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Tilz RR, Feher M, Vogler J, Bode K, Duta AI, Ortolan A, Lopez LD, Küchler M, Mamaev R, Lyan E, Sommer P, Braun M, Sciacca V, Demming T, Maslova V, Kuck KH, Heeger CH, Eitel C, Popescu SS. Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study. Europace 2024; 26:euae105. [PMID: 38647070 DOI: 10.1093/europace/euae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Simplified ablation technologies for pulmonary vein isolation (PVI) are increasingly performed worldwide. One of the most common complications following PVI are vascular access-related complications. Lately, venous closure systems (VCSs) were introduced into clinical practice, aiming to reduce the time of bed rest, to increase the patients' comfort, and to reduce vascular access-related complications. The aim of the present study is to compare the safety and efficacy of using a VCS to achieve haemostasis following single-shot PVI to the actual standard of care [figure-of-eight suture and manual compression (MC)]. METHODS AND RESULTS This is a prospective, multicentre, randomized, controlled, open-label trial performed at three German centres. Patients were randomized 1:1 to undergo haemostasis either by means of VCS (VCS group) or of a figure-of-eight suture and MC (F8 group). The primary efficacy endpoint was the time to ambulation, while the primary safety endpoint was the incidence of major periprocedural adverse events until hospital discharge. A total of 125 patients were randomized. The baseline characteristics were similar between the groups. The VCS group showed a shorter time to ambulation [109.0 (82.0, 160.0) vs. 269.0 (243.8, 340.5) min; P < 0.001], shorter time to haemostasis [1 (1, 2) vs. 5 (2, 10) min; P < 0.001], and shorter time to discharge eligibility [270 (270, 270) vs. 340 (300, 458) min; P < 0.001]. No major vascular access-related complication was reported in either group. A trend towards a lower incidence of minor vascular access-related complications on the day of procedure was observed in the VCS group [7 (11.1%) vs. 15 (24.2%); P = 0.063] as compared to the control group. CONCLUSION Following AF ablation, the use of a VCS results in a significantly shorter time to ambulation, time to haemostasis, and time to discharge eligibility. No major vascular access-related complications were identified. The use of MC and a figure-of-eight suture showed a trend towards a higher incidence of minor vascular access-related complications.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Kerstin Bode
- Department of Rhythmology, Heart Center of Leipzig, Leipzig, Germany
| | - Alexandru Ionut Duta
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Angela Ortolan
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Lisbeth Delgado Lopez
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Mirco Küchler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Roman Mamaev
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Evgeny Lyan
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Philipp Sommer
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Thomas Demming
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Vera Maslova
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Christian-Hendrik Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Sorin Stefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
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Ishikura M, Kobori A, Sasaki Y, Murai R, Okada T, Toyota T, Taniguchi T, Kim K, Ehara N, Kinoshita M, Furukawa Y. Importance of the relative epicardial connection locations and right-sided pulmonary vein isolation line for successful pulmonary vein isolation. J Cardiovasc Electrophysiol 2023; 34:841-848. [PMID: 36758950 DOI: 10.1111/jce.15855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The presence of an epicardial connection (EC) decreases the success rate of pulmonary vein isolation (PVI); however, the effect of designing isolation lines has not been evaluated. We sought to clarify the effects of designing an anterior line for right-sided PVI considering the presence and location of the EC. METHODS Seventy-four consecutive patients who underwent initial catheter ablation for atrial fibrillation were retrospectively included in this study. The presence of the EC was determined by the left atrial (LA) activation map during right atrial pacing, and patients were divided into EC-positive (n = 23, 31%) and EC-negative (n = 51, 69%) groups. EC-positive patients were further subdivided based on the EC location: on-the-line group, (EC on the PVI line, n = 11); inside-line group (EC on the pulmonary vein [PV] side, n = 10); and outside-line group (EC on the LA side, n = 2). The PVI parameters were compared among the three groups. RESULTS The success rates of the first-pass isolation were comparable between the EC-negative and EC-positive groups (70.6% vs. 60.9%, ns), but the success rate was significantly higher in the on-the-line group than in the inside-line group (91% vs. 20%, p = 0.002). First-pass isolation was successful in both patients in the outside-line group. Additional carina ablation was required only in the inside-line group. CONCLUSIONS The association between the EC site and the right-sided PV anterior isolation line affected the success rate of first-pass isolation. For successful right-sided PVI, it is important to consider the EC site when designing the PVI line.
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Affiliation(s)
- Masahiro Ishikura
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Sasaki
- 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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Kim JA, Chelu MG. Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 66:585-595. [PMID: 36089635 DOI: 10.1007/s10840-022-01369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF. METHODS A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects. RESULTS One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI - 11.92 to 13.55 min, I2 100%). CONCLUSIONS In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.
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Affiliation(s)
- Jitae A Kim
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, TX, USA.
- Texas Heart Institute, Houston, TX, USA.
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Cryoballoon Ablation versus Radiofrequency Ablation in Patients with Persistent Atrial Fibrillation (CRRF-PeAF): Protocol for a Prospective, Multicenter, Randomized, Controlled Study. IJC HEART & VASCULATURE 2022; 41:101074. [PMID: 35782707 PMCID: PMC9241129 DOI: 10.1016/j.ijcha.2022.101074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
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Schlögl S, Schlögl KS, Bengel P, Bergau L, Haarmann H, Rasenack E, Hasenfuss G, Zabel M. Impact of open-irrigated radiofrequency catheter with contact force measurement on the efficacy and safety of atrial fibrillation ablation: a single-center direct comparison. J Interv Card Electrophysiol 2022; 65:685-693. [PMID: 35907108 PMCID: PMC9726666 DOI: 10.1007/s10840-022-01316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In atrial fibrillation (AF) patients, catheter ablation of pulmonary veins (PVI) is the most effective therapeutic option to maintain sinus rhythm. To improve successful PVI, contact force-sensing (CF) catheters became routinely available. Previous studies did not clearly show superior clinical efficacy in comparison with non-CF catheters. METHODS We investigated consecutive patients, who underwent index PVI for AF at our hospital between 2012 and 2018. Three hundred and fifty-four patients were ablated without CF. After availability of CF catheters in 2016, 317 patients were ablated using CF. In case of crossover between the groups, follow-up was censored. The primary endpoint was any documented atrial tachycardia (AT) or atrial fibrillation > 30 s after a 3-month blanking period. Secondary endpoints were procedural characteristics and periprocedural complications. RESULTS There was no significant difference between the groups at baseline except hyperlipidemia. After 365 days of follow-up, 67% of patients in the CF group remained free from AF/AT recurrence compared to 59% in non-CF group (P = 0.038). In multivariable Cox regression analysis, non-CF ablation was an independent risk factor for AF recurrence besides age and persistent AF. Total fluoroscopy time (15 ± 7.6 vs. 28 ± 15.9 min) and total procedure time (114 ± 29.6 vs. 136 ± 38.5 min) were significantly lower for CF-guided PVI (P < 0.001). Complication rates did not differ between groups (P = 0.661). CONCLUSIONS In our study, the AT/AF recurrence rate and pulmonary vein reconnection rate is lower after CF PVI with a similar complication rate but lower total procedure time and total fluoroscopy time compared to non-CF PVI.
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Affiliation(s)
- Simon Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Klaudia Stella Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Philipp Bengel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Leonard Bergau
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Helge Haarmann
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Eva Rasenack
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuss
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Markus Zabel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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