1
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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [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: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
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Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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4
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Suga K, Kato H, Akita S, Sakurai T, Ota R, Okada T, Murakami H, Kada K, Tsuboi N, Yanagisawa S, Inden Y, Murohara T. Optimal ablation settings of TactiFlex SE laser-cut irrigated-tip catheter: comparison with ThermoCool SmartTouch SurroundFlow porous irrigated-tip catheter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01797-9. [PMID: 38573538 DOI: 10.1007/s10840-024-01797-9] [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: 01/05/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The TactiFlex SE catheter (TFSE, Abbott) with a contact force (CF) sensor and a laser-cut irrigated-tip has recently become available but lacks a lesion quality marker. This study aimed to explore distinctions in lesion characteristics between the TFSE and the ThermoCool SmartTouch SurroundFlow catheter (STSF, Biosense Webster), which utilizes a porous irrigated tip, and to assess the most effective application settings for the TFSE. METHODS Lesions were generated using varying settings of radiofrequency power (30-50 W), CF (10-20 g), application duration (10-40 s), and catheter orientation (perpendicular or parallel) in an ex vivo porcine model. Comparative analysis between the TFSE and STSF was conducted for lesion characteristics and incidence of steam pops using predictive models in regression analyses. RESULTS Among 720 applications, the TFSE exhibited a significantly lower incidence of steam pops compared to the STSF (0.6% vs. 36.8%, P < 0.001). Moreover, coefficients of determination (R2) for the TFSE were higher than those for the STSF concerning lesion depth (0.710 vs. 0.541) and volume (0.723 vs. 0.618). The lesion size generated with the TFSE was notably smaller than that with the STSF under identical application settings. Additionally, to achieve a lesion depth ≥ 4.0 mm, the TFSE required an application duration 8-12 s longer than the STSF under similar settings. CONCLUSIONS The TFSE demonstrated a lower incidence of steam pops and superior predictability in lesion size compared to the STSF. However, the TFSE necessitated a longer application duration than the STSF to achieve an adequate lesion size.
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Affiliation(s)
- Kazumasa Suga
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shigeki Akita
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Taku Sakurai
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Ryusuke Ota
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Takuya Okada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hisashi Murakami
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Kenji Kada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Naoya Tsuboi
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
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5
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Saglietto A, Turturiello D, Viveros D, Bellido A, Alderete J, Zaraket F, Franco-Ocaña P, Huguet M, Cámara Ó, Vătășescu R, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial. Europace 2024; 26:euae087. [PMID: 38652090 PMCID: PMC11036893 DOI: 10.1093/europace/euae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). METHODS AND RESULTS Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). CONCLUSION LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.
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Affiliation(s)
- Giulio Falasconi
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Saglietto
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Turturiello
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Fatima Zaraket
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Paula Franco-Ocaña
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | | | - Radu Vătășescu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
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6
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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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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8
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Fitzpatrick N, Herczeg S, Hong K, Seaver F, Rosalejos L, Boles U, Jauvert G, Keelan E, O’Brien J, Tahin T, Galvin J, Széplaki G. Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry. Front Cardiovasc Med 2024; 10:1332868. [PMID: 38292455 PMCID: PMC10825003 DOI: 10.3389/fcvm.2023.1332868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Background Catheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence; hence, there is scope to potentially improve outcomes through technical innovations such as ablation index (AI) guidance during AF ablation. We present real-world 5-year follow-up data of AI-guided pulmonary vein isolation. Methods We retrospectively followed 123 consecutive patients who underwent AI-guided CA shortly after its introduction to routine practice. Data were collected from the MPH AF Ablation Registry with the approval of the institutional research board. Results Our patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger left atrial sizes compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures is as follows: year 1: 0.95, year 2: 0.92, year 3: 0.85, year 4: 0.79, and year 5: 0.72. Age >75 years (p = 0.02, HR: 2.7, CI: 1.14-6.7), BMI >35 kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8-11.4), and left atrial width as measured on CT in the upper quartile (p = 0.04, HR: 2.5, CI: 1-5.7) were statistically significant independent predictors of recurrent AF. Conclusion AI-guided CA is an effective treatment for AF, with 95.8% of patients remaining free from atrial arrhythmia at 1 year and 72.3% at 5 years, allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age >75 years, BMI >35 kg/m2, and markedly enlarged atria were associated with higher recurrence rates.
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Affiliation(s)
- N. Fitzpatrick
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - S. Herczeg
- Department of Cardiology, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - K. Hong
- Health Sciences Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - F. Seaver
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - L. Rosalejos
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - U. Boles
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - G. Jauvert
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - E. Keelan
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - J. O’Brien
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - T. Tahin
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - J. Galvin
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Health Sciences Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - G. Széplaki
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Takahashi R, Taniguchi Y. Characteristics of tissue temperature during ablation with THERMOCOOL SMARTTOUCH SF versus TactiCath versus QDOT MICRO catheters (Qmode and Qmode+): An in vivo porcine study. J Cardiovasc Electrophysiol 2024; 35:7-15. [PMID: 37794818 DOI: 10.1111/jce.16092] [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: 04/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION High-power short-duration (HPSD) ablation at 50 W, guided by ablation index (AI) or lesion size index (LSI), and a 90 W/4 s very HSPD (vHPSD) setting are available for atrial fibrillation (AF) treatment. Yet, tissue temperatures during ablation with different catheters around venoatrial junction and collateral tissues remain unclear. METHODS In this porcine study, we surgically implanted thermocouples on the epicardium near the superior vena cava (SVC), right pulmonary vein, and esophagus close to the inferior vena cava. We then compared tissue temperatures during 50W-HPSD guided by AI 400 or LSI 5.0, and 90 W/4 s-vHPSD ablation using THERMOCOOL SMARTTOUCH SF (STSF), TactiCath ablation catheter, sensor enabled (TacthCath), and QDOT MICRO (Qmode and Qmode+ settings) catheters. RESULTS STSF produced the highest maximum tissue temperature (Tmax ), followed by TactiCath, and QDOT MICRO in Qmode and Qmode+ (62.7 ± 12.5°C, 58.0 ± 10.1°C, 50.0 ± 12.1°C, and 49.2 ± 8.4°C, respectively; p = .005), achieving effective transmural lesions. Time to lethal tissue temperature ≥50°C (t-T ≥ 50°C) was fastest in Qmode+, followed by TacthCath, STSF, and Qmode (4.3 ± 2.5, 6.4 ± 1.9, 7.1 ± 2.8, and 7.7 ± 3.1 s, respectively; p < .001). The catheter tip-to-thermocouple distance for lethal temperature (indicating lesion depth) from receiver operating characteristic curve analysis was deepest in STSF at 5.2 mm, followed by Qmode at 4.3 mm, Qmode+ at 3.1 mm, and TactiCath at 2.8 mm. Ablation at the SVC near the phrenic nerve led to sudden injury at t-T ≥ 50°C in all four settings. The esophageal adventitia injury was least deep with Qmode+ ablation (0.4 ± 0.1 vs. 0.8 ± 0.4 mm for Qmode, 0.9 ± 0.3 mm for TactiCath, and 1.1 ± 0.5 mm for STSF, respectively; p = .005), correlating with Tmax . CONCLUSION This study revealed distinct tissue temperature patterns during HSPD and vHPSD ablations with the three catheters, affecting lesion effectiveness and collateral damage based on Tmax and/or t-T ≥ 50°C. These findings provide key insights into the safety and efficacy of AF ablation with these four settings.
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Affiliation(s)
- Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Medical Research Support Center, Institute of Medical Science, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Medical Research Support Center, Institute of Medical Science, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
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10
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Rottner L, Metzner A. Atrial Fibrillation Ablation: Current Practice and Future Perspectives. J Clin Med 2023; 12:7556. [PMID: 38137626 PMCID: PMC10743921 DOI: 10.3390/jcm12247556] [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: 11/14/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Catheter ablation to perform pulmonary vein isolation (PVI) is established as a mainstay in rhythm control of atrial fibrillation (AF). The aim of this review is to provide an overview of current practice and future perspectives in AF ablation. The main clinical benefit of AF ablation is the reduction of arrhythmia-related symptoms and improvement of quality of life. Catheter ablation of AF is recommended, in general, as a second-line therapy for patients with symptomatic paroxysmal or persistent AF, who have failed or are intolerant to pharmacological therapy. In selected patients with heart failure and reduced left-ventricular fraction, catheter ablation was proven to reduce all-cause mortality. Also, optimal management of comorbidities can reduce AF recurrence after AF ablation; therefore, multimodal risk assessment and therapy are mandatory. To date, the primary ablation tool in widespread use is still single-tip catheter radiofrequency (RF) based ablation. Additionally, balloon-based pulmonary vein isolation (PVI) has gained prominence, especially due to its user-friendly nature and established safety and efficacy profile. So far, the cryoballoon (CB) is the most studied single-shot device. CB-based PVI is characterized by high efficiency, convincing success rates, and a beneficial safety profile. Recently, CB-PVI as a first-line therapy for AF was shown to be superior to pharmacological treatment in terms of efficacy and was shown to reduce progression from paroxysmal to persistent AF. In this context, CB-based PVI gains more and more importance as a first-line treatment choice. Non-thermal energy sources, namely pulsed-field ablation (PFA), have garnered attention due to their cardioselectivity. Although initially applied via a basket-like ablation tool, recent developments allow for point-by-point ablation, particularly with the advent of a novel lattice tip catheter.
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Affiliation(s)
- Laura Rottner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
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11
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Lee AC. Selecting High-Power Short-Duration Radiofrequency Ablation: How High Is High? JACC Clin Electrophysiol 2023; 9:2584-2586. [PMID: 37855772 DOI: 10.1016/j.jacep.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Adam C Lee
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
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12
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Chen WJ, Gan CX, Cai YW, Liu YY, Xiao PL, Zou LL, Xiong QS, Qin F, Tao XX, Li R, Du HA, Liu ZZ, Yin YH, Ling ZY. Impact of high-power short-duration atrial fibrillation ablation technique on the incidence of silent cerebral embolism: a prospective randomized controlled study. BMC Med 2023; 21:461. [PMID: 37996906 PMCID: PMC10666361 DOI: 10.1186/s12916-023-03180-3] [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: 04/18/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND High-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter. METHODS From June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator's discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24-72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. RESULTS All enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group (p = 0.685). No significant differences were observed between two groups regarding the average number of lesions (p = 0.751), maximum lesion diameter (p = 0.405), and total lesion volume per patient (p = 0.669). Persistent AF and CHA2DS2-VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure (p = 0.572) and at the 3-month follow-up (p = 0.743). CONCLUSIONS Involving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter. TRIAL REGISTRATION Clinicaltrials.gov: NCT04408716. AF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow.
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Affiliation(s)
- Wei-Jie Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Chun-Xia Gan
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yang-Wei Cai
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yang-Yang Liu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pei-Lin Xiao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Li-Li Zou
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Qing-Song Xiong
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Fang Qin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Xie-Xin Tao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Ran Li
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Hua-An Du
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Zeng-Zhang Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Yue-Hui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China
| | - Zhi-Yu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan'an District, Chongqing, 400060, China.
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13
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Waranugraha Y, Tsai CT, Lin LY. Index-Guided High-Power Radiofrequency Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis Study. Curr Cardiol Rep 2023; 25:1397-1414. [PMID: 37874469 DOI: 10.1007/s11886-023-01968-6] [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] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW Studies have suggested the superiority of high-power compared to standard-power radiofrequency ablation ablation (RFCA). This study aimed to assess the efficacy and safety of high-power compared to standard-power RFCA guided by ablation index (AI) or lesion index (LSI). RECENT FINDINGS A systematic review and meta-analysis study comparing IGHP and IGLP approaches for AF ablation was conducted. The relevant published studies comparing IGHP and IGSP methods for RFCA in AF patients until October 2022 were collected from Cochrane, ProQuest, PubMed, and ScienceDirect. A total of 2579 AF patients from 11 studies were included, 1682 received IGHP RFCA, and 897 received IGSP RFCA. To achieve successful pulmonary vein isolation (PVI), the IGHP RFCA group had a significantly shorter procedure time than the IGHP RFCA group (mean difference (MD) -19.91 min; 95% CI -25.23 to -14.59 min; p < 0.01), radiofrequency (RF) application time (MD -10.92 min; 95% CI -14.70 to -7.13 min; p < 0.01), and fewer number of lesions (MD -10.90; 95% CI -18.77 to -3.02; p < 0.01) than the IGSP RFCA. First-pass PVI was significantly greater in the IGHP RFCA group than in the IGSP RFCA group (risk ratio (RR) 1.17; 95% CI 1.07 to 1.28; p < 0.01). The IGHP RFCA is an effective and efficient strategy for AF ablation. The superiority of IGHP RFCA includes the shorter procedure time, shorter RF application time, fewer number of lesions for complete PVI, and more excellent first-pass PVI.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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14
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Castrejón-Castrejón S, Martínez Cossiani M, Jáuregui-Abularach M, Basterra Sola N, Ibáñez Criado JL, Osca Asensi J, Roca Luque I, Moya Mitjans A, Quesada Dorador A, Hidalgo Olivares VM, Pérez Castellano N, Fernández Gómez JM, Macías-Ruiz MR, Bochard Villanueva B, Gonzalo Bada N, Fernández Prieto A, Guido López LE, Martínez Maldonado ME, Merino D, Escobar Cervantes C, Merino JL. Multicenter prospective comparison of conventional and high-power short duration radiofrequency application for pulmonary vein isolation: the high-power short-duration radiofrequency application for faster and safer pulmonary vein ablation (POWER FAST III) trial. J Interv Card Electrophysiol 2023; 66:1889-1899. [PMID: 36807734 DOI: 10.1007/s10840-023-01509-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Electrical isolation of pulmonary veins (PV) with high-power short-duration (HPSD) radiofrequency application (RFa) may reduce the duration of atrial fibrillation (AF) ablation, without compromising the procedural efficacy and safety in comparison with the conventional approach. This hypothesis has been generated in several observational studies; the POWER FAST III will test it in a randomized multicenter clinical trial. METHODS It is a multicenter randomized, open-label and non-inferiority clinical trial with two parallel groups. AF ablation using 70 W and 9-10 s RFa is compared with the conventional technique using 25-40 W RFa guided by numerical lesion indexes. The main efficacy objective is the incidence of atrial arrhythmia recurrences electrocardiographically documented during 1-year follow-up. The main safety objective is the incidence of endoscopically detected esophageal thermal lesions (EDEL). This trial includes a substudy of incidence of asymptomatic cerebral lesions detected by magnetic resonance imaging (MRI) after ablation. RESULTS A randomized clinical trial compares for the first time high-power short-duration and conventional ablation in order to obtain data about the efficacy and safety of the high-power technique in an adequate methodological context. CONCLUSIONS The results of the POWER FAST III could support the use of the high-power short-duration ablation in clinical practice. REGISTRATION ClinicalTrials.gov: NTC04153747.
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Affiliation(s)
- Sergio Castrejón-Castrejón
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Marcel Martínez Cossiani
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Miguel Jáuregui-Abularach
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Nuria Basterra Sola
- Cardiology Department, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - José Luis Ibáñez Criado
- Cardiology Department, Hospital General Universitario de Alicante-ISABIAL (Instituto de Investigación Sanitaria Y Biomédica de Alicante), Alicante, Spain
| | | | - Ivo Roca Luque
- Cardiology Department, Hospital Clínic, Barcelona, Spain
| | | | | | | | | | | | | | | | - Nerea Gonzalo Bada
- Acute Care Unit, Department of Gastroenterology, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | | | - Leonardo Elías Guido López
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | | | - Daniel Merino
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Carlos Escobar Cervantes
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - José Luis Merino
- Arrhythmia & Robotic EP Unit, Cardiology Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain.
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Boersma L, Andrade JG, Betts T, Duytschaever M, Pürerfellner H, Santoro F, Tzeis S, Verma A. Progress in atrial fibrillation ablation during 25 years of Europace journal. Europace 2023; 25:euad244. [PMID: 37622592 PMCID: PMC10451004 DOI: 10.1093/europace/euad244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
The first edition of Europace journal in 1999 came right around the time of the landmark publication of the electrophysiologists from Bordeaux, establishing how elimination of ectopic activity from the pulmonary veins (PVs) resulted in a marked reduction of atrial fibrillation (AF). The past 25 years have seen an incredible surge in scientific interest to develop new catheters and energy sources to optimize durability and safety of ablation, as well as study the mechanisms for AF and devise ablation strategies. While ablation in the beginning was performed with classic 4 mm tip catheters that emitted radiofrequency (RF) energy to create tissue lesions, this evolved to using irrigation and contact force (CF) measurement while increasing power. Also, so-called single-shot devices were developed with balloons and arrays to create larger contiguous lesions, and energy sources changed from RF current to cryogenic ablation and more recently pulsed field ablation with electrical current. Although PV ablation has remained the basis for every AF ablation, it was soon recognized that this was not enough to cure all patients, especially those with non-paroxysmal AF. Standardized approaches for additional ablation targets have been used but have not been satisfactory in all patients so far. This led to highly technical mapping systems that are meant to unravel the drivers for the maintenance of AF. In the following sections, the development of energies, strategies, and tools is described with a focus on the contribution of Europace to publish the outcomes of studies that were done during the past 25 years.
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Affiliation(s)
- Lucas Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Center, PO 2500, 3430 EM Nieuwegein, The Netherlands
| | - Jason G Andrade
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Cardiology Department, Center for Cardiovascular Innovation, Vancouver, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Tim Betts
- Department of Cardiology, Oxford University, Oxford, UK
| | | | | | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Stylianos Tzeis
- Cardiology Department, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Atul Verma
- Cardiology Department, McGill University Health Center, Montreal, Quebec, Canada
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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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Schildt S, Fredersdorf S, Jungbauer CG, Hauck C, Tarnowski D, Debl K, Neef S, Schach C, Sossalla S, Maier LS, Üçer E. A Pilot Trial to Compare the Long-Term Efficacy of Pulmonary Vein Isolation with High-Power Short-Duration Radiofrequency Versus Laser Energy with Rapid Ablation Mode. J Cardiovasc Dev Dis 2023; 10:98. [PMID: 36975862 PMCID: PMC10057338 DOI: 10.3390/jcdd10030098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Pulmonary vein (PV) reconnection is the major cause of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The probability of reconnection is higher if the primary lesion is not sufficiently effective, which can be unmasked with an adenosine provocation test (APT). High-power short-duration radiofrequency energy (HPSD) guided with ablation index (AI) and the third generation of the visually guided laser balloon (VGLB) are new methods for PVI. METHODS A total of 70 participants (35 in each group) who underwent a PVI with either AI-guided HPSD (50 W; AI 500 for the anterior and 400 for the posterior wall, respectively) or VGLB ablation were included in this observational pilot trial. Twenty minutes after each PVI, an APT was performed. The primary endpoint was the event-free survival from AF after three years. RESULTS A total of 137 (100%) PVs in the HPSD arm and 131 PVs (98.5%) in the VGLB arm were initially successfully isolated (p = 0.24). The overall procedure duration was similar in both arms (155 ± 39 in HPSD vs. 175 ± 58 min in VGLB, p = 0.191). Fluoroscopy time, left atrial dwelling time and duration from the first to the last ablation were longer in the VGLB arm (23 ± 8 vs. 12 ± 3 min, p < 0.001; 157 (111-185) vs. 134 (104-154) min, p = 0.049; 92(59-108) vs. 72 (43-85) min, p = 0.010). A total of 127 (93%) in the HPSD arm and 126 (95%) PVs in the VGLB arm remained isolated after APT (p = 0.34). The primary endpoint was met 1107 ± 68 days after ablation in 71% vs. 66% in the VGLB and HPSD arms, respectively (p = 0.65). CONCLUSIONS HPSD and VGLB did not differ with respect to long-term outcome of PVI. A large, randomized study should be conducted to compare clinical outcomes with respect to these new ablation techniques.
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Affiliation(s)
- Sönke Schildt
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sabine Fredersdorf
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Carsten G Jungbauer
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian Hauck
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Daniel Tarnowski
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kurt Debl
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Stefan Neef
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian Schach
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Samuel Sossalla
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Lars S Maier
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ekrem Üçer
- Internal Medicine II, Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
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Basij M, John S, Bustamante D, Kabbani L, Maskoun W, Mehrmohammadi M. Integrated Ultrasound and Photoacoustic-Guided Laser Ablation Theranostic Endoscopic System. IEEE Trans Biomed Eng 2023; 70:67-75. [PMID: 35724291 PMCID: PMC10355465 DOI: 10.1109/tbme.2022.3184495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advancements in ablation techniques have paved the way towards the development of safer and more effective clinical procedures for treating various maladies such as atrial fibrillation (AF). AF is characterized by rapid, chaotic atrial activation and is commonly treated using radiofrequency applicators or laser ablation catheters. However, the lack of thermal lesion formation and temperature monitoring capabilities in these devices prevents them from measuring the treatment outcome directly. In addition, poor differentiation between healthy and ablated tissues leads to incomplete ablation, which reduces safety and causes complications in patients. Hence, a novel photoacoustic (PA)-guided laser ablation theranostic device was developed around a traditional phased-array endoscope. The proposed technology provides lesion formation, tissue distinguishing, and temperature monitoring capabilities. Our results have validated the lesion monitoring capability of the proposed technology through PA correlation maps. The tissue distinguishing capability of the theranostic device was verified by the measurable differences in the PA signal between pre-and post-ablated mice myocardial tissue. The increase in the PA signal with temperature variations caused by the ablation laser confirmed the ability of the proposed device to provide temperature feedback.
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Affiliation(s)
- Maryam Basij
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - Samuel John
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - David Bustamante
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - Loay Kabbani
- Department of Vascular Surgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Waddah Maskoun
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering at Wayne State University and Scientific member of molecular imaging at Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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O'Neill L, El Haddad M, Berte B, Kobza R, Hilfiker G, Scherr D, Manninger M, Wijnmaalen AP, Trines SA, Wielandts JY, Gillis K, Lycke M, De Becker B, Tavernier R, Le Polain De Waroux JB, Knecht S, Duytschaever M. Very High-Power Ablation for Contiguous Pulmonary Vein Isolation: Results From the Randomized POWER PLUS Trial. JACC Clin Electrophysiol 2022; 9:511-522. [PMID: 36752467 DOI: 10.1016/j.jacep.2022.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Very high-power, short-duration (90-W/4-second) ablation for pulmonary vein isolation (PVI) may reduce procedural times. However, shorter applications with higher power may impact lesion quality. OBJECTIVES In this multicenter, randomized controlled trial, we compared procedural efficiency, efficacy, and safety of PVI using 90-W/4-second ablation to 35/50-W ablation. METHODS Patients with paroxysmal or persistent atrial fibrillation undergoing first-time PVI were randomized to pulmonary vein encirclement with contiguous applications using very high-power, short-duration applications (90 W over 4 seconds) or 35/50-W applications (titrated up to ablation index >550 anteriorly and >400 posteriorly). Prospective endpoints were procedural efficiency (procedure time and first-pass isolation), safety (including esophageal endoscopic evaluation), and 6-month effectiveness using repetitive Holter monitoring. RESULTS One hundred eighty patients were randomized, 90 to the 90-W group (mean age: 64.2 ± 8.9 years) and 90 to the 35/50-W group (mean age: 62.3 ± 10.8 years). Procedural time was shorter in the 90-W group vs the 35/50-W group (70 [interquartile range: 60-80] vs 75 [interquartile range: 65-88.3] minutes; P = 0.009). A nonsignificant trend towards lower rates of first-pass isolation was seen in the 90-W group (83.9% vs 90%; P = 0.0852). No major complications were observed in both groups with esophageal injury occurring in 1 patient per group. At 6 months, 17% of patients in the 90-W group vs 15% in the 35/50-W group experienced recurrent arrhythmia (P = 0.681). CONCLUSIONS Contiguous ablation using very high-power, short-duration applications results in a significant but modest reduction in procedure time with similar safety and 6-month efficacy vs a conventional approach. A hybrid approach combining both ablation modalities might be the most optimal strategy. (POWER PLUS [Very High Power Ablation in Patients With Atrial Fibrillation Schedule for a First Pulmonary Vein Isolation]; NCT04784013).
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Affiliation(s)
- Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium; Luzerner Kantonsspital, Luzern, Switzerland
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Kris Gillis
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
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Shuang T, Kong L, Cheng F, Wang X. Prevalence, Predictors and Mechanisms of Steam Pops in Ablation Index-Guided High-Power Pulmonary Vein Isolation. J Cardiovasc Dev Dis 2022; 9:jcdd9120441. [PMID: 36547438 PMCID: PMC9781888 DOI: 10.3390/jcdd9120441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Despite the good cooling effect of the contact-force porous catheter, the risk of steam pops (SP) remains one of the major concerns in high-power circumferential pulmonary vein isolation (CPVI). This study aimed to investigate the prevalence, predictors and possible mechanisms of SPs in CPVI. Patients experiencing SPs in de novo high-power CPVI were 1:3 matched by non-SP patients with gender, age (±5 years) and left atrial diameter (LAD) (±5 mm) to compare the ablation parameters of SP and non-SP lesions. Catheter tip displacement (Tipdisp) was compared between “edge-of-ridge” and “PV-side-of-ridge” placement at anterior and roof segments of the left pulmonary vein (PV). SPs occurred in 11 (1.57%) of 701 patients, including 6 at the antero-superior left PV, 2 at the roof, 1 at the postero-superior left PV, 1 at the bottom left PV and 1 at the antero-superior aspect of the right PV. There was significantly shorter RF delivery duration (13.9 ± 6.3 vs. 23.3 ± 6.0 s), greater Δimpedance (17.6 ± 6.7 vs. 6.7 ± 4.1 Ω) and lower ablation index (357.7 ± 68.8 vs. 430.2 ± 30.7) in SP patients than those in non-SP patients. Δimpedance >12 Ω during ablation could predict SP occurrence. Tipdisp was greater in “PV-side-of-ridge” than that in “edge-of -ridge” placement (3.2 ± 1.6 mm vs. 2.0 ± 0.8 mm) at antero-superior and roof segments of the left PV. The prevalence of SP was 1.57% in high-power CPVI procedures, with the most common site at the antero-superior segment of the left PV. Δimpedance was a significant predictor of SP occurrence. “PV-side-of-ridge” ablation at antero-superior and roof segments of left PV might predispose to SP occurrence due to excessive tissue coverage.
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21
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Guckel D, Bergau L, Braun M, El Hamriti M, Mörsdorf M, Fink T, Sciacca V, Khalaph M, Imnadze G, Sommer P, Sohns C. Direct comparison of two 50 W high power short duration approaches-Temperature- versus ablation index-guided radiofrequency ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2517-2527. [PMID: 36104929 DOI: 10.1111/jce.15674] [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: 06/02/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Approaches applying higher energy levels for shorter periods (high power short duration, HPSD) to improve lesion formation for atrial fibrillation (AF) ablation have been introduced. This single-center study aimed to compare the efficacy, safety, and lesion formation using the novel DiamondTemp (DT) catheter or an ablation index (AI)-guided HPSD ablation protocol using a force-sensing catheter with surround-flow irrigation. METHODS One hundred thirteen consecutive patients undergoing radiofrequency-guided catheter ablation (RFCA) for AF were included. Forty-five patients treated with the DT catheter (50 W, 9 s), were compared to 68 consecutive patients undergoing AI-guided ablation (AI anterior 550; AI posterior 400) adherent to a 50 W HPSD protocol. Procedural data and AF recurrence were evaluated. RESULTS Acute procedural success was achieved in all patients (n = 113, 100%). DT-guided AF ablation was associated with a longer mean procedure duration (99.10 ± 28.30 min vs. 78.24 ± 25.55, p < .001) and more RF applications (75.24 ± 30.76 min vs. 61.27 ± 14.06, p = .019). RF duration (792.13 ± 311.23 s vs. 1035.54 ± 287.24 s, p < .001) and fluoroscopy dose (183.81 ± 178.13 vs. 295.80 ± 247.54 yGym2 , p = .013) were lower in the DT group. AI-guided HPSD was associated with a higher AF-free survival rate without reaching statistical significance (p = .088). Especially patients with PERS AF (p = .009) as well as patients with additional atrial arrhythmia substrate (p = .002) benefited from an AI-guided ablation strategy. CONCLUSION Temperature- and AI- controlled HPSD RFCA using 50 W was safe and effective. AI-guided HPSD ablation seems to be associated with shorter procedure durations and fewer RF applications. Particularly in advanced AF, freedom from AF-recurrence may be improved using an AI-guided HPSD approach.
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Affiliation(s)
- Denise Guckel
- 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
| | - Martin Braun
- 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
| | - Maximilian Mörsdorf
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- 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
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control. J Clin Med 2022; 11:jcm11226871. [PMID: 36431348 PMCID: PMC9696051 DOI: 10.3390/jcm11226871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, the time of Diagnosis-to-Intervention appears crucial. Recent evidence shows that earlier rhythm control is associated with a lower risk of adverse cardiovascular outcomes in patients with early AF. Particularly, CA as an initial first line rhythm control strategy is associated with significant reduction of arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA is shown to significantly lower the risk of progression from paroxysmal AF to persistent AF. When treating persistent AF, the overall clinical success after ablation remains unsatisfactory, however the ablation outcome in patients with "early" persistent AF appears better than those with "late" persistent AF. "Adjunctive" ablation on top of pulmonary vein isolation (PVI), e.g., ablation of atrial low voltage area, left atrial posterior wall, vein of Marshall, left atrial appendage, etc., may further reduce arrhythmia recurrence in selected patient group. New ablation concepts or new ablation technologies have been developing to optimize therapeutic effects or safety profile and may ultimately improve the clinical outcome.
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Safe and effective delivery of high-power, short-duration radiofrequency ablation lesions with a flexible-tip ablation catheter. Heart Rhythm O2 2022; 4:42-50. [PMID: 36713045 PMCID: PMC9877396 DOI: 10.1016/j.hroo.2022.10.009] [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] [Indexed: 11/23/2022] Open
Abstract
Background High-power, short-duration (HPSD) radiofrequency ablation (RFA) may reduce ablation time. Concerns that catheter-mounted thermocouples (TCs) can underestimate tissue temperature, resulting in elevated risk of steam pop formation, potentially limit widespread adoption of HPSD ablation. Objective The purpose of this study was to compare the safety and efficacy of HPSD and low-power, long-duration (LPLD) RFA in the context of pulmonary vein isolation (PVI). Methods An open-irrigated ablation catheter with a contact force sensor and a flexible-tip electrode containing a TC at its distal end (TactiFlexTM Ablation Catheter, Sensor EnabledTM, Abbott) was used to isolate the left pulmonary veins (PVs) in 12 canines with HPSD RFA (50 W for 10 seconds) and LPLD RFA (30 W for a maximum of 60 seconds). PVI was assessed at 30 minutes and 28 ± 3 days postablation. Computed tomographic scans were performed to assess PV stenosis after RFA. Lesions were evaluated with histopathology. Results A total of 545 ablations were delivered: 252 with LPLD (0 steam pops) and 293 with HPSD RFA (2 steam pops) (P = .501). Ablation time required to achieve PVI was >3-fold shorter for HPSD than for LPLD RFA (P = .001). All 24 PVs were isolated 30 minutes after ablation, with 12/12 LPLD-ablated and 11/12 HPSD-ablated PVs still isolated at follow-up. Histopathology revealed transmural ablations for HPSD and LPLD RFA. No major adverse events occurred. Conclusion An investigational ablation catheter effectively delivered RFA lesions. Ablation time required to achieve PVI with HPSD with this catheter was >3-fold shorter than with LPLD RFA.
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Chinitz JS, Harris EQ. Mitigating Esophageal Injury after Atrial Fibrillation Ablation Guided by Ablation Index; CLOSEr to goal. J Cardiovasc Electrophysiol 2022; 33:2285-2287. [PMID: 35979648 DOI: 10.1111/jce.15655] [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: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
In the ongoing quest to optimize outcomes for atrial fibrillation ablation, efforts continue to balance the reliable creation of durable transmural ablation lesions, while minimizing risk to neighboring sensitive structures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jason S Chinitz
- South Shore University Hospital, Northwell Health, Bay Shore, NY
| | - Eli Q Harris
- Nassau University Medical Center, East Meadow, NY
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Francke A, Naumann G, Weidauer MC, Scharfe F, Schoen S, Wunderlich C, Christoph M. Esophageal safety in CLOSE-guided 50W high-power-short-duration pulmonary vein isolation - The PREHEAT-PVI-Registry. J Cardiovasc Electrophysiol 2022; 33:2276-2284. [PMID: 35979645 DOI: 10.1111/jce.15656] [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: 05/04/2022] [Revised: 06/12/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
AIMS Pulmonary vein isolation (PVI) using high-power-short-duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short-term to mid-term efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. METHODS In a single-centre experience, 388 consecutive standardized first-time AF ablation were performed using a CLOSE-guided-fixed-50W-circumferential PVI and substrate modification without intraprocedural oesophageal temperature measurement. 300 patients underwent post-procedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. RESULTS EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low-grade KCC 1 lesions with fast healing tendencies. 6 patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender and body-mass-index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 grams, p<0.001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 sec., p<0.001), while achieved AI was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). CONCLUSIONS Incidence of EDEL after CLOSE-guided-50W-HPSD PVI is lower compared to historical cohorts using standard-power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 grams. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Francke
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - G Naumann
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - M C Weidauer
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - F Scharfe
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - S Schoen
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - C Wunderlich
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - M Christoph
- Klinikum Chemnitz - MEDiC, Flemmingstraße 2, 09116, Chemnitz, 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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Liu Z, Liu LF, Liu XQ, Liu J, Wang YX, Liu Y, Liu XP, Yang XC, Chen ML. Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation. Front Cardiovasc Med 2022; 9:949918. [PMID: 35990990 PMCID: PMC9387669 DOI: 10.3389/fcvm.2022.949918] [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: 05/21/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ablation in a milder AI-targeting setting are unknown. The goal of this study was to explore the efficacy and safety of HP-AI-guided ablation in a milder AI-targeting setting. Methods Patients who underwent pulmonary vein isolation (PVI) for AI-guided atrial fibrillation ablation in our center were enrolled and divided into 2 groups according to the ablation power used. In the HP-AI group, the ablation power was over 45 W, while the low power-AI group was ablated with <35 W power. The targeted AIs were 450–500 in the anterior wall and 350–400 in the posterior wall. The efficacy outcome was expressed as the single-procedure atrial arrhythmia-free survival between 91 days and 1 year. Safety outcomes included severe adverse events (SAEs), including symptomatic pulmonary vein (PV) stenosis, atrioesophagal fistula, cardiac tamponade, stroke, thromboembolism events, myocardial infarction, and major bleeding. Results A total of 134 patients were enrolled, of whom 74 underwent PVI using HP-AI, while 60 received low power-AI ablation. After a mean follow-up time of 7.4 months, 22 (16.4%) patients showed arrhythmia recurrence: 5 (6.8%) patients in the HP-AI group and 17 (28.3%) patients in the low power-AI group. The HP-AI group showed a significantly higher arrhythmia-free survival than the low power-AI group (p = 0.011). Two patients in the low power-AI group and 1 patient in the HP-AI group developed an SAE (p = NS). Compared with the low power-AI group, the HP-AI group demonstrated a higher PV first-pass isolation rate, shorter ablation time, and fewer patients with anatomical leakages and sites of unreached AI. Conclusion In a milder AI setting, HP-AI ablation might result in significantly higher arrhythmia-free survival than low power-AI ablation and a similar safety profile.
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Salló Z, Perge P, Balogi B, Orbán G, Piros K, Herczeg S, Nagy KV, Osztheimer I, Ábrahám P, Merkely B, Gellér L, Szegedi N. Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:935705. [PMID: 35872909 PMCID: PMC9300971 DOI: 10.3389/fcvm.2022.935705] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHigh-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.MethodsOne hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).ResultsBilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001).ConclusionOur prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.
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Gasimova NZ, Nechepurenko AA, Kropotkin EB, Ivanitsky EA, Kolunin GV, Shavshin DA, Antolic B, Artyukhina EA, Abdrakhmanov AS, Korolev KS, Lebedev DS, Mikhaylov EN. Performance of the ablation index during pulmonary vein isolation: periprocedural data from a multicenter registry. J Interv Card Electrophysiol 2022; 65:167-177. [PMID: 35575867 PMCID: PMC9109667 DOI: 10.1007/s10840-022-01242-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study aimed to assess the achievement of target ablation index (AI) values and their impact on first-pass pulmonary vein isolation (FPI) as well as to identify FPI predictors. METHODS Atrial fibrillation (AF) ablation was performed according to the local practice, and target AIs were evaluated. The actual AI was calculated as the median value of all ablation points for the anterior and posterior left atrial (LA) walls. RESULTS A total of 450 patients from nine centers were enrolled. Patients with first-time ablation (n = 408) were divided into the FPI and non-FPI groups. In the FPI group, a higher median target AI was reported for both the anterior and posterior LA walls than those in the non-FPI group. A higher actual AI was observed for the anterior LA wall in the FPI group. The actual AI was equal to or higher than the target AI for the posterior, anterior, and both LA walls in 54%, 47%, and 35% (n = 158) cases, respectively. Parameters such as hypertension, stroke, ablation power, actual AI value on the anterior wall, target AI values on both LA walls, AI achievement on the posterior wall, carina ablation, and operator experience were all associated with FPI in a univariate logistic regression model; only carina ablation was an independent predictor of FPI. CONCLUSIONS According to our multicenter study, FPI and a target AI were not achieved in a significant proportion of AF ablation procedures. Higher actual and target AI values were associated with FPI, but only carina ablation can independently predict FPI.
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Affiliation(s)
- Nigar Z Gasimova
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia.
| | - Anatoly A Nechepurenko
- Federal Center of Cardiovascular Surgery, 4 Pokrovskaya Roscha str, 414011, Astrakhan, Russia
| | - Evgeny B Kropotkin
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Eduard A Ivanitsky
- Federal Center of Cardiovascular Surgery, 45 Karaulnaya str, 660020, Krasnoyarsk, Russia
| | - Grigorii V Kolunin
- Tyumen Cardiology Research Center, 111 Melnikayte str, 625026, Tyumen, Russia
| | - Dmitry A Shavshin
- Federal Center of High Medical Technologies, 4a Kaliningradskoe highway, 238312, Kaliningrad, Russia
| | - Bor Antolic
- University Medical Center, 7 Zaloska cesta, 1000, Lyublyana, Slovenia
| | - Elena A Artyukhina
- Vishnevskiy National Medical Research Center of Surgery, 27 Bolshaya Serpukhovskaya str, 117997, Moscow, Russia
| | - Ayan S Abdrakhmanov
- National Research Cardiac Surgery Center, 38 Turan ave, 010000, Nur-Sultan, Kazakhstan
| | - Konstantin S Korolev
- Saint-Petersburg Pediatric University, 2 Litovskaya str, 194100, Saint-Petersburg, Russia
| | - Dmitry S Lebedev
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
| | - Evgeny N Mikhaylov
- Almazov National Medical Research Centre, 2 Akkuratova str, 197341, Saint-Petersburg, Russia
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Ding WY, Tovmassian L, Bierme C, Kozhuharov N, Snowdon RL, Gupta D. Ablation index-guided 50W radiofrequency ablation for left atrial posterior wall isolation in atrial fibrillation. Indian Pacing Electrophysiol J 2022; 22:200-206. [PMID: 35642824 PMCID: PMC9263631 DOI: 10.1016/j.ipej.2022.05.002] [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: 02/26/2022] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022] Open
Abstract
Background Ablation index (AI)-guided ablation for posterior wall isolation (PWI) using high-power, short-duration remains untested. We sought to evaluate the acute outcomes of AI-guided 50 W ablation vs. conventional ablation, and investigate the differences in relationship between contact force (CF), time and AI in both groups. Methods Consecutive patients undergoing first-time AI-guided ablation with PWI using either 50 W or 35–40 W ablation were enrolled. Acute procedural metrics and individual lesion level ablation data were compared between groups. Results 40 patients (50 W: n = 20, 35–40 W: n = 20) with atrial fibrillation were included. Total procedure time was significantly reduced with 50 W (120 vs. 143 mins, p = 0.004) and there was a trend toward decreased ablation time (22 vs. 28 mins, p = 0.052). First pass and acute success of PWI were comparable between the 50 W and 35–40 W groups (10 vs. 8 patients, p = 0.525 and 20 vs. 19 patients, p = 1.000, respectively). Individual lesion analysis of all 959 RF applications (50 W: n = 458, 35–40 W: n = 501) demonstrated that 50 W ablation led to lower ablation time per lesion (10.4 vs. 13.0s, p < 0.001), and increased AI (471 vs. 461, p < 0.001) and impedance drop (7.4 vs. 6.9ohms, p = 0.007). Excessive ablations (AI>600 for roof line; AI>500 elsewhere) were more frequently observed in the 50 W group (9.0% vs. 4.6%, p = 0.007). CF had very good discriminative capability for excessive ablation in both groups. At 50 W, limiting the CF to <10 g reduced the number of excessive ablations on the floor line and within the posterior box to 12% and 4%,respectively. Recurrence of atrial arrhythmias at 12 months were comparable between the groups. Conclusion AI-guided 50 W RF ablation reduces the ablation time of individual lesions and total procedure time without compromising first pass and acute success rates of PWI or 12-month outcomes compared to conventional powers.
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Bortone A, Albenque JP, Ramirez FD, Haïssaguerre M, Combes S, Constantin M, Laborie G, Brault-Noble G, Marijon É, Jaïs P, Pambrun T. 90 vs 50-Watt Radiofrequency Applications for Pulmonary Vein Isolation: Experimental and Clinical Findings. Circ Arrhythm Electrophysiol 2022; 15:e010663. [PMID: 35363039 DOI: 10.1161/circep.121.010663] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fifty-watt radiofrequency applications have proven to be safe and efficient for pulmonary vein isolation (PVI). However, as PV reconnection still occurs and ablation catheter instability significantly contributes to suboptimal lesion formation, a new ablation catheter capable of delivering 90 W for 4 seconds only has been developed with the aim of improving PVI outcomes. In this setting, we sought to determine whether 90 W applications create transmural lesions without collateral damage experimentally and whether they can safely improve PVI procedures clinically compared with 50 W settings. METHODS Experimentally, individual lesions were created in vivo in the right atrium of 6 swine with 90 W-4 seconds applications using the SmartTouch-SF catheter in a power-controlled mode (3 animals) or the QDOT-MICRO catheter in a temperature-controlled mode (3 animals). Clinically, PVI was performed in a homogenous population of 150 consecutive paroxysmal atrial fibrillation patients using CARTO and the QDOT-MICRO catheter in a temperature-controlled mode (75 patients 50 W-ablation index-guided and 75 patients 90 W-4 seconds). RESULTS Mostly, (94.9%) experimental lesions were transmural in the thin-walled right atrium of swine. However, collateral damage was observed with both catheters in 17.9% of lesions. Clinically, 90 W procedures had a lower first-pass PVI rate (49% versus 81%, P<10-4) and a higher acute PV reconnection rate (21% versus 5%, P=0.004) than 50 W procedures, whereas total procedural duration (62 versus 66 minutes, P=0.09), 1-year sinus rhythm maintenance (88% versus 90%, P=0.6) and safety (1 tamponade per group) were similar in both groups. CONCLUSIONS Experimentally, using the QDOT-MICRO catheter, 90 W-4 seconds lesions are mostly transmural in the thin-walled right atrium of swine (median depth 1.87 mm) with a moderate lesion diameter of 6.62 mm but retain the potential for collateral damage. Clinically, 90 W-4 seconds applications are associated with a lower first-pass PVI rate and a higher acute PV reconnection rate than 50 W applications but similar safety outcomes and effectiveness at 1 year.
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Affiliation(s)
- Agustín Bortone
- ELSAN, Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes (A.B., G.L.)
| | | | - F Daniel Ramirez
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux (F.D.R., M.H., M.C., P.J., T.P.).,Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (F.D.R., M.H., M.C., P.J., T.P.).,Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada (F.D.R.)
| | - Michel Haïssaguerre
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux (F.D.R., M.H., M.C., P.J., T.P.).,Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (F.D.R., M.H., M.C., P.J., T.P.)
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, Toulouse (J.-P.A., S.C.)
| | - Marion Constantin
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux (F.D.R., M.H., M.C., P.J., T.P.).,Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (F.D.R., M.H., M.C., P.J., T.P.)
| | - Guillaume Laborie
- ELSAN, Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes (A.B., G.L.)
| | - Guillaume Brault-Noble
- ELSAN, Service d'Anesthésie et de Réanimation, Hôpital Privé Les Franciscaines, Nîmes (G.B.-N.)
| | - Éloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France (É.M.)
| | - Pierre Jaïs
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux (F.D.R., M.H., M.C., P.J., T.P.).,Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (F.D.R., M.H., M.C., P.J., T.P.)
| | - Thomas Pambrun
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux (F.D.R., M.H., M.C., P.J., T.P.).,Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (F.D.R., M.H., M.C., P.J., T.P.)
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Mueller J, Halbfass P, Sonne K, Nentwich K, Ene E, Berkovitz A, Lehmkuhl L, Barth S, Simu GR, Wächter C, Behnes M, Deneke T. Safety aspects of very high power very short duration atrial fibrillation ablation using a modified Radiofrequency RF-Generator: Single center experience. J Cardiovasc Electrophysiol 2022; 33:920-927. [PMID: 35233883 DOI: 10.1111/jce.15433] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION High power short duration ablation proved to be an effective and safe ablation technique for atrial fibrillation (AF). In former case series a significant amount of post-ablation coagulation at the catheter tip as well as silent cerebral lesions in post-procedural cerebral MRI have been identified in patients undergoing de-novo AF ablations with very high power 90 W short duration (vHPvSD) ablations using the QDot ablation catheter in combination with a novel RF-generator (nGEN, BiosenseWebster). Therefore, the RF generator software has been recently modified. METHODS AND RESULTS Consecutive patients undergoing a first AF ablation including pulmonary vein isolation (PVI) with vHPvSD (90 W, with a predefined ablation time of 3 seconds at posterior LA wall sites and 4 seconds at other ablation sites) using the QDOT Micro ablation catheter (Biosense Webster) in conjunction with the technically modified nGEN RF generator (software V1c; Biosense Webster) were included. Procedural characteristics including first-pass isolation per pulmonary vein (PV) pair and early reconnection location within the 30-minute waiting period were recorded. In all patients post-ablation endoscopy to document any thermal esophageal injury (EDEL) and in eligible patients a cerebral magnetic resonance imaging (cMRI) to detect silent cerebral events (SCE)/lesions (SCL) were performed. All acute procedure related complications were recorded during the time until hospital discharge. Furthermore, short-term and mid-term success after 3 and 6 to 12 months of follow-up was investigated. In total, 34 consecutive patients (67±9 years; 62% male; 68% paroxysmal AF) were included. First-pass isolation of all PVs was achieved in 6/34 (18%) patients. First-pass isolation was seen in 37/68 (54%) of PV pairs. Early reconnection occurred in 11 (32%) patients (including reconnections at posterior LA wall sites n=6 and at non-posterior sites n=5). No patient had an EDEL (0%). In 6/23 (26%) patients undergoing post-ablation cerebral MRI SCE were identified. In 6 patients coagulation on the catheter tip was detected at the end of the procedure. No further peri- or post-procedural complications were detected. Early AF recurrence before discharge was seen in 1/34 (3%) of the patients included in this study. Within 3 months 10/34 (29%) revealed AF recurrence during blanking period. After a mean follow-up of 7 months 31/34 (88%) patients revealed sinus rhythm. CONCLUSION AF ablation using 90W vHPvSD with a specialized ablation catheter in conjunction with a recently modified RF-generator was associated with no EDEL in the whole study cohort and 26% SCE in a subgroup of patients undergoing acute post-ablation cerebral MRI. Accordingly to our previously published results, a relevant number of catheter tip coagulations was identified in this patient cohort even after modifications of the RF-generator. The vHPvSD ablation technique using the present and the previous generator seems to be associated with a very low rate of esophageal injury. However, the recently revised generator software also produced a relevant number of catheter tip coagulum formation and SCE. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Julian Mueller
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany.,Department of Cardiology and Angiology, Philipps-University Marburg, Germany.,First Department of Medicine, University Medical Centre Mannheim, Germany
| | - Philipp Halbfass
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany.,Department of Cardiology and Angiology, Philipps-University Marburg, Germany
| | - Kai Sonne
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Karin Nentwich
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Elena Ene
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Artur Berkovitz
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Lukas Lehmkuhl
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Germany
| | - Sebastian Barth
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Gelu Radu Simu
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Christian Wächter
- Department of Cardiology and Angiology, Philipps-University Marburg, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Germany
| | - Thomas Deneke
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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Francke A, Scharfe F, Schoen S, Wunderlich C, Christoph M. Reconnection patterns after high-power-short-duration pulmonary vein isolation Reconnection patterns after CLOSE-guided 50W high-power-short-duration circumferential pulmonary vein isolation and substrate modification - PV reconnection might no longer be an issue. J Cardiovasc Electrophysiol 2022; 33:1136-1145. [PMID: 35118734 DOI: 10.1111/jce.15396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ablation of atrial fibrillation (AF) with high-power-short-duration (HPSD) radiofrequency (RF) technology is emerging as a new standard of care in many electrophysiology laboratories. While procedural short-term efficacy and efficiency is very promising, little is known about mid- to long-term effects of HPSD ablation for pulmonary vein isolation and left atrial substrate modification. METHODS AND RESULTS In a single-centre registry, 412 AF procedures were performed in 400 individual patients using a standardized CLOSE protocol guided fixed 50W HPSD ablation, aiming for an ablation index (AI) of 400 on the posterior and 550 on the anterior wall. Additional substrate-tailored lines were performed when required. After a mean clinical follow-up of 337 ± 134 days, 15 patients suffered from AF recurrence beyond the blinding period. 12 gave consent to the indicated re-ablation. Here, 11 of 12 patients had chronic isolation of all 4 pulmonary veins (PV). In 3 of 6 patients, a reconnection of additional left atrial ablation lines was revealed. 10 out of 12 patients showed progressive fibrous atrial cardiomyopathy and required additional left atrial substrate modification or re-isolation of left-atrial lines. During the follow-up no clinical case of atrioesophageal fistula was registered. No PV stenosis after initial HPSD PVI was documented. CONCLUSIONS Patients requiring re-ablation of AF or other atrial tachycardia after a fixed 50W HPSD circumferential PVI and substrate modification predominantly suffer from progressive fibrous atrial cardiomyopathy, while PV reconnection appears to be a rare cause of AF recurrence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Francke
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - F Scharfe
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - S Schoen
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - C Wunderlich
- Helios Klinikum Pirna, Struppener Str. 13, 01797, Pirna, Germany
| | - M Christoph
- Klinikum Chemnitz, TU Dresden Campus Chemnitz - MEDiC, Flemmingstraße 2, 09116, Chemnitz, Germany
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The target ablation index values for electrical isolation of the superior vena cava. J Interv Card Electrophysiol 2022; 64:687-694. [PMID: 35112239 DOI: 10.1007/s10840-021-01112-w] [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: 08/17/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The ablation index (AI), developed as a radiofrequency (RF) catheter ablation composite component endpoint, which incorporates contact force (CF), time, and power in a weighted formula, has been reported to be useful for a durable pulmonary vein isolation (PVI) to treat atrial fibrillation (AF). No study has reported the target AI value for the SVC isolation (SVCI). In this study, we aimed to investigate the target AI for the SVCI. METHODS Thirty-six AF patients who underwent an initial SVCI were enrolled. Ablation was performed at 556 points. The sites where dormant conduction was induced or additional ablation was needed were defined as touch up sites (n = 36). We compared the energy deliver time, power, generator impedance (GI) drop, local bipolar voltage, contact force (CF), force-time integral (FTI), and AI between the touch up sites and the no touch up sites (n = 520). RESULTS The FTI and AI were significantly lower at the touch up sites (touch up sites vs. no touch up sites; FTI, 126.5 [99.3-208.8] vs. 244 [184-340.8], p < 0.0001; AI, 350.1 ± 43.6 vs. 277.2 ± 21.8, p < 0.0001). The median value of the AI at the no touch up sites was 350, and no reconnections were seen where the minimum AI value was more than 308. Most of the touch up sites were located in the anterior wall and lateral wall (anterior wall, 20/36 sites [55.6%]; lateral wall, 10/36 sites [27.8%]; septal wall, 6/36 sites [16.7%]; posterior wall, 0/36sites [0.0%]). CONCLUSION The target AI value for the SVCI should be 350, and at least 308 would be needed.
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Lozano Granero C, Franco E, Matía Francés R, Hernández-Madrid A, Sánchez-Pérez I, Zamorano Gómez JL, Moreno J. Impact of power and contact force on index-guided radiofrequency lesions in an ex vivo porcine heart model. J Interv Card Electrophysiol 2022; 63:687-697. [PMID: 34997886 DOI: 10.1007/s10840-021-01110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Lesion size index (LSI) and ablation index (AI) are markers of lesion quality that incorporate power, contact force (CF) and time in a weighted formula to estimate lesion size. Although accurate predicting lesion depth in vitro, their precision in lesion size estimation has not been well established for certain power and CF settings. We conducted an experimental ex vivo study to analyse the effect of power and CF in size and morphology of ablation lesions in a porcine heart model. METHODS Twenty-four sets of 10 perpendicular epicardial radiofrequency applications were performed with two commercially available catheters (TactiCath, Sensor Enabled; and SmartTouch) on porcine left ventricle submerged in 37 °C saline, combining different power (25, 30, 35, 40, 50 and 60 W) and CF (10 and 20 g) settings, and aiming at a lower (LSI/AI of 5/400) or higher (LSI/AI of 6/550) index. After each application, lesions were cross-sectioned and measured. RESULTS Four hundred eighty lesions were performed. For a given target index and CF, significant differences in lesion volume and depth with different power were observed with both catheters, generally with smaller lesions using higher power. Lesions performed with CF of 10 g were particularly smaller with TactiCath compared to SmartTouch; lesions with CF of 20 g aiming a low LSI/AI were, however, bigger; lesions with CF of 20 g aiming a high LSI/AI were similar. In general, high-power lesions were wider and shallower than low-power lesions, especially with SmartTouch. CONCLUSION Size and morphology of index-guided radiofrequency lesions varied significantly with different power and CF settings.
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Affiliation(s)
- Cristina Lozano Granero
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain.
| | - Eduardo Franco
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Roberto Matía Francés
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Antonio Hernández-Madrid
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | - Inmaculada Sánchez-Pérez
- Paediatric Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
| | | | - Javier Moreno
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón Y Cajal, M-607, km 9100, 28034, Madrid, Spain
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Khanra D, Hamid A, Deshpande S, Mukherjee A, Petkar S, Saeed M, Basu-Ray I. Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation. Anatol J Cardiol 2022; 26:2-14. [PMID: 35191380 PMCID: PMC8878944 DOI: 10.5152/anatoljcardiol.2021.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other. METHODS A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. RESULTS Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I2=62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups. CONCLUSION HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.
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Affiliation(s)
| | | | | | | | - Sanjiv Petkar
- Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust; Wolverhampton-United Kingdom
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Halbfass P, Wielandts JY, Knecht S, Le Polain de Waroux JB, Tavernier R, De Wilde V, Sonne K, Nentwich K, Ene E, Berkovitz A, Mueller J, Lehmkuhl L, Reichart A, Lüsebrink U, Duytschaever M, Deneke T. Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury. Europace 2021; 24:400-405. [PMID: 34757432 DOI: 10.1093/europace/euab261] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Very high-power short-duration (vHPSD) via temperature-controlled ablation (TCA) is a new modality to perform radiofrequency pulmonary vein isolation (PVI), conceivably at the cost of a narrower safety margin towards the oesophagus. In this two-centre trial, we aimed to determine the safety of vHPSD-based PVI with specific emphasis on silent oesophageal injury. METHODS AND RESULTS Ninety consecutive patients with atrial fibrillation (AF) underwent vHPSD-PVI (90 W, 3-4 s, TCA) using the QDOT MICRO catheter, in conjunction with the nGEN (Bad Neustadt, n = 45) or nMARQ generator (Bruges, n = 45). All patients underwent post-ablation oesophageal endoscopy. Procedural parameters and complications were recorded. A subgroup of 21 patients from Bad Neustadt underwent cerebral magnetic resonance imaging (cMRI) to detect silent cerebral events (SCEs). Mean age was 67 ± 9 years, 59% patients were male, and 66% patients had paroxysmal AF. Pulmonary vein isolation was obtained in all cases after 96 ± 29 min. No steam pop, cardiac tamponade, stroke, or fistula was reported. None of the 90 patients demonstrated oesophageal ulceration (0%). Charring was not observed in the nMARQ cohort (0% vs. 11% in the nGEN group). In 5 out of 21 patients (24%), cMRI demonstrated SCE (exclusively nGEN cohort). CONCLUSION Temperature-controlled vHPSD catheter ablation allows straightforward PVI without evidence of oesophageal ulcerations or symptomatic complications. Catheter tip charring and silent cerebral lesions when using the nGEN generator have led to further modification.
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Affiliation(s)
- Philipp Halbfass
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | | | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Vincent De Wilde
- Department of Gastro-Enterology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Kai Sonne
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | - Karin Nentwich
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | - Elena Ene
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | - Artur Berkovitz
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | - Julian Mueller
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
| | - Lukas Lehmkuhl
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Amelie Reichart
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Ulrich Lüsebrink
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | | | - Thomas Deneke
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany
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Mao ZJ, Pei Y, Lin H, Xiang Y, Huang ZQ, Xiao FY, Chen YH. Assessment of High-Power Catheter Ablation in Patients With Atrial Fibrillation: A Meta-Analysis. Front Cardiovasc Med 2021; 8:609590. [PMID: 34746245 PMCID: PMC8564349 DOI: 10.3389/fcvm.2021.609590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: High-power radiofrequency (RF) catheter ablation was considered as a promising alternative strategy to conventional-power ablation in the treatment of patients with atrial fibrillation (AF). This study sought to compare the efficacy and safety of high-power energy delivery to that of conventional-power setting in AF catheter ablation. Methods: We performed a systematic review of relevant literature in Pubmed, Embase, Cochrane library, and Google Scholar database. Sixteen eligible studies totaling 3,307 patients (1,929 for high-power ablation; 1,378 for conventional-power ablation) met inclusion criteria. Results: During a median 12 month follow-up, high-power ablation showed a significantly higher AF/atrial tachycardia-free survival rate in comparison with conventional-power ablation (risk ratio [RR] 1.09, 95% CI 1.02 to 1.15, p = 0.008). Notably, a high-power strategy convincingly decreased the procedure time (weighted mean difference [WMD] -46.11 min, 95% CI -59.15 to -33.07, p < 0.001) and RF ablation time (WMD -19.19 min, 95% CI -24.47 to -13.90, p < 0.001), along with reduced fluoroscopy time (WMD -7.82 min, 95% CI -15.13 to -0.68, p = 0.036). In addition, there was no perceptible difference in the potential risk of procedure-related complications between these two approaches (RR 0.81, 95% CI 0.48 to 1.37, p = 0.428). Conclusions: High-power RF catheter ablation was associated with an improvement in long-term sinus rhythm maintenance for treatment of AF, without exacerbating the risk of adverse events during the procedure. Impressively, high-power pulmonary vein isolation had the potential to shorten the application duration and minimize fluoroscopic exposure.
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Affiliation(s)
- Zhi-Jie Mao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Pei
- Department of Cardiology, The First People's Hospital of JinZhong, Yuci, China
| | - Hui Lin
- Department of Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yin Xiang
- Department of Cardiology, Xinhua Hospital Affiliated to The Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Zhou-Qing Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang-Yi Xiao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-He Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y. Actual tissue temperature during ablation index-guided high-power short-duration ablation versus standard ablation: Implications in terms of the efficacy and safety of atrial fibrillation ablation. J Cardiovasc Electrophysiol 2021; 33:55-63. [PMID: 34713525 DOI: 10.1111/jce.15282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Actual in vivo tissue temperatures and the safety profile during high-power short-duration (HPSD) ablation of atrial fibrillation have not been clarified. METHODS We conducted an animal study in which, after a right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We recorded tissue temperatures during a 50 W-HPSD ablation and 30 W-standard ablation targeting an ablation index (AI) of 400 (5-15 g contact force). RESULTS Maximum tissue temperatures reached with HSPD ablation were significantly higher than that reached with standard ablation (62.7 ± 12.5 vs. 52.7 ± 11.4°C, p = 0.033) and correlated inversely with the distance between the catheter tip and thermocouple, regardless of the power settings (HPSD: r = -0.71; standard: r = -0.64). Achievement of lethal temperatures (≥50°C) was within 7.6 ± 3.6 and 12.1 ± 4.1 s after HPSD and standard ablation, respectively (p = 0.003), and was best predicted at cutoff points of 5.2 and 4.4 mm, respectively. All HPSD ablation lesions were transmural, but 19.2% of the standard ablation lesions were not (p = 0.011). There was no difference between HPSD and standard ablation regarding the esophageal injury rate (30% vs. 33.3%, p > 0.99), with the injury appearing to be related to the short distance from the catheter tip. CONCLUSIONS Actual tissue temperatures reached with AI-guided HPSD ablation appeared to be higher with a greater distance between the catheter tip and target tissue than those with standard ablation. HPSD ablation for <7 s may help prevent collateral tissue injury when ablating within a close distance.
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Affiliation(s)
- Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
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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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Lee SR, Park HS, Choi EK, Lee E, Oh S. Acute and long-term efficacy of ablation index-guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry. J Arrhythm 2021; 37:1250-1259. [PMID: 34621423 PMCID: PMC8485805 DOI: 10.1002/joa3.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 07/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Theoretically, targeting the same ablation index (AI) using higher power may achieve the same lesion size with a shorter ablation time. We evaluated the acute and long-term efficacy of higher-powered ablation guided by ablation index (HPAI) compared with conventional-powered ablation guided by AI (CPAI) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). METHODS Drug refractory symptomatic AF patients who had been ablated with 40 W on the anterior/roof segments and 30 W on the posterior/inferior/carina segments were enrolled (HPAI group). We compared the HPAI group with the CPAI group who were ablated with 30 W on the anterior/roof segments and 25 W on the posterior/inferior/carina segments. The same AI was targeted (≥450 on the anterior/roof segments and ≥350 on the posterior/inferior/carina segments). We compared ablation time, acute pulmonary vein reconnection (PVR) and 1-year AF recurrence between the two groups. RESULTS A total of 118 patients were included (86 in the HPAI group and 32 in the CPAI group, paroxysmal AF, 73%). There was no significant difference in the acute PVR rate between the HPAI and the CPAI groups (3.7% vs. 4.2%, P = .580) with a 41% reduction in ablation time for PVI (38.7 ± 8.3 vs. 65.8 ± 13.7 minutes, P < .001). The 1-year AF recurrence rate was not significantly different between HPAI and CPAI groups (12.8% vs. 21.9%, Log-rank P = .242). There were no major complications in either group. CONCLUSIONS Increased power during AF ablation, using the same AI targets, reduced the procedure and ablation times, and showed a comparable acute and long-term outcome without compromising safety. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique identifier: NCT04379557.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Hyoung-Seob Park
- Division of Cardiology Department of Internal Medicine Dongsan Medical Center Keimyung University Daegu Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Seil Oh
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
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Yazaki K, Ejima K, Kataoka S, Kanai M, Higuchi S, Yagishita D, Shoda M, Hagiwara N. Regional differences in the predictors of acute electrical reconnection following high-power pulmonary vein isolation for paroxysmal atrial fibrillation. J Arrhythm 2021; 37:1260-1269. [PMID: 34621424 PMCID: PMC8485794 DOI: 10.1002/joa3.12597] [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: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Acute pulmonary vein reconnection (PVR) is associated with long procedure times and large radiofrequency (RF) energy delivery during pulmonary vein isolation (PVI). Although the efficacy of high-power PVI (HP-PVI) has been recently established, the determinants of acute PVR following HP-PVI remain unclear. METHODS We evaluated data on 62 patients with paroxysmal atrial fibrillation undergoing unipolar signal modification (USM)-guided HP-PVI. A 50-W RF wave was applied for 3-5 seconds after USM. In the segments adjacent to the esophagus (SAEs), the RF time was limited to 5 seconds. Each circle was subdivided into six regions (segments), and the possible predictors of acute PVR, including minimum contact force (CFmin), minimum force-time integral (FTImin), minimum ablation index (AImin), minimum impedance drop (Imp-min), and maximum inter-lesion distance (ILDmax), were assessed in each segment. RESULTS We investigated 1162 ablations in 744 segments (including 124 SAEs). Acute PVR was observed in 21 (17%) SAEs and 43 (7%) other segments (P = .001). The acute PVR segments were characterized by significantly lower CFmin, FTImin, AImin, and Imp-min values in the segments other than the SAEs and larger ILDmax values in the SAEs. Furthermore, lower Imp-min and larger ILDmax values independently predicted acute PVR in the segments other than the SAEs and SAEs (odds ratios 0.90 and 1.39 respectively). Acute PVR was not significantly associated with late atrial fibrillation recurrence. CONCLUSIONS Avoiding PVR remains a challenge in HP-PVI cases, but it might be resolved by setting the optimal target impedance drop and lesion distance values.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Miwa Kanai
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Satoshi Higuchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Clinical Research Division for Heart Rhythm Management Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
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Chen S, Pürerfellner H, Ouyang F, Kiuchi MG, Meyer C, Martinek M, Futyma P, Zhu L, Schratter A, Wang J, Acou WJ, Ling Z, Yin Y, Liu S, Sommer P, Schmidt B, Chun JKR. Catheter ablation vs. antiarrhythmic drugs as 'first-line' initial therapy for atrial fibrillation: a pooled analysis of randomized data. Europace 2021; 23:1950-1960. [PMID: 34405878 DOI: 10.1093/europace/euab185] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as 'initial therapy' for AF is to be determined. METHODS AND RESULTS Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27-0.48, P < 0.001). This significance was maintained in subgroup analyses of 1- and 2-year follow-up (P < 0.001). Catheter ablation was associated with significantly greater improvement in QoL regarding AFEQT score and 36-Item Short-Form Health Survey score. The incidence of serious adverse events between ablation and AADs group (5.6% vs. 4.9%, P = 0.62) was similar. CONCLUSIONS Catheter ablation as 'initial therapy' was superior to AADs in maintenance of sinus rhythm and improving QoL for patients with symptomatic paroxysmal AF, without increasing risk of serious adverse events.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Helmut Pürerfellner
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Feifan Ouyang
- Klinik und Poliklinik für Kardiologie, Universitäres Herz und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Márcio Galindo Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Martinek
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Lin Zhu
- Medizinisch-Geriatrische Klinik, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | - Jiazhi Wang
- Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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44
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O'Brien J, Obeidat M, Kozhuharov N, Ding WY, Tovmassian L, Bierme C, Chin SH, Chu GS, Luther V, Snowdon RL, Gupta D. Procedural efficiencies, lesion metrics, and 12-month clinical outcomes for Ablation Index-guided 50 W ablation for atrial fibrillation. Europace 2021; 23:878-886. [PMID: 33693677 DOI: 10.1093/europace/euab031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The safety of Ablation Index (AI)-guided 50 W ablation for atrial fibrillation (AF) remains uncertain, and mid-term clinical outcomes have not been described. The interplay between AI and its components at 50 W has not been reported. METHODS AND RESULTS Eighty-eight consecutive AF patients (44% paroxysmal) underwent AI-guided 50 W ablation. Procedural and 12-month clinical outcomes were compared with 93 consecutive controls (65% paroxysmal) who underwent AI-guided ablation using 35-40 W. Posterior wall isolation (PWI) was performed in 44 (50%) and 23 (25%) patients in the 50 and 35-40 W groups, respectively, P < 0.001. The last 10 patients from each group underwent analysis of individual lesions (n = 1230) to explore relationships between different powers and the AI components. Pulmonary vein isolation was successful in all patients. Posterior wall isolation was successful in 41/44 (93.2%) and 22/23 (95.7%) in the 50 and 35-40 W groups, respectively (P = 0.685). Radiofrequency times (20 vs. 26 min, P < 0.001) and total procedure times (130 vs. 156 min, P = 0.002) were significantly lower in the 50 W group. No complication or steam pop was seen in either group. Twelve-month freedom from arrhythmia was similar (80.2% vs. 82.8%, P = 0.918). A higher proportion of lesions in the 50 W group were associated with impedance drop >7 Ω (54.6% vs. 45.5%, P < 0.001). Excessive ablation (AI >600 anteriorly, >500 posteriorly) was more frequent in the 50 W group (9.7% vs. 4.3%, P < 0.001). CONCLUSION Ablation Index-guided 50 W AF ablation is as safe and effective as lower powers and results in reduced ablation and procedure times. Radiofrequency lesions are more likely to be therapeutic, but there is a higher risk of delivering excessive ablation.
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Affiliation(s)
- Jim O'Brien
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Mohammed Obeidat
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Nikola Kozhuharov
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wern Yew Ding
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Lilith Tovmassian
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Cedric Bierme
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Shui Hao Chin
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Gavin S Chu
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Vishal Luther
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Richard L Snowdon
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - Dhiraj Gupta
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
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45
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Althoff TF, Mont L. Novel concepts in atrial fibrillation ablation-breaking the trade-off between efficacy and safety. J Arrhythm 2021; 37:904-911. [PMID: 34386116 PMCID: PMC8339092 DOI: 10.1002/joa3.12592] [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: 05/05/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 01/04/2023] Open
Abstract
Despite substantial technological and procedural advances that have improved the efficacy and safety of AF ablation in recent years, the long-term durability of ablation lesions is still not satisfactory. There also remains concern regarding rare but potentially life-threatening procedure-related complications like cardiac tamponade and atrioesophageal fistulae. Current ablation strategies are aiming to optimize the trade-off between efficacy and safety, where more extensive ablation appears to inevitably increase the risk of collateral injury. However, new forms of energy application may have the potential to resolve this quandary. The emerging concept of high power-short duration radiofrequency ablation features a more favorable lesion geometry that appears ideally suited to create contiguous lesions in the thin-walled atrium. Moreover, novel non-thermal ablation methods based on electroporation appear to provide a unique selectivity for cardiomyocytes and to spare surrounding tissues composed of other cell types. Both, high power-short duration and electroporation ablation might have the potential to break the trade-off between effective lesions and collateral damage and to substantially improve risk-benefit ratios in AF ablation. In addition, both approaches lead to considerable reductions in ablation times. However, their putative benefits regarding efficacy, efficiency, and safety remain to be proven in randomized controlled trials.
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Affiliation(s)
- Till F. Althoff
- Department of Cardiology and AngiologyCharité – University Medicine BerlinCharité Campus MitteBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
- Hospital Clínic Atrial Fibrillation Unit (UFA)Arrhythmia SectionCardiovascular Institute, Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Lluís Mont
- Hospital Clínic Atrial Fibrillation Unit (UFA)Arrhythmia SectionCardiovascular Institute, Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV)MadridSpain
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46
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[Pulmonary vein isolation using radiofrequency ablation]. Herzschrittmacherther Elektrophysiol 2021; 32:395-405. [PMID: 34309747 DOI: 10.1007/s00399-021-00794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Catheter ablation represents the primary treatment for most arrhythmias. The effectiveness of catheter ablation for the treatment of atrial fibrillation is superior to drug therapy. Therefore, catheter ablation has been established as an increasingly common procedure in clinical routine. In this context, the electrical isolation of the pulmonary veins (PVI) constitutes the cornerstone of the interventional therapy of paroxysmal and persistent atrial fibrillation. This article describes the procedure of pulmonary vein isolation utilizing radiofrequency point-by-point ablation. It shall be a practical guide for the staff in the electrophysiological laboratory. This article continues a series of manuscripts focusing on interventional electrophysiology topics in the course of EP (electrophysiology) training.This article describes the procedure of pulmonary vein isolation utilizing radiofrequency point-by-point ablation. It shall be a practical guide for the staff in the electrophysiological laboratory. This article continues a series of manuscripts dealing with topics of interventional electrophysiology in the course of EP training.
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47
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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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48
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Osei K, Sulkin MS, Hamann JJ, Hughes C, Shuros A, Nagy T, Kapa S, Meyers J. Local impedance-guided radiofrequency ablation with standard and high power: Results of a preclinical investigation. J Cardiovasc Electrophysiol 2021; 32:2060-2068. [PMID: 34223691 DOI: 10.1111/jce.15135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Local impedance (LI) drop measured with microfidelity electrodes embedded in the tip of an ablation catheter accurately reflects tissue heating during radiofrequency (RF) ablation. Previous studies found 15-30 Ω LI drops created successful lesions, while more than 40 Ω drops were associated with steam pops. The objective of this study was to evaluate the safety and efficacy of LI-guided ablation using standard (30 W) and high-power (50 W) in a preclinical model. METHODS RF lesions were created in explanted swine hearts (n = 6) to assess the feasibility of LI-guided ablation by targeting 10, 20, or 30 Ω (n = 20/group) drops. Subsequently, LI-guided ablation was evaluated in a chronic animal model (n = 8 Canines, 25-29 kg, 30/50 W). During the index procedure point-by-point intercaval line ablation and left inferior pulmonary vein (PV) isolation were performed. RF duration was at the operators' discretion but discontinued early if a 15-30 Ω drop was achieved. Operators attempted to avoid LI drops of more than 40 Ω. At 1-month, durable conduction block was evaluated with electroanatomic mapping followed by necropsy and histopathology. RESULTS In explanted tissue, terminating ablation at 10, 20, or 30 Ω LI drops created statistically larger lesions (p < .05; 1.8 [1.6-2.4] mm, 3.3 [3.0-3.7] mm; 4.9 [4.3-5.5] mm). LI-guided high-power ablation in vivo significantly reduced RF duration per application compared to standard-power (p < .05; intercaval: 8.9 ± 5.2 vs. 18.1 ± 11.0 s, PV: 9.6 ± 5.4 vs. 23.2 ± 10.3 s). LI drops of 15-40 Ω were more readily achievable for high-power (90.1%, 318/353) than standard-power (71.7%, 243/339). All intercaval lines and PV isolations were durable (16/16) at 1-month. Necropsy revealed no major collateral injury to the pericardium, phrenic nerve, esophagus, or lungs. There was no pericardial effusion, stroke, tamponade, or PV stenosis. Vagal nerve injury was found in two 30 W animals after using 19.7 ± 13.9 and 19.5 ± 11.8 s RF applications. CONCLUSION LI-guided ablation was found to be safe and efficacious in a chronic animal model. High-power ablation more readily achieved more than 15 Ω drops, reduced RF duration compared with standard-power, and had no major RF collateral injury.
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Affiliation(s)
- Kofi Osei
- Iowa Heart Center, West Des Moines, Iowa, USA
| | | | | | | | - Allan Shuros
- Boston Scientific Corp., Saint Paul, Minnesota, USA
| | - Tamas Nagy
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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49
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Francke A, Taha NS, Scharfe F, Schoen S, Wunderlich C, Christoph M. Procedural efficacy and safety of standardized, ablation index guided fixed 50 W high-power short-duration pulmonary vein isolation and substrate modification using the CLOSE protocol. J Cardiovasc Electrophysiol 2021; 32:2408-2417. [PMID: 34252990 DOI: 10.1111/jce.15158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Ablation index (AI)-guided ablation according to the CLOSE protocol is very effective in terms of chronic pulmonary vein isolation (PVI). However, the optimal radiofrequency (RF) power remains controversial. Here, we thought to investigate the efficiency and safety of an AI-guided fixed circumferential 50 W high-power short-duration (HPSD) PVI using the CLOSE protocol. METHODS AND RESULTS In a single-center trial, 40 patients underwent randomized PVI using AI-guided ablation without esophageal temperature monitoring. In 20 patients a CLOSE protocol guided fixed 50 W HPSD was followed irrespective of the anatomical localization. Twenty subjects were treated according to the CLOSE protocol with standard power settings (20 W posterior and 40 W roof and anterior wall). In addition, 80 consecutive patients were treated according to the HPSD protocol to gather additional safety data. All patients underwent postprocedural esophagogastroduodenoscopy to reveal esophageal lesions (EDELs). The mean total procedural time was 80.3 ± 22.5 in HPSD compared to control 109.1 ± 27.4 min (p < .001). The total RF-time was significantly lower in HPSD with 1379 ± 505 s versus control 2374 ± 619 s (p < .001). There were no differences in periprocedural complications. EDEL occurred in 13% in the HPSD and 10% in the control group. EDEL occurring in the 50 W HSDP patients were smaller, more superficial, and had a faster healing tendency. CONCLUSION A fixed 50 W HPSD circumferential PVI relying on the AI and CLOSE protocol reduce the total procedure time and the total RF time, without increasing the complication rates. The incidence of EDELs was similar using 50 W at the posterior atrial wall.
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50
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Varley AL, Kreidieh O, Godfrey BE, Whitmire C, Thorington S, D'Souza B, Kang S, Hebsur S, Ravindran BK, Zishiri E, Gidney B, Sellers MB, Singh D, Salam T, Metzl M, Ro A, Nazari J, Fisher WG, Costea A, Magnano A, Oza S, Morales G, Rajendra A, Silverstein J, Zei PC, Osorio J. A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives. J Interv Card Electrophysiol 2021; 62:487-494. [PMID: 34212280 PMCID: PMC8249214 DOI: 10.1007/s10840-021-01031-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10–12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF’s multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071 (registration date: September 12, 2019) Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01031-w.
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Affiliation(s)
- Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA.
- Birmingham VA Health System, AL, Birmingham, USA.
| | - Omar Kreidieh
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Brigham E Godfrey
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Carolyn Whitmire
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Susan Thorington
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Benjamin D'Souza
- Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, PA, Philadelphia, USA
| | | | | | | | | | - Brett Gidney
- Santa Barbara Cottage Hospital, CA, Santa Barbara, USA
| | | | - David Singh
- Center for Heart Rhythm Disorders, The Queen's Medical Center, HI, Honolulu, USA
| | - Tariq Salam
- PulseHeart Institute, Multicare Health System, WA, Tacoma, USA
| | - Mark Metzl
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Alex Ro
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Jose Nazari
- NorthShore University HealthSystem, IL, Evanston, USA
| | | | - Alexandru Costea
- Division of Cardiovascular Health and Disease, University of Cincinnati, OH, Cincinnati, USA
| | - Anthony Magnano
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Saumil Oza
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Gustavo Morales
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | | | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Jose Osorio
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
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