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Fong KY, Zhao JJ, Chan YH, Wang Y, Yeo C, Tan VH. Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AAD.
Method: Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores.
Results: Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25–0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25–0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07–0.30) for combined CBA and RFA, 0.20 (95% CI=0.10–0.41) for hot-balloon ablation, 0.43 (95% CI=0.15–1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18–0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy.
Conclusion: The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis.
Keywords: Atrial fibrillation, catheter ablation, network meta-analysis
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yue Wang
- Changi General Hospital, Singapore
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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Sideris S, Tsartsalis D, Dragioti E, Fragakis N, Chaimani A. Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2022; 12:diagnostics12020433. [PMID: 35204535 PMCID: PMC8870912 DOI: 10.3390/diagnostics12020433] [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: 12/14/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65–0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46–0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2–2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
- Correspondence:
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
| | - Lars O. Karlsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Antonios P. Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Ioan Liuba
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Henrik Almroth
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Anders Hassel Jönsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece;
| | - Dimitrios Tsartsalis
- Department of Clinical Physiology, Linköping University Hospital, 581 85 Linköping, Sweden;
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Linköping University Hospital, 581 85 Linköping, Sweden;
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
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Mol D, Houterman S, Balt JC, Bhagwandien RE, Blaauw Y, Delnoy PPH, van Driel VJ, Driessen AH, Folkeringa RJ, Hassink RJ, van Huysduynen BH, Luermans JG, Ouss AJ, Stevenhagen YJ, van Veghel D, Westra SW, de Jong JS, de Groot JR. Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique. Europace 2020; 23:216-225. [DOI: 10.1093/europace/euaa255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
Abstract
Aims
Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1–3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation.
Methods and results
The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98–4.45) and 2.02 (95% CI 1.03–4.00) respectively.
Conclusion
The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications.
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Affiliation(s)
- Daniel Mol
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St. Antonius, Nieuwegein, The Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Antoine H Driessen
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Justin G Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexandre J Ouss
- Department of Cardiology and Cardiac Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonas S de Jong
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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Zhou X, Dai J, Xu X, Lian M, Lou Y, Lv Z, Wang Z, Mao W. Comparative efficacy and safety of catheter ablation interventions for atrial fibrillation: comprehensive network meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2020; 62:199-211. [PMID: 33011920 DOI: 10.1007/s10840-020-00878-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Point-by-point radiofrequency (RF) ablation has been the cornerstone of pulmonary vein isolation (PVI) for patients with atrial fibrillation (AF); however, it remains a complex and time-consuming procedure. Many novel AF catheter ablation (CA) techniques have been introduced, but whether they represent valuable alternatives remains controversial. Thus, we conducted a network meta-analysis to comprehensively evaluate the efficacy and safety of different CA interventions. METHODS We systematically searched several databases (Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov ) from inception to March, 2020. The primary outcomes of interest were freedom from atrial tachyarrhythmia (AT) and procedure-related complications; secondary outcomes included procedure time and fluoroscopy time. RESULTS Finally, 33 randomized controlled trials (RCTs) with a total of 4801 patients were enrolled. No significant differences were found among the different interventions in terms of primary efficacy or safety outcomes. PVAC was most likely to have the shortest procedure time (Prbest = 61.5%) and nMARQ the shortest fluoroscopy time (Prbest = 60.6%); compared with conventional irrigated RF (IRF) ablation, cryoballoon ablation (CBA) showed comparable clinical efficacy and safety; CBA with second-generation CB (CB2) had a significantly shorter procedure time than IRF with contact force technology (CF-IRF) (WMD = - 20.75; p = 0.00). CONCLUSION There is insufficient evidence to suggest that one CA technique is superior to another. However, PVAC may be associated with a shorter procedural duration, and the CB2 catheters also seemed to reduce the procedure time compared with that of CF-IRF. Further large-scale studies are warranted to compare the available CA techniques and provide an up-to-date optimum recommendation.
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Affiliation(s)
- Xinbin Zhou
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Jin Dai
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xiaoming Xu
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Miaojun Lian
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yang Lou
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengtian Lv
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhijun Wang
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Wei Mao
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China.
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Kukendrarajah K, Papageorgiou N, Jewell P, Hunter RJ, Ang R, Schilling R, Providencia R. Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials. J Cardiovasc Electrophysiol 2020; 31:2192-2205. [PMID: 32495462 DOI: 10.1111/jce.14598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
AIMS We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined.
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Affiliation(s)
- Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Paul Jewell
- Department of Critical Care, Royal Free Hospital, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - Rui Providencia
- The Farr Institute of Health Informatics Research, University College London, London, UK
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Nguyen DT, Zheng L, Zipse MM, Borne RT, Tzou WS, Fleeman B, Sauer WH. Bipolar radiofrequency ablation creates different lesion characteristics compared to simultaneous unipolar ablation. J Cardiovasc Electrophysiol 2019; 30:2960-2967. [DOI: 10.1111/jce.14213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Duy T. Nguyen
- Section of Cardiac Electrophysiology, Division of CardiologyStanford UniversityPalo Alto California
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Matthew M. Zipse
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Ryan T. Borne
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Wendy S. Tzou
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Blake Fleeman
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - William H. Sauer
- Section of Cardiac Electrophysiology, Division of CardiologyBrigham and Women's HospitalBoston Massachusetts
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Glowniak A, Tarkowski A, Wojewoda K, Wysokinska K, Kozak M, Wacinski P, Wysokinski A. Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome. J Clin Med 2019; 8:E1589. [PMID: 31581683 PMCID: PMC6832435 DOI: 10.3390/jcm8101589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is a routine treatment in atrial fibrillation (AF). Single-shot techniques were introduced to simplify the procedure. We analyzed time-dependent changes in procedural parameters, acute success, complication rates, and long-term outcomes during our initial experience with multipolar phased-radiofrequency (RF) ablation. Methods and Results: The first 126 consecutive patients (98 male; age: 58.8 ± 8.7 years) who underwent PVI with phased-RF ablation at our center were included in the study. Procedural parameters, complication rate, acute success and 12-month efficacy were compared in the first, second and third group of 42 consecutive patients. In all patients, 516/526 PVs were effectively isolated (98.1%), with no differences between the tierces (p = 0.67). Procedure (169.8 vs. 132.9 vs. 105.8 min, p < 0.0001), fluoroscopy (32.9 vs. 24.3 vs. 14.1 min, p < 0.0001) and left atrial dwell (83.0 vs. 61.9 vs. 51.4 min, p < 0.0001) times were significantly reduced with experience in tierces 1-3, respectively. In the 12-month follow-up, 60.3% of patients were arrhythmia-free with no differences between the tierces (p = 0.88). In multivariate analysis, the relapse in the blanking period (p < 0.0001), time from AF diagnosis (p = 0.004) and left atrial diameter (p = 0.012) were the only independent predictors of AF recurrence. CONCLUSIONS The learning curve effect was demonstrated in procedural parameters, but not in the complication rate nor the long-term success of PVI with phased-RF technique. The relapse in the blanking period was the strongest predictor of treatment failure in long-time observation.
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Affiliation(s)
- Andrzej Glowniak
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland.
| | - Adam Tarkowski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Katarzyna Wojewoda
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Katarzyna Wysokinska
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Mariusz Kozak
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Piotr Wacinski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Andrzej Wysokinski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
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Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What's the Culprit? MEDICINA-LITHUANIA 2019; 55:medicina55080505. [PMID: 31434315 PMCID: PMC6723553 DOI: 10.3390/medicina55080505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation.
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Essebag V, Azizi Z, Alipour P, Khaykin Y, Leong‐Sit P, Sarrazin J, Sturmer M, Morillo C, Terricabras M, Amit G, Roux J, Patterson S, Verma A. Comparison of efficacy of phased multipolar versus traditional radiofrequency ablation: A prospective, multicenter study (CAPCOST). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:942-950. [DOI: 10.1111/pace.13737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Vidal Essebag
- McGill University Health Centre Montreal Quebec Canada
- Hôpital Sacré‐Coeur de Montréal Montreal Quebec Canada
| | - Zahra Azizi
- Southlake Regional Health Centre Newmarket Ontario Canada
- Faculty of HealthYork University Ontario Canada
| | - Pouria Alipour
- Southlake Regional Health Centre Newmarket Ontario Canada
- Faculty of HealthYork University Ontario Canada
| | - Yaariv Khaykin
- Southlake Regional Health Centre Newmarket Ontario Canada
| | | | | | | | - Carlos Morillo
- Libin Cardiovascular Institute of AlbertaUniversity of Calgary Calgary Alberta Canada
| | | | - Guy Amit
- Hamilton Health Sciences Hamilton Ontario Canada
| | - Jean‐Francois Roux
- Centre hospitalier universitaire de Sherbrooke (CHUS) Sherbrooke Quebec Canada
| | | | - Atul Verma
- Southlake Regional Health Centre Newmarket Ontario Canada
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Glowniak A, Tarkowski A, Janczarek M, Wysokinski A. Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques - incidence and risk factors. Arch Med Sci 2019; 18:632-638. [PMID: 35591832 PMCID: PMC9102510 DOI: 10.5114/aoms.2019.85348] [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: 03/29/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Silent cerebral infarcts (SCIs) detected by diffusion-weighted magnetic resonance (DW-MRI) following atrial fibrillation (AF) ablation have been reported, with the incidence of 1-38%. We aimed to compare the incidence of SCIs following AF ablation with four different technologies and analyze the risk factors. Material and methods A total of 104 patients (mean age: 59.9 ±9.5 years, 68 males) with symptomatic AF, referred for ablation, were included in the study. The AF ablation was performed with irrigated radiofrequency point-by-point technique (RF group) in 24 patients, and with 3 different single-shot techniques: phased-RF (PVAC) in 46, second-generation cryoballoon (CB) in 24 and irrigated multipolar RF catheter (nMARQ) in 10 patients. In all patients DW-MRI was performed pre- and post-procedurally to evaluate the incidence of SCIs. Procedural parameters, complication rate and post-procedural SCI incidence were compared between the groups. Results Procedure (167.1 vs. 110.5 vs. 106.0 vs. 141.5 min, p < 0.001), fluoroscopy (22.7 vs. 15.9 vs. 16.3 vs. 15.3 min, p = 0.048) and LA dwell (101.5 vs. 53.9 vs. 56.0 vs. 97.0 min, p < 0.001) times compared respectively between RF, PVAC, CB and nMARQ groups were significantly shorter with single-shot techniques. The number of new-onset SCIs was 4/24 (16.7%) in RF, 7/46 (15.2%) in PVAC, 1/24 (4.2%) in CB and 1/10 (10%) in the nMARQ group. Univariate analysis identified procedure duration (p = 0.02), lower LV ejection fraction (p = 0.03), persistent form of arrhythmia (p = 0.007) and intraprocedural cardioversion (p = 0.002) as risk factors of new-onset SCIs. Conclusions Silent cerebral infarcts can be detected following AF ablation regardless of the technology used. Prolonged procedure time, lower ejection fraction, persistent form of arrhythmia and intraprocedural cardioversion increase the risk of SCIs.
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Affiliation(s)
- Andrzej Glowniak
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Adam Tarkowski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Marzena Janczarek
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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11
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Koźluk E, Piątkowska A, Rodkiewicz D, Peller M, Kochanowski J, Opolski G. Direct results of a prospective randomized study comparing ablation with the nMARQ catheter and the PVAC catheter used with and without a 3D system (MAPER 3D Study). Arch Med Sci 2019; 15:78-85. [PMID: 30697256 PMCID: PMC6348353 DOI: 10.5114/aoms.2017.68054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/12/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Our aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control. MATERIAL AND METHODS One hundred two patients (70 male, 57 ±11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 - ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 - a PVAC catheter used with the EnSite system; group 3 - ablation with a PVAC catheter without a 3D system. RESULTS Complete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 ±2.9 min/808.8 ±393.9 cGy/cm2 vs. 13.6 ±5.6 min/1662.6 ±677.8 cGy/cm2 and 18.8 ±7.6 min/2327.9 ±975.5 cGy/cm2; p < 0.001). Procedure duration was shorter in group 1 (82.9 ±18.8 min vs. 101.2 ±19.6 min, p < 0.001 and 99.8 ±20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 ±543.5 ml vs. 1077.9 ±280.5 ml and 1076.5 ±375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up. CONCLUSIONS The lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid.
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Affiliation(s)
- Edward Koźluk
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Piątkowska
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department of Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Rodkiewicz
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Peller
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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12
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Christoph Geller J, Kuntze T. Ablation of atrial fibrillation: surgery may show the way. Europace 2018; 20:f282-f283. [PMID: 29186502 DOI: 10.1093/europace/eux309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Johann Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Robert Koch Allee 9, Bad Berka, Germany.,Otto-von-Guericke School of Medicine, Leipziger Strasse 44, Magdeburg, Germany
| | - Thomas Kuntze
- Division of Cardiac Surgery, Zentralklinik Bad Berka, Robert Koch Allee 9, Bad Berka, Germany
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13
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Fujii S, Zhou JR, Dhir A. Anesthesia for Cardiac Ablation. J Cardiothorac Vasc Anesth 2018; 32:1892-1910. [DOI: 10.1053/j.jvca.2017.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/19/2022]
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14
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 681] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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15
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Laish-Farkash A, Suleiman M. Comparison of the Efficacy of PVAC ® and nMARQ ™ for paroxysmal atrial fibrillation. J Atr Fibrillation 2017; 9:1550. [PMID: 29250292 DOI: 10.4022/jafib.1550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 11/10/2022]
Abstract
Pulmonary vein isolation (PVI) has become the mainstay of therapy for atrial fibrillation (AF) and one of the most frequently performed procedures in the cardiac electrophysiology laboratory. PVI by a single-tip radiofrequency (RF) ablation catheter remains a complex and time-consuming procedure, especially in centers with limited experience. In order to simplify the PVI procedure, to shorten it and reduce the complication rate, circular multi-electrode catheters were introduced for simultaneous mapping and ablation. The common concept of these "single-shot" AF ablation technologies is the creation of circular lesions for PVI by placing the ablation device at the antrum of the pulmonary veins without the need for continuous repositioning. In this review we describe the main features of two circular non-balloon ablation catheters- PVAC®, which is based on the phased RF, duty-cycled ablation technology, and nMARQ™, the irrigated multi-electrode electro-anatomically guided catheter - and compare the clinical outcomes of these technologies, mainly for paroxysmal AF patients, based on current available data.
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Affiliation(s)
- Avishag Laish-Farkash
- Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Medical Campus, Haifa, Israel
| | - Mahmoud Suleiman
- Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Medical Campus, Haifa, Israel
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16
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Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies. Indian Pacing Electrophysiol J 2017; 17:36-43. [PMID: 29072991 PMCID: PMC5405748 DOI: 10.1016/j.ipej.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/28/2017] [Accepted: 02/14/2017] [Indexed: 12/23/2022] Open
Abstract
Aims Pulmonary vein isolation is effective in reducing atrial fibrillation (AF) episodes. Previous studies suggest single-shot techniques are effective and safe for this purpose. Procedural and clinical outcomes were compared between multi-electrode and point-by-point radiofrequency ablations by performing a meta-analysis of all randomized and non-randomized studies. Methods and results Systematic reviews of MEDLINE and Cochrane Library databases were performed. Studies comparing procedural (procedure and fluoroscopy times) and clinical (AF recurrence) outcomes were included in the meta-analysis. A total of 13 clinical studies (5 randomized and 8 non-randomized) including 2152 patients met the inclusion criteria. In patients underwent multi-electrode ablation, there were significant reductions in both total procedure and fluoroscopy times, compared with point-by-point ablation (mean difference = −34.3 min [95% CI (−50.1 to −18.5)], p < 0.001 and mean difference = −7.1 min [95% CI (−12.0 to −2.2)], p < 0.01, respectively). These significances also continued in patients with paroxysmal AF. No such difference was observed in regard to AF recurrence between the 2 ablation strategies (RR = 0.90 [95% CI (0.80–1.01)], p = 0.066). This insignificance was also observed in patients with paroxysmal AF. Conclusions In a heterogeneous AF population, multi-electrode ablation is as effective as point-by-point ablation, with better procedural and fluoroscopy durations.
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17
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1293] [Impact Index Per Article: 184.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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18
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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De Greef Y, Ströker E, Schwagten B, Kupics K, De Cocker J, Chierchia GB, de Asmundis C, Stockman D, Buysschaert I. Complications of pulmonary vein isolation in atrial fibrillation: predictors and comparison between four different ablation techniques: Results from the MIddelheim PVI-registry. Europace 2017; 20:1279-1286. [DOI: 10.1093/europace/eux233] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/15/2017] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yves De Greef
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
- Department of Cardiology, Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, Jette, Belgium
| | - Edwin Ströker
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
- Department of Cardiology, Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, Jette, Belgium
| | - Bruno Schwagten
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
| | - Kaspars Kupics
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
| | - Jeroen De Cocker
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
| | - Gian-Battista Chierchia
- Department of Cardiology, Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, Jette, Belgium
| | - Carlo de Asmundis
- Department of Cardiology, Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, Jette, Belgium
| | - Dirk Stockman
- Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium
| | - Ian Buysschaert
- Department of Cardiology, ASZ Hospital Aalst, Merestraat 80, Aalst, Belgium
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20
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Spitzer SG, Leitz P, Langbein A, Karolyi L, Scharfe F, Weinmann T, Rämmler C, Pott C, Mönnig G, Eckardt L. Circumferential pulmonary vein isolation with second-generation multipolar catheter in patients with paroxysmal or persistent atrial fibrillation: Procedural and one-year follow-up results. Int J Cardiol 2017; 241:212-217. [DOI: 10.1016/j.ijcard.2017.04.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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21
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Reissmann B, Metzner A, Kuck KH. Cryoballoon ablation versus radiofrequency ablation for atrial fibrillation. Trends Cardiovasc Med 2017; 27:271-277. [DOI: 10.1016/j.tcm.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/17/2022]
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22
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Shin DI, Guelker JE, Blockhaus C, Schmidt J, Kurt M, Clasen L, Mueller P, Bansemir L, Brinkmeyer C, Bufe A, Kelm M, Makimoto H. One-Year Success Rate of Pulmonary Vein Isolation Using a Novel Irrigated Multipolar Mapping and Ablation Catheter With Reduced Power Settings. Int Heart J 2017; 58:205-210. [PMID: 28321025 DOI: 10.1536/ihj.16-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of a novel irrigated multipolar ablation and mapping catheter for pulmonary vein isolation in patients with atrial fibrillation (AF) has demonstrated reasonable acute success rates and short procedure times, however, long-term outcome data are limited. The aim of this study was to analyze the long-term efficacy of this novel ablation system utilizing a reduced power setting for safety purposes.A total of 89 patients with paroxysmal (63 of 89 patients; 71%) or persistent AF underwent PVI with a reduced power setting of maximum 20 Watts (W) unipolar radiofrequency energy and 30 seconds in duration. In cases of persistent AF, atrial substrate ablation was performed additionally. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months and included 5-day Holter ECGs. All of the 347 identified pulmonary veins were successfully isolated. Mean procedure times in PVI and PVI plus substrate ablation were 102 ± 25 minutes and 126 ± 32 minutes, respectively, applying a mean total radiofrequency time of 14 ± 6 minutes and 19 ± 9 minutes. Mean fluoroscopy time was 17 ± 8 minutes and 18 ± 6 minutes, respectively. Follow-up was available for all 89 patients. At one-year follow-up, 44 (70%) patients with paroxysmal AF and 11 (42%) patients with persistent AF remained in stable sinus rhythm after a singleprocedure and off antiarrhythmic drugs.The use of a novel irrigated multipolar ablation catheter with a reduced power setting is safe and feasible, and demonstrates a one-year success rate of 70% in paroxysmal AF and 42% in persistent AF.
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Affiliation(s)
- Dong-In Shin
- Heart Centre Niederrhein, Department of Cardiology, Helios Clinics Krefeld
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23
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Chen YH, Lin H, Xie CL, Hou JW, Li YG. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis. Europace 2017; 19:552-559. [PMID: 28431050 DOI: 10.1093/europace/euw201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/08/2016] [Indexed: 10/13/2023] Open
Abstract
AIMS Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). METHODS AND RESULTS We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). CONCLUSION From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hui Lin
- Department of Respiratory, The Second Af?liated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, Shanghai 200092, China
| | - Jian-Wen Hou
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
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Sugihara C, Barlow N, Owens E, Sallomi D, Sulke N. Hyperacute And Chronic Changes In Cerebral Magnetic Resonance Images After Pvac, nmarq And Epicardial Thoracoscopic Surgical Ablation For Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2016; 8:1388. [PMID: 27909499 DOI: 10.4022/jafib.1388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 11/10/2022]
Abstract
Threshold testing of cardiac rhythm devices is essential to monitoring the proper functioning of such devices (1). However, the currently method of applying multiple ECG leads to the patient is burdensome and time consuming (2). We are presenting a completely new way to perform cardiac rhythm device threshold testing using pulse oximetry. Twenty patients, with varying cardiac rhythm devices and pacing modes, were enrolled and had their atrial and ventricular thresholds tested. A comparison was made between simultaneous threshold determinations via the standard EGM based method and the new pulse oximetry based method. 75% of the ventricular threshold tested and 58% of the atrial thresholds tested were the same with the two testing methods. The remainder of the tests (25% of ventricular threshold and 42% of the atrial threshold tests) varied by +0.25 V. This study shows that pulse oximetry based testing is an accurate, reliable, and easy way to perform cardiac rhythm device threshold testing and may complement traditional methods to perform such tests in the future.
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Affiliation(s)
- Conn Sugihara
- Eastbourne Hospital, East Sussex Healthcare NHS Trust, UK
| | - Neil Barlow
- Eastbourne Hospital, East Sussex Healthcare NHS Trust, UK
| | - Emma Owens
- Eastbourne Hospital, East Sussex Healthcare NHS Trust, UK
| | - David Sallomi
- Eastbourne Hospital, East Sussex Healthcare NHS Trust, UK
| | - Neil Sulke
- Eastbourne Hospital, East Sussex Healthcare NHS Trust, UK
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Kabunga P, Phan K, Ha H, Sy RW. Meta-Analysis of Contemporary Atrial Fibrillation Ablation Strategies. JACC Clin Electrophysiol 2016; 2:377-390. [DOI: 10.1016/j.jacep.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/01/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022]
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First results and follow-up of a second-generation circular mapping and ablation catheter. J Interv Card Electrophysiol 2016; 47:213-219. [PMID: 27230934 DOI: 10.1007/s10840-016-0140-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Pulmonary vein isolation with radiofrequency energy is widely used as a strategy for catheter ablation of atrial fibrillation (AF). Anatomically designed catheters have been developed to increase the efficiency of AF ablation procedures. The second-generation circular ablation catheter, PVAC GOLD, was re-designed to improve energy delivery and mitigate emboli. We investigated the procedural efficiency, biophysics, and chronic efficacy of PVAC GOLD in patients with AF. METHODS We consecutively enrolled 40 patients (60 ± 11 years) with highly symptomatic, drug refractory AF. The first 20 patients were treated with the first-generation PVAC. The subsequent 20 patients were treated with the second-generation PVAC GOLD catheter. All patients were followed up at 3, 6, and 12 months. RESULTS All 164 targeted PVs were successfully isolated. Ablations performed with PVAC GOLD showed a significant reduction in total number of ablations needed for PVI, fluoroscopy, and procedure times compared to PVAC (34.7 ± 7.0 vs. 27.0 ± 6.5; p = 0.009), fluoroscopy (29.5 ± 9.5 vs. 23.4 ± 7.0; p = 0.026), and procedure time (93.8 ± 18.9 vs. 83.1 ± 10.6; p = 0.033). PVAC GOLD showed improved biophysics including a reduction of low power ablations and an increase in mean effective energy delivery. At 12 months follow-up, AF recurrence rates were comparable in the two groups (35 vs. 30 %; p = 0.735). There were no adverse events. CONCLUSIONS The redesigned PVAC GOLD catheter demonstrates a reduction in radiofrequency ablation and procedure time and improved biophysics while maintaining chronic efficacy compared to the first-generation PVAC.
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Buist TJ, Gal P, Ottervanger JP, Smit JJJ, Ramdat Misier AR, Delnoy PPHM, Adiyaman A, Jager PL, Elvan A. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2016; 10:251-7. [DOI: 10.1016/j.jcct.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/07/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Ernst S. Multielectrode Pulmonary Vein Isolation Versus Single Tip Wide Area Catheter Ablation-Paroxysmal Atrial Fibrillation: Is There Any Mystery in Pulmonary Vein Isolation? Circ Arrhythm Electrophysiol 2016; 9:e004077. [PMID: 27071828 DOI: 10.1161/circep.116.004077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sabine Ernst
- From the Department of Cardiology, Royal Brompton and Harefield Hospital, and Imperial College London, London, United Kingdom.
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Boersma LV, van der Voort P, Debruyne P, Dekker L, Simmers T, Rossenbacker T, Balt J, Wijffels M, Degreef Y. Multielectrode Pulmonary Vein Isolation Versus Single Tip Wide Area Catheter Ablation for Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:e003151. [DOI: 10.1161/circep.115.003151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/17/2016] [Indexed: 11/16/2022]
Abstract
Background—
Single-shot ablation techniques may facilitate safe and simple pulmonary vein isolation to treat paroxysmal atrial fibrillation. Multielectrode pulmonary vein isolation versus single tip wide area catheter ablation-paroxysmal atrial fibrillation is the first multinational, multicenter, prospective, noninferiority randomized clinical trial comparing multielectrode-phased radiofrequency ablation (MEA) to standard focal irrigated radiofrequency ablation (STA) using 3-dimensional navigation.
Methods and Results—
Patients with paroxysmal atrial fibrillation were randomized to MEA (61 patients) or STA (59 patients). Preprocedure transesophageal echocardiogram and computed tomography/magnetic resonance imaging (also 6-month postprocedure) were performed. Mean age was 57 years, 25% female sex, BMI was 28, CHA
2
DS
2
–VASc score was 0 to 1 in 82%, 8% had previous right atrial ablation, whereas all had at least 1 antiarrhythmic drug failure. The MEA group had significantly shorter mean procedure time (96±36 versus 166±46 minutes,
P
<0.001) and fluoroscopy time (23±9 versus 27±9 minutes,
P
=0.023). The total radiofrequency energy duration was 22±8 minutes for MEA versus 36±13 minutes for STA (
P
<0.001) with confirmed pulmonary vein isolation in all patients. Hospital admission was 1 day in both groups, without major adverse events either during the procedure or during 30-day follow-up. Two patients in the STA group had 1 PV with asymptomatic narrowing >50%. Freedom of atrial fibrillation for MEA and STA was 86.4% and 89.7% at 6 months, dropping to 76.3% and 81.0% at 12 months.
Conclusions—
In this multicenter, randomized clinical trial, MEA and STA had similar rates of single-procedure acute pulmonary vein isolation without serious adverse events in the first 30 days. MEA had slightly lower long-term arrhythmia freedom, but showed marked and significantly shorter procedure, fluoroscopy, and radiofrequency energy times.
Clinical Trial Registration—
URL:
www.clinicaltrials.gov
; Unique identifier: NCT01696136.
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Affiliation(s)
- Lucas V. Boersma
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Pepijn van der Voort
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Pilippe Debruyne
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Lukas Dekker
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Tim Simmers
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Tom Rossenbacker
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Jippe Balt
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Maurits Wijffels
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
| | - Yves Degreef
- From the Cardiology Department, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands (L.V.B., J.B., M.W.); Cardiology Department, Catharina Ziekenhuis, Eindhoven, The Netherlands (P.v.d.V., L.D., T.S.); Cardiology Department, Imelda Ziekenhuis, Bonheiden, Belgium (P.D., T.R.); and Cardiology Department, AZ Middelheim, Antwerpen, Belgium (Y.D.)
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Verma A. Multipolar ablation for atrial fibrillation: are we going in circles? Europace 2016; 18:631-2. [PMID: 27001037 DOI: 10.1093/europace/euw004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Atul Verma
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON, Canada L3Y 2P6
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31
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Davies EJ, Clayton B, Lines I, Haywood GA. Persistent Atrial Fibrillation Ablation using the Tip-Versatile Ablation Catheter. Heart Lung Circ 2016; 25:645-51. [PMID: 26906282 DOI: 10.1016/j.hlc.2015.12.096] [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: 06/19/2015] [Revised: 12/01/2015] [Accepted: 12/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanisms by which persistent atrial fibrillation (PsAF) develops are incompletely understood. Consequently, the optimal strategy for the ablative management of PsAF remains debated. Current methods are often time consuming, complex and non-reproducible. We assessed the Tip-Versatile Ablation Catheter (T-VAC) technique, a rapidly delivered, empirical technique based on the box-set concept using duty-cycled linear catheter ablation technology. METHODS Forty-four procedures in 40 patients undergoing PsAF ablation with the novel technique were prospectively entered onto a database: 27 de novo. Primary endpoint was freedom from arrhythmia at over two-year follow-up. Secondary endpoints were time to first arrhythmia recurrence, freedom from atrial fibrillation (AF) on and off antiarrhythmic drugs (AAD), procedural and fluoroscopy duration and complication rate. RESULTS At mean follow-up of 33 months, absolute freedom from arrhythmia recurrence was 45% in the de novo group. Overall, at 33 (IQR 24-63) months, 60% of de novo patients were in sustained normal sinus rhythm and a further 15% reported only occasional paroxysms of AF at long-term follow-up. Procedure time was 192±25 mins, total energy delivered 2239±883s and fluoroscopy time was 60±10mins. CONCLUSION In selected patients with persistent AF, a long-term rate of 60% arrhythmia free survival off AAD can be achieved using this novel T-VAC technique.
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Affiliation(s)
| | - Ben Clayton
- South West Cardiothoracic Centre, Plymouth, UK
| | - Ian Lines
- South West Cardiothoracic Centre, Plymouth, UK
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De Greef Y, Dekker L, Boersma L, Murray S, Wieczorek M, Spitzer SG, Davidson N, Furniss S, Hocini M, Geller JC, Csanádi Z. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel pulmonary vein ablation catheter GOLD: results of the PRECISION GOLD trial. Europace 2016; 18:687-95. [PMID: 26826134 PMCID: PMC4880114 DOI: 10.1093/europace/euv385] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/25/2015] [Indexed: 01/05/2023] Open
Abstract
Aims This prospective, multicentre study (PRECISION GOLD) evaluated the incidence of asymptomatic cerebral embolism (ACE) after pulmonary vein isolation (PVI) using a new gold multi-electrode radiofrequency (RF) ablation catheter, pulmonary vein ablation catheter (PVAC) GOLD. Also, procedural efficiency of PVAC GOLD was compared with ERACE. The ERACE study demonstrated that a low incidence of ACE can be achieved with a platinum multi-electrode RF catheter (PVAC) combined with procedural manoeuvres to reduce emboli. Methods and results A total of 51 patients with paroxysmal atrial fibrillation (AF) (age 57 ± 9 years, CHA2DS2-VASc score 1.4 ± 1.4) underwent AF ablation with PVAC GOLD. Continuous oral anticoagulation using vitamin K antagonists, submerged catheter introduction, and heparinization (ACT ≥ 350 s prior to ablation) were applied. Cerebral magnetic resonance imaging (MRI) scans were performed within 48 h before and 16–72 h post-ablation. Cognitive function assessed by the Mini-Mental State Exam at baseline and 30 days post-ablation. New post-procedural ACE occurred in only 1 of 48 patients (2.1%) and was not detectable on MRI after 30 days. The average number of RF applications per patient to achieve PVI was lower in PRECISION GOLD (20.3 ± 10.0) than in ERACE (28.8 ± 16.1; P = 0.001). Further, PVAC GOLD ablations resulted in significantly fewer low-power (<3 W) ablations (15 vs. 23%, 5 vs. 10% and 2 vs. 7% in 4:1, 2:1, and 1:1 bipolar:unipolar energy modes, respectively). Mini-Mental State Exam was unchanged in all patients. Conclusion Atrial fibrillation ablation with PVAC GOLD in combination with established embolic lowering manoeuvres results in a low incidence of ACE. Pulmonary vein ablation catheter GOLD demonstrates improved biophysical efficiency compared with platinum PVAC. Trial registration ClinicalTrials.gov NCT01767558.
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Affiliation(s)
- Yves De Greef
- ZNA Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| | - Lukas Dekker
- Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | | | - Marcus Wieczorek
- St Agnes Hospital, Witten/Herdecke University, School of Medicine, Bocholt, Germany
| | | | - Neil Davidson
- University Hospital of South Manchester, Manchester, UK
| | | | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France
| | | | - Zoltan Csanádi
- Institute of Cardiology, University of Debrecen, Debrecen, Hungary
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Leitz P, Güner F, Wasmer K, Foraita P, Pott C, Dechering DG, Zellerhoff S, Kochhäuser S, Lange PS, Eckardt L, Mönnig G. Data on procedural handling and complications of pulmonary vein isolation using the pulmonary vein ablation catheter GOLD®. Europace 2015; 18:696-701. [DOI: 10.1093/europace/euv355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/28/2015] [Indexed: 01/01/2023] Open
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Laish-Farkash A, Khalameizer V, Fishman E, Cohen O, Yosefy C, Cohen I, Katz A. Safety, efficacy, and clinical applicability of pulmonary vein isolation with circular multi-electrode ablation systems: PVAC® vs. nMARQ™ for atrial fibrillation ablation. Europace 2015; 18:807-14. [PMID: 26589623 DOI: 10.1093/europace/euv258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/06/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS We compare our experience with available circular multi-electrode catheters for atrial fibrillation (AF) ablation: PVAC(®), a phased radiofrequency system, and nMARQ™, an irrigated tip-CARTO-based technology. METHODS AND RESULTS Prospective observational study of 175 consecutive patients with follow-up duration of at least 5 months who underwent pulmonary vein isolation (PVI) for symptomatic AF using PVAC(®) (n = 93, age 61.4 ± 9.8 years; 60% male, 13% persistent AF) vs. nMARQ™ (n = 82, age 63.2 ± 10.6 years; 67% male, 24% persistent AF). Procedure and radiation times were 94 ± 27 and 33 ± 13 min for PVAC(®) and 81 ± 18 and 30 ± 8.5 for nMARQ™ (P = 0.0008 and P = 0.18), respectively. The number of applications and the total burning time (min) were 20 ± 7 and 19 ± 6.7 for PVAC(®) and 16 ± 5.6 and 11 ± 4 for nMARQ™ (P < 0.0001 for both), respectively. In two nMARQ™ patients with small atria and pulmonary veins (PVs) and in two PVAC(®) patients with large PVs, the procedure failed; switching to the alternative technology was successful. Acute success rate was 97% for PVAC(®) and 95% for nMARQ™. There was one tamponade in nMARQ™ group and non-significant different minor complications for both techniques. One-year freedom from AF was 79 and 80.7% with PVAC(®) vs. nMARQ™, after one PVI, and 88 vs. 87.7% after two PVIs. CONCLUSION Both technologies have short procedure and fluoroscopy times, comparable complication rates, and comparable acute and 1-year success rates. The number of applications and total procedure and burning times were shorter with nMARQ™. nMARQ™ was more suitable for larger atria and PVs. Thus, a patient-based pre-ablation anatomy definition is probably warranted for appropriate selection of technology type.
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Affiliation(s)
- Avishag Laish-Farkash
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimir Khalameizer
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeny Fishman
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ornit Cohen
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chaim Yosefy
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Cohen
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amos Katz
- Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kiss A, Sándorfi G, Nagy-Baló E, Martirosyan M, Csanadi Z. Phased RF Ablation: Results and Concerns. J Atr Fibrillation 2015; 8:1240. [PMID: 27957176 DOI: 10.4022/jafib.1240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022]
Abstract
Treatment of atrial fibrillation (AF) with catheter ablation has proven to be a safe and effective treatment modality which is offered to an increasing number of patients in many centers. Pulmonary vein isolation (PVI) is an established cornerstone of AF ablation strategies. Athough the isolation of the pulmonary veins (PVs) with irrigated focal radiofrequency (RF) catheters using a point-by-point method is considered as the gold standard, it can be challenging to create contiguous lesions, time consuming, and require advanced three dimensional (3D) mapping and navigational systems. The phased RF ablation system was designed to address many of these challenges associated with conventional focal RF ablation. In this review, we describe the main features of phased RF ablation and summarize the data available on clinical outcome with this technology.
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Affiliation(s)
- Alexandra Kiss
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Gábor Sándorfi
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Edina Nagy-Baló
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | | | - Zoltan Csanadi
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
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36
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Pulmonary vein stenosis after pulmonary vein isolation using duty-cycled unipolar/bipolar radiofrequency ablation guided by intracardiac echocardiography. J Interv Card Electrophysiol 2015; 44:47-54. [DOI: 10.1007/s10840-015-0028-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022]
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QIAN PIERRE, BARRY MICHAELANTHONY, NGUYEN TRANG, ROSS DAVID, KOVOOR PRAMESH, MCEWAN ALISTAIR, THOMAS STUART, THIAGALINGAM ARAVINDA. A Novel Microwave Catheter Can Perform Noncontact Circumferential Endocardial Ablation in a Model of Pulmonary Vein Isolation. J Cardiovasc Electrophysiol 2015; 26:799-804. [DOI: 10.1111/jce.12683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/10/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- PIERRE QIAN
- Cardiology Department; Westmead Hospital; Sydney Australia
| | | | - TRANG NGUYEN
- Cardiology Department; Westmead Hospital; Sydney Australia
- School of Electrical and Information Engineering; University of Sydney; Sydney Australia
| | - DAVID ROSS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - PRAMESH KOVOOR
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - ALISTAIR MCEWAN
- Cardiology Department; Westmead Hospital; Sydney Australia
- School of Electrical and Information Engineering; University of Sydney; Sydney Australia
| | - STUART THOMAS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - ARAVINDA THIAGALINGAM
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
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One-year follow-up after irrigated multi-electrode radiofrequency ablation of persistent atrial fibrillation. Europace 2015; 18:85-91. [DOI: 10.1093/europace/euv020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/26/2015] [Indexed: 11/14/2022] Open
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Wasmer K, Foraita P, Leitz P, Güner F, Pott C, Lange P, Eckardt L, Mönnig G. Safety profile of multielectrode-phased radiofrequency pulmonary vein ablation catheter and irrigated radiofrequency catheter. Europace 2015; 18:78-84. [DOI: 10.1093/europace/euv046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/13/2015] [Indexed: 11/12/2022] Open
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40
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Arroja JD, Zimmermann M. Phrenic nerve lesion: A potential complication of the nMARQ ablation technique. Int J Cardiol 2015; 180:91-2. [DOI: 10.1016/j.ijcard.2014.11.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
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