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De Smet MAJ, Wielandts JY, El Haddad M, De Becker B, François C, Tavernier R, le Polain de Waroux JB, Duytschaever M, Knecht S. Risk assessment of esophageal ulceration following left atrial radiofrequency linear ablation. J Cardiovasc Electrophysiol 2024. [PMID: 38818534 DOI: 10.1111/jce.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Esophageal safety following radiofrequency (RF) left atrial (LA) linear ablation has not been established. To determine the esophageal safety profile of LA linear RF lesions, we performed systematic esophagogastroduodenoscopy in all patients with intraesophageal temperature rise (ITR) ≥ 38.5°C. METHODS AND RESULTS Between December 2021 and July 2023, a total of 200 consecutive patients with atrial tachyarrhythmia (ATA) underwent linear ablation with posterior dome (roof or floor) or posterior mitral isthmus line transection. Patients with ITR ≥ 38.5°C were scheduled for esophageal endoscopy ~3 weeks after ablation. Patient and ATA characteristics, procedural parameters, endoscopy findings and ablation lesion data were collected and analyzed. One hundred thirty-three out of 200 (67%) patients showed ITR ≥ 38.5°C during LA linear ablation. ITR (with maximal temperature of 45.7°C) was more frequently observed during floor line ablation (82% of cases). ITR was less observed during roof line ablation (34%) and posterior mitral isthmus ablation (4%). Endoscopy, performed in 115 patients after 24 ± 10 days, showed esophageal ulceration in four patients (two patients Kansas City classification [KCC] 2a and two patients KCC 2b). No patient showed esophageal perforation or fistula. CONCLUSION Temperature rise during LA linear ablation is frequent and ulceration risk exists, particularly when floor line is performed. Safety measures are needed to avoid potential severe complications like esophageal perforation and fistula.
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Affiliation(s)
| | | | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | - Clara François
- Department of Cardiology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | | | - Sébastien Knecht
- Department of Cardiology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
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De Becker B, El Haddad M, De Smet M, François C, Tavernier R, le Polain de Waroux JB, Duytschaever M, Knecht S. Early atrial fibrillation recurrence post catheter ablation: Analysis from insertable cardiac monitor in the era of optimized radiofrequency ablation. Heart Rhythm 2024; 21:521-529. [PMID: 38246570 DOI: 10.1016/j.hrthm.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is associated with ablation-induced proarrhythmogenic inflammation; however, existing studies used intermittent monitoring or nonoptimized radiofrequency (RF) applications (noncontiguous or without ablation index target value). OBJECTIVE The purpose of this study was to investigate the relationship between ERAT and late recurrence based on insertable cardiac monitor (ICM) data. METHODS We compiled data from Close-To-Cure and Close Maze studies, which enrolled patients who underwent RF ablation for paroxysmal or persistent atrial fibrillation (AF). All patients were implanted with an ICM 2-3 months before ablation. RESULTS We studied 165 patients (104 with paroxysmal AF, 61 with persistent AF). Over the 1-year follow-up period, 41 of the patients experienced late recurrence. The risk of late recurrence was higher in patients experiencing ERAT (hazard ratio [HR] 6.2; 95% confidence interval [CI] 3.0-13.0), with negative and positive predictive values of 90.5% and 45.7%, respectively. Median burden of AF during the blanking period was significantly higher in patients with late recurrence (7.9% [0.0%-99.6%]) compared to those without recurrence (0.0% [0.0%-6.0]; P <.001). For each 1% increase in AF burden during the blanking period, late recurrence increased by 4.6% (HR 1.046; 95% CI 1.035-1.059). The best tradeoff for predicting AF from ERAT occurrence was AF burden of 0.6% and last ERAT at 64 days. CONCLUSION In patients ablated for paroxysmal and persistent AF with a durable RF lesion set and implanted with a continuous monitoring device, postablation early AF recurrence and burden significantly predict late recurrence. The post-AF ablation blanking period should be reduced to 2 months.
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Affiliation(s)
| | | | | | - Clara François
- Cardiology Department, AZ Sint Jan Bruges, Bruges, Belgium
| | - René Tavernier
- Cardiology Department, AZ Sint Jan Bruges, Bruges, Belgium
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Mechulan A, Dieuzaide P, Peret A, Vaugrenard T, Houamria S, Pons F, Nait-Saidi L, Miliani I, Lemann T, Bouharaoua A, Prévot S. Strategy to achieve mitral isthmus flutter ablation by radiofrequency: the SHERIFF plan. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01804-z. [PMID: 38602601 DOI: 10.1007/s10840-024-01804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Achieving mitral isthmus (MI) block can be challenging. This prospective study evaluated the feasibility and efficacy of a systematic strategy comprising three consecutive steps to achieve MI block. METHODS Twenty consecutive patients (mean (± SD) age 71.4 ± 6.98 years) undergoing ablation of perimitral atrial tachycardia (PMAT) between December 2019 and November 2021 were included. MI was ablated using a systematic strategy comprising up to three consecutive steps: (1) endocardial ablation from the superolateral mitral annulus to the left pulmonary veins; (2) additional epicardial ablation in the coronary sinus (CS) on the opposite side of the endocardial line; and (3) ablation of early activation sites between endocardial and epicardial breakthroughs. RESULTS MI block was successfully achieved in 19/20 patients (95%). MI block after endocardial radiofrequency ablation alone (step 1) was observed in 7/20 patients (35%). Epicardial ablation within the CS on the other side of the endocardial line (step 2) resulted in bidirectional MI block in three more patients. Endocardial ablation of epicardial conduction was successful for nine additional patients (95% success). At the 12-month follow-up, five patients (25%) displayed recurrence of arrhythmia after a single procedure. One patient had electrical cardioversion for persistent atrial fibrillation. Four patients had a redo procedure for left atrial flutter and only two patients (10%) had conduction across the MI and showed recurrence of PMAT. No complications occurred. CONCLUSIONS The three-step ablation strategy resulted in a high rate of acute and durable MI block. PMAT recurrence after a single procedure was 10% at 1-year follow-up.
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Affiliation(s)
- Alexis Mechulan
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France.
| | - Pierre Dieuzaide
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Angélique Peret
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Thibaud Vaugrenard
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Sophiane Houamria
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Frederic Pons
- Service de Cardiologie, Hôpital d'Instruction Des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, France
| | - Lyassine Nait-Saidi
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Ichem Miliani
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Thomas Lemann
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Ahmed Bouharaoua
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
| | - Sébastien Prévot
- Ramsay Santé, Hôpital Privé Clairval, Service Cardiologie-Rythmologie, Marseille, France
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Zuo S, Sang C, Long D, Bo X, Lai Y, Guo Q, Wang Y, Li M, He L, Zhao X, Guo X, Liu N, Li S, Wang W, Jiang C, Tang R, Du X, Dong J, Ma C. Efficiency and Durability of EIVOM on Acute Reconnection After Mitral Isthmus Bidirectional Block. JACC Clin Electrophysiol 2024; 10:685-694. [PMID: 38658060 DOI: 10.1016/j.jacep.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reconnection after mitral isthmus (MI) block with radiofrequency ablation is common. OBJECTIVES The aim of this study was to investigate the effects of ethanol infusion in the vein of Marshall (EIVOM) on acute reconnection after MI bidirectional block. METHODS Patients with persistent atrial fibrillation who were scheduled to receive radiofrequency ablation for the first time were randomly assigned to the radiofrequency catheter ablation (RFCA) group (n = 44) or the EIVOM group (n = 45). The RFCA group's strategy was bilateral pulmonary vein ablation and linear ablation; in the EIVOM group, EIVOM was performed first. The primary endpoint was acute reconnection 30 minutes after MI bidirectional block. RESULTS A total of 89 patients (average age 62.9 years; 57.3% male) were enrolled. The average duration for persistent atrial fibrillation was 2.3 years. Before observation, all patients in the EIVOM group achieved MI bidirectional block (45 of 45 [100%]), compared with 84.1% (37 of 44) in the RFCA group. After the observation, 3 cases of MI reconnection occurred in the EIVOM group and 13 cases in the RFCA group (6.7% vs 35.1%; P < 0.05). After additional ablation, the final MI block rates in the EIVOM and RFCA groups were 97.8% (44 of 45) and 72.7% (32 of 44), respectively. During a 1-year follow-up, 8 of 45 patients who underwent EIVOM had recurrent atrial fibrillation, compared with 14 of 44 in the RFCA group (17.8% vs 31.8%; P < 0.01). CONCLUSIONS EIVOM can reduce acute reconnection after MI bidirectional block and significantly increase first-pass MI block.
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Affiliation(s)
- Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaowen Bo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qi Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Tonko JB, Silberbauer J, Mann I. How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block. Europace 2023; 25:euad283. [PMID: 37713215 PMCID: PMC10558061 DOI: 10.1093/europace/euad283] [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: 06/27/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann's bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical 'cut-and-sew' techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.
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Affiliation(s)
- Johanna Bérénice Tonko
- Institute for Cardiovascular Science, University College London, 5 University Street, WC1E 6JF London, UK
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - John Silberbauer
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - Ian Mann
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
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Masuda M, Inoue K, Tanaka N, Watanabe T, Makino N, Egami Y, Oka T, Minamiguchi H, Miyoshi M, Okada M, Kanda T, Mano T, Matsuda Y, Uematsu H, Sakio T, Kawasaki M, Sunaga A, Sotomi Y, Dohi T, Nakatani D, Hikoso S, Sakata Y. Long-Term Impact of Additional Ablation After Pulmonary Vein Isolation: Results From EARNEST-PVI Trial. J Am Heart Assoc 2023; 12:e029651. [PMID: 37642022 PMCID: PMC10547359 DOI: 10.1161/jaha.123.029651] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/30/2023] [Indexed: 08/31/2023]
Abstract
Background An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined. Methods and Results We conducted an extended follow-up of the multicenter randomized controlled EARNEST-PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12-month rhythm outcomes in patients with persistent AF between patients randomized to a PVI-alone strategy (n=248) or PVI-plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow-up period to 3 years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on-treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI-plus group than the PVI-alone group (29.0% versus 37.5%, P=0.036). On-treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF/AT recurrence rate than those with PVI only (26.3% versus 37.8%, P=0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%, P=0.76). At second ablation in 126 patients with AF/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%, P<0.0001). Conclusions Left atrial ablation in addition to PVI was efficacious during 3-year follow-up. Linear ablation was superior to other ablation strategies but may increase iatrogenic ATs. Registration URL: http://www.umin.ac.jp/ctr/index-j.htm; Unique identifier: UMIN000019449.
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Affiliation(s)
| | - Koichi Inoue
- Cardiovascular DivisionNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Nobuaki Tanaka
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | | | | | | | - Takafumi Oka
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | | | - Miwa Miyoshi
- Department of CardiologyOsaka Hospital, Japan Community Healthcare OrganizationOsakaJapan
| | - Masato Okada
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Takashi Kanda
- Cardiovascular DivisionOsaka Police HospitalOsakaJapan
| | - Toshiaki Mano
- Cardiovascular CenterKansai Rosai HospitalAmagasakiJapan
| | | | | | | | - Masato Kawasaki
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Akihiro Sunaga
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yohei Sotomi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Tomoharu Dohi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Daisaku Nakatani
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Shungo Hikoso
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yasushi Sakata
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
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Takagi T, Derval N, Duchateau J, Chauvel R, Tixier R, Marchand H, Bouyer B, André C, Kamakura T, Krisai P, Ascione C, Balbo C, Cheniti G, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication. Heart Rhythm 2023; 20:14-21. [PMID: 36115541 DOI: 10.1016/j.hrthm.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce. OBJECTIVE The purpose of this study was to evaluate the impact of gaps within such a lesion set. METHODS We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg). RESULTS Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05). CONCLUSION Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
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Affiliation(s)
- Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
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Sohns C, Bergau L, El-Hamriti M, Fox H, Molatta S, Braun M, Khalaph M, Imnadze G, Sommer P. Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation. Cardiol J 2022; 29:917-926. [PMID: 33346368 PMCID: PMC9788747 DOI: 10.5603/cj.a2020.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary. METHODS Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance. RESULTS Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion. CONCLUSIONS Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El-Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery and Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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9
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O’Neill L, De Becker B, De Smet M, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Atrial tachycardia occurring after a prior atrial fibrillation ablation procedure: Does non-inducibility matter? Front Cardiovasc Med 2022; 9:1073239. [PMID: 36568552 PMCID: PMC9769961 DOI: 10.3389/fcvm.2022.1073239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Recurrent atrial tachycardia (AT) is a common phenomenon after catheter ablation for AF, particularly in the setting of additional substrate ablation, with many studies demonstrating gap-related macro re-entrant AT (predominantly mitral and roof dependent) to be the dominant mechanism. Although multiple inducible ATs after ablation of the clinical AT are commonly described at repeat procedures, the optimal ablation strategy, and procedural endpoints are unclear in this setting. A recent randomized study addressing the question of non-inducibility as a procedural endpoint demonstrated no additional benefits to the ablation of all induced, non-clinical ATs, but it was limited by small numbers and high rates of non-inducibility. Nevertheless, once ablation of the clinical AT has been successfully performed, ensuring durable linear block and PV isolation may be sufficient for the prevention of further AT. Durable linear block, particularly at the mitral isthmus, is difficult to achieve but may be facilitated by the real-time evaluation of lesion quality and contiguity and the novel technique of vein of Marshall ethanol infusion. Large-scale, randomized trials are needed, nonetheless, to fully assess the optimal ablation strategy in the setting of recurrent AT post-AF ablation.
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10
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Qiao Y, Zhao Z, Cai X, Guo Y, Fu M, Liu K, Guo J, Guo T, Niu G. Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance. Front Cardiovasc Med 2022; 9:922910. [PMID: 36204561 PMCID: PMC9530740 DOI: 10.3389/fcvm.2022.922910] [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: 04/18/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The long-term outcomes of ablation index (AI)-guided radiofrequency catheter ablation (RFCA) on atrial fibrillation (AF) and different subtypes of heart failure (HF) remain unknown. The aim of the study was to evaluate the long-term prognosis of AI-guided RFCA procedures in patients with AF and concomitant HF. Methods We retrospectively included consecutive patients with AF and HF who underwent the initial RFCA procedure with AI guidance from March 2018 to June 2021 in our institution. The patients were categorized into two groups: HF with preserved ejection fraction (HFpEF) group and HF with mid-range ejection fraction (HFmrEF) +HF with reduced ejection fraction (HFrEF) group. Results A total of 101 patients were included. HFpEF and HFmrEF + HFrEF groups consisted of 71 (70.3%) and 30 patients (29.7%), respectively. During a median follow-up of 32.0 (18.2, 37.6) months, no significant difference was detected in AF recurrence between groups (21.1 vs. 33.3%) after multiple procedures, whereas the incidence of the composite endpoint of all-cause death, thromboembolic events, and HF hospitalization was significantly lower in HFpEF group (9.9 vs. 25.0%, Log-rank p = 0.018). In multivariable analysis, a history of hypertension [hazard ratio (HR) 4.667, 95% confidence interval (CI) 1.433–15.203, p = 0.011], left ventricular ejection fraction (LVEF) < 50% (HR 5.390, 95% CI 1.911–15.203, p = 0.001) and recurrent AF after multiple procedures (HR 7.542, 95% CI 2.355–24.148, p = 0.001) were independently associated with the incidence of the composite endpoint. Conclusion Long-term success could be achieved in 75% of patients with AF and concomitant HF after AI-guided RFCA procedures, irrespective of different HF subtypes. Preserved LVEF was associated with a reduction in the composite endpoint compared with impaired LVEF. Patients with recurrent AF tend to have a poorer prognosis.
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Affiliation(s)
- Yu Qiao
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Zhen Zhao
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Xiang Cai
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Yulong Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Mingpeng Fu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Ke Liu
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Jinrui Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Tao Guo
- Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China
| | - Guodong Niu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Guodong Niu
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11
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Makihara Y, Miyazaki S, Harama T, Obunai K, Watanabe H, Tada H. Ablation Index Guided Left Atrial Posterior Wall Isolation. Int Heart J 2022; 63:708-715. [PMID: 35908854 DOI: 10.1536/ihj.22-091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ablation index (AI)-guided linear ablation is reported to be feasible.We assessed the feasibility of AI-guided left atrial (LA) posterior wall isolations (PWIs) using different target AI values.Seventy-one persistent atrial fibrillation patients who underwent AI-guided PWIs following pulmonary vein isolation were included. LA linear lesions were created with strict contiguity (inter-lesion distance < 4 mm) and different predetermined AI target values (Group-1: 430, Group-2: 450). The data was analyzed retrospectively.The total radiofrequency application time of the roof and bottom-line ablation was a median of 2.8 (2.0, 3.8) and 3.6 (2.8, 4.3) minutes. The first-pass PWI success rate (26/35 [74.3%] versus 16/36 [44.4%], P = 0.011) and a first-pass roof line block (28/35 [80.0%] versus 21/36 [58.3%], P = 0.048) were significantly higher in Group-2 than Group-1, but that for the first-pass bottom line block was similar between Group-1 and Group-2 (29/36 [80.6%] versus 29/35 [82.9%], P = 0.80). Successful PWIs were achieved by additional applications in all. The significant parameter associated with a successful first-pass LA roof line block was a greater RF power, and that for the LA bottom were a higher radiofrequency power and shorter inter-lesion distance. Conduction gaps were mostly located at the middle of both lines. Among 22 roof line gaps, 12 were closed on the line whereas 10 (45.4%) required ablation inside the posterior wall for PWIs. On the contrary, all 11 gaps on bottom lines were closed on the line.Successful first-pass PWIs were obtained in 74% of patients using a target AI value of 450 and strict criteria for the lesion contiguity.
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Affiliation(s)
- Yu Makihara
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Shinsuke Miyazaki
- Department of Cardiovascular medicine, Faculty of Medical Sciences, University of Fukui
| | - Tomoko Harama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | - Hiroshi Tada
- Department of Cardiovascular medicine, Faculty of Medical Sciences, University of Fukui
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Khalaph M, Sommer P, Lucas P, Guckel D, Fink T, Sciacca V, Hamriti ME, Imnadze G, Braun M, Sohns C, Bergau L. First clinical experience using a visualized sheath for atrial fibrillation ablation. Pacing Clin Electrophysiol 2022; 45:922-929. [PMID: 35716400 DOI: 10.1111/pace.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recently, a novel steerable sheath allowing its real-time visualization within a 3D-mapping system was introduced to facilitate atrial fibrillation (AF) ablation. AIM This study aimed to assess safety and efficacy of AF ablation using the visualized sheath and to compare its performance with a matched control group of patients who received ablation with conventional and non-visualized sheaths. METHODS The study included consecutive patients between 09/2019 and 02/2021 who underwent routine AF ablation using the visualized sheath. Patients were regularly followed-up in our outpatient's clinic. Arrhythmia recurrence was defined as any atrial fibrillation (AF)/ atrial tachycardia (AT) episode lasting > 30 s after a blanking period of 3 months. RESULTS A total number of 100 patients undergoing ablation using the visualized sheath were compared to a group of 99 matched patients. No major complications were observed. Total procedure duration (108 ± 22 min vs. 112 ± 12 min; p = 0.045), fluoroscopy time (7 ± 3 min vs. 10 ± 5 min; p < 0.001) and -dose (507 ± 501 cGy*cm2 vs. 783 ± 433 cGy*cm2 ; p < 0.001) were significantly lower using the visualized sheath. The benefit in terms of procedure duration was mainly driven by a shortened left atrial dwell time (73 ± 13 min vs. 79 ± 12 min; p = 0.001). During a mean follow-up of 12 months, the overall procedural success was 85% in the visualized sheath group versus 83% in the control group (p = 0.948). CONCLUSION AF ablation using the novel visualized sheath is safe and effective and leads to a measurable decrease of procedure duration and radiation exposure. The integration of the novel sheath might help to further improve safety and efficacy of AF ablation.
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Affiliation(s)
- Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Philipp Lucas
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bochum, Germany
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13
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Ducceschi V, Zingarini G, Nigro G, Brasca FMA, Malacrida M, Carbone A, Lavalle C, Maglia G, Infusino T, Aloia A, Nicolis D, Auricchio C, Uccello A, Notaristefano F, Rago A, Botto GL, Esposito L. Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter. Pacing Clin Electrophysiol 2022; 45:612-618. [PMID: 35383979 DOI: 10.1111/pace.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. METHODS RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. RESULTS 392 point-by-point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4±12Ω prior to ablation and 92.0±11Ω after ablation (p<0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8±6Ω vs 8.7±4Ω; RedV: 17.2±6Ω vs 7.8±5Ω; UPC: 19.6±6Ω vs 10.1±5Ω, all p<0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure-related adverse events were reported. CONCLUSIONS A LI-guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | - Antonio Aloia
- Division of Cardiology, Presidio Ospedaliero di Vallo della Lucania, Italy
| | | | | | | | | | - Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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14
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Ramak R, Lipartiti F, Mojica J, Monaco C, Bisignani A, Eltsov I, Sorgente A, Capulzini L, Paparella G, Deruyter B, Iacopino S, Motoc AI, Luchian ML, Osorio TG, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Jordaens L, Brugada P, de Asmundis C, Chierchia GB. Comparison between the novel diamond temp and the classical 8-mm tip ablation catheters in the setting of typical atrial flutter. J Interv Card Electrophysiol 2022; 64:751-757. [PMID: 35239069 DOI: 10.1007/s10840-022-01152-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Radiofrequency (RF) catheter ablation is widely accepted as a first-line therapy for cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). The novel DiamondTemp (DT) catheter with temperature feedback during RF ablation has been released recently on the market. The purpose of this study was to evaluate the impact of DiamondTemp (DT) technology on ablation efficiency during AFL. METHODS In this single-center study, 30 consecutive patients with typical AFL indicated to ablation of CTI were included. The first 15 patients underwent CTI ablation using 8-mm tip catheter, and the following 15 patients underwent temperature-controlled RF ablation using DT catheter. The endpoints were number and mean total duration of RF applications, mean temperature reached in the setting of CTI, procedural times, and fluoroscopy times. RESULTS There were no significant differences between the two groups concerning baseline characteristics. Mean duration of the each application (71.5 s ± 30.6 vs 12.4 s ± 13.2, p value < 0.001), mean total duration of RF applications (517,73 s ± 377,96 vs 112,8 s ± 43,58; p value < 0.001), procedural times (51.6 min ± 24.2 vs 38.6 ± 8.2; p = 0.03), and fluoroscopy times (16.2 min ± 10.2 vs 8 min ± 4.24; p = 0.005) were longer in the 8-mm ablation catheter group. Mean temperature measurements (51.9 °C ± 3.59 vs 56.7 °C ± 3.34, p value < 0.003) were as well lower in the 8-mm ablation catheter group. CONCLUSIONS Catheter ablation of CTI-dependent AFL by means of DT resulted in a significant reduction of total and single application RF delivery time, procedure, and fluoroscopy times.
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Affiliation(s)
- Robbert Ramak
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Felicia Lipartiti
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ivan Eltsov
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Lucio Capulzini
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Deruyter
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Andreea Iulia Motoc
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maria Luiza Luchian
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thiago Guimaraes Osorio
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Luc Jordaens
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
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15
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Gillis K, O'Neill L, Wielandts JY, Hilfiker G, Almorad A, Lycke M, El Haddad M, le Polain de Waroux JB, Tavernier R, Duytschaever M, Knecht S. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation. JACC Clin Electrophysiol 2022; 8:367-376. [PMID: 35331432 DOI: 10.1016/j.jacep.2021.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block. BACKGROUND Achieving MI block with the use of RF ablation is challenging. METHODS Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMFIRST group) vs RF ablation as a first step preceding VOMEt (RFFIRST group). The study end point was incidence of MI block after RF ablation and after the 2 steps. RESULTS In VOMFIRST, VOMEt was successful in 30/35 patients (86%) resulting in a low-voltage area of 12 ± 7.4 cm2 and MI block in 2/35 patients (6%). VOMFIRST, compared with RFFIRST, was associated with higher incidence of MI block after endocardial (46% vs 11%; P < 0.001) and epicardial ablation (94% vs 43%; P < 0.001), with fewer endocardial applications (4 vs 11 vs 4; P < 0.001) and similar epicardial applications (7 vs 8; P = 0.68). Incidence of MI block after the 2 steps was 94% vs 63% (P = 0.001) in VOMFIRST vs RFFIRST, respectively. Additional touch-up RF ablation in both groups resulted in final MI block in all but 1 patient (99%). CONCLUSIONS VOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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Affiliation(s)
- Kris Gillis
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
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16
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Francke A, Scharfe F, Schoen S, Wunderlich C, Christoph M. Reconnection patterns after high-power-short-duration pulmonary vein isolation Reconnection patterns after CLOSE-guided 50W high-power-short-duration circumferential pulmonary vein isolation and substrate modification - PV reconnection might no longer be an issue. J Cardiovasc Electrophysiol 2022; 33:1136-1145. [PMID: 35118734 DOI: 10.1111/jce.15396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ablation of atrial fibrillation (AF) with high-power-short-duration (HPSD) radiofrequency (RF) technology is emerging as a new standard of care in many electrophysiology laboratories. While procedural short-term efficacy and efficiency is very promising, little is known about mid- to long-term effects of HPSD ablation for pulmonary vein isolation and left atrial substrate modification. METHODS AND RESULTS In a single-centre registry, 412 AF procedures were performed in 400 individual patients using a standardized CLOSE protocol guided fixed 50W HPSD ablation, aiming for an ablation index (AI) of 400 on the posterior and 550 on the anterior wall. Additional substrate-tailored lines were performed when required. After a mean clinical follow-up of 337 ± 134 days, 15 patients suffered from AF recurrence beyond the blinding period. 12 gave consent to the indicated re-ablation. Here, 11 of 12 patients had chronic isolation of all 4 pulmonary veins (PV). In 3 of 6 patients, a reconnection of additional left atrial ablation lines was revealed. 10 out of 12 patients showed progressive fibrous atrial cardiomyopathy and required additional left atrial substrate modification or re-isolation of left-atrial lines. During the follow-up no clinical case of atrioesophageal fistula was registered. No PV stenosis after initial HPSD PVI was documented. CONCLUSIONS Patients requiring re-ablation of AF or other atrial tachycardia after a fixed 50W HPSD circumferential PVI and substrate modification predominantly suffer from progressive fibrous atrial cardiomyopathy, while PV reconnection appears to be a rare cause of AF recurrence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Francke
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - F Scharfe
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - S Schoen
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - C Wunderlich
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - M Christoph
- Klinikum Chemnitz, TU Dresden Campus Chemnitz - MEDiC, Flemmingstraße 2, 09116, Chemnitz, Germany
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17
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Hayashida S, Nagashima K, Kurokawa S, Arai M, Watanabe R, Wakamatsu Y, Otsuka N, Yagyu S, Iso K, Okumura Y. Modified ablation index: a novel determinant of a successful first-pass left atrial posterior wall isolation. Heart Vessels 2021; 37:802-811. [PMID: 34709460 DOI: 10.1007/s00380-021-01971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
Although a left atrial posterior wall isolation (LAPWI) in addition to a pulmonary vein isolation is a well-accepted option for persistent atrial fibrillation (AF), a complete isolation can be challenging. This study aimed to evaluate the performance of a modified ablation index (AI) (AI/bipolar voltage along the ablation line) for predicting a durable LAPWI. The study included 55 consecutive patients, aged 65 ± 11 years, who underwent an electroanatomic mapping-guided LAPWI of AF. The association between the gaps (first-pass LAPWI failure and/or acute LAPW reconnections), voltage amplitude along the roof and floor lines, and thickness of the LAPW was investigated. Gaps occurred in 22 patients (40%) and in 26 (8%) of the 330 line segments. Gaps were associated with a relatively high bipolar voltage (3.38 ± 1.83 vs. 1.70 ± 1.12 mV, P < 0.0001) and thick LA wall (2.52 ± 1.15 vs. 1.42 ± 0.44 mm, P < 0.0001). A modified AI ≤ 199 AU/mV, bipolar voltage ≥ 2.64 mV, wall thickness ≥ 2.04 mm, and roof ablation line ≥ 43.4 mm well predicted gaps (AUCs: 0.783, 0.787, 0.858, and 0.752, respectively). A high-voltage zone, thick LAPW, and long roof ablation line appeared to be determinants of gaps, and a modified AI ≥ 199 AU/mV along the ablation lines appeared to predict an acute durable LAPWI.
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Affiliation(s)
- Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Division of Cardiology, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Seina Yagyu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuki Iso
- Division of Cardiology, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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18
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Lycke M, O’Neill L, Gillis K, Wielandts JY, Le Polain De Waroux JB, Tavernier R, Knecht S, Duytschaever M. How Close Are We toward an Optimal Balance in Safety and Efficacy in Catheter Ablation of Atrial Fibrillation? Lessons from the CLOSE Protocol. J Clin Med 2021; 10:jcm10184268. [PMID: 34575379 PMCID: PMC8469113 DOI: 10.3390/jcm10184268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Abstract
Catheter ablation for atrial fibrillation (AF) is a common treatment strategy in patients with drug-resistant, symptomatic AF. In patients with paroxysmal and short-standing persistent AF, pulmonary vein isolation (PVI) is often enough to prevent recurrence of atrial tachyarrhythmia (ATA). Point-by-point encircling of the PVs with radiofrequency (RF) applications, together with cryoballoon ablation, have been the mainstay strategies for the last 10 to 20 years. Each of these strategies, however, suffers from the delicate balance between preventing PV reconnection, on the one hand (toward more energy), and preventing (mainly esophageal) complications (toward less energy), on the other. The CLOSE protocol was developed as an RF ablation strategy that would result in the safe creation of durable isolation leading to improved outcomes. Basically, the aim of the protocol is to enclose the pulmonary veins with stable, contiguous (intertag distance, ITD ≤ 6 mm) and optimized lesions (35 Watts, W, RF applications up to ablation index targets of ≥400 and ≥550 at the posterior and anterior wall). In this review, we describe the background of the CLOSE protocol and the studies from the St Jan Bruges research group on procedural performance, efficacy, and safety of the CLOSE protocol in (a) single-center prospective PILOT study (CLOSE-PILOT), (b) a single-center prospective study with continuous rhythm monitoring (CLOSE to CURE), (c) a database of systematic esophageal endoscopic studies, (d) a multicenter prospective study (VISTAX), and (e) the CLOSE database (comprising > 400 patients). We also discuss the results of the randomized POWER-AF study comparing conventional CLOSE to high power CLOSE (up to 50 W). Finally, we discuss the performance, safety, and efficacy of the CLOSE protocol in light of the emerging changes in the field of catheter ablation being ultra-short high-power ablation and electroporation.
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19
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O’Neill L, Wielandts JY, Gillis K, Hilfiker G, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy. J Clin Med 2021; 10:jcm10184060. [PMID: 34575173 PMCID: PMC8467025 DOI: 10.3390/jcm10184060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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20
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Spittler R, Bahlke F, Hoffmann BA, Marx A, Mollnau H, Quesada-Ocete B, Konrad T, Rostock T. Durable pulmonary vein isolation but not complex substrate ablation determines the type of arrhythmia recurrence after persistent atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:417-426. [PMID: 34373981 DOI: 10.1007/s10840-021-01048-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complex ablation for persistent atrial fibrillation (AF) aims to modify the arrhythmogenic substrates to become incapable to perpetuate the arrhythmia. Ablation-associated determinants of atrial tachycardia (AT) rather than AF recurrences are unknown. The aim of the study was to evaluate the association between the type of arrhythmia recurrence and electrophysiological findings during redo procedures. METHODS A total number of 384 consecutive patients with persistent AF underwent complex ablation consisting of PV isolation (PVI), biatrial electrogram-guided ablation, and linear ablation with the desired procedural endpoint of AF termination. Electrophysiological findings during redo procedures and its relation to AR type are the subject of this study. RESULTS Overall, 177 (46%) patients underwent a second procedure. Patients with AT recurrences had significantly more often persistent PVI (47 vs. 25%; P = 0.002). Moreover, a higher number of recovered PVs were associated with AF recurrence (3 PVs recovered, AF = 16.1% vs. AT = 5.2%; P = 0.02; 4 PVs recovered, AF = 18.5% vs. AT = 6.3%; P = 0.01), regardless of the extent of substrate ablation during the first procedure. CONCLUSIONS Durable PV isolation but not the extent of atrial substrate ablation determines the type of arrhythmia recurrence. Thus, the PVs may represent dominant perpetuators (and not only triggers) of persistent AF even in the presence of a significantly modified atrial substrate.
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Affiliation(s)
- Raphael Spittler
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany.
| | - Fabian Bahlke
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | | | - Alexandra Marx
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Hanke Mollnau
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Blanca Quesada-Ocete
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Torsten Konrad
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
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21
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Viola G, Stabile G, Bandino S, Rossi L, Marrazzo N, Pecora D, Bottoni N, Solimene F, Schillaci V, Scaglione M, Ocello S, Baiocchi C, Santoro A, Donzelli S, De Ruvo E, Lavalle C, Sanchez-Gomez JM, Pastor JFA, Grandio PC, Ferraris F, Castro A, Rebellato L, Marchese P, Adao L, Primo J, Barra S, Casu G. Safety, efficacy, and reproducibility of cavotricuspid isthmus ablation guided by the ablation index: acute results of the FLAI study. Europace 2021; 23:264-270. [PMID: 33212484 DOI: 10.1093/europace/euaa215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Ablation index (AI) is a marker of lesion quality during catheter ablation that incorporates contact force, time, and power in a weighted formula. This index was originally developed for pulmonary vein isolation as well as other left atrial procedures. The aim of our study is to evaluate the feasibility and efficacy of the AI for the ablation of the cavotricuspid isthmus (CTI) in patients presenting with typical atrial flutter (AFL). METHODS AND RESULTS This prospective multicentre non-randomized study enrolled 412 consecutive patients with typical AFL undergoing AI-guided cavotricuspid isthmus ablation. The procedure was performed targeting an AI of 500 and an inter-lesion distance measurement of ≤6 mm. The primary endpoints were CTI 'first-pass' block and persistent block after a 20-min waiting time. Secondary endpoints included procedural and radiofrequency duration and fluoroscopic time. A total of 412 consecutive patients were enrolled in 31 centres (mean age 64.9 ± 9.8; 72.1% males and 27.7% with structural heart disease). The CTI bidirectional 'first-pass' block was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting time was achieved in 405 patients (98.3%). Mean procedural, radiofrequency, and fluoroscopic time were 56.5 ± 28.1, 7.8 ± 4.8, and 1.9 ± 4.8 min, respectively. There were no major procedural complications. There was no significant inter-operator variability in the ability to achieve any of the primary endpoints. CONCLUSION AI-guided ablation with an inter-lesion distance ≤6 mm represents an effective, safe, and highly reproducible strategy to achieve bidirectional block in the treatment of typical AFL.
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Affiliation(s)
- Graziana Viola
- San Francesco Hospital, Via Mannironi 1, 08100 Nuoro, Italy
| | | | | | - Luca Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Domenico Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joao Primo
- Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal
| | - Sergio Barra
- Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal.,Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - Gavino Casu
- San Francesco Hospital, Via Mannironi 1, 08100 Nuoro, Italy.,Department of Biomedical Science, University of Sassari, Sassari, Italy
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22
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Lai Y, Liu X, Sang C, Long D, Li M, Ge W, Liu X, Lu Z, Guo Q, Jiang C, Zuo S, Jiang C, Bai R, Tang R, Guo X, Li S, Liu N, Wang W, Zhao X, Li C, Du X, Dong J, Ma C. Effectiveness of ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the "upgraded 2C3L" approach) for catheter ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1849-1856. [PMID: 34028114 DOI: 10.1111/jce.15108] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). METHODS AND RESULTS The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p = .006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p < .001) and MI (7.0 vs. 11.8 min, p < .001) and required less cardioversion (50 [78.5%] vs. 113 [90.4%], p = .007). During the 12-month follow-up, 58 (87.9%) patients were free from atrial fibrillation/atrial tachycardia in group 1 compared with 81 (64.8%) in group 2 (p < .001). In multivariate cox regression, the "upgraded 2C3L" procedure is associated with a lower recurrence rate (hazard ratio = 0.27, 95% confidence interval = 0.12-0.59). CONCLUSION Compared with the conventional "2C3L" approach, the "upgraded 2C3L" approach has higher effectiveness for ablation of PeAF.
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Affiliation(s)
- Yiwei Lai
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caihua Sang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weili Ge
- Department of Cardiology, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Xiangfei Liu
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qi Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Taizhou Hospital of Zhejiang Province, Taizhou, China.,Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China.,Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Jiang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Zuo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songnan Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyi Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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23
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O'Neill L, Duytschaever M, Knecht S. Atrial fibrillation ablation in patients with hypertrophic cardiomyopathy: do not throw in the towel too fast! Europace 2021; 23:1334-1335. [PMID: 33930128 DOI: 10.1093/europace/euab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Louisa O'Neill
- Dienst Cardiologie, AZ Sint-Jan, Ruddershove 10, 8000 Brugge, Belgium
| | | | - Sébastien Knecht
- Dienst Cardiologie, AZ Sint-Jan, Ruddershove 10, 8000 Brugge, Belgium
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24
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La Rosa G, Quintanilla JG, Salgado R, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Villacastín J, Jalife J, Pérez-Castellano N, Filgueiras-Rama D. Anatomical targets and expected outcomes of catheter-based ablation of atrial fibrillation in 2020. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:341-359. [PMID: 33283883 DOI: 10.1111/pace.14140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
Anatomical-based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter-based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point-by-point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow-up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.
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Affiliation(s)
- Giulio La Rosa
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Jorge G Quintanilla
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Salgado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - David Filgueiras-Rama
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Pambrun T, Duchateau J, Delgove A, Denis A, Constantin M, Ramirez FD, Chauvel R, Tixier R, Welte N, André C, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Krisai P, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Frontera A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Walton RD, Derval N. Epicardial course of the septopulmonary bundle: Anatomical considerations and clinical implications for roof line completion. Heart Rhythm 2020; 18:349-357. [PMID: 33188900 DOI: 10.1016/j.hrthm.2020.11.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gaps in the roof line have been ascribed to epicardial conduction using the septopulmonary bundle. OBJECTIVES We sought to evaluate the frequency of septopulmonary bundle bypass during roof line ablation, to describe anatomical conditions favoring this epicardial gap, and to propose an alternative strategy when present. METHODS One hundred consecutive patients underwent atrial fibrillation ablation. A de novo roof line was created between the superior pulmonary veins. In cases of residual gaps, a floor line was created between the inferior pulmonary veins. Microtomography imaging and histological analyses of 5 human donor hearts were performed: a specific focus was made on the dome and the posterior wall. RESULTS Residual gaps were more frequent in roof lines than floor lines (33% vs 15%; P = .049). Electrogram morphologies, activation sequences, and pacing maneuvers indicated an epicardial bypass of the roof line in all cases. Conduction block was obtained in 67 roof lines and 28 floor lines, resulting in a 95% success rate of linear block, without "box" isolation. Between the superior pulmonary veins, the atrial myocardium was thicker and consistently displayed adipose tissue separating the septopulmonary bundle from the septoatrial bundle. CONCLUSION Epicardial conduction across the roof line is common and requires careful electrogram analysis to detect. In such cases, a floor line can be an effective alternative strategy, with clear validation criteria. Myocardial thickness and fat interposition may explain difficulties in achieving lesion transmurality during roof line ablation.
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Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Anaïs Delgove
- Bordeaux School of Surgery, CHU Bordeaux, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marion Constantin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Clémentine André
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Félix Bourier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Antonio Frontera
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Richard D Walton
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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26
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Sang C, Lai Y, Long D, Li M, Bai R, Jiang C, Wang W, Li S, Tang R, Guo X, Liu N, Zhao X, Zuo S, Wen S, Ning M, Wu J, Du X, Dong J, Ma C. Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:773-781. [PMID: 32856303 DOI: 10.1111/pace.14052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Songnan Wen
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital; National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular Diseases Capital Medical University Beijing China
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27
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Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias. Heart Rhythm 2020; 17:211-219. [DOI: 10.1016/j.hrthm.2019.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 11/17/2022]
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28
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Pambrun T, Denis A, Duchateau J, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Derval N. MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL-PLAN case series. J Cardiovasc Electrophysiol 2018; 30:7-15. [PMID: 30461121 DOI: 10.1111/jce.13797] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/10/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Beyond pulmonary veins (PV) isolation, the ablation strategy for persistent atrial fibrillation (AF) remains controversial. Substrate ablation may provide a high termination rate but at the cost of impaired atrial physiology and recurrent complex re-entries. To overcome these pitfalls, we investigated a new lesion set based on important anatomical considerations. METHODS AND RESULTS The case series included 10 consecutive patients with persistent AF. Three atrial structures were successively targeted: (1) coronary sinus and vein of Marshall (CS-VOM) musculature elimination; (2) PVs isolation; and (3) anatomical isthmuses block. The lesion set completion was the procedural endpoint. Step 1: VOM ethanol infusion was feasible in all cases (mean time of 33.4 ± 9.4 minutes), mean radiofrequency (RF) time for CS-VOM bundles was 14.4 ± 6.9 minutes. Step 2: mean RF time for PV isolation was 27.7 ± 9.3 minutes. Step 3: mean RF time for mitral, roof, and cavotricuspid lines was 5.7 ± 2.3, 8.1 ± 4.3, and 5.9 ± 1.9 minutes, respectively. The lesion set was achieved in all patients. Mean procedure time was 270 ± 29.9 minutes. AF termination and noninducibility were, respectively, obtained in 50% and 90% of the patients. After a 6-month follow-up, all patients were free from arrhythmia recurrence. CONCLUSION The present case series reports a new ablation strategy systematically targeting anatomical structures previously identified as possibly involved in the fibrillatory process and the recurrent tachycardias. The resulting lesion set provides good short-term outcomes. Although promising, these preliminary results need to be confirmed in the larger prospective study.
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Affiliation(s)
- Thomas Pambrun
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Département de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux-Pessac, France
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29
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Sivasambu B, Hakim JB, Barodka V, Chrispin J, Berger RD, Ashikaga H, Ciuffo L, Tao S, Calkins H, Marine JE, Trayanova N, Spragg DD. Initiation of a High-Frequency Jet Ventilation Strategy for Catheter Ablation for Atrial Fibrillation: Safety and Outcomes Data. JACC Clin Electrophysiol 2018; 4:1519-1525. [PMID: 30573114 DOI: 10.1016/j.jacep.2018.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the current investigation is to examine whether use of high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) performed with force-sensing catheters is associated with improved outcomes. BACKGROUND Catheter ablation is well established as therapy for symptomatic atrial fibrillation (AF). Reconnection following PVI is commonly observed during repeat ablation procedures. Technologies that may optimize catheter stability and lesion delivery include both force-sensing ablation catheters and HFJV. METHODS Patients undergoing PVI at Johns Hopkins Hospital were prospectively enrolled in a registry. The study compared procedural characteristics, adverse event rates, and 1-year procedural outcomes in patients undergoing PVI supported either by standard ventilation or HFJV. Patient and procedural aspects were otherwise constant. RESULTS Eighty-four HFJV patients and 84 matched control patients with 1-year outcome data were identified. Atrial arrhythmia recurrence occurred in 26 of 84 HFJV patients (31%) and 42 of 84 control patients (50%; p = 0.019). In patients with paroxysmal AF, arrhythmia recurrence in HFJV and control patients was 27.3% and 47.3%, respectively (p = 0.045). In patients with persistent AF, arrhythmia recurrence rates were not significantly different (37.9% in HFJV patients, 55.2% in control patients; p = 0.184). On multivariate analysis, HFJV was independently associated with improved freedom from arrhythmia recurrence. Vasopressor use during HFJV cases was significantly higher than during standard ventilation (79.7% vs. 22.4%; p = 0.001). Indices of catheter stability and contact force adequacy were significantly higher in the HFJV patients than in control patients. Complication rates in the 2 groups were similarly low. CONCLUSIONS Use of HFJV in patients undergoing PVI with radiofrequency force-sensing catheters is associated with improved outcomes, without appreciable increase in adverse procedural events.
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Affiliation(s)
- Bhradeev Sivasambu
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joe B Hakim
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Viachaslau Barodka
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan Chrispin
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ronald D Berger
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Luisa Ciuffo
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Susumu Tao
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joseph E Marine
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Natalia Trayanova
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - David D Spragg
- Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, Maryland.
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30
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Sandoval Z, Castro M, Alirezaie J, Bessière F, Lafon C, Dillenseger JL. Transesophageal 2D ultrasound to 3D computed tomography registration for the guidance of a cardiac arrhythmia therapy. ACTA ACUST UNITED AC 2018; 63:155007. [DOI: 10.1088/1361-6560/aad29a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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