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Ouchi K, Sakuma T, Kisaki S, Tokutake K, Yamane T, Ojiri H. Changes in pulmonary vein size and narrowing depend on the cardiac cycle before and after pulmonary vein isolation. Heart Vessels 2024:10.1007/s00380-024-02378-6. [PMID: 38526754 DOI: 10.1007/s00380-024-02378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Abstract
Accurate measurement of the pulmonary vein dimension (PVD) is important for determining stenosis and efficacy following pulmonary vein isolation (PVI). Little is known about the quantitative evaluation of the impact of the cardiac cycle on pulmonary vein (PV) morphology before and after PVI. This study aims to investigate variations in the ostial size of the PV during the cardiac cycle before and after PVI and the effect of the cardiac cycle on PV stenosis and reduction rate using cardiac computed tomography (CT). Sixty-eight patients with atrial fibrillation who underwent cardiac CT before and after PVI at our institution between 23 January 2021 and 5 February 2022 were retrospectively analyzed. The maximum and minimum PVD were measured at each segment before and after the PV. Each PV was evaluated according to the PVD reduction rate (ΔPVD), calculated as follows: (1 - post-PVD/pre-PVD) × 100 (%). The average dimension of all PVs at the end-diastolic frame was significantly reduced compared to that at the end-systolic frame before PVI. The average dimensions of the right superior and right inferior PV at the end-diastolic frame were significantly reduced compared with those at the end-systolic frame following PVI. The average reduction rate of dimension-classified stenosis of PVs, except for the left inferior PV at the end-diastolic frame, was significantly reduced compared with that at the end-systolic frame. The cardiac cycle affects PVD assessment, including PV stenosis, after PVI. PVD measurement is recommended to be unified to the end-systolic frame of the cardiac cycle to avoid underestimating PV stenosis before and after PVI, ensuring appropriate management and follow-up.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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2
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Yamasaki T, Kakita K, Pak M, Hattori T. Quantitative comparison of the isolation lesions between conventional- and larger-sized visually guided laser balloon ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01738-6. [PMID: 38427180 DOI: 10.1007/s10840-024-01738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The importance of a wider circumferential isolation of the pulmonary veins (PV), which includes a large portion of the left atrial posterior wall (LAPW), has been suggested in several studies. However, the extended isolation area using a larger inflated visually guided laser balloon (VGLB) ablation remains to be elucidated. METHODS Seventy-eight patients with atrial fibrillation (AF) who underwent VGLB ablation were enrolled in this prospective study. An electroanatomic map of the left atrium was obtained before and after PV isolation (PVI) using a conventional-sized VGLB. The isolation areas were extended by the largest-sized VGLB ablation and remapped in the same manner. After the ablation, isolation areas were calculated with CARTO-3 system. The one-year atrial arrhythmia (Ata) recurrence was assessed. RESULTS: The largest-sized VGLB ablation yielded statistically greater areas of isolation in left-sided PV antrum (PVA) (11.5 ± 2.3 cm2 vs. 15.9 ± 3.5 cm2, P < .001) and right-sided PVA (14.2 ± 3.3 cm2 vs. 20.6 ± 4.4 cm2, P < .001) than the conventional-sized VGLB. Further, non-ablated LAPW (12.3 ± 4.4 cm2 vs. 7.8 ± 3.9 cm2, P < .001) was significantly reduced after largest-sized VGLB ablation, compared to the conventional-sized VGLB ablation. The one-year Ata freedom was 83.7% in patients with paroxysmal AF and 96.4% in those with persistent AF. CONCLUSION The largest-sized VGLB ablation technique can create a significantly wider isolation area of PVA and debulk a large amount of LAPW than the conventional-sized VGLB ablation. The one-year outcome was similarly high in paroxysmal and persistent AF.
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Affiliation(s)
- Takashi Yamasaki
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan.
| | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
| | - Misun Pak
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
| | - Tetsuhisa Hattori
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
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3
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Heeger CH, Tilz RR. Laser light in the era of pulsed field ablation - still a competitor? J Interv Card Electrophysiol 2024; 67:29-30. [PMID: 37930504 PMCID: PMC10769969 DOI: 10.1007/s10840-023-01664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Christian-Hendrik Heeger
- Department of Rhythmologie, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Roland Richard Tilz
- Department of Rhythmologie, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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4
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Funasako M, Petrů J, Hála P, Janotka M, Škoda J, Chovanec M, Šedivá L, Reddy VY, Neužil P. Acute and long-term results with the 3 rd generation visually guided laser balloon ablation system for pv isolation. J Interv Card Electrophysiol 2024; 67:53-60. [PMID: 36805921 PMCID: PMC10770210 DOI: 10.1007/s10840-023-01499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Visually guided laser balloon ablation is known as an effective pulmonary vein (PV) isolation device. The third-generation laser balloon ablation system (X3) equipped with compliant balloon and an automated motor-driven laser output mechanism, namely RAPID mode, has been clinically proven for PV isolation. METHODS PV isolation with X3 was performed in all the patients with paroxysmal and early-stage persistent atrial fibrillation (AF). Acute data for PV isolation and clinical outcomes including supraventricular tachyarrhythmia (SVT: AF, atrial flutter, or atrial tachycardia)-free survival rate beyond 1 year were analyzed. RESULTS A total of 110 patients (62 ± 13 years old, 80% of paroxysmal AF) were treated with X3. RAPID mode with was utilized to achieve PV isolation in all cases. In combination with RAPID mode and spot mode laser ablation, 91.1% (380/417) of veins were isolated on the first circumferential lesion set and did not require touch-up ablation and during the index procedure 100% of attempted veins were isolated. The mean procedure time was 77.0 ± 22.7 min and LA dwell time was 61.9 ± 22.0 min. Total duration of laser application was 5.1 ± 2.3 min per vein. At 1 year, SVT-free survival rate was 93.7% in paroxysmal AF patients, and 81.1% in persistent AF patients. CONCLUSIONS A novel continuous automatic laser balloon ablation system was proved to be safe and effective for both paroxysmal and persistent AF patients. The clinical result demonstrated that PV isolation with X3 could achieve a high SVT-free survival rate.
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Affiliation(s)
- Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic.
| | - Jan Petrů
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Pavel Hála
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Marek Janotka
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Jan Škoda
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Milan Chovanec
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Lucie Šedivá
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
| | - Vivek Y Reddy
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
- The Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Petr Neužil
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague, 15030, Czech Republic
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Plank K, Bordignon S, Urbanek L, Chen S, Tohoku S, Schaack D, Hirokami J, Efe T, Chun KRJ, Schmidt B. Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:2425-2433. [PMID: 37767744 DOI: 10.1111/jce.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Pulsed field ablation (PFA) is a new ablation technology for atrial fibrillation (AF). Data regarding early recurrences of atrial tachyarrhythmia (ERAT) after PFA-pulmonary vein isolation (PVI) are sparse. METHODS Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI. A dedicated catheter delivering bipolar energy (1.9-2.0 kV) was used. Late recurrence (LR) was defined as documented AF/atrial tachycardia (AT) lasting more than 30 s after a 90-day blanking period. RESULTS Two hundred and thirty-one patients (42% female, age 69 ± 12, 55% paroxysmal AF [PAF]) were included in this analysis. Median follow-up time was 367 days (interquartile range: 253-400). Forty-six patients (21%) experienced ERAT after a median of 23 days (46% in PAF and 54% in persistent AF [persAF]). Kaplan-Meier estimated freedom of AF/AT was 74.2% at 1 year, 81.8% for PAF, and 64.8% for persAF (p = .0079). Of patients experiencing ERAT, an LR was observed in 54%. There was no significant difference of LR between those who presented with very early ERAT (0-45 days) and those with ERAT (46-90 days) (p = .57). In multivariate analysis, ERAT (hazard ratio [HR]: 3.370; 95% confidence interval [95% CI]: 1.851-6.136; p < .001) and female sex (HR: 2.048; 95% CI: 1.114-3.768; p = .021) were the only independent predictors for LR. CONCLUSIONS ERAT could be recorded in 21% of patients after PFA-PVI and was an independent predictor for LR. We found no difference in the rate of LRs among patients experiencing ERAT before or after 45 days.
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Affiliation(s)
- Karin Plank
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Tolga Efe
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
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6
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Tokuda M, Yamashita S, Shiomi S, Sakurai R, Sato H, Oseto H, Yokoyama M, Tokutake K, Kato M, Narui R, Tanigawa SI, Yoshimura M, Yamane T. Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation Using a Cryoballoon, Hot Balloon, or Laser Balloon. Circ J 2023; 87:1711-1719. [PMID: 37258224 DOI: 10.1253/circj.cj-23-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI.Methods and Results: A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient. CONCLUSIONS Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.
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Affiliation(s)
- Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine
- Department of Cardiology, Jikei Katsushika Medical Center
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine
| | - Satoko Shiomi
- Department of Cardiology, Jikei Katsushika Medical Center
| | - Ryutaro Sakurai
- Department of Cardiology, The Jikei University School of Medicine
| | - Hidenori Sato
- Department of Cardiology, Jikei Katsushika Medical Center
| | - Hirotsuna Oseto
- Department of Cardiology, The Jikei University School of Medicine
| | - Masaaki Yokoyama
- Department of Cardiology, The Jikei University School of Medicine
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine
| | | | | | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine
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7
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Goya M, Hirao K, Aonuma K, Nogami A, Yamane T, Yamauchi Y, Okishige K, Yotsukura A, Kimura M, Naito S, Kato R, Nitta J, Inaba O, Satomi K, Morita N, Kobayashi Y, Inden Y, Yoshida Y, Kakita K, Kobori A, Kusano K, Inoue K, Masuda M, Hiroshima K, Koyama J, Kumagai K, Okumura K. Initial multicenter clinical experience with the first-generation endoscopic guided laser balloon in Japan. J Interv Card Electrophysiol 2023; 66:1713-1721. [PMID: 36765021 DOI: 10.1007/s10840-023-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Isolation of the pulmonary veins (PVs) is the golden standard for atrial fibrillation (AF) ablation. To achieve a permanent PV isolation, the endoscopic guided HeartLight laser balloon system was invented. We analyzed the safety and efficacy of this laser balloon system. METHODS AND RESULTS Three hundred four patients from 21 investigational sites inside Japan were enrolled in this study. One thousand sixty-two out of 1175 PVs (90.4%) were isolated using the HeartLight laser balloon. The isolation rate of the left superior, left inferior, right superior, and right inferior PVs was 87.8%, 91.3%, 91.6%, and 92.1%, respectively. The procedure time, defined as the time from the venous access to taking out the balloon, was 155 ± 39 min. The fluoroscopic time was 44 ± 25 min. The mean follow-up period was 309 ± 125 days. The freedom from AF recurrence at 3 months was 89.0% and at 12 months 82.1%. Adverse events occurred in 22 patients (7.2%) including phrenic nerve injury lasting more than 3 months in 1.6% and strokes in 1.0% of the patients. CONCLUSIONS This initial experience demonstrated that the laser balloon ablation was feasible for PV isolation in Japanese AF patients.
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Affiliation(s)
- Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Akihiko Yotsukura
- Department of Cardiovascular Medicine, Hokko Memorial Hospital, Sapporo, Japan
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Junichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Ken Kakita
- Department of Arrhythmia, Koseikai Takeda Hospital, Kyoto, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Koichiro Kumagai
- Heart Rhythm Center Fukuoka Sanno Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
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8
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Boersma L, Andrade JG, Betts T, Duytschaever M, Pürerfellner H, Santoro F, Tzeis S, Verma A. Progress in atrial fibrillation ablation during 25 years of Europace journal. Europace 2023; 25:euad244. [PMID: 37622592 PMCID: PMC10451004 DOI: 10.1093/europace/euad244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
The first edition of Europace journal in 1999 came right around the time of the landmark publication of the electrophysiologists from Bordeaux, establishing how elimination of ectopic activity from the pulmonary veins (PVs) resulted in a marked reduction of atrial fibrillation (AF). The past 25 years have seen an incredible surge in scientific interest to develop new catheters and energy sources to optimize durability and safety of ablation, as well as study the mechanisms for AF and devise ablation strategies. While ablation in the beginning was performed with classic 4 mm tip catheters that emitted radiofrequency (RF) energy to create tissue lesions, this evolved to using irrigation and contact force (CF) measurement while increasing power. Also, so-called single-shot devices were developed with balloons and arrays to create larger contiguous lesions, and energy sources changed from RF current to cryogenic ablation and more recently pulsed field ablation with electrical current. Although PV ablation has remained the basis for every AF ablation, it was soon recognized that this was not enough to cure all patients, especially those with non-paroxysmal AF. Standardized approaches for additional ablation targets have been used but have not been satisfactory in all patients so far. This led to highly technical mapping systems that are meant to unravel the drivers for the maintenance of AF. In the following sections, the development of energies, strategies, and tools is described with a focus on the contribution of Europace to publish the outcomes of studies that were done during the past 25 years.
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Affiliation(s)
- Lucas Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Center, PO 2500, 3430 EM Nieuwegein, The Netherlands
| | - Jason G Andrade
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Cardiology Department, Center for Cardiovascular Innovation, Vancouver, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Tim Betts
- Department of Cardiology, Oxford University, Oxford, UK
| | | | | | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Stylianos Tzeis
- Cardiology Department, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Atul Verma
- Cardiology Department, McGill University Health Center, Montreal, Quebec, Canada
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9
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Kondo Y, Kajiyama T, Chiba T, Nakano M, Kobayashi Y. Continuous RAPID-mode ablation with a third-generation laser balloon. IJC HEART & VASCULATURE 2022; 43:101137. [PMID: 36275422 PMCID: PMC9578977 DOI: 10.1016/j.ijcha.2022.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/18/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chuo‐ku, Japan
- Corresponding author at: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 2608670, Japan.
| | - Takatsugu Kajiyama
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chuo‐ku, Japan
| | - Toshinori Chiba
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chuo‐ku, Japan
| | - Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chuo‐ku, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chuo‐ku, Japan
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10
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Radiofrequency Current Versus Balloon-Based Ablation for Atrial Fibrillation. Am J Cardiol 2022; 178:52-59. [PMID: 35817597 DOI: 10.1016/j.amjcard.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
Abstract
The basis for selection of contemporary ablation technologies for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains unclear. We compared procedural data and efficacy in a propensity score-matched cohort treated with 4 ablation technologies in a center mainly using cryoballoon (CB). A total of 819 consecutive patients with AF underwent PVI, using radiofrequency current (RFC) (65 patients), CB (693 patients), hot balloon (HB) (74 patients), and laser balloon (LB) (52 patients). A total of patients (82% paroxysmal AF) were selected from each group according to the propensity score. Procedural data and freedom from atrial tachyarrhythmia recurrence after the index procedure were compared. All pulmonary veins were isolated in all groups. Procedure time was shorter in CB and HB groups (RFC: 148 ± 53 vs CB: 85 ± 37 vs HB: 102 ± 31 vs LB: 140 ± 28 minutes, p <0.001). RFC touch-up was most commonly required for PVI in the HB group among balloon groups (40%) (p <0.001). Total complication rate was 4% to 18% without any statistical differences between groups (p = 0.123). Phrenic nerve injury occurred most often in the CB group (16%) (p <0.001). During a mean follow-up of 21 ± 6 months, there were no significant differences among groups for freedom from atrial tachyarrhythmia recurrence after the index procedure (RFC: 68% vs CB: 78% vs HB: 76% vs LB: 76%, p = 0.440). In conclusion, all the ablation technologies facilitate safe and efficient PVI, with slight differences in the procedural data and complications.
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Schmidt B, Bordignon S, Tohoku S, Chen S, Bologna F, Urbanek L, Pansera F, Ernst M, Chun KRJ. 5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation. Circ Arrhythm Electrophysiol 2022; 15:e010817. [PMID: 35617232 DOI: 10.1161/circep.121.010817] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology. METHODS All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. In the validation phase (n=25), device electrogram quality was compared with a circular mapping catheter to assess pulmonary vein isolation and esophageal temperature monitoring was used. In the streamline phase (n=166), a single-catheter approach was implemented. Postprocedural cerebral magnetic resonance imaging was performed in 53 patients. In 52 patients, esophageal endoscopy was performed at day 1 after the procedure. Follow-up was performed using 72 hours Holter ECGs. RESULTS On a pulmonary vein basis, pulmonary vein isolation rate was 100% including a single shot isolation rate of 99.5%. The electrogram information of the pulsed field ablation catheter and the circular mapping catheter were 100% congruent. Neither esophageal temperature rises nor esophageal thermal injury were observed. Two minor strokes occurred, presumable due to air embolism during catheter exchanges through the large bore sheath (13.8 F ID). In the streamline phase, reduced procedure times (46±14 versus 38±13 minutes, P=0.004), no further strokes and a low incidence of silent cerebral injury (10/53 patients; 19%) were noted. During short-term follow-up, 17/191 patients (9%) had a atrial tachyarrhythmia recurrence. CONCLUSIONS The pulsed field ablation device allows for simple and safe simple single shot pulmonary vein isolation using standard sedation protocols. Procedural speed and efficacy are remarkable and streamlining measures have added safety.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie (B.S.), Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Francesco Pansera
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Matthias Ernst
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
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12
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Tohoku S, Schmidt B, Bordignon S, Chen S, Bologna F, Julian Chun KR. Initial clinical experience of pulmonary vein isolation using the ultra-low temperature cryoablation catheter for patients with atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1371-1379. [PMID: 35488736 DOI: 10.1111/jce.15519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The iCLAS ultra-low temperature cryoablation (ULTC) system has recently brought to the market. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation in atrial fibrillation (AF) ablation. The use of an esophageal warming balloon is recommended when using the system to reduce the potential for collateral esophageal injury. OBJECTIVE To describe the initial clinical experience when using ULTC in the AF treatment without general anesthesia (GA). METHODS Consecutive patients undergoing AF ablation using ULTC under deep sedation without GA were enrolled. We assessed the procedural data focusing on "single-shot isolation" defined as successful pulmonary vein (PV) isolation after the first application. Esophagogastroduodenoscopy was systematically performed the day after ablation. RESULTS A total of 27 AF patients (67% paroxysmal AF) were analyzed. One-hundred-four out of 106 PVs (98.1%) were isolated solely using ULTC. The mean procedure time was 79 ± 30 min. The mean number of applications per PV was 2.6 ± 1.0. Single-shot isolation was achieved in 57 PVs (54%) varying across PVs from left superior- to inferior PVs (40-64%). Single procedure six-month recurrence free rate was 84%. No major complication (cerebrovascular event, pericardial effusion/tamponade, esophageal damage on esophagogastroduodenoscopy) occurred. A single transient phrenic nerve palsy occurred during the right superior PV ablation which had recovered by the 3-month follow up appointment. CONCLUSIONS AF ablation using the novel ULTC system seemed feasible without GA and enabled >50% single-shot isolation rate. The promising safety profile has to be confirmed in large-scaled studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | | | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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Sasaki Y, Kobori A, Ishikura M, Murai R, Okada T, Toyota T, Taniguchi T, Kim K, Ehara N, Kinoshita M, Furukawa Y. Effectiveness of a manual dragging laser irradiation technique using the first‐generation endoscopic laser balloon ablation system for pulmonary vein isolation. J Arrhythm 2022; 38:327-335. [PMID: 35785395 PMCID: PMC9237312 DOI: 10.1002/joa3.12711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although high efficacy of laser balloon (LB) ablation for atrial fibrillation (AF) has been shown, the conventional point‐by‐point technique requires a long procedure time. We investigated the clinical effectiveness of the manual dragging laser technique. Methods We enrolled 51 consecutive patients with paroxysmal AF who underwent pulmonary vein isolation (PVI) using first‐generation LB (LB1) at our institution. The first 25 patients underwent PVI using a point‐by‐point laser irradiation maneuver (point‐by‐point group). The latter 26 patients underwent PVI using a manually dragging laser irradiation maneuver (dragging group). The power and delivery time for the laser energy were selected from a preset protocol with 5.5–12 W and 20–30 s for each application. The dragging irradiation method was performed by manually rotating approximately 1.5°/s during one irradiation application. Results PVI was successful in all cases. The duration of PVI was shorter (66 ± 20 vs. 116 ± 39 min, p < 0.0001), and the number of laser irradiations for the 4PVs were significantly less in the dragging group. There were four recurrent cases (16%) in the point‐by‐point group and 1 (4%) in the dragging group. There was no significant difference in the survival rate free from recurrence after the blanking period between the two groups (log‐rank p = 0.1570). The complications were similar between the groups (4% vs. 4%, ns). Conclusions The manual dragging laser irradiation technique using LB1 could shorten the PVI procedure time while preserving clinical effectiveness.
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Affiliation(s)
- Yasuhiro Sasaki
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Atsushi Kobori
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Masahiro Ishikura
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Ryosuke Murai
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Taiji Okada
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Toshiaki Toyota
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Tomohiko Taniguchi
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Kitae Kim
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Natsuhiko Ehara
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Makoto Kinoshita
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
| | - Yutaka Furukawa
- Department of Cardiology Kobe City Medical Center General Hospital Kobe Japan
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14
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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15
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Nagase T, Asano S, Fukunaga H, Kasai Y, Inoue K, Sekiguchi Y, Tanizaki K, Murai T, Nanasato M, Umemura J, Nitta J, Isobe M. Evaluation of linear lesion formation and thermodynamics by dragging ablation with the third-generation laser balloon. Heart Rhythm O2 2022; 3:311-318. [PMID: 35734297 PMCID: PMC9207738 DOI: 10.1016/j.hroo.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The lesion formation properties of a motorized rotational delivery (RAPID) mode, third-generation laser balloon (LB3) ablation compared to point-by-point laser ablation in patients with atrial fibrillation remain unclear. Objective The purpose of this study was to assess lesion characteristics and thermodynamics in LB3 ablation with a RAPID mode in vitro model. Methods Chicken muscles were cauterized using LB3 in RAPID mode with 13 W and 15 W and 50% overlapped point-by-point fashion with 7 W/30 seconds, 8.5 W/20 seconds, 10 W/20 seconds, and 12 W/20 seconds. Lesion depth, width, and continuity were compared. Lesion continuity was classified by the visible gap degree categorized from 1 (perfect) to 3 (poor). Thermodynamics and maximum tissue temperatures were assessed under infrared thermographic monitoring. Fifteen and 5 lesions were evaluated per ablation protocol for measurement of lesion size and continuity and for thermographic assessment, respectively. Results Lesion depth and width were smaller in RAPID mode laser ablation than point-by-point laser ablation (P <.001). However, RAPID mode laser ablation revealed sufficient mean lesion depth of 5 mm or more. Lesion continuity was 1 (perfect) in all samples in RAPID mode laser ablation and point-by-point laser ablation (P = 1). Infrared thermographic observation demonstrated fast and gapless linear lesion formation with thermal stacking in RAPID mode laser ablation. Maximum tissue temperature was lower in RAPID mode laser ablation than point-by-point laser ablation (P <.001). Conclusion RAPID mode LB3 ablation could provide fast, gapless, and acceptable lesion formation with thermal stacking and moderate tissue temperature rise.
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Affiliation(s)
- Takahiko Nagase
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
- Address reprint requests and correspondence: Dr Takahiko Nagase, Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan.
| | - So Asano
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroshi Fukunaga
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuhei Kasai
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kohei Tanizaki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tatsuya Murai
- Department of Pathology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Jun Umemura
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort. J Cardiovasc Dev Dis 2021; 8:jcdd8120183. [PMID: 34940538 PMCID: PMC8704020 DOI: 10.3390/jcdd8120183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 01/29/2023] Open
Abstract
Laser balloon (LB) has emerged as an interesting strategy for pulmonary vein isolation in paroxysmal atrial fibrillation (AF). A third-generation LB has recently been developed, allowing a continuous ablation set. We aimed to compare the results from our center's experience with second and third-generation LBs to a cohort of matched patients who had undergone radiofrequency ablation (RFA) with contact-force catheters. This retrospective monocenter case-control study included our first 50 LB paroxysmal AF ablations (26 second and 24 third-generation LB) and 50 RFA controls, matched on age, sex and left atrial dilation. The two groups had similar baseline parameters. LB procedures were significantly shorter than RFA (129 (110-160) vs. 160 (119-198) min, p = 0.007). During AF ablation, two major complications occurred in each group. At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14). Moreover, we observed that third-generation LB procedures were associated with shorter laser applications (22 (19-29) vs. 69 (55-76) min, p < 0.001) and procedural durations (111 (100-128) vs. 151.5 (128.5-167) min, p < 0.001) compared to second-generation LB procedures. In the context of the major increase in the number of AF ablations, LB demonstrated consistent results in terms of clinical success, complications and also reduced procedure durations compared to RFA.
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Tohoku S, Bordignon S, Bologna F, Chen S, Urbanek L, Operhalski F, Chun KJ, Schmidt B. Laser balloon in pulmonary vein isolation for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2021; 18:1083-1091. [PMID: 34618626 DOI: 10.1080/17434440.2021.1990754] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Visually guided laser balloon (LB) catheter has been an established modality dedicated for pulmonary vein (PV) isolation in patients with atrial fibrillation. The newly updated version of this novel device has technically evolved recent years. AREAS COVERED This review will summarize the contemporary technical evolution of LB catheter. Available efficacy outcomes and the historical change of ablation style will be evaluated. Furthermore, the future perspectives for clinical practice are discussed. EXPERT COMMENTARY The initial LB ablation system provided comparable clinical results in PV isolation with other technologies, but with a unique strategical concept enabling the direct visualization of the tissue to cauterize. With multigenerational development, the LB catheter has been equipped with more compliant balloon for favorable PV occlusion and a robotically motor driven continuous ablation mode (RAPID mode). These technical innovations changed the concept of the ablation strategy using LB catheter as 'point-by-point' into 'single-shot' fashion. The remaining tasks are further improvements such as equipping with real-time recording system of intracardiac electrogram, durable structured balloon and the instrument for visualizing the cauterization area in a 360-degree panoramic view, which includes potential possibilities to develop this novel device to the more optimal device for PV isolation.
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Affiliation(s)
- Shota Tohoku
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Stefano Bordignon
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Fabrizio Bologna
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Shaojie Chen
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Lukas Urbanek
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Kr Julian Chun
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
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18
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Tohoku S, Bordignon S, Chen S, Zanchi S, Bianchini L, Trolese L, Operhalski F, Urbanek L, Chun KRJ, Schmidt B. Single-sweep pulmonary vein isolation using the new third-generation laser balloon-Evolution in ablation style using endoscopic ablation system. J Cardiovasc Electrophysiol 2021; 32:2923-2932. [PMID: 34535929 DOI: 10.1111/jce.15245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode). AIM To determine the feasibility of single-shot fashioned ablation using X3. METHODS Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on "Single-sweep PVI" defined as successful PVI with a single RAPID mode energy application, and on "first-pass isolation" defined as successful PVI after initial circular lesion set. RESULTS One hundred AF patients (56% male, age: 68 ± 10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep PVI and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep PVI rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs: 49.5%, p = .0239) and at PVs with maximal ostial diameter <24 mm (57.6% vs. >24 mm: 36.8%, p = .0151). The mean total procedure and fluoroscopy times were 43.0 ± 10 and 4.0 ± 2 min, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed. CONCLUSION The new X3 EAS allows for single-shot fashioned ablation in terms of single-sweep PVI in half or more of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.
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Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Luca Trolese
- Universitäts Herzzentrum Freiburg-Bad Krozingen, Klinik für Kardiologie und Angiologie I, Freiburg, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
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Validation of lesion durability following pulmonary vein isolation using the new third-generation laser balloon catheter in patients with recurrent atrial fibrillation. J Cardiol 2021; 78:388-396. [PMID: 34332839 DOI: 10.1016/j.jjcc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The second- and third-generation endoscopic ablation systems (EAS2 and EAS3) have been launched in recent years. We aimed to assess the lesion durability as well as gap localization using the multigenerational novel technologies in patients with recurrent atrial fibrillation (AF). METHODS Consecutive patients who underwent second ablation for recurrent AF following the initial pulmonary vein isolation (PVI) with EAS2 or EAS3 were retrospectively investigated. The persistent durability of PVI, gap localization at the second procedure, and procedural/anatomical features of durable PVI were analyzed. RESULTS Among 225 patients treated with EAS3 (N = 125) and EAS2 (N = 100), 34 patients (EAS3: 13 patients, 50 PVs, EAS2: 21 patients, 82 PVs) underwent a second procedure because of recurrent AF mean 11.9 ± 9.3 months after the initial procedure. Persistent isolation of all four PVs was recorded in 6 (46.2%) patients in EAS3 group and 4 (19.1%) patients in EAS2 group (p = 0.130). Ninety-one out of 132 (68.9%) PVs were persistently isolated with a higher rate in EAS3 group (82.0% vs. EAS2 group: 61.0%, p = 0.0113). A total of 45 gaps were recorded in 41 PVs. Right superior PV (RSPV) was the predominantly common reconnected vein (15 gaps, 14 PVs) irrespective of generations (EAS3: 4 gaps in 3 PVs and EAS2: 12 gaps in 11 PVs). Logistic multivariate regression analysis revealed ablation without reduced energy dose (5.5-7 W) as an independent predictor of durable PVI [adjusted OR: 3.70, 95% CI (1.408-10.003)], p = 0.008]. CONCLUSION The technical innovation resulted in a higher lesion durability in EAS3-guided PVI in patients with recurrent AF. The most common gap location was found at RSPV in successor EASs. Ablation without reduced energy was a predictor of durable PVI in successor EASs.
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