1
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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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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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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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Paymard M, Deyell MW, Laksman ZW, Yeung-Lai-Wah JA, Chakrabarti S. Correlation of unipolar electrogram modification with ablation index during pulmonary vein isolation: A pilot study. Pacing Clin Electrophysiol 2023; 46:138-143. [PMID: 36514201 DOI: 10.1111/pace.14642] [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: 12/07/2021] [Revised: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) using radiofrequency catheter ablation is a widely accepted therapy for drug-refractory atrial fibrillation patients. Elimination of the negative component of the local unipolar electrogram (UEGM) during PVI is a marker of transmural lesion formation. The ablation index (AI) can predict the quality of ablation lesion. Combining these two parameters could make PVI safer and efficient. The purpose of this pilot study was to examine the correlation between UEGM modification characteristics of the different target areas of left atrium and the associated AI values during PVI. METHODS We analyzed 10 patients who underwent PVI using radiofrequency energy. The local electrophysiological properties and ablation parameters of 15 designated areas of interest in the left atria targeted by radiofrequency catheter ablation were collected. RESULTS Out of the 10 patients, six were men (mean age 66 years) and 80% had paroxysmal AF. The mean time to achieve the UEGM modification in the posterior wall was shorter than that of the anterior wall (8.9 seconds vs. 11.1 s, respectively). The UEGM modification for every lesion was achieved at significantly lower AI values than conventional AIs (p < .001). CONCLUSION During PVI, the AIs deduced according to the local UEGM modification are markedly shorter than those generally recommended AIs in contemporary practice. This indicates that conventionally recommended AIs could be safely reduced while ensuring the efficacy and quality of radiofrequency ablation during PVI. This approach would probably reduce to risk of collateral thermal injuries.
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Affiliation(s)
- Mohammad Paymard
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Yeung-Lai-Wah
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Unipolar Electrogram-Guided versus Lesion Size Index-Guided Catheter Ablation in Patients with Paroxysmal Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9070229. [PMID: 35877591 PMCID: PMC9320701 DOI: 10.3390/jcdd9070229] [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: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This research explores the relationship between the unipolar electrogram (UP-EGM) and lesion size index (LSI) in different regions of continuous circular lesions (CCLs) and to assess the safety and efficacy of UP-EGM-guided versus LSI-guided radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF). Methods: A total of 120 patients with drug-refractory PAF who underwent index RFCA were scheduled to be consecutively included from March 2020 to April 2021. All the patients were randomly divided 1:1 into two groups: the UP-EGM group and the LSI group. The first-pass PVI rate, acute PVI rate, and the sinus rhythm maintenance rate were compared. Results: A total of 120 patients with PAF were included in the study: the UP-EGM group (n = 60) and the LSI group (n = 60). All the LSI values in the UP-EGM group were less than those in the corresponding regions in the LSI group (all p < 0.001). There were no significant differences in the first-pass PVI rate and acute PVI rate between the two groups. After a mean follow-up period of 11.31 ± 1.70 months, the sinus rhythm maintenance rate in the UP-EGM group was comparable to that in the LSI group (90% vs. 91.7%, p = 0.752). Conclusion: UP-EGM-guided and LSI-guided RFCA are both effective and safe in patients with PAF. However, UP-EGM may be more suitable than LSI for guiding individual RFCA.
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6
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Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. Europace 2021; 24:874-886. [PMID: 34964469 DOI: 10.1093/europace/euab279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is an important alternative to antiarrhythmic drugs in the treatment of symptomatic atrial fibrillation. However, the inability to consistently achieve durable isolation of the pulmonary veins hampers the long-term efficacy of PVI procedures. The large number of factors involved in RF lesion formation and the complex interplay of these factors complicate reliable creation of durable and transmural ablation lesions. Various surrogate markers of ablation lesion formation have been proposed that may provide information on RF lesion completeness. Real-time assessment of these surrogates may aid in the creation of transmural ablation lesions, and therefore, holds potential to decrease the risk of PV reconnection and consequent post-PVI arrhythmia recurrence. Moreover, titration of energy delivery until lesions is transmural may prevent unnecessary ablation and subsequent adverse events. Whereas several surrogate markers of ablation lesion formation have been described over the past decades, a 'gold standard' is currently lacking. This review provides a state-of-the-art overview of ablation strategies that aim to enhance durability of RF-PVI, with special focus on real-time available surrogates of RF lesion formation in light of the biophysical basis of RF ablation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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7
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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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8
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Padmanabhan D, Sugrue A, Vaidya V, Witt C, Yasin O, Naksuk N, Killu A, Foxall T, Drakulic BS, Venkatachalam KL, Asirvatham SJ. Incremental benefit of a novel signal recording system during mapping and ablation. Europace 2021; 23:130-138. [PMID: 33094311 DOI: 10.1093/europace/euaa194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Current electrophysiology signal recording and mapping systems have limited dynamic range (DR) and bandwidth, which causes loss of valuable information during acquisition of cardiac signals. We evaluated a novel advanced signal processing platform with the objective to obtain and assess additional information of clinical importance. METHODS AND RESULTS Over 10 canines, we compared intracardiac recordings within all cardiac chambers, in various rhythms, in pacing and during radiofrequency (RF) ablation across two platforms; a conventional system and the PURE EP™ [(PEP); Bio Sig Technologies, Inc., Los Angeles, CA, USA]. Recording cardiac signals with varying amplitudes were consistently and reproducibly observed, without loss of detail or introduction of artefact. Further the amplitude of current of injury (COI) on the unipolar signals correlated with the instantaneous contact force (CF) recorded on the sensing catheter in all the animals (r2 = 0.94 in ventricle). The maximum change in the unipolar COI correlated with the change in local electrogram amplitude during non-irrigated RF ablation (r2 = 0.61 in atrium). Reduction in artefact attributable to pacing (20 sites) and noise during ablation (48 sites) was present on the PEP system. Within the PEP system, simultaneous display of identical signals, filtered differently, aided the visualization of discrete conduction tissue signals. CONCLUSION Compared to current system, the PEP system provided incremental information including identifying conduction tissue signals, estimates of CF and a surrogate for lesion formation. This novel signal processing platform with increased DR and minimal front-end filtering may be useful in clinical practice.
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Affiliation(s)
- Deepak Padmanabhan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Vaibhav Vaidya
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Chance Witt
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Omar Yasin
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Niyada Naksuk
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ammar Killu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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9
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van Schie MS, Starreveld R, Roos-Serote MC, Taverne YJHJ, van Schaagen FRN, Bogers AJJC, de Groot NMS. Classification of sinus rhythm single potential morphology in patients with mitral valve disease. Europace 2021; 22:1509-1519. [PMID: 33033830 PMCID: PMC7544534 DOI: 10.1093/europace/euaa130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The morphology of unipolar single potentials (SPs) contains information on intra-atrial conduction disorders and possibly the substrate underlying atrial fibrillation (AF). This study examined the impact of AF episodes on features of SP morphology during sinus rhythm (SR) in patients with mitral valve disease. Methods and results Intraoperative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium (RA, LA), Bachmann’s bundle (BB), and pulmonary vein area (PVA) was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). Unipolar SPs were classified according to their differences in relative R- and S-wave amplitude ratios. A clear predominance of S-waves was observed at BB and the RA in both the no AF and PAF groups (BB 88.8% vs. 85.9%, RA 92.1% vs. 85.1%, respectively). Potential voltages at the RA, BB, and PVA were significantly lower in the PAF group (P < 0.001 for each) and were mainly determined by the size of the S-waves amplitudes. The largest difference in S-wave amplitudes was found at BB; the S-wave amplitude was lower in the PAF group [4.08 (2.45–6.13) mV vs. 2.94 (1.40–4.75) mV; P < 0.001]. In addition, conduction velocity (CV) at BB was lower as well [0.97 (0.70–1.21) m/s vs. 0.89 (0.62–1.16) m/s, P < 0.001]. Conclusion Though excitation of the atria during SR is heterogeneously disrupted, a history of AF is characterized by decreased SP amplitudes at BB due to loss of S-wave amplitudes and decreased CV. This suggests that SP morphology could provide additional information on wavefront propagation.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Maarten C Roos-Serote
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Frank R N van Schaagen
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
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10
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Efficiency, Safety, and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Atrial Fibrillation. Cardiol Res Pract 2021; 2021:8821467. [PMID: 33643666 PMCID: PMC7902128 DOI: 10.1155/2021/8821467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone therapy of atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) is performed using a point-by-point method to achieve durable PVI. However, this procedure remains complex and time-consuming, and the long-term clinical outcomes are still not satisfactory. Recently, there has been increasing interest in the clinical application of high-power short-duration (HPSD) approaches in the field of RFCA. HPSD ablation, distinguishing it from the conventional ablation strategy, delivers RF energy at a high power and saves the dwell time at each site. It is unknown whether the HPSD approach can bring some gratifying changes in the field of RF energy ablation. A number of experimental studies and clinical studies have been conducted regarding this topic. The review aimed to summarize the research findings and evaluate the procedural efficiency, safety, and clinical outcomes of the HPSD approach based on the evidence available to date.
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11
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Qian PC, Nguyen DM, Barry MA, Tran V, Lu J, Thiagalingam A, Thomas SP, McEwan A. Optimizing Impedance Change Measurement During Radiofrequency Ablation Enables More Accurate Characterization of Lesion Formation. JACC Clin Electrophysiol 2020; 7:471-481. [PMID: 33888268 DOI: 10.1016/j.jacep.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to determine whether a novel impedance thermal imaging system (ITIS) provides an impedance measurement that is better correlated with lesion dimensions than circuit impedance during radiofrequency (RF) ablation. BACKGROUND A 5- to 10-Ω impedance drop is clinically used to corroborate an effective RF ablation lesion. However, the contribution of local tissue heating to circuit impedance change is small and dependent on the local environment of the catheter and placement of the grounding patch. METHODS ITIS uses ablation catheter and skin electrodes to perform 4-terminal impedance measurements with separate voltage sensing and current injection electrode pairs. Seven sheep underwent endocardial ventricular irrigated RF ablation at 40 W for 60 s. ITIS impedance and circuit impedance were both measured throughout ablation. When the sheep were sacrificed, ablation lesions were cut along their long axis; the depth, width, and surface area of the cut surface were measured. RESULTS A total of 68 RF ablations were performed, with a median depth of 3.5 mm (interquartile range [IQR]: 2.1 to 4.9 mm), width of 8.3 mm (IQR: 5.7 to 10.8 mm), and surface area of 23.8 mm2 (IQR: 9.3 to 43.0 mm2). ITIS impedance change had good correlation with lesion depth, width, and surface area (R = 0.76, R = 0.87, and R = 0.87, respectively); and superior to circuit impedance for lesion depth, width, and surface area (p = 0.0018, p = 0.0004, and p = 0.0001, respectively). CONCLUSIONS By optimizing the current path and using 4-terminal impedance measurement during RF ablation, the contribution of tissue temperature changes to measured impedance is better standardized to provide a more reliable measure than conventional ablation circuit impedance.
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Affiliation(s)
- Pierre C Qian
- Westmead Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia.
| | - Duc Minh Nguyen
- Faculty of Engineering and Information Technology, University of Sydney, Sydney, Australia; Department of Biomedical Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Michael Anthony Barry
- Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia; Faculty of Engineering and Information Technology, University of Sydney, Sydney, Australia
| | - Vu Tran
- Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia
| | - Juntang Lu
- Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia
| | - Stuart P Thomas
- Westmead Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Sydney, Australia
| | - Alistair McEwan
- Faculty of Engineering and Information Technology, University of Sydney, Sydney, Australia
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12
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Anderson RD, Lee G, Campbell T, Bennett RG, Kizana E, Watts T, Kalman J, Kumar S. Scar nonexcitability using simultaneous pacing for substrate ablation of ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1219-1234. [PMID: 32720390 DOI: 10.1111/pace.14025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe an expedited strategy of simultaneous high-output pacing during radiofrequency ablation to achieve scar homogenization and electrical inexcitability as an approach for substrate ablation for scar-related ventricular tachycardia (VT). BACKGROUND Scar homogenization with additional testing for electrical inexcitability is known endpoints for catheter ablation, but achieving both can be time consuming. We describe a strategy of simultaneous pacing during radiofrequency ablation to expedite this approach. METHODS AND RESULTS Ten patients (age 74 ± 6 years; all men, (LV) ejection fraction of 33% ± 8%, ischemic cardiomyopathy, 9; VT storm, 7) underwent scar homogenization with electrical inexcitability to pacing (10 mA, 9 ms pulse width), as well as noninducibility of any VT as an acute procedural endpoint. Thirty-four VTs were inducible in 10 patients with a total of 1127 ablation lesions applied. Median ablation lesions per patient were 97 (interquartile range [IQR]25-75 71-151), and the total ablation time was 49 minutes (IQR25-75 45-56 minutes) with average duration per lesion of 32.2 seconds (IQR25-75 25.8-37.8 seconds). Average power was 33 W (IQR25-75 32-38 W), average contact force was 13 g (IQR25-75 11.9-14.6 g) with a median impedance drop of 9.6 Ω/lesion (IQR25-75 8.1-10.0 Ω). There were no ventricular fibrillation episodes using this strategy. The median procedure time was 246 minutes (IQR25-75 214-293 minutes). Acute procedural success was seen in nine patients with 97% of VTs noninducible. CONCLUSION Simultaneous ablation with high output pacing to achieve scar inexcitability, when combined with scar homogenization and noninducibility of any VT may be an expeditious, safe, and effective technique for catheter ablation.
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Affiliation(s)
- Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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13
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Pollnow S, Schwaderlapp G, Loewe A, Dössel O. Monitoring the dynamics of acute radiofrequency ablation lesion formation in thin-walled atria - a simultaneous optical and electrical mapping study. BIOMED ENG-BIOMED TE 2020; 65:327-341. [PMID: 31756159 DOI: 10.1515/bmt-2019-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/27/2019] [Indexed: 11/15/2022]
Abstract
Background Radiofrequency ablation (RFA) is a common approach to treat cardiac arrhythmias. During this intervention, numerous strategies are applied to indirectly estimate lesion formation. However, the assessment of the spatial extent of these acute injuries needs to be improved in order to create well-defined and durable ablation lesions. Methods We investigated the electrophysiological characteristics of rat atrial myocardium during an ex vivo RFA procedure with fluorescence-optical and electrical mapping. By analyzing optical data, the temporal growth of punctiform ablation lesions was reconstructed after stepwise RFA sequences. Unipolar electrograms (EGMs) were simultaneously recorded by a multielectrode array (MEA) before and after each RFA sequence. Based on the optical results, we searched for electrical features to delineate these lesions from healthy myocardium. Results Several unipolar EGM parameters were monotonically decreasing when distances between the electrode and lesion boundary were smaller than 2 mm. The negative component of the unipolar EGM [negative peak amplitude (Aneg)] vanished for distances lesser than 0.4 mm to the lesion boundary. Median peak-to-peak amplitude (Vpp) was decreased by 75% compared to baseline. Conclusion Aneg and Vpp are excellent parameters to discriminate the growing lesion area from healthy myocardium. The experimental setup opens new opportunities to investigate EGM characteristics of more complex ablation lesions.
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Affiliation(s)
- Stefan Pollnow
- Karlsruhe Institute of Technology, Institute of Biomedical Engineering, Fritz-Haber-Weg 1, Karlsruhe 76131, Germany, Tel.: +49-721-608-42650, Fax: +49-721-608-42789
| | - Gerald Schwaderlapp
- Karlsruhe Institute of Technology, Institute of Biomedical Engineering, Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Axel Loewe
- Karlsruhe Institute of Technology, Institute of Biomedical Engineering, Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
| | - Olaf Dössel
- Karlsruhe Institute of Technology, Institute of Biomedical Engineering, Fritz-Haber-Weg 1, Karlsruhe 76131, Germany
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14
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Ejima K, Higuchi S, Yazaki K, Kataoka S, Yagishita D, Kanai M, Shoda M, Hagiwara N. Comparison of high-power and conventional-power radiofrequency energy deliveries in pulmonary vein isolation using unipolar signal modification as a local endpoint. J Cardiovasc Electrophysiol 2020; 31:1702-1708. [PMID: 32378266 PMCID: PMC7383605 DOI: 10.1111/jce.14532] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
Introduction Negative component abolition of the unipolar signal (unipolar signal modification [USM]) reflects the lesion transmurality. The purpose of this study was to compare the procedural safety and outcome between high‐power and conventional‐power atrial radiofrequency applications during a pulmonary vein isolation (PVI) using USM as a local endpoint. Methods and Results High‐power (50 W) and conventional‐power (25‐40 W) applications were compared among 120 consecutive patients with paroxysmal atrial fibrillation who underwent a USM‐guided PVI. The first 60 patients were treated with conventional‐power (CP) group and last 60 with high‐power (HP) group. The atrial radiofrequency applications lasted for 5 to 10 seconds (CP group) or 3 to 5 seconds (HP group) after the USM. All procedures were performed using 3D mapping systems with image integration and esophageal temperature monitoring. The baseline characteristics were similar between the two groups. The HP group had fewer acute PV reconnections (62% vs 78%; P = .046) and a reduced procedure time (119.3 ± 28.1 vs 140.1 ± 51.2 minutes; P = .04). Freedom from recurrence after a single ablation procedure without any antiarrhythmic drugs was higher in the HP group than CP group (88.3% vs 73.3% at 12‐months after the procedure, log‐rank; P = .0423). There were no major complications that required any intervention. Conclusions The high‐power PVI guided by USM decreased the procedural time and may improve the procedural outcomes without compromising the safety.
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Affiliation(s)
- Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Miwa Kanai
- 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, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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15
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Yazaki K, Ejima K, Kanai M, Kataoka S, Higuchi S, Yagishita D, Shoda M, Hagiwara N. Impedance drop predicts acute electrical reconnection of the pulmonary vein-left atrium after pulmonary vein isolation using short-duration high-power exposure. J Interv Card Electrophysiol 2020; 59:575-584. [PMID: 31902084 DOI: 10.1007/s10840-019-00691-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the efficacy and identify the relevant factors for durable lesion creation in pulmonary vein isolation (PVI) using a high-power short-duration (HPSD) strategy. METHODS Thirty-two consecutive patients who underwent PVI using HPSD (50 W) (HP group: HP-G) were compared with 32 controls using normal power (25-40 W) (conventional group: C-G). The segments were divided into 12 segments per group; thus, there were 768 segments for analysis. Radiofrequency (RF) ablation (RFA) was mainly performed under guidance with a unipolar electrogram at the distal tip of the ablation catheter in both groups. The high-power strategy reduced radiofrequency energy (P < 0.0001), RFA time (P < 0.0001), acute pulmonary vein reconnection (PVR) segments (P = 0.02), and several three-dimensional-mapping-related indices except for minimum impedance drop (Imp-min). RESULTS There was a significant difference only in Imp-min between the subjects with acute PVR and those without in the HP-G (P = 0.002). Multivariate analysis revealed Imp-min to be the only independent predictor of the absence of PVR after adjusting for maximum inter-lesion distance and minimum ablation index (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.07-1.39, P = 0.001). In the region-specific analysis, this was attenuated in posterior segments, where the HP strategy independently predicted the absence of PVR (OR 2.80 [95% CI 1.32-6.30], P = 0.007). CONCLUSION The HPSD strategy reduced RF time, RF energy, and three-dimensional mapping-related indices but also improved the acute outcome. The HP strategy may be a sophisticated strategy under guidance with the impedance drop rather than the ablation index.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, 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, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
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16
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Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias: Evolution or History Repeating Itself? JACC Clin Electrophysiol 2019; 4:707-723. [PMID: 29929663 DOI: 10.1016/j.jacep.2018.03.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)-sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.
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Affiliation(s)
- Nilshan Ariyarathna
- Cardiology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - William G Stevenson
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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17
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Ejima K, Kato K, Okada A, Wakisaka O, Kimura R, Ishizawa M, Imai T, Toyama Y, Shoda M, Hagiwara N. Comparison Between Contact Force Monitoring and Unipolar Signal Modification as a Guide for Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 12:e007311. [DOI: 10.1161/circep.119.007311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Both contact force monitoring (CFM) and unipolar signal modification (USM) are guides for ablation, which improve the efficacy of pulmonary vein isolation of atrial fibrillation. We sought to compare the outcomes of atrial fibrillation ablation guided by CFM or USM.
Methods:
A total of 136 patients with paroxysmal atrial fibrillation underwent a circumferential pulmonary vein isolation using CF sensing ablation catheters and were randomly assigned to undergo catheter ablation guided by either CFM (CFM-guided group: n=70) or USM (USM-guided group: n=66). In the USM-guided group, each radiofrequency application lasted until the development of completely positive unipolar electrograms. In the CFM-guided group, a CF of 20 g (range, 10–30 g) and minimum force-time integral of 400 g were the targets for each radiofrequency application. The primary end point was freedom from any atrial tachyarrhythmia recurrence without antiarrhythmic drugs at 12-months of follow-up.
Results:
The cumulative freedom from recurrences at 12-months was 85% in the USM-guided group and 70% in the CFM-guided group (
P
=0.031). The incidence of time-dependent and ATP-provoked early electrical reconnections between the left atrium and PVs, procedural time, fluoroscopic time, and average force-time integral, did not significantly differ between the 2 groups. The radiofrequency time for the pulmonary vein isolation was shorter in the USM-guided group than CFM-guided group but was not statistically significant (
P
=0.077).
Conclusions:
USM was superior to CFM as an end point for radiofrequency energy deliveries during the pulmonary vein isolation in patients with paroxysmal atrial fibrillation in terms of the 12-month recurrence-free rate.
Clinical Trial Registration:
URL:
https://www.umin.ac.jp/ctr/index.htm
. Unique identifier: UMIN000021127.
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Affiliation(s)
- Koichiro Ejima
- Department of Cardiology, Tokyo Women’s Medical University, Japan (K.E., M.S., N.H.)
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Japan (K.K.)
| | - Ayako Okada
- Department of Cardiology, Shinshu University, Matsumoto, Japan (A.O.)
| | - Osamu Wakisaka
- Department of Cardiology, Oita Medical Center, Japan (O.W.)
| | - Ryusuke Kimura
- Department of Arrhythmia, Kanazawa Cardiovascular Hospital, Japan (R.K.)
| | - Makoto Ishizawa
- Department of Cardiology, Kagawa University, Takamatsu, Japan (M.I.)
| | - Taku Imai
- Department of Cardiology, Suwa Central Hospital, Chino, Japan (T.I.)
| | - Yuko Toyama
- Department of Cardiology, Takamatsu Red Cross Hospital, Japan (Y.T.)
| | - Morio Shoda
- Department of Cardiology, Tokyo Women’s Medical University, Japan (K.E., M.S., N.H.)
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women’s Medical University, Japan (K.E., M.S., N.H.)
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18
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Pambrun T, Durand C, Constantin M, Masse A, Marra C, Meillet V, Haïssaguerre M, Jaïs P, Bortone A. High-Power (40-50 W) Radiofrequency Ablation Guided by Unipolar Signal Modification for Pulmonary Vein Isolation: Experimental Findings and Clinical Results. Circ Arrhythm Electrophysiol 2019; 12:e007304. [PMID: 31164003 DOI: 10.1161/circep.119.007304] [Citation(s) in RCA: 45] [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 Although proposed to facilitate pulmonary vein isolation (PVI), high-power ablation may favor extracardiac damage. Negative component abolition of the unipolar signal reflects lesion transmurality. The present study sought to evaluate the safety and efficacy of high-power ablation using unipolar signal modification as a local end point. Methods High power and standard power were compared in 4 swine and 100 consecutive patients referred for PVI. The first 50 patients were included in the control group (25-30 W) and the last 50 patients in the study group (40-50 W). Atrial radiofrequency applications were stopped 2 s (study group and swine) or 5 s (control group) after unipolar signal modification. Ventricular radiofrequency applications of 500 J (25 W·20 s versus 50 W·10 s) were performed at the swine epicardium. Results Swine gross necropsy did not show any extracardiac damage related to atrial lesions. At equal energy of 500 J, 50 W lesions were deeper (3±0.9 versus 2.6±1.1 mm; P=0.03) and wider (6.2±2 versus 5±2.3 mm; P=0.006) than 25 W lesions. No complications occurred during the clinical study, whatever the power output used for PVI. For a similar sinus rhythm maintenance at 12 months (90% versus 88%; P=0.75), the study group displayed higher first-pass PVI (92% versus 73%; P<0.001), lower acute pulmonary vein reconnection (2% versus 17%; P<0.001), reduced procedure time (73.1±18.2 versus 107.4±21.2 min; P<0.001), and ablation time (13±2.9 versus 30.3±8.8 min; P<0.001). Conclusions High-power PVI guided by unipolar signal modification safely decreases procedural burden while ensuring robust 12-month outcomes.
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Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Cyril Durand
- Département de Rythmologie, Infirmerie Protestante, Lyon, France (C.D.)
| | - Marion Constantin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Alexandre Masse
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Céline Marra
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Valentin Meillet
- Biosense Webster France, Johnson & Johnson, Issy les Moulin-eaux (A.M., C.M., V.M.)
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, France (T.P, M.C., M.H., P.J.)
| | - Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.)
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19
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Tomlinson DR, Myles M, Stevens KN, Streeter AJ. Transmural unipolar electrogram change occurs within 7 s at the left atrial posterior wall during pulmonary vein isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:922-929. [PMID: 31127636 DOI: 10.1111/pace.13729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess occurrence of a histologically validated measure of transmural (TM) atrial ablation-pure R unipolar electrogram (UE) morphology change-at first-ablated left atrial posterior wall (LAPW) sites during contact force (CF)-guided pulmonary vein isolation (PVI). METHODS Objectively annotated VISITAG™ Module and CARTOREPLAY™ (Biosense Webster Inc., Diamond Bar, CA, USA) UE morphology data were retrospectively analyzed in 23 consecutive patients undergoing PVI under general anesthesia. RESULTS PVI without spontaneous/dormant recovery was achieved in all, employing 16.3 (3.2) min of radiofrequency (RF; 30 W) energy. All first-ablated LAPW sites demonstrated RS UE morphology preablation, with RF-induced pure R UE morphology change in 98%. Time to pure R UE morphology was significantly shorter at left-sided LAPW sites (4.9 [2.1] vs 6.7 [2.5] s; P = .02), with significantly greater impedance drop (median 13.5 vs 9.9 Ω; P = .003). Importantly, neither first-site RF duration (14.9 vs 15.0 s) nor maximum ablation catheter tip distance moved (during RF) was significantly different, yet the mean CF was significantly higher at right-sided sites (16.5 vs 11.2 g; P = .002). Concurrent impedance and objectively annotated bipolar electrogram (BE) data demonstrated ∼6-8 Ω impedance drop and ∼30% BE decrease at the time of first pure R UE morphology change. CONCLUSIONS Using objective ablation site annotation, UE morphology evidence of TM RF effect was demonstrated far sooner than considered biologically possible according to the "conventional" 20-40 s RF per-site approach, with significantly greater ablative effect evident at left-sided sites. This novel methodology represents a scientifically more rigorous foundation toward future research into the biological effects of RF ablation in vivo.
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Affiliation(s)
- David R Tomlinson
- South West Cardiothoracic Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Madison Myles
- Dorset Heart Centre, Royal Bournemouth and Christchurch Hospitals NHS Foundation, Bournemouth, UK
| | - Kara N Stevens
- Department of Medical Statistics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Adam J Streeter
- Department of Medical Statistics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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20
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Unipolar electrogram-guided radiofrequency catheter ablation in paroxysmal atrial fibrillation: electrogram patterns and outcomes. J Interv Card Electrophysiol 2018; 54:203-208. [PMID: 30327991 DOI: 10.1007/s10840-018-0470-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Transmural lesions (TLs) are the crucial point for radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients. Previous studies have reported that complete positive unipolar electrogram (UP-EGM) after ablation is associated with transmural lesions. However, UP-EGM patterns may differ in different regions of continuous circular lesions (CCLs) around the pulmonary vein ostia after ablation. We aimed to analyze the different UP-EGM patterns in different CCL regions after ablation and the effectiveness of UP-EGM guided RFCA in paroxysmal atrial fibrillation (PAF). METHODS A total of 43 patients with PAF (aged 59 ± 11 years; 65% male) were consecutively included. Pulmonary vein isolation was achieved by contiguous point-by-point RFCA. UP-EGM was recorded by the ablation catheter. Both CCLs were divided into six regions. Two points were randomly chosen from each region to analyze UP-EGM type after ablation. All the patients were followed for atrial arrhythmias recurrence. RESULTS All pulmonary veins were isolated with complete bidirectional block. A total of 1032 RFCA points with complete positive UP-EGM were collected. UP-EGM morphology after ablation was divided into four different types defined as R, rR', Rr', and M. M patterns mostly appeared in anterosuperior (65%) and roof (49%) regions of left CCLs. In the remaining regions, the percentage of non-M patterns (R, rR', and Rr') ranged from 63% in posteroinferior regions of right CCLs to 88% in anteroinferior regions of right CCLs. After a mean follow-up time of 19 months, 37 (86%) patients remained in sinus rhythm. CONCLUSION Most (72%) UP-EGM types after ablation are non-M patterns. Pulmonary vein isolation guided by UP-EGM with a complete positive pattern in PAF patients is reliable.
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21
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Chinitz JS, Michaud GF, Stephenson K. Impedance-guided Radiofrequency Ablation: Using Impedance to Improve Ablation Outcomes. J Innov Card Rhythm Manag 2017; 8:2868-2873. [PMID: 32477757 PMCID: PMC7252711 DOI: 10.19102/icrm.2017.081003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/06/2017] [Indexed: 11/06/2022] Open
Abstract
Despite the achievement of acute conduction block during catheter ablation, the recovery of conduction at previously ablated sites remains a primary factor implicated in arrhythmia recurrence after initial ablation. Real-time markers of adequate ablation lesion creation are needed to ensure durable ablation success. However, the assessment of acute lesion formation is challenging, and requires interpretation of surrogate markers of lesion creation that are frequently unreliable. Careful monitoring of impedance changes during radiofrequency catheter ablation has emerged as a highly specific marker of local tissue destruction. Ablation strategies guided by close impedance monitoring during ablation applications have been demonstrated to achieve high levels of success for ablation of atrial fibrillation. Impedance decrease during ablation may therefore be used as an additional endpoint beyond acute conduction block, in order to improve the durability of ablation lesions. In this manuscript, available methods of real-time lesion assessment are reviewed, and the rationale and technique for impedance-guided ablation are described.
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Affiliation(s)
- Jason S Chinitz
- Department of Cardiology, Hofstra Northwell School of Medicine, Northwell Health, Southside Hospital, Bay Shore, NY, USA
| | - Gregory F Michaud
- Arrhythmia Section, Vanderbilt Heart and Vascular Center, Vanderbilt University Medical School, Nashville, TN
| | - Kent Stephenson
- Department of Cardiology, Hofstra Northwell School of Medicine, Northwell Health, Southside Hospital, Bay Shore, NY, USA
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22
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Bortone A, Lagrange P, Cauchemez B, Durand C, Dieuzaide P, Prévot S, Mechulan A, Pambrun T, Martin R, Parlier P, Masse A, Marijon E, Albenque JP. Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study. J Interv Card Electrophysiol 2017. [PMID: 28643171 DOI: 10.1007/s10840-017-0264-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Elimination of the negative component of the unipolar atrial electrogram is a reliable indicator of the creation of a transmural lesion. Contact-force (CF) sensing technology has the potential to increase the durability of pulmonary vein isolation (PVI). In the present multicenter study, we assessed the 2-year sinus rhythm (SR) maintenance rate in patients with paroxysmal atrial fibrillation (PAF) after PVI guided by these two approaches. METHODS Two hundred fifteen consecutive PAF patients (62.1 ± 10.1 years, 65 women) were prospectively enrolled. All patients underwent PVI under CARTO guidance according to a systematic contiguous "point-by-point" approach, using radiofrequency energy, and a CF externally irrigated ablation catheter with the goal of at least 10g (ideally 20g) of force. The ablation endpoint of each individual lesion was elimination of the negative component of the unipolar atrial signal. The procedural endpoint was PVI with bidirectional block. RESULTS All PVs were successfully isolated. After 30 min of waiting time, 35 patients (16%) had PV reconnection and in all of them, the PVs were re-isolated. Two years after a single ablation procedure, 187 patients (87%) remained arrhythmia free, without anti-arrhythmic drugs. Of the 28 patients presenting with AF recurrence, 25 had PV reconnection and underwent repeat PVI while in the remaining 3 patients, all four PVs were isolated and extra-PV triggers were identified. There were six groin hematomas and one transient ischemic attack. CONCLUSIONS Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.
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Affiliation(s)
- Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
| | | | - Bruno Cauchemez
- Service de Rythmologie, Clinique Ambroise Paré, Neuilly sur Seine, France
| | - Cyril Durand
- Département de Rythmologie, Infirmerie Protestante, Lyon, France
| | - Pierre Dieuzaide
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Sébastien Prévot
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Alexis Mechulan
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Thomas Pambrun
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.,LYRIC Institute/INSERM 1045, University Hospital Haut-Leveque, Bordeaux, France
| | - Ruairidh Martin
- LYRIC Institute/INSERM 1045, University Hospital Haut-Leveque, Bordeaux, France
| | - Pauline Parlier
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Alexandre Masse
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
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23
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Bun SS, Ayari A, Latcu DG, Errahmouni A, Saoudi N. Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use. J Cardiovasc Electrophysiol 2017; 28:745-753. [PMID: 28419605 DOI: 10.1111/jce.13222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/06/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Remote magnetic navigation (RMN) and contact force (CF) sensing catheters are available technologies for radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Our purpose was to compare time to electrogram (EGM) modification suggesting transmural lesions between RMN and CF-guided AF ablation. METHODS AND RESULTS A total of 1,008 RF applications were analyzed in 21 patients undergoing RMN (n = 11) or CF-guided ablation (n = 10) for paroxysmal AF. All procedures were performed in sinus rhythm during general anesthesia. Time to EGM modification was measured until transmurality criteria were fulfilled: (1) complete disappearance of R if initial QR morphology; (2) diminution > 75% of R if initial QRS morphology; (3) complete disappearance of R' of initial RSR' morphology. Impedance drop as well as force time integral (FTI) were also assessed for each application. Mean CF at the beginning of each RF application in the CF group was 11 ± 2 g and mean FTI per application was 488 ± 163 gs. Time to EGM modification was significantly shorter in the RMN group (4.52 ± 0.1 seconds vs. 5.6 ± 0.09 seconds; P < 0.00001). There was no significant difference between other procedural parameters. CONCLUSION Remote magnetic AF ablation is associated with faster EGM modification suggesting transmurality than optimized CF and FTI-guided catheter ablation.
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Affiliation(s)
- Sok-Sithikun Bun
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
| | - Anis Ayari
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
| | | | | | - Nadir Saoudi
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
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24
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Mini Electrodes on Ablation Catheters: Valuable Addition or Redundant Information?-Insights from a Computational Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:1686290. [PMID: 28553365 PMCID: PMC5434470 DOI: 10.1155/2017/1686290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/02/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022]
Abstract
Radiofrequency ablation has become a first-line approach for curative therapy of many cardiac arrhythmias. Various existing catheter designs provide high spatial resolution to identify the best spot for performing ablation and to assess lesion formation. However, creation of transmural and nonconducting ablation lesions requires usage of catheters with larger electrodes and improved thermal conductivity, leading to reduced spatial sensitivity. As trade-off, an ablation catheter with integrated mini electrodes was introduced. The additional diagnostic benefit of this catheter is still not clear. In order to solve this issue, we implemented a computational setup with different ablation scenarios. Our in silico results show that peak-to-peak amplitudes of unipolar electrograms from mini electrodes are more suitable to differentiate ablated and nonablated tissue compared to electrograms from the distal ablation electrode. However, in orthogonal mapping position, no significant difference was observed between distal electrode and mini electrodes electrograms in the ablation scenarios. In conclusion, catheters with mini electrodes bring about additional benefit to distinguish ablated tissue from nonablated tissue in parallel position with high spatial resolution. It is feasible to detect conduction gaps in linear lesions with this catheter by evaluating electrogram data from mini electrodes.
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25
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Padmanabhan D, Foxall T, Drakulic B, Witt C, Killu A, Naksuk N, Sugrue A, Venkatachalam KL, Asirvatham S. Initial Experience with the BioSig PURE EP™ Signal Recording System: An Animal Laboratory Experience. J Innov Card Rhythm Manag 2017; 8:2690-2699. [PMID: 32494447 PMCID: PMC7252935 DOI: 10.19102/icrm.2017.080407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/11/2017] [Indexed: 11/06/2022] Open
Abstract
Current signal recording and processing systems have come a long way since their initial inception and use. There is, however, still ample scope for improvement, not only in the troubleshooting of their limitations, but also in the expansion of the boundaries in the recording of intracardiac signals. Here, we recount our experience with the use of the PURE EP™ signal recording system (BioSig Technologies, Inc., Minneapolis, MN, USA) in the animal laboratory.
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Affiliation(s)
| | | | | | - Chance Witt
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ammar Killu
- Department of Electrophysiology, Brigham and Womens' Hospital, Boston, MA
| | - Niyada Naksuk
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - K L Venkatachalam
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Samuel Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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26
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Simulation of intracardiac electrograms around acute ablation lesions. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2016. [DOI: 10.1515/cdbme-2016-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractRadiofrequency ablation (RFA) is a widely used clinical treatment for many types of cardiac arrhythmias. However, nontransmural lesions and gaps between linear lesions often lead to recurrence of the arrhythmia. Intracardiac electrograms (IEGMs) provide real-time information regarding the state of the cardiac tissue surrounding the catheter tip. Nevertheless, the formation and interpretation of IEGMs during the RFA procedure is complex and yet not fully understood. In this in-silico study, we propose a computational model for acute ablation lesions. Our model consists of a necrotic scar core and a border zone, describing irreversible and reversible temperature induced electrophysiological phenomena. These phenomena are modeled by varying the intra- and extracellular conductivity of the tissue as well as a regulating zone factor. The computational model is evaluated regarding its feasibility and validity. Therefore, this model was compared to an existing one and to clinical measurements of five patients undergoing RFA. The results show that the model can indeed be used to recreate IEGMs. We computed IEGMs arising from complex ablation scars, such as scars with gaps or two overlapping ellipsoid scars. For orthogonal catheter orientation, the presence of a second necrotic core in the near-field of a punctiform acute ablation lesion had minor impact on the resulting signal morphology. The presented model can serve as a base for further research on the formation and interpretation of IEGMs.
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27
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Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation: A Case Series. JACC Clin Electrophysiol 2016; 2:723-731. [PMID: 29759751 DOI: 10.1016/j.jacep.2016.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/17/2016] [Accepted: 05/26/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures. BACKGROUND Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). METHODS Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures. RESULTS Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21%), and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20%) in the AF group and 10 of 15 patients (67%) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022). CONCLUSIONS Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.
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28
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de Vries LJ, Szili-Torok T. Optimizing contact force during ablation of atrial fibrillation: available technologies and a look to the future. Future Cardiol 2016; 12:197-207. [DOI: 10.2217/fca.15.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In a select atrial fibrillation population, catheter ablation is considered first-line therapy. Prevention of early reconnection of the isolated pulmonary veins is an important goal for a successful treatment. Here, adequate catheter–tissue contact is crucial. One of the most promising new advances, therefore, is contact force (CF) sensing technology. The aim of this review is to provide an overview of innovations regarding catheter ablation of atrial fibrillation with a special focus on CF optimization. Both experimental and human studies show how CF sensing catheters lead to a reduction of fluoroscopy time, increased procedural safety and a better clinical outcome. Possible future developments include new parameters combining real-time ablation data, direct visualization of lesion formation and incorporation of robotics.
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Affiliation(s)
- Lennart J de Vries
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
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29
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Baldinger SH, Michaud GF. Cardiac electrophysiologist׳s perspective on minimally invasive surgery for atrial fibrillation. Trends Cardiovasc Med 2015; 26:278-9. [PMID: 26586607 DOI: 10.1016/j.tcm.2015.09.002] [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: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel H Baldinger
- Cardiovascular Division, Cardiac Arrhythmia Center, Brigham and Women׳s Hospital, Boston, MA
| | - Gregory F Michaud
- Cardiovascular Division, Cardiac Arrhythmia Center, Brigham and Women׳s Hospital, Boston, MA.
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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PAMBRUN THOMAS, ROIG JÉRÉMIE, BOUZEMAN ABDESLAM, MAUPAS ERIC, CIOBOTARU VLAD, BOULENC JEANMARC, APPETITI ANTHONY, PUJADAS-BERTHAULT PÉNÉLOPE, RIOUX PHILIPPE, BORTONE AGUSTÍN. Modification of the Unipolar Atrial Electrogram as a Local Endpoint During Common Atrial Flutter Ablation. J Cardiovasc Electrophysiol 2015; 26:1196-1203. [DOI: 10.1111/jce.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/10/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- THOMAS PAMBRUN
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - JÉRÉMIE ROIG
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - ABDESLAM BOUZEMAN
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - ERIC MAUPAS
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - VLAD CIOBOTARU
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - JEAN-MARC BOULENC
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - ANTHONY APPETITI
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | | | - PHILIPPE RIOUX
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
| | - AGUSTÍN BORTONE
- Service de Cardiologie; Hôpital Privé Les Franciscaines; Nîmes France
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Bortone A, Brault-Noble G, Appetiti A, Marijon E. Elimination of the Negative Component of the Unipolar Atrial Electrogram as an In Vivo Marker of Transmural Lesion Creation. Circ Arrhythm Electrophysiol 2015; 8:905-11. [DOI: 10.1161/circep.115.002894] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
Abstract
Background—
It has been experimentally shown that elimination of the negative component of the unipolar atrial electrogram (R morphology completion) during radiofrequency applications reflects transmural lesions creation. Subsequently, it has been clinically suggested that such a transmurality can be either irreversible or reversible. The present study is aimed to determine, at the histological level, whether transmural lesions, assessed by R morphology completion, might indeed be reversible in some circumstances or not.
Methods and Results—
In 6 Mongrel hound dogs, superior and inferior vena cavae were isolated and individual lesions were created in the right atrium using radiofrequency energy (30 W/48°C/17 mL/min as presettings and 10
g
of force in average) under CARTO guidance. Five types of lesions were created; R
+
0: termination of ablation at the time of R morphology completion; R
+
5, R
+
10, or R
+
20: extension of ablation for 5, 10, or 20 seconds, respectively, after R morphology achievement; and conventional: radiofrequency applications lasting 30 seconds irrespective of the atrial electrogram modification. All conventional, R
+
5, R
+
10, and R
+
20 lesions were necrotic and transmural, whereas some R
+
0 lesions were not (comprising a part of necrosis and a part of reversible cell damage). Interestingly, surrounding organ injuries were observed after conventional, R
+
10, and R
+
20 radiofrequency applications but were not observed after R
+
0 and R
+
5 applications.
Conclusions—
Elimination of the negative component of the unipolar atrial electrogram reflects, in general, irreversible transmural necrosis creation. In some cases, however, it translates transmural lesion only (with potential reversibility) likely related to transient cell damage creation.
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Affiliation(s)
- Agustín Bortone
- From the Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.); Département Anesthésie Réanimation Douleur Urgence, CHRU Caremeau, Nîmes, France (G.B.-N.); Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France (A.A.); Paris Cardiovascular Research Center (Inserm U970), Université Paris Descartes, Paris, France (E.M.); and Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France (E.M.)
| | - Guillaume Brault-Noble
- From the Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.); Département Anesthésie Réanimation Douleur Urgence, CHRU Caremeau, Nîmes, France (G.B.-N.); Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France (A.A.); Paris Cardiovascular Research Center (Inserm U970), Université Paris Descartes, Paris, France (E.M.); and Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France (E.M.)
| | - Anthony Appetiti
- From the Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.); Département Anesthésie Réanimation Douleur Urgence, CHRU Caremeau, Nîmes, France (G.B.-N.); Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France (A.A.); Paris Cardiovascular Research Center (Inserm U970), Université Paris Descartes, Paris, France (E.M.); and Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France (E.M.)
| | - Eloi Marijon
- From the Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France (A.B.); Département Anesthésie Réanimation Douleur Urgence, CHRU Caremeau, Nîmes, France (G.B.-N.); Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France (A.A.); Paris Cardiovascular Research Center (Inserm U970), Université Paris Descartes, Paris, France (E.M.); and Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France (E.M.)
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Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter. J Interv Card Electrophysiol 2015; 43:297-306. [DOI: 10.1007/s10840-015-0002-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/30/2015] [Indexed: 12/20/2022]
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Keller MW, Schuler S, Wilhelms M, Lenis G, Seemann G, Schmitt C, Dössel O, Luik A. Characterization of radiofrequency ablation lesion development based on simulated and measured intracardiac electrograms. IEEE Trans Biomed Eng 2014; 61:2467-78. [PMID: 24816474 DOI: 10.1109/tbme.2014.2322515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radiofrequency ablation (RFA) therapy is the gold standard in interventional treatment of many cardiac arrhythmias. A major obstacle is nontransmural lesions, leading to recurrence of arrhythmias. Recent clinical studies have suggested intracardiac electrogram (EGM) criteria as a promising marker to evaluate lesion development. Seeking for a deeper understanding of underlying mechanisms, we established a simulation approach for acute RFA lesions. Ablation lesions were modeled by a passive necrotic core surrounded by a borderzone with properties of heated myocardium. Herein, conduction velocity and electrophysiological properties were altered. We simulated EGMs during RFA to study the relation between lesion formation and EGM changes using the bidomain model. Simulations were performed on a three-dimensional setup including a geometrically detailed representation of the catheter with highly conductive electrodes. For validation, EGMs recorded during RFA procedures in five patients were analyzed and compared to simulation results. Clinical data showed major changes in the distal unipolar EGM. During RFA, the negative peak amplitude decreased up to 104% and maximum negative deflection was up to 88% smaller at the end of the ablation sequence. These changes mainly occurred in the first 10 s after ablation onset. Simulated unipolar EGMs reproduced the clinical changes, reaching up to 83% negative peak amplitude reduction and 80% decrease in maximum negative deflection for transmural lesions. In future studies, the established model may enable the development of further EGM criteria for transmural lesions even for complex geometries in order to support clinical therapy.
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Kumar S, Michaud GF. Unipolar Electrogram Morphology to Assess Lesion Formation During Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:1050-2. [DOI: 10.1161/circep.113.001145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saurabh Kumar
- From the Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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