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Yan QD, Gong KZ, Chen XH, Chen JH, Xu Z, Wang WW, Zhang FL. Comparison of Second-Generation Cryoballoon Ablation and Quantitative Radiofrequency Ablation Guided by Ablation Index for Atrial Fibrillation. Angiology 2024; 75:462-471. [PMID: 36809222 DOI: 10.1177/00033197231159254] [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] [Indexed: 02/23/2023]
Abstract
We compared the efficacy and complication rates of quantitative radiofrequency ablation guided by ablation index (RFCA-AI) with those of second-generation cryoballoon ablation (CBA-2). Consecutive patients (n = 230) with symptomatic atrial fibrillation (AF) undergoing a first ablation CBA-2 (92 patients) or RFCA-AI (138 patients) procedure were enrolled in this study. The late recurrence rate in the CBA-2 group was higher than that in the RFCA-AI group (P = .012). Subgroup analysis showed the same result in patients with paroxysmal AF (PAF) (P = .039), but no difference was found in patients with persistent AF (P = .21). The average operation duration in the CBA-2 group (85 [75-99.5] minutes) was shorter than that in the RFCA-AI group (100 [84.5-120] minutes) (P < .0001), but the average exposure time (17.36(13.87-22.49) vs 5.49(4.00-8.24) minutes) in the CBA-2 group and X-ray dose (223.25(149.15-336.95) vs 109.15(80.75-168.7) mGym) were significantly longer than those in RFCA-AI group (P < .0001). Multivariate logistic regression analysis showed that left atrial diameter (LAD), early recurrence, and methods of ablation (cryoballoon ablation) were independent risk factors for late recurrence after AF ablation. Early recurrence of AF and LAD were independent risk factors for predicting late recurrence after AF ablation.
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Affiliation(s)
- Qin-Dan Yan
- Department of Rehabilitation, Xiamen Humanity Rehabilitation Hospital, Xiamen, China
| | - Ke-Zeng Gong
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xue-Hai Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Hua Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhe Xu
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei-Wei Wang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fei-Long Zhang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Clinical Medical Research Center for Heart and Macrovascular Diseases, Fujian Medical University Union Hospital, Fuzhou, China
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Nagase T, Kikuchi T, Unno T, Arai R, Tatsukawa S, Yoshida Y, Yoshino C, Nishida T, Tanaka T, Ishino M, Kato R, Kuwada M. Impedance-guided modified CLOSE protocol ablation can reduce ablation index necessary for pulmonary vein isolation in patients with atrial fibrillation. J Cardiol 2024; 83:291-297. [PMID: 37684006 DOI: 10.1016/j.jjcc.2023.09.002] [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: 05/09/2023] [Revised: 07/21/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Real-time monitoring of generator impedance drop is not considered in CLOSE protocol pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF). We verified whether additional information of impedance drop could minimize ablation index required for PVI using modified CLOSE protocol (target ablation index ≥ 500 on anterior wall and ≥400 on posterior wall along with inter-lesion distance of 3-6 mm and maximum power of 35 W) without any adverse effect of procedural data and efficacy. METHODS Sixty consecutive Japanese AF patients [paroxysmal AF: 43 (72 %) patients] underwent first-time PVI with modified CLOSE protocol with real-time monitoring of impedance drop (impedance-guided modified CLOSE protocol). Ablation tags were colored according to impedance drop and ablation was immediately terminated before reaching target ablation index if impedance drop of ≥10 Ω was confirmed. Ablation index needed for PVI, first-pass PVI rate, other procedural data, and atrial tachyarrhythmia recurrence were evaluated. RESULTS Mean ablation index and impedance drop on anterior and posterior walls were 437.6 ± 43.5 Ω and 10.2 ± 2.6 Ω and 393.3 ± 27.4 Ω and 9.3 ± 2.2 Ω, respectively. First-pass PVI per PV pair was accomplished in 90/120 (75 %). No complications occurred. PV gaps after first-pass ablation were locationally most often found on right posterior wall than on the other parts (p < 0.001). There were no differences in mean contact force, impedance drop, and ablation index between walls with and without PV gaps after first-pass PV ablation. During a mean follow-up of 24 ± 9 months, survival from atrial tachyarrhythmia recurrence was 51/60 (85 %) patients. CONCLUSIONS Using additional generator impedance drop information may be useful to minimize radiofrequency current application to accomplish PVI with modified CLOSE protocol while maintaining efficacy and safety in Japanese AF population.
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Affiliation(s)
- Takahiko Nagase
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan.
| | | | - Takatoshi Unno
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | - Ryoichi Arai
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | | | | | - Chiyo Yoshino
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | | | - Takahisa Tanaka
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | | | - Ryuichi Kato
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
| | - Masao Kuwada
- Department of Cardiology, Higashiyamato Hospital, Tokyo, Japan
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Wada T, Matsuo K, Takayama S, Ochi M, Arisuda Y, Akai H, Koide Y, Otsuka H, Kawamoto K, Tanakaya M, Katayama Y. Identification of epicardial connections can improve the success rate of first-pass right pulmonary vein isolation. Heart Rhythm O2 2024; 5:266-273. [PMID: 38840766 PMCID: PMC11148491 DOI: 10.1016/j.hroo.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Epicardial connections between the right pulmonary vein (PV) and the right atrium have been reported. Objective The purpose of this study was to evaluate the usefulness of our new pulmonary vein isolation (PVI) strategy with identification of these epicardial connections. Methods Overall, 235 patients with atrial fibrillation were included. High-density mapping of the left atrium was performed to identify the earliest activation sites (EASs) before PVI in all patients. With our new strategy, if EASs around the right PV carina were identified, we ablated these sites and performed usual first-pass circumferential PVI. The patients were divided into 2 groups according to the ablation strategy. One hundred fifteen patients underwent first-pass PVI without information on EASs (nonanalyzed group), and 78 patients underwent ablation at EASs around the right PV carina in addition to PVI (analyzed group). After first-pass ablation around the PV antrum, remapping was performed. Results High-density mapping before PVI showed that the prevalence of EASs around the right PV carina was 10.9% in all patients (9.6% in the nonanalyzed group, 12.8% in the analyzed group; P = .74. The first-pass right PVI success rate was higher in the analyzed group than in the nonanalyzed group (93.6% vs 82.6%; P = .04). The radiofrequency application time for PVI was significantly shorter in the analyzed group than in the nonanalyzed group (45.6 ± 1.0 minutes vs 51.2 ± 0.9 minutes; P <.05). Conclusion Identification of epicardial connections before ablation could improve the success rate of first-pass right PVI.
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Affiliation(s)
- Tadashi Wada
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Keita Matsuo
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Shin Takayama
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Masahiko Ochi
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yurie Arisuda
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hiroaki Akai
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuji Koide
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hiroaki Otsuka
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Kenji Kawamoto
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Machiko Tanakaya
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yusuke Katayama
- Department of Cardiovascular Medicine, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
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Heeger CH, Kuck KH, Tilz RR. Very high-power short-duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series. J Cardiovasc Electrophysiol 2024; 35:547-556. [PMID: 37855621 DOI: 10.1111/jce.16113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
The QDOT MICRO™ Catheter is a novel open-irrigated contact force-sensing radiofrequency ablation catheter. It offers very high-power short-duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.
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Affiliation(s)
- Christian-H Heeger
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roland R Tilz
- Department of Rhythmology, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lubeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Heeger CH, Subin B, Eitel C, Ștefan Popescu S, Phan HL, Mamaev R, Bartoli L, Große N, Reincke S, Traub A, Lopez D, Kirstein B, Hatahet S, Kuck KH, Vogler J, Tilz RR. Pulmonary vein isolation durability after very high-power short-duration ablation utilizing a very-close protocol - The FAST AND FURIOUS redo study. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2024; 50:101325. [PMID: 38419611 PMCID: PMC10899720 DOI: 10.1016/j.ijcha.2023.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 03/02/2024]
Abstract
Background Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. Although acute efficacy and safety for PVI was recently shown data on chronic PVI durability is limited. Here chronic PVI durability was evaluated during repeat electrophysiological procedures in patients after initial vHP-SD and conventional RF based PVI. Methods A total of 25 consecutive patients with repeat left atrial procedures after initial vHP-SD based PVI were included in this study. Twenty-five patients with previous conventional RF based PVI and repeat left atrial procedures served as control (control group). Results For index procedures the median RF time was 328 (277, 392) seconds (vHP-SD) and 1470 (1310, 1742) seconds (control); p < 0.001, the median procedure time was 55 (53, 68) minutes (vHP-SD) and 110 (94, 119) (control); p < 0.001). First pass isolation rate was 84 % (vHP-SD) and 88 % (control, p = 0.888). No differences for severe adverse events (vHP-SD: 1/25, 4 % vs. control: 0/25, 0 %; p = 0.676 were detected.Chronic durability of all PVs was assessed in vHP-SD: 16/25 (64 %) and control: 8/25 (32 %) patients (p = 0.023) and vHP-SD: 81 % and control: 62 % of PVs were found to be isolated (p = 0.003). For right PVs vHP-SD: 84 % vs. control: 60 % of PVs (p < 0.001) and for left PVs vHP-SD: 78 % vs. control: 64 % (p = 0.123) were found to be isolated. Conclusions PVI solely utilizing vHP-SD via a very close-protocol provides fast, safe and effective acute PVI. High rates of chronically isolated pulmonary veins have been detected.
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Affiliation(s)
- Christian-H Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Behnam Subin
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Sorin Ștefan Popescu
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Huong-Lan Phan
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Roman Mamaev
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Lorenzo Bartoli
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Niels Große
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Samuel Reincke
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Anna Traub
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Delgado Lopez
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Bettina Kirstein
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Sascha Hatahet
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Julia Vogler
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Chen WT, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Hsieh YC, Li CH, Chen SA. Lower contact force predicts right pulmonary vein carina breakthrough after ablation index-guided pulmonary vein isolation using high-power short-duration. J Cardiovasc Electrophysiol 2024; 35:60-68. [PMID: 37888200 DOI: 10.1111/jce.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Carina breakthrough (CB) at the right pulmonary vein (RPV) can occur after circumferential pulmonary vein isolation (PVI) due to epicardial bridging or transient tissue edema. High-power short-duration (HPSD) ablation may increase the incidence of RPV CB. Currently, the surrogate of ablation parameters to predict RPV CB is not well established. This study investigated predictors of RPV CB in patients undergoing ablation index (AI)-guided PVI with HPSD. METHODS The study included 62 patients with symptomatic atrial fibrillation (AF) who underwent AI-guided PVI using HPSD. Patients were categorized into two groups based on the presence or absence of RPV CB. Lesions adjacent to the RPV carina were assessed, and CB was confirmed through residual voltage, low voltage along the ablation lesions, and activation wavefront propagation. RESULTS Out of the 62 patients, 21 (33.87%) experienced RPV CB (Group 1), while 41 (66.13%) achieved first-pass RPV isolation (Group 2). Despite similar AI and HPSD, patients with RPV CB had lower contact force (CF) at lesions adjacent to the RPV carina. Receiver operating characteristic (ROC) curve analysis identified CF < 10.5 g as a predictor of RPV CB, with 75.7% sensitivity and 56.2% specificity (area under the curve: 0.714). CONCLUSION In patients undergoing AI-guided PVI with HPSD, lower CF adjacent to the carina was associated with a higher risk of RPV CB. These findings suggest that maintaining higher CF during ablation in this region may reduce the occurrence of RPV CB.
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Affiliation(s)
- Wei-Tso Chen
- Department of Medicine, Division of Cardiology, Hualien Tzu Chi, Hospital, Hualien, Taiwan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ling Kuo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Cheng-I Wu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shin-Huei Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Cheng-Hung Li
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
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Buschmann E, Van Steenkiste G, Duytschaever M, Boussy T, Vernemmen I, Ibrahim L, Schauvliege S, Decloedt A, van Loon G. Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system. Equine Vet J 2023. [PMID: 38151793 DOI: 10.1111/evj.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Recently, treatment of equine atrial tachycardia by three-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) has been described. Myocardial sleeves in the caudal vena cava and pulmonary veins are a potential trigger for initiation and perpetuation of atrial tachycardia and atrial fibrillation in the horse. Isolation of these myocardial sleeves by RFCA may be an effective treatment for these arrhythmias. OBJECTIVES To describe the feasibility of 3D EAM and RFCA to isolate caudal vena cava and pulmonary veins in adult horses using 3D mapping and a contact force (CF)-guided ablation system. STUDY DESIGN In vivo experiments. METHODS 3D EAM and RFCA was performed in five horses without cardiovascular disease under general anaesthesia, using the CF-guided system CARTO®3. Point-by-point RFCA aimed for isolation of caudal vena cava and pulmonary veins. Radiofrequency energy was delivered in power-controlled mode with a target power of 45 W, CF between 10 and 15 g and 30 mL/min irrigation rate, until an ablation-index of 450-500 was reached. RESULTS In the right atrium, myocardial sleeves of the caudal vena cava were isolated (n = 5). In the left atrium, isolation of ostium II (n = 3), ostium III (n = 1) and ostium I, II and III en bloc (n = 1) was performed. Successful isolation was confirmed by entrance and exit block. MAIN LIMITATIONS Horses were euthanised at the end of the procedure, so long term effects such as potential reconnection of isolated veins could not be studied. CONCLUSIONS This is the first description of 3D EAM and RFCA with CARTO®3 in horses, thereby showing the technical feasibility and successful caudal vena cava and pulmonary vein isolation. CF measurement allowed monitoring of catheter-tissue contact, resulting in efficient acute lesion creation as confirmed by entrance and exit block. This is a promising treatment for cardiac arrhythmias in horses.
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Affiliation(s)
- Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Yano M, Egami Y, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M, Tanouchi J. Comparison of myocardial injury and inflammation between ablation index-guided and conventional contact force-guided ablation in atrial fibrillation patients. J Interv Card Electrophysiol 2023; 66:2021-2030. [PMID: 37000285 DOI: 10.1007/s10840-023-01536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Ablation index (AI)-guided ablation improves the incidence of arrhythmia recurrence as compared to conventional contact force (CF)-guided ablation. The aim of this study was to elucidate the differences in the biomarkers associated with myocardial injury and inflammation between conventional CF-guided and AI-guided ablation. METHODS Atrial fibrillation (AF) patients who underwent pulmonary vein isolation (PVI) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry were enrolled. We divided the patients into two groups: conventional CF-guided PVI (CF group) and AI-guided PVI (AI group). The differences in biomarkers associated with myocardial injury and inflammation, and long-term durability of PVI between the two groups were evaluated. RESULTS This study population included a total of 794 patients (CF-guided, 241 patients; AI-guided, 553 patients). Total application time was significantly shorter, and total application number was significantly smaller in AI than CF group. High-sensitive troponin I (hs-TnI) post-ablation was significantly higher in AI than CF group (p < 0.001), even after taking the total application number and total application time into consideration. No significant differences in inflammatory markers changes from pre- to post-ablation were observed between the two groups. AI-guided ablation was significantly associated with the hs-TnI post-ablation by multiple regression analysis. The PV reconnection ratio was significantly smaller in AI than CF group (p = 0.037). CONCLUSIONS AI-guided ablation had the ability to create larger lesions than CF-guided ablation despite no increase in inflammation and achieved the better PVI durability than that of CF-guided.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, 591-8025, Japan
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9
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Nehashi T, Kaneshiro T, Nodera M, Yamada S, Takeishi Y. Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation. J Arrhythm 2023; 39:884-893. [PMID: 38045469 PMCID: PMC10692864 DOI: 10.1002/joa3.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Background This study thought to elucidate the anatomical features that can predict an epicardial connection (EC) between the right pulmonary vein (RPV) and right atrium. Methods We retrospectively analyzed 251 consecutive patients undergoing initial radiofrequency pulmonary vein isolation. We defined EC as present when RPV could not be isolated with circumferential ablation and additional ablation for the conduction gap if needed, and RPV isolation could be achieved by ablation for the earliest activation site >10 mm inside the initial ablation line. Using computed tomography data, we evaluated the RPV bifurcation angle, and the area occupation ratio of the carina region to the RPV antrum (ARC) for predicting EC. In subjects with EC undergoing RPV activation mapping after circumferential ablation, the correlation between conduction delay and bipolar/unipolar potential voltage in the carina region was investigated. Results There were ECs in 45 out of 251 patients (17.9%). The RPV bifurcation angle (47.7° vs. 38.8°, p < .001) and ARC (37.2% vs. 29.7%, p < .001) were significantly greater in the EC (+) group. Multivariate logistic regression analysis revealed that RPV bifurcation angle (odds ratio [OR]: 1.994, p = .002) and ARC (OR: 3.490, p = .013) were independent predictors of EC. In nine patients with EC undergoing carina region mapping, the unipolar potential voltage was correlated with conduction delay in RPV with EC (R = -0.401, p < .001). Conclusion Anatomical features suggesting a wider RPV carina region could predict the presence of EC, and potential with high voltage could be helpful for detecting EC connection sites.
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Affiliation(s)
- Takeshi Nehashi
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Takashi Kaneshiro
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Minoru Nodera
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Shinya Yamada
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
- Department of Arrhythmia and Cardiac PacingFukushima Medical UniversityFukushimaJapan
| | - Yasuchika Takeishi
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
- Department of Arrhythmia and Cardiac PacingFukushima Medical UniversityFukushimaJapan
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10
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Kiedrowicz RM, Wielusinski M, Krasnik W, Jankowska O, Zakrzewski S, Duda L, Peregud-Pogorzelska M, Kladna A, Kazmierczak J. The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation. J Clin Med 2023; 12:5056. [PMID: 37568458 PMCID: PMC10420066 DOI: 10.3390/jcm12155056] [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: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes. METHODS A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments. RESULTS Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that AFR was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model. CONCLUSIONS Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.
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Affiliation(s)
- Radoslaw M. Kiedrowicz
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Maciej Wielusinski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Wojciech Krasnik
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Olga Jankowska
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Szymon Zakrzewski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | - Lukasz Duda
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
| | | | - Aleksandra Kladna
- Department of History of Medicine and Medical Ethics, Pomeranian Medical University, Rybacka 1, 70-204 Szczecin, Poland
| | - Jaroslaw Kazmierczak
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland (O.J.)
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11
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Sousa PA, Barra S, Saleiro C, Khoueiry Z, Adão L, Primo J, Lagrange P, Lebreiro A, Fonseca P, Pereira M, Puga L, Oliveiros B, Elvas L, Gonçalves L. Ostial vs. wide area circumferential ablation guided by the Ablation Index in paroxysmal atrial fibrillation. Europace 2023; 25:euad160. [PMID: 37345859 PMCID: PMC10286571 DOI: 10.1093/europace/euad160] [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] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) guided by the Ablation Index (AI) has shown high acute and mid-term efficacy in the treatment of paroxysmal atrial fibrillation (AF). Previous data before the AI-era had suggested that wide-area circumferential ablation (WACA) was preferable to ostial ablation. However, with the use of AI, we hypothesize that ostial circumferential ablation is non-inferior to WACA and can improve outcomes in paroxysmal AF. METHODS AND RESULTS Prospective, multicentre, non-randomized, non-inferiority study of consecutive patients were referred for paroxysmal AF ablation from January 2020 to September 2021. All procedures were performed using the AI software, and patients were separated into two different groups: WACA vs. ostial circumferential ablation. Acute reconnection, procedural data, and 1-year arrhythmia recurrence were assessed. During the enrolment period, 162 patients (64% males, mean age of 60 ± 11 years) fulfilled the study inclusion criteria-81 patients [304 pulmonary vein (PV)] in the WACA group and 81 patients (301 PV) in the ostial group. Acute PV reconnection was identified in 7.9% [95% confidence interval (CI), 4.9-11.1%] of PVs in the WACA group compared with 3.3% (95% CI, 1.8-6.1%) of PVs in the ostial group [P < 0.001 for non-inferiority; adjusted odds ratio 0.51 (95% CI, 0.23-0.83), P = 0.05]. Patients in the WACA group had longer ablation (35 vs. 29 min, P = 0.001) and procedure (121 vs. 102 min, P < 0.001) times. No significant difference in arrhythmia recurrence was seen at 1-year of follow-up [11.1% in WACA vs. 9.9% in ostial, hazard ratio 1.13 (95% CI, 0.44-1.94), P = 0.80 for superiority]. CONCLUSION In paroxysmal AF patients treated with tailored AI-guided PVI, ostial circumferential ablation is not inferior to WACA with regard to acute PV reconnection, while allowing quicker procedures with less ablation time.
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Affiliation(s)
- Pedro A Sousa
- Pacing and Electrophysiology Unit, Department of Cardiology, Coimbra’s Hospital and University Center, Morada: Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, V. N. Gaia, Portugal
| | - Carolina Saleiro
- Pacing and Electrophysiology Unit, Department of Cardiology, Coimbra’s Hospital and University Center, Morada: Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal
| | - Ziad Khoueiry
- Department of Cardiology, Clinique Saint Pierre, Perpignan, France
| | - Luís Adão
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - João Primo
- Department of Cardiology, Vila Nova de Gaia and Espinho Hospital Center, V. N. Gaia, Portugal
| | | | - Ana Lebreiro
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Vila Nova de Gaia and Espinho Hospital Center, V. N. Gaia, Portugal
| | | | - Luís Puga
- Pacing and Electrophysiology Unit, Department of Cardiology, Coimbra’s Hospital and University Center, Morada: Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal
| | | | - Luís Elvas
- Pacing and Electrophysiology Unit, Department of Cardiology, Coimbra’s Hospital and University Center, Morada: Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal
| | - Lino Gonçalves
- Pacing and Electrophysiology Unit, Department of Cardiology, Coimbra’s Hospital and University Center, Morada: Praceta Prof Mota Pinto, Coimbra 3000-075, Portugal
- ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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12
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Heeger CH, Sano M, Popescu SȘ, Subin B, Feher M, Phan HL, Kirstein B, Vogler J, Eitel C, Hatahet S, Kuck KH, Tilz RR. Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol-the FAST AND FURIOUS PVI study. Europace 2023; 25:880-888. [PMID: 36546582 PMCID: PMC10062369 DOI: 10.1093/europace/euac243] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS The very high-power short-duration (vHP-SD) radiofrequency (RF) ablation concept of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective, and faster procedures. Utilizing conventional ablation, the 'close protocol' has been verified. Since lesion formation of vHP-SD ablation creates wider but shallower lesions we adapted the close protocol to an individualized and tighter 'very-close protocol' of 3-4 mm of inter-lesion distance (ILD) at the anterior and 5-6 mm at the posterior aspect of the left atrium using vHP-SD only. Here, we evaluated the safety and efficacy of vHP-SD ablation for PVI utilizing a very-close protocol in comparison with standard ablation. METHODS AND RESULTS A total of 50 consecutive patients with symptomatic AF were treated with a very-close protocol utilizing vHP-SD (vHP-SD group). The data were compared with 50 consecutive patients treated by the ablation-index-guided strategy (control group). The mean RF time was 352 ± 81 s (vHP-SD) and 1657 ± 570 s (control, P < 0.0001), and the mean procedure duration was 59 ± 13 (vHP-SD) and 101 ± 38 (control, P < 0.0001). The first-pass isolation rate was 74% (vHP-SD) and 76% (control, P = 0.817). Severe adverse events were reported in 1 (2%, vHP-SD) and 3 (6%, control) patients (P = 0.307). A 12-month recurrence-free survival was 78% (vHP-SD) and 64% (control, P = 0.142). PVI durability assessed during redo-procedures was 75% (vHP-SD) vs. 33% (control, P < 0.001). CONCLUSIONS PVI solely utilizing vHP-SD via a very-close protocol provides safe and effective procedures with a high rate of first-pass isolations. The procedure duration and ablation time were remarkably low. A 12-month follow-up and PVI durability are promising.
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Affiliation(s)
- Christian-H Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Makoto Sano
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
- Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Sorin Ștefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Behnam Subin
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Huong-Lan Phan
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Sascha Hatahet
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
- LANS Cardio, Stephansplatz 5, Hamburg 20354, Germany
| | - Roland R Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck D-23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- LANS Cardio, Stephansplatz 5, Hamburg 20354, Germany
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13
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Krzyżanowski K, Kiliszek M, Uziębło-Życzkowska B, Smalc-Stasiak M, Winkler A, Krzesiński P. The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5250. [PMID: 37047866 PMCID: PMC10094726 DOI: 10.3390/ijerph20075250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION How wide the encircling line is made may influence the outcomes of pulmonary vein isolation (PVI). In the present study we hypothesised that the distance between the lines encircling the pulmonary veins may correspond with the extent of wide antral circumferential ablation (WACA). The aim of the study was to assess the impact of the distance and the area between the lines on the posterior wall of the left atrium on first-pass isolation rate and 12-month freedom from atrial arrhythmia in patients undergoing PVI ablation. METHODS AND RESULTS One hundred sixteen patients underwent circumferential ablation index (AI)-guided PVI. The distance between the encircling ablation lines was measured off-line between the uppermost points (right and left) and the lowest points and as the area between the encircling lines on the posterior wall. The first-pass isolation rate and 12-month freedom from atrial arrhythmia were 59% and 73%, respectively. Distance between the encircling lines measured linearly or as the area of the posterior wall, assessed as direct values or indexed to left atrial dimensions, did not differ between patients with and without first-pass isolation or between patients with and without recurrences of atrial arrhythmia. CONCLUSIONS The distance between the ablation lines did not influence the rate of first-pass isolation and arrhythmia recurrence in the long-term follow-up after PVI procedures incorporating the ablation index protocol.
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Affiliation(s)
- Krystian Krzyżanowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
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14
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Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Madaffari A, Seiler J, Mühl A, Tanner H, Roten L, Reichlin T. Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters. J Cardiovasc Electrophysiol 2023; 34:292-299. [PMID: 36490307 DOI: 10.1111/jce.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Nakashima T, Nagase M, Shibahara T, Ono D, Yamada T, Tanabe G, Suzuki K, Yamaura M, Ido T, Takahashi S, Okura H, Aoyama T. Revisiting exit block after entrance block: Investigation of ablation index-guided pulmonary vein isolation. Pacing Clin Electrophysiol 2023; 46:144-151. [PMID: 36527191 DOI: 10.1111/pace.14646] [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: 10/13/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Unidirectional block, left atrium to pulmonary vein (LA-PV) entrance block without PV-LA exit block, has not been fully investigated in the setting of ablation index (AI)-guided pulmonary vein (PV) isolation (PVI). The aim of this study was to investigate unidirectional blocks during AI-guided PVI. METHODS After achieving entrance block, exit block was evaluated by pacing from the catheter placed in the PV. Local PV musculature capture without conduction to the LA was necessary to prove exit block. RESULTS In total, 441 PVs (including nine left common PVs) from 113 consecutive patients (mean age: 71 ± 12 years, 77 men, 61 paroxysmal atrial fibrillation cases) who underwent initial AI-guided PVI for atrial fibrillation were studied. Entrance block was achieved in all PVs. of the 247/441 (56%) PVs showing local PV musculature capture, 5/247 (2.0%) showed unidirectional blocks. Three of the five PVs (left superior and inferior PVs in one patient; right superior PV in another patient) showed LA-PV reconnection, requiring additional ablation to achieve bidirectional block during the procedure. Two of the five PVs (left superior and inferior PVs in one patient) showed LA-PV reconnection, and thereafter, LA-PV conduction became blocked again spontaneously, leading to bidirectional block without further ablation during the procedure. CONCLUSION AI-guided PVI presented a low prevalence of unidirectional block (2%), using entrance block alone as the endpoint of PVI could therefore be justified.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan.,Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masaru Nagase
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Taro Shibahara
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Daiju Ono
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Gen Tanabe
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Keita Suzuki
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Makoto Yamaura
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan.,Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Takahisa Ido
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan.,Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shigekiyo Takahashi
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takuma Aoyama
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan.,Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan.,Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
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16
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Ablation index-guided high-power vs. moderate-power cavotricuspid isthmus ablation. Heart Vessels 2023; 38:90-95. [PMID: 35852611 DOI: 10.1007/s00380-022-02125-9] [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: 04/03/2022] [Accepted: 06/15/2022] [Indexed: 01/06/2023]
Abstract
Ablation index (AI)-guided ablation is useful for pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation. However, the impact of radiofrequency (RF) application power on CTI ablation with a fixed target AI remains unclear. One-hundred-thirty drug-refractory atrial fibrillation and/or atrial flutter patients who underwent AI-guided CTI ablation with or without PVI between July 2020 and August 2021 were randomly assigned to high-power (45 W) and moderate-power (35 W) groups. We performed CTI ablation with the same target AI value in both groups: 500 for the anterior 1/3 segments and 450 for the posterior 2/3 segments. In total, first-pass conduction block of the CTI was obtained in 111 patients (85.4%), with 7 patients (5.4%) showing CTI reconnection. The rate of first-pass conduction block was significantly higher in the 45 W group (61/65, 93.8%) than in the 35 W group (50/65, 76.9%, P = 0.01). CTI ablation and CTI fluoroscopy time were significantly shorter in the 45 W group than in the 35 W group (CTI ablation time: 192.3 ± 84.8 vs. 319.8 ± 171.4 s, P < 0.0001; CTI fluoroscopy time: 125.2 ± 122.4 vs. 171.2 ± 124.0 s, P = 0.039). Although there was no significant difference, steam pops were identified in two patients from the 45 W group at the anterior segment of the CTI. The 45 W ablation strategy was faster and provided a higher probability of first-pass conduction block than the 35 W ablation strategy for CTI ablation with a fixed AI target.
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High-power short-duration versus low-power long-duration ablation guided by the ablation index. Int J Cardiol 2023; 370:209-214. [PMID: 36228764 DOI: 10.1016/j.ijcard.2022.10.013] [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: 06/10/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
AIMS To compare the two different ablation strategies, both guided by the Ablation Index (AI), in the setting of atrial fibrillation (AF) ablation: high-power short-duration (HPSD) ablation using 40 W on the posterior wall and 50 W elsewhere versus low-power long-duration (LPLD) using 25 W posteriorly and 35 W elsewhere. METHODS Prospective, multicenter nonrandomized, noninferiority study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. Ablation was guided by the AI (≥500 for anterior segments, ≥450 for the roof and inferior segments and 400 posteriorly) and an interlesion distance (ILD) ≤ 6 mm. Patients were separated into two groups: HPSD vs LPLD. Acute reconnection (after adenosine trial) and 2-year outcomes were assessed. RESULTS 160 patients (61% males, median age of 62 [IQR 51-69] years), fulfilled the study inclusion criteria - 80 patients (316 pulmonary veins [PV]) in the HPSD group and 80 patients (314 PV) in the LPLD. The probability of acute PV reconnection was similar between both groups: 2.2% in HPSD, 95%CI 0.6% to 3.8% vs. 3.4% in LPLD, 95%CI 1.4% to 5.4%; p < 0.001 for noninferiority. Median PV ablation time (20 min vs 30 min, p < 0.01) and procedure duration (80 min vs 100 min, p < 0.001) were shorter in the HPSD group. After a median follow-up of 26 months, arrhythmia recurrence was similar between groups (17.5% in HPSD group vs. 18.8% in LPLD group, p = 0.79). CONCLUSIONS In paroxysmal AF patients treated with the Ablation Index, a HPSD strategy is noninferior to the more standard LPLD ablation, while allowing for quicker procedures with shorter ablation times.
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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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Schade A, Costello-Boerrigter L, Deneke T, Steinborn F, Chapran M, Vathie K, Milisavljevic N, Franz M, Surber R, Assani M, Hamo H, Khshfeh M, Lauten A, Mattea V. Oesophageal safety in voltage-guided atrial fibrillation ablation using ablation index or contact force only: a prospective comparison. Europace 2022; 24:1909-1916. [PMID: 35851917 DOI: 10.1093/europace/euac103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Left atrial ablation using radiofrequency (RF) is associated with endoscopically detected thermal oesophageal lesions (EDELs). The aim of this study was to compare EDEL occurrence after conventional contact force-guided (CFG) RF ablation vs. an ablation index-guided (AIG) approach in clinical routine of voltage-guided ablation (VGA). Predictors of EDEL were also assessed. METHODS AND RESULTS This study compared CFG (n = 100) with AIG (n = 100) in consecutive atrial fibrillation ablation procedures, in which both pulmonary vein isolation and VGA were performed. In the AIG group, AI targets were ≥500 anteriorly and ≥350-400 posteriorly. Upper endoscopy was performed after ablation.The CFG and AIG groups had comparable baseline characteristics. The EDEL occurred in 6 and 5% (P = 0.86) in the CFG and AIG groups, respectively. Category 2 lesions occurred in 4 and 2% (P = 0.68), respectively. All EDEL healed under proton pump inhibitor therapy. The AI > 520 was the only predictor of EDEL [odds ratio (OR) 3.84; P = 0.039]. The more extensive Category 2 lesions were predicted by: AI max > 520 during posterior ablation (OR 7.05; P = 0.042), application of posterior or roof lines (OR 5.19; P = 0.039), existence of cardiomyopathy (OR 4.93; P = 0.047), and CHA2DS2-VASc score (OR 1.71; P = 0.044). The only Category 2 lesion with AI max < 520 (467) occurred in a patient with low body mass index. CONCLUSIONS Both methods were comparable with respect to clinical complications and EDEL. In consideration of previous reconnection data and our study results regarding oesophageal safety, optimal AI target range might be between 400 and 450.
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Affiliation(s)
- Anja Schade
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Lisa Costello-Boerrigter
- Department of Cardiology and Center for Clinical Studies, Central Clinic Bad Berka, Robert-Koch-Alle 9, 99438 Bad Berka, Germany
| | - Thomas Deneke
- Department of Cardiology II/Interventional Electrophysiology, Rhoen-Klinikum Campus Bad Neustadt, Von-Guttenberg Str. 11, 97616 Bad Neustadt, Germany
| | - Frank Steinborn
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Mykhaylo Chapran
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Koroush Vathie
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Nemanja Milisavljevic
- Department of Internal Medicine 2, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Marcus Franz
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Ralf Surber
- Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Mohamad Assani
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Hussam Hamo
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Muhammed Khshfeh
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Alexander Lauten
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Violeta Mattea
- Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
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Effectiveness and Safety of High-Power Radiofrequency Ablation Guided by Ablation Index for the Treatment of Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5609764. [PMID: 35991126 PMCID: PMC9391153 DOI: 10.1155/2022/5609764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Background To investigate the efficacy and safety of ablation index- (AI-) guided high-power radiofrequency ablation in the treatment of atrial fibrillation (AF). Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50 W, 40 W, and 30 W; AI = 500). And a total of 100 consecutive patients with paroxysmal AF undergoing pulmonary vein isolation (PVI) were included. The patients were divided into two groups (n = 50 for each) as follows: control group, treated with conventional power (30 W) ablation mode; and study group, treated with high power (40 W) radiofrequency ablation mode. All groups were treated with the same AI value guided the ablation (target AI = 400/500 on posterior/anterior wall, respectively). Acute pulmonary vein (PV) reconnection was assessed post adenosine administration 20 minutes after ablation. Subsequently, pathological observation of porcine heart lesions and necrotic tissue was performed. Additionally, statistical analyses were carried out on patients' baseline clinical characteristics, surgical data, and total RF energy. Results In swine ventricular endocardial RF applications, compared with 40 W and 30 W, the use of 50 W was associated with shallower tissue lesion depth (p < 0.001) and greater lesion maximum diameter (p < 0.001). Compared with 40 W and 30 W, tissue necrosis caused by 50 W was the deepest and largest (p < 0.001). In pulmonary vein isolation (PVI), there was no significant difference in baseline data between the study group and control group (p > 0.05). In patients with paroxysmal atrial fibrillation, the procedure time in the high-power group was significantly shortened (p < 0.001). The ablation time was significantly shorter (p < 0.001). Compared with control group, RF energy per point and acute pulmonary vein (PV) reconnection were lower (p < 0.001), and first-pass PVI was higher (p < 0.01) in study group. There were no significant differences in complications and sinus rhythm maintenance at 12 months between the two groups (p > 0.05). Conclusions Compared with conventional (30 W) PVI, AI-guided high-power (40 W) was safe and associated with shorter procedure time and reduced acute PV reconnection.
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Jiang R, Chen M, Fan J, Yi F, Tang A, Liu X, Zhu W, Liu S, Huang X, Liu Q, Ju W, Zhang X, Li J, He J, Shi L, Zhou G, Wang Y, Fu G, Jiang C. Efficacy of ablation index-guided pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:1186-1193. [PMID: 35939332 DOI: 10.1111/pace.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation index (AI) is a novel technology of ablation lesion quality to help improve homogeneity of lesion size and continuity. In this study, we aim to evaluate whether AI-guided PVI improves clinical outcomes compared to CF-guided PVI in patients with paroxysmal AF (PAF). METHODS Patients undergoing first-time radiofrequency ablation for PAF were randomized in a 2:1 ratio to two groups: AI-guided PVI and CF-guided PVI. In the AI group, AI ≥500 was recommended at the anterior/superior/inferior walls, 350-400 at the posterior wall, and inter-lesion distance ≤4 mm. The primary endpoint is the freedom from atrial arrhythmia recurrence during 12 months follow-up, without antiarrhythmic drug therapy (ADT). The key secondary endpoints include intra-procedural efficiency and peri-procedural complications. RESULTS 225 patients were randomized (AI group (n = 149) and CF group(n = 76)). First-pass isolation rate in AI group was significantly higher than that in CF group (58.3% vs. 43.4%, p = 0.035). After a median follow-up of 12.2 months, 154/225(68.4%) of patients were free from atrial arrhythmia recurrence without ADT, which was higher in AI group compared with CF group, but without significant difference (71.1% vs. 63.2%, p = 0.253). The incidence of peri-procedural complications is low and without difference between two groups. CONCLUSIONS AI-guided ablation provided higher acute efficacy than CF-guided ablation in PV isolation for patients with paroxysmal AF. The long-term success rate in AI group was higher than CF group, but did not reach statistical significance. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Fan
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Fu Yi
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Anli Tang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingpeng Liu
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Wenqing Zhu
- The Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaowen Liu
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobo Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi Zhang
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Jie Li
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jiangui He
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Shi
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Genqing Zhou
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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22
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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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Di Biase L, Monir G, Melby D, Tabereaux P, Natale A, Manyam H, Athill C, Delaughter C, Patel A, Gentlesk P, Liu C, Arkles J, McElderry HT, Osorio J. Composite Index Tagging for PVI in Paroxysmal AF. JACC Clin Electrophysiol 2022; 8:1077-1089. [DOI: 10.1016/j.jacep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
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Xiong Q, Liao J, Chen W, Xiao P, Du H, He Q, Yin Y, Ling Z, Chen S. Tailored Target Ablation Index Guided Pulmonary Vein Isolation in Treating Paroxysmal Atrial Fibrillation: A Single Center Randomized Study in Asian Population (AI-Asian-I). Front Cardiovasc Med 2022; 9:937913. [PMID: 35872904 PMCID: PMC9300915 DOI: 10.3389/fcvm.2022.937913] [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: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficacy and safety of lower ablation indexes (AI) guided pulmonary vein isolation (PVI) in treating paroxysmal atrial fibrillation (AF). Methods Ninety patients with paroxysmal AF scheduled for radiofrequency ablation were randomly divided into three groups. The AI targets for PVI were as follows: In group A/B/C, 550/500/450 for roof and anterior wall, and 400/350/300 for posterior/inferior wall. The first-pass PVI rate, ablation time, complications and recurrence of atrial tachyarrhythmia (ATa) were compared. Results The mean age was 62.5 years (male: 63.0%), mean body mass index (BMI): 24.35 ± 3.66 kg/m2. The baseline characteristics were comparable. There was no significant difference in the first-pass PVI rate among the three groups (left-sided-PV: 66.7% vs. 80% vs. 73.3%, P = 0.51; right-sided-PV: 70% vs. 83.3% vs. 73.3%, P = 0.64), also with similar gap rate during the procedural waiting time. At 1-year follow-up there was no significant difference in the recurrence rate of ATa among the three groups (10% vs. 13.3% vs. 13.3%, P = 1.00). The ablation time in the Group C was significantly less than that in the other two groups (47.8 min. vs. 47.0 min. vs. 36.6 min, P < 0.001). Higher AI seemed to link a non-significant trend toward higher rate of pericardial effusion (group A + B vs. group C:6.7% vs. 0%, P = 0.30), although the rate of overall complications was not different among the three groups. Conclusion This randomized study shows that, a relatively lower target AI guided ablation may be similarly effective to achieve PVI with significantly reduced ablation time and obtain similar clinical outcome in treating paroxysmal AF in Asian population. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT:04549714].
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Nair GM, Birnie DH, Wells GA, Nery PB, Redpath CJ, Sarrazin JF, Roux JF, Parkash R, Bernier M, Sterns LD, Novak P, Veenhuyzen G, Morillo CA, Singh SM, Sturmer M, Chauhan VS, Angaran P, Essebag V. Augmented wide area circumferential catheter ablation for reduction of atrial fibrillation recurrence (AWARE) trial: Design and rationale. Am Heart J 2022; 248:1-12. [PMID: 35219715 DOI: 10.1016/j.ahj.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recurrence of atrial fibrillation (AF) after a pulmonary vein isolation procedure is often due to electrical reconnection of the pulmonary veins. Repeat ablation procedures may improve freedom from AF but are associated with increased risks and health care costs. A novel ablation strategy in which patients receive "augmented" ablation lesions has the potential to reduce the risk of AF recurrence. OBJECTIVE The Augmented Wide Area Circumferential Catheter Ablation for Reduction of Atrial Fibrillation Recurrence (AWARE) Trial was designed to evaluate whether an augmented wide-area circumferential antral (WACA) ablation strategy will result in fewer atrial arrhythmia recurrences in patients with symptomatic paroxysmal AF, compared with a conventional WACA strategy. METHODS/DESIGN The AWARE trial was a multicenter, prospective, randomized, open, blinded endpoint trial that has completed recruitment (ClinicalTrials.gov NCT02150902). Patients were randomly assigned (1:1) to either the control arm (single WACAlesion set) or the interventional arm (augmented- double WACA lesion set performed after the initial WACA). The primary outcome was atrial tachyarrhythmia (AA; atrial tachycardia [AT], atrial flutter [AFl] or AF) recurrence between days 91 and 365 post catheter ablation. Patient follow-up included 14-day continuous ambulatory ECG monitoring at 3, 6, and 12 months after catheter ablation. Three questionnaires were administered during the trial- the EuroQuol-5D (EQ-5D) quality of life scale, the Canadian Cardiovascular Society Severity of Atrial Fibrillation scale, and a patient satisfaction scale. DISCUSSION The AWARE trial was designed to evaluate whether a novel approach to catheter ablation reduced the risk of AA recurrence in patients with symptomatic paroxysmal AF.
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Affiliation(s)
- Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | - Pablo B Nery
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | | | - Ratika Parkash
- Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada
| | - Martin Bernier
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Laurence D Sterns
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Paul Novak
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - George Veenhuyzen
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carlos A Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Marcio Sturmer
- Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Vijay S Chauhan
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vidal Essebag
- McGill University Health Centre, Montreal, Quebec, Canada; Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada
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Sousa PA, Barra S, Adão L, Primo J, Khoueiry Z, Puga L, Lebreiro A, Fonseca P, Lagrange P, Gonçalves L. Assessment of the Need of a Waiting Period after Pulmonary Vein Isolation with the Ablation Index Software. J Cardiovasc Electrophysiol 2022; 33:1725-1733. [PMID: 35637604 DOI: 10.1111/jce.15568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/20/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Since the widespread availability of contact-force sensing catheters, the need of a waiting period after pulmonary vein isolation (PVI) has not been reassessed. We aim to evaluate whether a waiting period is still necessary after PVI guided by the Ablation Index (AI). METHODS Prospective, multicenter, randomized study of consecutive patients referred for paroxysmal atrial fibrillation (AF) ablation from May 2019 to February 2020. Patients were randomized in a 1:1 ratio to PVI with versus without a waiting period of 20 minutes. Acute pulmonary vein (PV) reconnection after adenosine challenge was the primary endpoint. A per-protocol analysis was designed to determine whether a strategy of dismissing the waiting period after PVI was noninferior to waiting 20minutes for identifying acute PV reconnection. PVI was guided by tailored AI values and an inter-lesion distance ≤6mm. RESULTS During the enrollment period, 167 patients (56% males, mean age of 57±14 years) fulfilled the study inclusion criteria - 84 patients (308 PV) in the waiting period group (group A) and 83 patients (314 PV) in the group without a waiting period (group B). Acute PV reconnection was identified in 3.8% (95% CI, 1.7% to 5.9%) of PVs in the study group B compared to 2.9% (95% CI, 1.0% to 4.8%) of PVs in the group A (p=0.002 for non-inferiority). At 1-year follow-up there was no significant difference in arrhythmia recurrence between groups (9.5% in group A vs. 9.6% in group B, HR 1.03 [95% CI, 0.39-2.73], p=0.98). CONCLUSIONS In paroxysmal AF patients submitted to ablation, a tailored PVI guided by the Ablation Index rendered a 20-minute waiting period unnecessary. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pedro A Sousa
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrábida, V. N. Gaia, Portugal
| | - Luís Adão
- Cardiology Department, University Hospital Center of São João, Porto, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia & Espinho Hospital Center, V. N. Gaia, Portugal
| | - Ziad Khoueiry
- Cardiology Department, Clinique Saint Pierre, Perpignan, France
| | - Luís Puga
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - Ana Lebreiro
- Cardiology Department, University Hospital Center of São João, Porto, Portugal
| | - Paulo Fonseca
- Cardiology Department, Vila Nova de Gaia & Espinho Hospital Center, V. N. Gaia, Portugal
| | | | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.,ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Solimene F, Stabile G, Ramos P, Segreti L, Cauti FM, De Sanctis V, Maggio R, Ramos-Maqueda J, Mont L, Schillaci V, Malacrida M, Garcia-Bolao I. Improved procedural workflow for catheter ablation of paroxysmal AF with high-density mapping system and advanced technology: Rationale and study design of a multicenter international study. Clin Cardiol 2022; 45:597-604. [PMID: 35446440 PMCID: PMC9175242 DOI: 10.1002/clc.23806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. METHODS The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single-arm, international post-market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post-ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post-ablation to proactively detect and manage any recurrences within the 90-day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post-ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. DISCUSSION The DELETE AF trial will provide additional knowledge on long-term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at ClinicalTrials.gov (NCT05005143).
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Affiliation(s)
| | | | - Pablo Ramos
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | | | - Javier Ramos-Maqueda
- Department of Cardiology, Section for Electrophysiology, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
| | - Lluis Mont
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Ignacio Garcia-Bolao
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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Sun Y, Xiao X, Yin X, Gao L, Yu X, Zhang R, Wang Z, Dai S, Yang Y, Xia Y. Impact of baseline impedance of pulmonary vein antrum on success of catheter ablation for paroxysmal atrial fibrillation guided by ablation index. BMC Cardiovasc Disord 2022; 22:179. [PMID: 35439961 PMCID: PMC9016960 DOI: 10.1186/s12872-022-02530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Ablation index (AI) is an effective ablation quality marker. Impedance is also an important factor for lesion formation. The present study evaluated the influence of the baseline impedance in the effect of ablation for atrial fibrillation (AF) guided by AI. Methods This was a retrospective study. 101 patients with paroxysmal AF (PAF) were enrolled. All patients underwent radiofrequency ablation guided by the same AI strategy. The ablation strategy was pulmonary vein (PV) isolation with non-PV triggers ablation. The baseline impedance of the ablation points was recorded. The patients were followed up every 3 months or so. Results During a median follow-up of 12 (4–14) months, freedom from AF/atrial tachycardia recurrence were 82.2%. No difference existed in baseline characteristics between the success group and the recurrence group. The average baseline impedance was 124.3 ± 9.7 Ω. The baseline impedance of the ablation points in success group was lower compared to the recurrence group (122.9 ± 9.4 vs. 130.5 ± 8.8 Ω, P < 0.01). The ratio of impedance drop in the success group was higher than the recurrence group ([8.8 ± 1.4]% vs. [8.1 ± 1.2]%, P = 0.03). Multivariate analysis revealed that baseline impedance, PAF duration and AI were the independent predictors of AF recurrence. The cumulative free of recurrence rate of low-impedance group (≤ 124 Ω, n = 54) was higher than that of high-impedance group. Conclusion Baseline impedance correlates with clinical outcome of radiofrequency ablation for PAF guided by AI. Higher impedance in the same AI strategy may result in an ineffective lesion which probably causes recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02530-y.
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Affiliation(s)
- Yuanjun Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xianjie Xiao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China.
| | - Lianjun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xiaohong Yu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Rongfeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Zhongzhen Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Shiyu Dai
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Yanzong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China.
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Sousa PA, Puga L, Adão L, Primo J, Khoueiry Z, Lebreiro A, Fonseca P, Lagrange P, Elvas L, Gonçalves L. Two years after pulmonary vein isolation guided by ablation index—a multicenter study. J Arrhythm 2022; 38:346-352. [PMID: 35785367 PMCID: PMC9237314 DOI: 10.1002/joa3.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Pedro A. Sousa
- Pacing & Electrophysiology Unit, Cardiology Department Coimbra's Hospital and University Center Coimbra Portugal
| | - Luís Puga
- Pacing & Electrophysiology Unit, Cardiology Department Coimbra's Hospital and University Center Coimbra Portugal
| | - Luís Adão
- Cardiology Department University Hospital Center of São João Porto Portugal
| | - João Primo
- Cardiology Department Vila Nova de Gaia & Espinho Hospital Center Portugal
| | - Ziad Khoueiry
- Cardiology Department Clinique Saint Pierre Perpignan France
| | - Ana Lebreiro
- Cardiology Department University Hospital Center of São João Porto Portugal
| | - Paulo Fonseca
- Cardiology Department Vila Nova de Gaia & Espinho Hospital Center Portugal
| | | | - Luís Elvas
- Pacing & Electrophysiology Unit, Cardiology Department Coimbra's Hospital and University Center Coimbra Portugal
| | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology Department Coimbra's Hospital and University Center Coimbra Portugal
- ICBR, Faculty of Medicine University of Coimbra Coimbra Portugal
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Hijioka N, Kaneshiro T, Nehashi T, Amami K, Nodera M, Yamada S, Kamioka M, Ishida T, Takeishi Y. Procedural characteristics of pulmonary vein isolation with high-power short-duration setting compared to conventional setting. BMC Cardiovasc Disord 2022; 22:14. [PMID: 35067224 PMCID: PMC8785467 DOI: 10.1186/s12872-022-02459-2] [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: 11/14/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to investigate the safety and efficacy of high-power short-duration (HP-SD) ablation compared to conventional ablation in patients with atrial fibrillation (AF). Methods We enrolled consecutive 158 drug-refractory symptomatic AF patients (119 males, mean age 63 ± 10 years) who had undergone first radiofrequency pulmonary vein isolation (PVI). PVI was performed using the conventional setting (20–35 W) in 73 patients (Conventional group) and using the HP-SD setting (45–50 W) in 85 patients (HP-SD group). The rate of first pass isolation, remaining gaps after circumferential ablation, dormant conduction, and the radiofrequency application time in each pulmonary vein (PV) were compared between the groups. Results The first pass isolation ratio was significantly higher in the HP-SD group than in the Conventional group (81% vs. 65%, P = 0.027) in the right PV, but did not differ in the left PV. The remaining gaps were fewer in the right superior PV (4% vs. 21%, P = 0.001) and left inferior PV (1% vs. 8%, P = 0.032) areas, and the radiofrequency application time in each PV was shorter (right PV, 12.0 ± 8.9 min vs. 34.0 ± 31.7 min, P < 0.001; left PV, 10.6 ± 3.6 min vs. 25.7 ± 22.3 min, P < 0.001) in the HP-SD group than in the Conventional group. Conclusion The use of the HP-SD setting might contribute to improve the first pass isolation rate and to shorten the radiofrequency application time in each PV. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02459-2.
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Matsuura G, Fukaya H, Ogawa E, Kawakami S, Mori H, Saito D, Sato T, Nakamura H, Ishizue N, Oikawa J, Kishihara J, Niwano S, Ako J. Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: Insight from a porcine experimental study with 2 different LI-sensing catheters. J Cardiovasc Electrophysiol 2022; 33:380-388. [PMID: 35018687 DOI: 10.1111/jce.15356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local impedance (LI) can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). However, data on the effects of catheter contact angle on LI parameters are scarce. This study aimed to evaluate the influence of catheter contact angle on LI changes and lesion size with 2 different LI-sensing catheters in a porcine experimental study. METHODS Lesions were created by the INTELLANAV MiFi™ OI (MiFi) and the INTELLANAV STABLEPOINT™ (STABLEPOINT). RFCA was performed with 30 watts and a duration of 30 seconds. The CF (0, 5, 10, 20, and 30 g) and catheter contact angle (30°, 45°, and 90°) were changed in each set (n=8 each). The LI rise, LI drop, and lesion size were evaluated. RESULTS The LI rise increased as CF increased. There was no angular dependence with the LI rise under all CFs in the MiFi. On the other hand, the LI rise at 90° was lower than at 30° under 5 and 10 g of CF in STABLEPOINT. The LI drop increased as CF increased. Regarding the difference in catheter contact angles, the LI drop at 90° was lower than that at 30° for both catheters. The maximum lesion widths and surface widths were smaller at 90° than at 30°, whereas there were no differences in lesion depths. CONCLUSION The LI drop and lesion widths at 90° were significantly smaller than those at 30°, although the lesion depths were not different among the 3 angles for the MiFi and STABLEPOINT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Emiyu Ogawa
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Sota Kawakami
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Tamura S, Shimeno K, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Differences in the durability of left atrial posterior wall isolation based on the isolation process. J Interv Card Electrophysiol 2022; 65:45-51. [PMID: 34985641 DOI: 10.1007/s10840-021-01108-6] [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: 07/16/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The best strategy for durable left atrial posterior wall isolation (PWI) after completion of pulmonary vein isolation (PVI) is not yet determined. This study aimed to examine the differences in the durability of PWI based on the isolation process and the predictors of the reconduction of PWI. METHODS Among the 221 patients (mean age, 65 ± 11 years) with consecutive non-paroxysmal atrial fibrillation (AF) who completed PVI and PWI, 50 patients undergoing repeat AF ablation were enrolled and divided into the following groups based on how PWI was achieved at the initial procedure: by only the first line on the roof and floor line (group A), by additional gap ablation to the first line or second liner ablation next to the first line (group B), and by adjunct ablation inside the PW revealing the earliest activation (group C). RESULTS Reconduction of PWI occurred in 24 of the 50 patients (48%). The durability of PWI in groups A, B, and C was 81% (17 of 21 patients), 75% (6 of 8 patients), and 14% (3 of 21 patients), respectively (p < 0.01). In a multivariate analysis, the ablation inside the PW for PWI was the independent predictor of the reconduction of PWI (p < 0.001). CONCLUSION PWI achieved by the ablation inside the PW resulted in a high rate of reconduction. It may be necessary to aim to achieve the PWI without ablating the inside of the PW to prevent reconduction.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Kenichi Nakatsuji
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
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Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. Europace 2021; 24:874-886. [PMID: 34964469 DOI: 10.1093/europace/euab279] [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: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is an important alternative to antiarrhythmic drugs in the treatment of symptomatic atrial fibrillation. However, the inability to consistently achieve durable isolation of the pulmonary veins hampers the long-term efficacy of PVI procedures. The large number of factors involved in RF lesion formation and the complex interplay of these factors complicate reliable creation of durable and transmural ablation lesions. Various surrogate markers of ablation lesion formation have been proposed that may provide information on RF lesion completeness. Real-time assessment of these surrogates may aid in the creation of transmural ablation lesions, and therefore, holds potential to decrease the risk of PV reconnection and consequent post-PVI arrhythmia recurrence. Moreover, titration of energy delivery until lesions is transmural may prevent unnecessary ablation and subsequent adverse events. Whereas several surrogate markers of ablation lesion formation have been described over the past decades, a 'gold standard' is currently lacking. This review provides a state-of-the-art overview of ablation strategies that aim to enhance durability of RF-PVI, with special focus on real-time available surrogates of RF lesion formation in light of the biophysical basis of RF ablation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Kaneshiro T, Takeishi Y. Esophageal thermal injury in catheter ablation of atrial fibrillation. Fukushima J Med Sci 2021; 67:95-101. [PMID: 34803083 PMCID: PMC8784191 DOI: 10.5387/fms.2021-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary vein isolation is an established method for the catheter ablation of atrial fibrillation. Esophageal thermal injuries, such as esophageal erosion, ulceration and periesophageal nerve injury leading to gastric hypomotility, are important complications associated with pulmonary vein isolation. In this review article, we describe the mechanisms, characteristics and the predictors of esophageal thermal injury associated with pulmonary vein isolation.
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Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine/Arrhythmia and Cardiac Pacing, Fukushima Medical University
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine/Arrhythmia and Cardiac Pacing, Fukushima Medical University
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Smith A, Amin AK, El‐Zein R, Billakanty SR, Chopra N. Relationship between Surpoint Tag Index, a Radiofrequency Ablation lesion quality indicator, and Atrial wall thickness in Cavotricuspid isthmus Ablations exhibiting bidirectional block. J Arrhythm 2021; 38:118-125. [PMID: 35222758 PMCID: PMC8851572 DOI: 10.1002/joa3.12662] [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: 07/09/2021] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background An RFA lesion quality indicator, Surpoint Tag Index® (TI) incorporates key factors: power, time, and contact force, impacting lesion quality. TI accurately estimates lesion depth in animal studies. However, the relationship between TI and in‐vivo atrial wall thickness in patients exhibiting bidirectional block remains unknown. Objective To describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block. Methods Data from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point‐by‐point RF lesions (<45 W) utilizing a Thermocool Smarttouch® SF ablation catheter and CARTO‐3 mapping were retrospectively analyzed. Operators were blinded to TI data and CTI thickness. CTI thickness was obtained using ICE images on Cartosound pre‐ablation. Durable lesions were defined as part of a lesion set exhibiting bidirectional block of >30 min. Results In lesions exhibiting bidirectional block, the thinnest (1–2 mm; 5% lesions) and thickest (8–10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2–6 mm; 80%) correlated with a TI of 455 ± 72 (p = 0.001). There was a weak but positive correlation between TI and CTI thickness (r = 0.2; p ≤ 0.01). Examined in sectors, the anterior 1/3rd CTI was the thickest (4.8 ± 1.9 mm) but correlated with a similar TI value (479 ± 75 vs. 471 ± 70; p = 0.34) as the thinner middle 1/3rd (3.8 ± 1.7 mm; p ≤ 0.0001). Conclusion A mean TI value of 455 correlates with bidirectional block across the bulk of CTI with lower and higher values needed for the thinner and thicker portions, respectively. Tissue composition, aside from wall thickness, influences TI values for the creation of the bidirectional block.
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Affiliation(s)
- Alexander Smith
- Department of Internal Medicine Riverside Methodist Hospital Columbus Ohio USA
| | - Anish K. Amin
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Rayan El‐Zein
- Department of Internal Medicine OhioHealth Doctors Hospital Columbus Ohio USA
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
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De Bortoli A, Ole-Gunnar A, Torbjørn H. Relationship between ablation index and myocardial biomarkers after radiofrequency catheter ablation for atrial fibrillation. Indian Pacing Electrophysiol J 2021; 22:61-67. [PMID: 34861368 PMCID: PMC8981157 DOI: 10.1016/j.ipej.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Further in-vivo evidence is needed to support the usefulness of ablation index (AI) in guiding atrial fibrillation (AF) ablation. We aimed at evaluating the relationship between AI and other lesion indicators and the release of myocardial-specific biomarkers following radiofrequency AF ablation. Methods Forty-six patients underwent a first-time radiofrequency AF ablation and were prospectively enrolled in this study. Pulmonary vein isolation was performed by six experienced electrophysiologists with a point-by-point approach, guided by strict Visitag criteria and consistent AI target values. Myocardial-specific biomarkers troponin T and creatine kinase myocardial band were measured after 6 (TnT6 and CKMB6) and 20 h (TnT20 and CKMB20) following sheath removal. Ablation duration, impedance drop (ID), force-time integral (FTI) and AI were registered automatically and analyzed offline. Results TnT release was 985 ± 495 ng/L and 1038 ± 461 ng/L (p = ns) while CKMB release was 7.3 ± 2.7 μg/L and 6.5 ± 2.1 μg/L (p < 0.001) at 6 and 20 h respectively. Ablation duration, ID, FTI and AI were all significantly correlated with the release of myocardial-specific biomarkers both at 6 and 20 h. Ablation index showed the highest degree of correlation with TnT6, TnT20, CKMB6 and CKMB20 (Pearson's R 0.69, 0.69, 0.61, 0.64 respectively, p < 0.001). Multiple regression analysis demonstrated that AI had the strongest association with TnT6, TnT20, CKMB6 and CKMB20 (β 0.43, β 0.71, β 0.44 and β 0.43 respectively). Conclusion Ablation index appears as the strongest lesion indicator as measured by the release of myocardial-specific biomarkers following radiofrequency catheter ablation for AF.
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Affiliation(s)
- Alessandro De Bortoli
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Anfinsen Ole-Gunnar
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Holm Torbjørn
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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37
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Mulder MJ, Kemme MJB, Hopman LHGA, Hagen AMD, van de Ven PM, Hauer HA, Tahapary GJM, van Rossum AC, Allaart CP. Ablation Index-guided point-by-point ablation versus Grid annotation-guided dragging for pulmonary vein isolation: A randomized controlled trial. J Cardiovasc Electrophysiol 2021; 33:64-72. [PMID: 34820931 PMCID: PMC9299027 DOI: 10.1111/jce.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
Introduction Radiofrequency (RF) atrial fibrillation (AF) ablation using a catheter dragging technique may shorten procedural duration and improve durability of pulmonary vein isolation (PVI) by creating uninterrupted linear ablation lesions. We compared a novel AF ablation approach guided by Grid annotation allowing for “drag lesions” with a standard point‐by‐point ablation approach in a single‐center randomized study. Methods Eighty‐eight paroxysmal or persistent AF patients were randomized 1:1 to undergo RF‐PVI with either a catheter dragging ablation technique guided by Grid annotation or point‐by‐point ablation guided by Ablation Index (AI) annotation. In the Grid annotation arm, ablation was visualized using 1 mm³ grid points coloring red after meeting predefined stability and contact force criteria. In the AI annotation arm, ablation lesions were created in a point‐by‐point fashion with AI target values set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Patients were followed up for 12 months after PVI using ECGs, 24‐h Holter monitoring and a mobile‐based one‐lead ECG device. Results Procedure time was not different between the two randomization arms (Grid annotation 71 ± 19 min, AI annotation 72 ± 26 min, p = .765). RF time was significantly longer in the Grid annotation arm compared with the AI annotation arm (49 ± 8 min vs. 37 ± 8 min, respectively, p < .001). Atrial tachyarrhythmia recurrence was documented in 10 patients (23%) in the Grid annotation arm compared with 19 patients (42%) in the AI annotation arm with time to recurrence not reaching statistical significance (p = .074). Conclusions This study shows that a Grid annotation‐guided dragging approach provides an alternative to point‐by‐point RF‐PVI using AI annotation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Yasumoto K, Egami Y, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Tsuda M, Okamoto N, Tanaka A, Matsunaga-Lee Y, Yano M, Shutta R, Sakata Y, Nishino M, Tanouchi J. Ablation index-guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score-matched analysis. J Interv Card Electrophysiol 2021; 64:479-487. [PMID: 34674119 DOI: 10.1007/s10840-021-01059-y] [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: 06/16/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)-guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)-guided PVI. METHODS Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period. RESULTS A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269-0.639, P < 0.001). CONCLUSIONS AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.
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Affiliation(s)
- Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasuyuki Egami
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Kohei Ukita
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Akito Kawamura
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Hitoshi Nakamura
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yutaka Matsuhiro
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Masaki Tsuda
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Naotaka Okamoto
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Akihiro Tanaka
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Masamichi Yano
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Ryu Shutta
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masami Nishino
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan.
| | - Jun Tanouchi
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
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39
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Okamatsu H, Okumura K, Kaneko S, Negishi K, Hayashi K, Tsurugi T, Tanaka Y, Nakao K, Sakamoto T, Koyama J. Ablation Index-Guided High-Power Radiofrequency Application Shortens the Procedure Time With Similar Outcomes to Conventional Power Application in Atrial Fibrillation Ablation. Circ Rep 2021; 3:559-568. [PMID: 34703933 PMCID: PMC8492404 DOI: 10.1253/circrep.cr-21-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background:
The impact of high-power radiofrequency (RF) application in ablation index (AI)-guided atrial fibrillation (AF) ablation has not been elucidated. Methods and Results:
We investigated 1,333 patients undergoing first AF ablation (median age 68 years; interquartile range [IQR] 61–73 years). The first 301 patients underwent AI-guided conventional power RF application (CP group), whereas the following 1,032 patients underwent high-power RF application (HP group). The minimum AI target values were 400, 360, and 260 at the left atrial anterior wall, posterior wall, and esophagus, respectively. RF power in the CP group was 30–40, 20–25, and 20 W at the anterior wall, posterior wall, and esophagus, respectively, compared with 50, 40, and 25, respectively, in the HP group. Procedure time was shorter in the HP than CP group (median 153 [IQR 129–190] vs. 180 (IQR 152–229) min; P<0.0001). The percentage of first-pass pulmonary vein isolation (69% vs. 73%; P=0.07) and all procedure-related complications (2.0% vs. 3.4%; P=0.19) was similar. Kaplan-Meier analysis showed similar recurrence-free survival (RFS) for all AF types. Respective 1-year RFS in the CP and HP groups was 82% and 87% in paroxysmal AF, 78% and 82% in persistent AF, and 59% and 58% in long-standing persistent AF. Conclusions:
In AI-guided AF ablation, high-power RF application shortens the procedure time without increasing complications and with similar outcomes.
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Affiliation(s)
- Hideharu Okamatsu
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Shozo Kaneko
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Kodai Negishi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Katsuhide Hayashi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Takuo Tsurugi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Yasuaki Tanaka
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
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40
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Teres C, Soto-Iglesias D, Penela D, Jáuregui B, Ordoñez A, Chauca A, Carreño JM, Scherer C, San Antonio R, Huguet M, Roque A, Ramírez C, Oller G, Jornet A, Palet J, Santana D, Panaro A, Maldonado G, de Leon G, Jiménez G, Evangelista A, Carballo J, Ortíz-Pérez JT, Berruezo A. Personalized paroxysmal atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: the 'Ablate by-LAW' single-centre study-a pilot study. Europace 2021; 24:390-399. [PMID: 34480548 DOI: 10.1093/europace/euab216] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine if adapting the ablation index (AI) to the left atrial wall thickness (LAWT), which is a determinant of lesion transmurality, is feasible, effective, and safe during paroxysmal atrial fibrillation (PAF) ablation. METHODS AND RESULTS Consecutive patients referred for PAF first ablation. Left atrial wall thickness three-dimensional maps were obtained from multidetector computed tomography and integrated into the CARTO navigation system. Left atrial wall thickness was categorized into 1 mm layers and AI was titrated to the LAWT. The ablation line was personalized to avoid thicker regions. Primary endpoints were acute efficacy and safety, and freedom from atrial fibrillation (AF) recurrences. Follow-up (FU) was scheduled at 1, 3, 6, and every 6 months thereafter. Ninety patients [60 (67%) male, age 58 ± 13 years] were included. Mean LAWT was 1.25 ± 0.62 mm. Mean AI was 366 ± 26 on the right pulmonary veins with a first-pass isolation in 84 (93%) patients and 380 ± 42 on the left pulmonary veins with first-pass in 87 (97%). Procedure time was 59 min (49-66); radiofrequency (RF) time 14 min (12.5-16); and fluoroscopy time 0.7 min (0.5-1.4). No major complication occurred. Eighty-four out of 90 (93.3%) patients were free of recurrence after a mean FU of 16 ± 4 months. CONCLUSION Personalized AF ablation, adapting the AI to LAWT allowed pulmonary vein isolation with low RF delivery, fluoroscopy, and procedure time while obtaining a high rate of first-pass isolation, in this patient population. Freedom from AF recurrences was as high as in more demanding ablation protocols. A multicentre trial is ongoing to evaluate reproducibility of these results.
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Albert Roque
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Carlos Ramírez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Guillermo Oller
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Agustí Jornet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Jordi Palet
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - David Santana
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Alejandro Panaro
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Giuliana Maldonado
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo de Leon
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Gustavo Jiménez
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Arturo Evangelista
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Julio Carballo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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41
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Hijioka N, Kaneshiro T, Nehashi T, Amami K, Nodera M, Yamada S, Yokokawa T, Misaka T, Takeishi Y. Influence of power setting on superior vena cava potential during right pulmonary vein isolation. J Interv Card Electrophysiol 2021; 65:25-31. [PMID: 34468891 DOI: 10.1007/s10840-021-01058-z] [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: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE High-power short-duration (HP-SD) ablation could reduce collateral tissue damage by shortening the conductive heating phase. However, it is difficult to evaluate the transmural effect of ablation lesions during pulmonary vein isolation (PVI) procedures. The present study aimed to evaluate the change in superior vena cava (SVC) potential delay as a surrogate marker of collateral tissue damage during right PVI, which is adjacent to SVC. METHODS Out of 250 consecutive patients who underwent PVI, 86 patients in whom SVC potential during sinus rhythm was recorded both before and after right PVI were analyzed. In 46 of the patients, an HP-SD setting of 45-50 W was used (HP-SD group). In the remaining 40 patients, a conventional power setting of 20-30 W was used (conventional group). We compared the change in SVC potential delay after right PVI, radiofrequency energy, and mean contact force in the anterior-superior right PVI line, which was close to the posterior aspect of SVC, between the two groups. RESULTS Although the total delivered radiofrequency energy (2,924 J vs. 2,604 J) and the mean contact force (18.5 g vs. 16.0 g) in the SVC overlapping area did not differ, the change in SVC potential delay after right PVI was significantly longer in the conventional group compared to the HP-SD group (5.0 ms vs. 0.0 ms, p < 0.001). CONCLUSIONS The changes in SVC potential delay after right PVI might be a surrogate marker of collateral tissue damage according to the used energy settings.
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Affiliation(s)
- Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan.
| | - Takeshi Nehashi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kazuaki Amami
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
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42
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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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43
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Gupta D, Duytschaever M, Berte B, De Potter T. Interlesion distance for radiofrequency pulmonary vein isolation: the quandary between targets and limits. Europace 2021; 23:815. [PMID: 33434278 DOI: 10.1093/europace/euaa352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Tom De Potter
- Onze Lieve Vrouwziekenhuis Ziekenhuis, Aalst, Belgium
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44
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Hoffmann P, Althoff TF. Randomized study defining the optimum target interlesion distance in ablation index-guided atrial fibrillation ablation: Authors' reply. Europace 2021; 23:816-817. [PMID: 33434268 DOI: 10.1093/europace/euaa354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philipp Hoffmann
- Department of Cardiology and Angiology, Charité-University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Till F Althoff
- Department of Cardiology and Angiology, Charité-University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Cardiology Department, Hospital Clínic Atrial Fibrillation Unit (UFA), Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
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45
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Effectiveness of Radiofrequency Catheter Ablation Using Ablation Index Versus Second Generation Cryoballoon in the Treatment of Persistent Atrial Fibrillation: A Matching-Adjusted Indirect Comparison. Adv Ther 2021; 38:4388-4402. [PMID: 34250584 PMCID: PMC8342373 DOI: 10.1007/s12325-021-01846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
Introduction Both radiofrequency (RF) and cryoballoon (CB) ablation are treatment options for persistent atrial fibrillation (PsAF). An important recent innovation in RF ablation is Ablation Index (AI), known also as the VISITAG SURPOINT™ Module, a composite lesion quality marker whose use has been shown to significantly reduce the incidence of acute and late pulmonary vein (PV) reconnection and the recurrence of atrial arrhythmias in PsAF. Due to a lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option in PsAF. The objective of the present study was to conduct a matching-adjusted indirect treatment comparison (MAIC) using individual patient-level data (IPD) to assess the comparative effectiveness of the THERMOCOOL SMARTTOUCH™ Catheter or the THERMOCOOL SMARTTOUCH™ SF Catheter with AI/VISITAG SURPOINT™ Module (STAI) versus the second-generation CB catheter (Arctic Front Advance™; herein referred to as CB) with respect to 12-month atrial arrhythmia recurrence, fluoroscopy time, and procedural efficiency. Methods IPD for STAI were obtained from four investigator-initiated studies and were pooled. Comparable CB studies identified from a systematic literature review were also pooled. In the absence of a common treatment arm between STAI and CB studies, an unanchored MAIC was conducted. The primary analysis compared the pooled STAI IPD to the pooled CB cohort, with corrections for differences across trials, including eligibility criteria and patient baseline characteristics. Scenario and sensitivity analyses were conducted to assess the robustness of the primary analysis. Results In the primary analysis, which was adjusted for left atrial diameter (LAD), age, diabetes, and sex, STAI was associated with a statistically significant 65% relative reduction in the rate of arrhythmia recurrence compared to CB at 12-month follow-up (HR 0.35; 95% CI 0.23, 0.52). STAI was associated with shorter total fluoroscopy time than CB but longer procedure time. Results were consistent across scenario and sensitivity analyses. Conclusion Radiofrequency ablation with AI significantly reduced atrial arrhythmia recurrence at 12-month follow-up and fluoroscopy time compared to CB, with longer procedure times. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01846-z.
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Gasperetti A, Sicuso R, Dello Russo A, Zucchelli G, Saguner AM, Notarstefano P, Soldati E, Bongiorni MG, Della Rocca DG, Mohanty S, Carbucicchio C, Duru F, Di Biase L, Natale A, Tondo C, Casella M. Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study. Europace 2021; 23:91-98. [PMID: 33063099 DOI: 10.1093/europace/euaa228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). METHODS AND RESULTS Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039]. CONCLUSION Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.
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Affiliation(s)
- Alessio Gasperetti
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | - Rita Sicuso
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, IT, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | - Ardan Muammer Saguner
- Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | | | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | | | - Firat Duru
- Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | - Luigi Di Biase
- Cardiology Department, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Alber Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, IT, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi" Marche Polytechnic University, Ancona, Italy
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Richard Tilz R, Sano M, Vogler J, Fink T, Saraei R, Sciacca V, Kirstein B, Phan HL, Hatahet S, Delgado Lopez L, Traub A, Eitel C, Schlüter M, Kuck KH, Heeger CH. Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study. IJC HEART & VASCULATURE 2021; 35:100847. [PMID: 34381869 PMCID: PMC8333145 DOI: 10.1016/j.ijcha.2021.100847] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
Background Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable pulmonary vein isolation (PVI) and is associated with encouraging clinical outcome. A novel CF sensing temperature-controlled radiofrequency (RF) ablation catheter allows for very high-power short-duration (vHP-SD, 90 W/4 s) ablation aiming a potentially safer, more effective and faster ablation. We thought to evaluate preliminary safety and efficacy of vHP-SD ablation for PVI utilizing a novel vHP-SD catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI utilizing conventional contact force (CF) sensing catheters. Methods and Results Fifty-six patients with paroxysmal or persistent AF were prospectively enrolled in this study. Twenty-eight consecutive patients underwent vHP-SD based PVI (vHP-SD group) and were compared to 28 consecutive patients treated with conventional CF-sensing catheters utilizing the AI (control group). All PVs were successfully isolated using vHP-SD. The median RF ablation time for vHP-SD was 338 (IQR 286, 367) seconds vs control 1580 (IQR 1350, 1848) seconds (p < 0.0001), the median procedure duration was vHP-SD 55 (IQR 48–60) minutes vs. control 105 (IQR 92–120) minutes (p < 0.0001). No differences in periprocedural complications were observed. Conclusions This preliminary data of the novel vHP-SD ablation mode provides safe and effective PVI. Procedure duration and RF ablation time were substantially shorter in the vHP-SD group in comparison to the control group.
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Affiliation(s)
- Roland Richard Tilz
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Makoto Sano
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany.,Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Julia Vogler
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Thomas Fink
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Roza Saraei
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Vanessa Sciacca
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Bettina Kirstein
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Huong-Lan Phan
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Sascha Hatahet
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Lisbeth Delgado Lopez
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Anna Traub
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | | | - Karl-Heinz Kuck
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany.,LANS Cardio, Stephansplatz 5, Hamburg 20354, Germany
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Zucchelli G, Parollo M, Guarracini F, Marini M, Di Cori A, Barletta V, De Lucia R, Segreti L, Bonmassari R, Bongiorni MG. Standard versus strict stability criteria in radiofrequency paroxysmal atrial fibrillation ablation using ablation index. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1404-1412. [PMID: 34224159 DOI: 10.1111/pace.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the outcome of paroxysmal atrial fibrillation (AF) ablation via pulmonary vein isolation using Ablation Index (AI) with strict or standard stability criteria. METHODS We enrolled 130 consecutive naive patients affected by paroxysmal AF who underwent PVI at two high-volume centers. AI target was ≥380 at the posterior wall and ≥500 at the anterior wall. Strict versus standard stability criteria were set for Group 1 (65 patients) and Group 2 (65 patients), respectively. We compared those strategies with a historical cohort of 72 consecutive patients treated at same centers in the VISITALY study, using average force ≥10 g and strict stability criteria as target parameters. Interlesion distance target was <6 mm. Recurrence was defined as any AF, atrial tachycardia (AT) or atrial flutter (AFL) during the 12 months after ablation, excluding a 90-days blanking period. RESULTS Procedure duration (224.05 ± 47.21 vs. 175.61 ± 51.29 min; p < .001), fluoroscopy time (11.85 ± 4.38 vs. 10.46 ± 6.49 min; p = .019) and pericardial effusion rate (9.23% vs. 0%; p = .01) were higher in Group 1 than in Group 2. Freedom from AF/AT/AFL at 12 months was not significantly different (Group 1: 86.15%; Group 2: 90.77%; p = .42). Compared to VISITALY study, there were not significant differences in terms of recurrences. CONCLUSION A strategy of PVI using AI with standard stability criteria performed the best in terms of procedure efficiency and safety. Twelve-months arrhythmia-free survival rate was comparable with other strategies pursuing an interlesion distance target <6 mm, regardless of the use of AI.
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Affiliation(s)
- Giulio Zucchelli
- Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | | | | | - Andrea Di Cori
- Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | | | - Raffaele De Lucia
- Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Luca Segreti
- Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
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Keçe F, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Mertens BJ, Schalij MJ, Zeppenfeld K, Trines SA. Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters. Heart Rhythm O2 2021; 2:290-297. [PMID: 34337580 PMCID: PMC8322820 DOI: 10.1016/j.hroo.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. OBJECTIVE To identify procedural and biophysical parameters predicting ERC. METHODS Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. RESULTS A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09-1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15-2.49], P = .008) and a longer TTI (HR 1.02 [1.01-1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. CONCLUSION Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.
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Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Adrianus P. Wijnmaalen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart J. Mertens
- Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A. Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
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Wang YJ, Tian Y, Shi L, Zeng LJ, Xie BQ, Li XX, Yang XC, Liu XP. Pulmonary vein isolation guided by moderate ablation index targets combined with strict procedural endpoints for patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1842-1848. [PMID: 34028119 DOI: 10.1111/jce.15106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ablation index (AI)-guided radiofrequency ablation has been increasingly used for the treatment of drug-resistant paroxysmal atrial fibrillation (AF),but the optimal AI targets remain to be determined. We aimed to examine the efficacy and safety of catheter ablation guided by moderate AI values but more strict procedural endpoints in patients with paroxysmal AF. METHODS We conducted a retrospective review of a consecutive series of patients who received their first AI-guided ablation for paroxysmal AF from 2017 to 2018. The standard procedural protocol recommends AI targets as follows: anterior: 400-450; posterior: 280-330; and roof/inferior wall: 380-430. After circumferential pulmonary vein isolation (PVI), we performed bipolar pacing along the ablation line, adenosine triphosphate (ATP)-provocation, and waited for 30 min to verify PVI. The primary clinical outcome was the rate of freedom from AF recurrence at 12 months. RESULTS A total of 140 consecutive patients were included. The mean procedure and ablation times were 132.2 ± 30.2 min and 24.2 ± 7.9 min, respectively. The first-pass isolation and final isolation rates were documented in 49.3% and in 100% of the patients, respectively. At 12 months, single-procedure freedom from atrial tachyarrhythmias was observed in 92.1% of patients. No major procedure-related complications were encountered. CONCLUSIONS Moderate AI-guided catheter ablation is highly effective for the treatment of drug-refractory paroxysmal AF in real-world settings. Over 90% of patients achieved single-procedure arrhythmia-free survival at 1 year. The outcome was obtained without major complications and the procedure involved relatively short procedure and ablation times.
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Affiliation(s)
- Yan-Jiang Wang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Liang Shi
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bo-Qia Xie
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xue-Xun Li
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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