observed in the groups. Recurrence of AFL occurred in 3 of 66 (5%) in the TC-group and in 2 of 87 (2%) in the Gold-group (p = 0.652). CONCLUSIONS In conclusion, acute and chronic efficacy of the irrigated Pt-Ir and gold-tip catheters were comparable. However, the dedicated catheter design was associated with decreased fluoroscopy duration.
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Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabian Burch
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Tobias Reichlin
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Aline Mühl
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Altmann
- Cardiology/Electrophysiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Peter Ammann
- Cardiology/Electrophysiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Beat Schaer
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
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9
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Elayi CS. Reduce procedure time for cavotricuspid flutter ablation: What is the optimal catheter? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1050-1051. [PMID: 28872691 DOI: 10.1111/pace.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Claude S Elayi
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, and Veterans Administration Medical Center, Lexington, KY, USA
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10
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Herman D, Osmancik P, Zdarska J, Prochazkova R. Routine use of intracardiac echocardiography for atrial flutter ablation is associated with reduced fluoroscopy time, but not with a reduction of radiofrequency energy delivery time. J Atr Fibrillation 2017; 10:1553. [PMID: 29250227 DOI: 10.4022/jafib.1553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/19/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Abstract
Background The ablation of cavotricuspid-isthmus (CTI) atrial flutter (AFL) dependent atrial flutter could be difficult in patients with complex anatomy of the CTI.The aim of the study was to assess whether the use of intracardiac echocardiography (ICE) was associated with less fluoroscopy time and faster ablations of cavotricuspid isthmus dependent atrial flutter (CTI-AFL). Methods Patients with an indication for an ablation of a CTI-AFL were enrolled. Patients in which ablation of a CTI-AFLas part of an atrial fibrillation ablation were not included. Randomization was done using the envelope method. Standard techniques (i.e., coronary sinus, 20-polar halo catheter, and an ablation catheter), and criteria of success (bidirectional block through the CTI) were used. In patients randomized to the ablation with ICE, a 10F AcuNav ICE probe (Siemens, Germany)was used. Results Seventy-nine patients were enrolled; 40 were randomized to ablation with ICE and 39 without ICE. The X-ray exposure was shorter (3.29±2.6 vs. 5.94±3.43 min, p<0.001) and total X-ray dose was reduced (3.30±1.98 vs. 6.68±5.25 Gy.cm2, p<0.001) in the ICE group. However, the total RF energy ablation time was not different between groups (ICE group: 604.56±380.46sec vs. 585.82±373.39 sec, p=0.8). The procedure duration was slightly longer in the ICE group (82.0±20.8 vs. 72.1±19.0 min, p=0.03). Procedural success was 100% (40/40) in the ICE group and 95% (37/39) in the control group. Two control patients required crossover to ICE at a prespecified point to achieve bidirectional block. There were two femoral hematomas in the ICE group and one in the control group. Conclusion The use of ICE for atrial flutter ablation is associated with less fluoroscopy time and improved ability to achieve bidirectional block compared to traditional conventional flutter ablation methods. However, it is not asoociated with reduced ablation time or overall procedure duration.
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Affiliation(s)
- Dalibor Herman
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital KralovskeVinohrady Prague, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital KralovskeVinohrady Prague, Czech Republic
| | - Jana Zdarska
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital KralovskeVinohrady Prague, Czech Republic
| | - Radka Prochazkova
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital KralovskeVinohrady Prague, Czech Republic
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11
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Narui R, Matsuo S, Isogai R, Tokutake K, Yokoyama K, Kato M, Ito K, Tanigawa SI, Yamashita S, Tokuda M, Inada K, Shibayama K, Miyanaga S, Sugimoto K, Yoshimura M, Yamane T. Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2017; 49:51-57. [PMID: 28285382 DOI: 10.1007/s10840-017-0238-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 02/23/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation. METHODS This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients). Peripheral oxygen saturation was continuously monitored via pulse oximetry throughout the procedure. RESULTS A spontaneous dissociated pulmonary vein activity after pulmonary vein isolation occurred more frequently in group M than in group D (29.1 vs 15.7%, P < 0.01). Adenosine-induced dormant pulmonary vein conduction was more frequently observed in group M than in group D (19.2 vs 13.0% P = 0.01). There were no significant differences in the incidence of non-pulmonary vein triggers between groups M and D (15.2 vs 11.1%, P = 0.53). The atrial fibrillation recurrence rate following the single procedure did not differ between the two groups (29.0 vs 26.5%, in groups M and D, P = 0.85). CONCLUSIONS Although deep sedation reduced the incidence of a dissociated pulmonary vein activity and dormant pulmonary vein conduction following pulmonary vein isolation, it did not affect the recurrence rate for atrial fibrillation after the procedure.
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Affiliation(s)
- Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Ito
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shin-Ichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenri Shibayama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoru Miyanaga
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Sugimoto
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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12
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Bencsik G. Novel strategies in the ablation of typical atrial flutter: role of intracardiac echocardiography. Curr Cardiol Rev 2015; 11:127-33. [PMID: 25308811 PMCID: PMC4356719 DOI: 10.2174/1573403x10666141013121843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 04/05/2014] [Indexed: 11/22/2022] Open
Abstract
Radiofrequency ablation (RFA) of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Despite a high success rate, ablation of the CTI can be unusually difficult in some cases. Multiple tools like angiography, 3D mapping, remote navigation and intracardiac echocardiography (ICE) have been introduced to facilitate typical flutter ablation. This review article summarizes the clinical value of different strategies and tools used for CTI ablation focusing on the importance of approaches utilizing ICE.
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Affiliation(s)
- Gábor Bencsik
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6. 6724 Szeged, Hungary.
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13
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Kajihara K, Nakano Y, Hirai Y, Ogi H, Oda N, Suenari K, Makita Y, Sairaku A, Tokuyama T, Motoda C, Fujiwara M, Watanabe Y, Kiguchi M, Kihara Y. Variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis. J Cardiovasc Electrophysiol 2014; 24:1344-51. [PMID: 23875907 PMCID: PMC4229059 DOI: 10.1111/jce.12231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. Methods and Results This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02). Conclusion Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
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Affiliation(s)
- Kenta Kajihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
- Address for correspondence: Kenta Kajihara, M.D., Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Fax: +81-82-257-5169; E-mail:
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yukoh Hirai
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Hiroshi Ogi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Noboru Oda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Kazuyoshi Suenari
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yuko Makita
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Mai Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yoshikazu Watanabe
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Masao Kiguchi
- Department of Radiology, Hiroshima University HospitalHiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
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WONG KELVINC, JONES MICHAEL, WEBB TERENCE, QURESHI NORMAN, BASHIR YAVER, BETTS TIMOTHYR, RAJAPPAN KIM. Mitral Isthmus Ablation is Feasible, Efficacious, and Safe Using a Remote Robotic Catheter System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1364-72. [DOI: 10.1111/pace.12201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- KELVIN C.K. WONG
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - MICHAEL JONES
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - TERENCE WEBB
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - NORMAN QURESHI
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - YAVER BASHIR
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - TIMOTHY R. BETTS
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - KIM RAJAPPAN
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
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15
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Mizuno H, Maccabelli G, Della Bella P. The utility of manually controlled steerable sheath in epicardial mapping and ablation procedure in patients with ventricular tachycardia. Europace 2012; 14 Suppl 2:ii19-ii23. [PMID: 22832913 DOI: 10.1093/europace/eus209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study is to evaluate the benefit of manually controlled steerable sheath, which provides greater flexibility and stability, in mapping and ablation procedure of ventricular tachycardia. METHODS AND RESULTS We retrospectively reviewed 40 patients who underwent epicardial mapping and conclusive ablation. The first attempt to reach the primary endpoint defined as successful creation of detailed map of entire epicardial space and was achieved in 16 patients. Among the remaining 24 patients, we used the steerable sheath and achieved further success to create an entire map in all patients. After the delivery of RF energy, final procedural success was defined as complete abolishment of late potential and no more induction of any VT, and that was obtained in 10 out of 16 patients mapped with conventional sheath and 21 out of 24 patients with steerable sheath. The advantage of the steerable sheath seemed to be consistent, regardless of the site of ablation. There was no procedure-related adverse event. CONCLUSIONS The manually controlled steerable sheath was safe and effective to achieve procedural success in patients with epicardial VT.
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Affiliation(s)
- Hiroya Mizuno
- Department of Advanced Cardiovascular Therapeutics, Osaka University, Osaka, Japan
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16
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Abstract
Mitral isthmus ablation forms part of the electrophysiologist’s armoury in the catheter ablation treatment of atrial fibrillation. It is well recognised however, that mitral isthmus ablation is technically challenging and incomplete ablation may be pro-arrhythmic, leading some to question its role. This article first reviews the evidence for the use of adjunctive mitral isthmus ablation and its association with the development of macroreentrant perimitral flutter. It then describes the practical techniques of mitral isthmus ablation, with particular emphasis on the assessment of bi-directional mitral isthmus block. The anatomy of the mitral isthmus is also discussed in order to understand the possible obstacles to successful ablation. Finally, novel techniques which may facilitate mitral isthmus ablation are reviewed.
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Affiliation(s)
- Kelvin Ck Wong
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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17
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WONG KELVINCK, QURESHI NORMAN, JONES MICHAEL, RAJAPPAN KIM, BASHIR YAVER, BETTS TIMOTHYR. Mitral Isthmus Ablation Using Steerable Sheath and High Ablation Power: A Single Center Experience. J Cardiovasc Electrophysiol 2012; 23:1193-200. [DOI: 10.1111/j.1540-8167.2012.02380.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Bun SS, Latcu DG, Prevot S, Bastard E, Franceschi F, Ricard P, Saoudi N, Deharo JC. Characteristics of recurrent clockwise atrial flutter after previous radiofrequency catheter ablation for counterclockwise isthmus-dependent atrial flutter. Europace 2012; 14:1340-3. [DOI: 10.1093/europace/eus068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Matsuo S, Yamane T, Date T, Hioki M, Narui R, Ito K, Tanigawa SI, Nakane T, Yamashita S, Tokuda M, Inada K, Nojiri A, Kawai M, Sugimoto KI, Yoshimura M. Completion of Mitral Isthmus Ablation Using a Steerable Sheath: Prospective Randomized Comparison With a Nonsteerable Sheath. J Cardiovasc Electrophysiol 2011; 22:1331-8. [PMID: 21649779 DOI: 10.1111/j.1540-8167.2011.02112.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan.
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Riga CV, Bicknell CD, Sidhu R, Cochennec F, Normahani P, Chadha P, Kashef E, Hamady M, Cheshire NJW. Advanced catheter technology: is this the answer to overcoming the long learning curve in complex endovascular procedures. Eur J Vasc Endovasc Surg 2011; 42:531-8. [PMID: 21388839 DOI: 10.1016/j.ejvs.2011.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 02/02/2011] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Advanced endovascular procedures require a high degree of skill with a long learning curve. We aimed to identify differential increases in endovascular skill acquisition in novices using conventional (CC), manually steerable (MSC) and robotic endovascular catheters (RC). MATERIALS/METHODS 10 novices cannulated all vessels within a CT-reconstructed pulsatile-flow arch phantom in the Simulated Endovascular Suite. Subjects were randomly assigned to conventional/manually-steerable/robotic techniques as the first procedure undertaken. The operators repeated the task weekly for 5 weeks. Quantitative (cannulation times, wire/catheter-tip movements, vessel wall hits) and qualitative metrics (validated rating scale (IC3ST)) were compared. RESULTS Subjects exhibited statistically significant differences when comparing initial to final performance for total procedure times and catheter-tip movements with all catheter types. Sequential non-parametric comparisons identified learning curve plateau levels at weeks 2 or 3(RCs, MSCs), and at week 4(CCs) for the majority of metrics. There were significantly fewer catheter-tip movements using advanced catheter technology after training (Week 5: CC 74 IQR(59-89) versus MSC 62(44-81); p = 0.028, and RC 33 (28-44); p = 0.012). RCs virtually eliminated wall hits at the arch (CC 29(28-76) versus RC 8(6-9); p = 0.005) and produced significantly higher overall performance scores (p < 0.02). CONCLUSION Advanced endovascular catheters, although more intricate, do not seem to take longer to master and in some areas offer clear advantages with regards to positional control, at a faster rate. RCs seem to be the most intuitive and advanced skill acquisition occurs with minimal training. Robotic endovascular technology may have a significantly shorter path to proficiency allowing an increased number of trainees to attempt more complex endovascular procedures earlier and with a greater degree of safety.
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Affiliation(s)
- C V Riga
- Regional Vascular & Endovascular Unit, Imperial College London, United Kingdom.
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