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Yamaguchi J, Takigawa M, Goya M, Martin CA, Negishi M, Yamamoto T, Ikenouchi T, Goto K, Shigeta T, Kawamura I, Nishimura T, Takamiya T, Tao S, Miyazaki S, Sasano T. Impact of contact force on the lesion characteristics of very high-power short-duration ablation using a QDOT-MICRO catheter. J Arrhythm 2024; 40:247-255. [PMID: 38586837 PMCID: PMC10995585 DOI: 10.1002/joa3.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 04/09/2024] Open
Abstract
Background Lesion size is reported to become larger as contact force (CF) increases. However, this has not been systematically evaluated in temperature-guided very high-power short-duration (vHPSD) ablation, which was therefore the purpose of this study. Methods Radiofrequency applications (90 W/4 s, temperature-control mode) were performed in excised porcine myocardium with four different CFs of 5, 15, 25, and 35 g using QDOT-MICRO™ catheter. Ten lesions for each combination of settings were created, and lesion metrics and steam-pops were compared. Results A total of 320 lesions were analyzed. Lesion depth, surface area, and volume were smallest for CF of 5 g than for 15, 25, and 35 g (depth: 2.7 mm vs. 2.9 mm, 3.0 mm, 3.15 mm, p < .01; surface area: 38.4 mm2 vs. 41.8 mm2, 43.3 mm2, 41.5 mm2, p < .05; volume: 98.2 mm3 vs. 133.3 mm3, 129.4 mm3, 126.8 mm3, p < .01 for all pairs of groups compared to CF = 5 g). However, no significant differences were observed between CFs of 15-35 g. Average power was highest for CF of 5 g, followed by 15, 25, and 35 g (83.2 W vs. 82.1 W vs. 77.1 W vs. 66.1 W, p < .01 for all pairs), reflecting the higher incidence of temperature-guided power titration with greater CFs (5 g:8.8% vs. 15 g:52.5% vs. 25 g:77.5% vs. 35 g:91.2%, p < .01 for all pairs except for 25 g vs. 35 g). The incidence of steam-pops did not significantly differ between four groups (5 g:3.8% vs. 15 g:10% vs. 25 g:6.2% vs. 35 g:2.5%, not significant for all pairs). Conclusions For vHPSD ablation, lesion size does not become large once the CF reaches 15 g, and the risk of steam-pops may be mitigated through power titration even in high CFs.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Clinical and Diagnostic Laboratory ScienceTokyo Medical and Dental UniversityTokyoJapan
| | - Masateru Takigawa
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | | | - Miho Negishi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tasuku Yamamoto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takashi Ikenouchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Kentaro Goto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takatoshi Shigeta
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Iwanari Kawamura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takuro Nishimura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tomomasa Takamiya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Susumu Tao
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
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Yamamoto T, Takigawa M, Shigeta T, Martin CA, Yamaguchi J, Amemiya M, Ikenouchi T, Negishi M, Kawamura I, Goto K, Nishimura T, Takamiya T, Tao S, Miyazaki S, Goya M, Sasano T. Effect of reference electrode on intracardiac electrograms: Close indifferent electrode vs Wilson central terminal. Heart Rhythm 2024:S1547-5271(24)00237-6. [PMID: 38460753 DOI: 10.1016/j.hrthm.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Unipolar electrograms (uni-EGMs) are an essential part of intracardiac mapping. Although Wilson central terminal (WCT) is conventionally used as a reference for signals, avoidance of contamination by far-field and nonphysiologic signals is challenging. OBJECTIVE The aim of the study was to explore the impact of an intracardiac indifferent reference electrode close to the recording electrodes, in lieu of WCT, on electrograms. METHODS Sinus node activation was mapped in patients undergoing catheter ablation by a multielectrode array with a close indifferent electrode (CIE) embedded in the distal end of the catheter shaft. An equal number of points was sequentially acquired at each site with use of CIE as a reference first and subsequently with WCT. Uni-EGMs, bipolar EGMs, and the earliest activation area (defined as the area activated in the first 10 ms of the beat) were compared between CIE- and WCT-based activation maps. RESULTS Seventeen patients (61 ± 18 years; 76% male) were studied. Uni-EGM voltages acquired with CIE were significantly larger than (n = 11) or comparable to (n = 4) those acquired with WCT. When points from the entire cohort were analyzed altogether, unipolar voltages and their maximum negative dV/dT and bipolar voltages recorded with CIE were significantly larger than those recorded with WCT (2.36 [1.42-3.79] mV vs 1.96 [1.25-3.03] mV, P < .0001; 0.40 [0.18-0.77] mV/s vs 0.35 [0.15-0.71] mV/s, P < .0001; and 1.46 [0.66-2.81] mV vs 1.33 [0.54-2.64] mV, P < .0001, respectively). The earliest activation area was significantly smaller in CIE-based activation maps than in WCT-based ones (0.3 [0.7-1.4] cm2 vs 0.6 [1.0-1.8] cm2, P = .01). CONCLUSION CIE-based maps were associated with an approximately 20% increase in unipolar voltage and may highlight the origin of a focal activation more clearly than WCT-based ones.
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Affiliation(s)
- Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Division of Advanced Arrhythmia Research, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Miki Amemiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Division of Advanced Arrhythmia Research, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Division of Advanced Arrhythmia Research, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Knops RE, El-Chami MF, Marquie C, Nordbeck P, Quast AFBE, Tilz RR, Brouwer TF, Lambiase PD, Cassidy CJ, Boersma LVA, Burke MC, Pepplinkhuizen S, de Veld JA, de Weger A, Bracke FALE, Manyam H, Probst V, Betts TR, Bijsterveld NR, Defaye P, Demming T, Elders J, Field DC, Ghani A, Golovchiner G, de Jong JSSG, Lewis N, Marijon E, Martin CA, Miller MA, Shaik NA, van der Stuijt W, Kuschyk J, Olde Nordkamp LRA, Arya A, Borger van der Burg AE, Boveda S, van Doorn DJ, Glikson M, Kaiser L, Maass AH, van Woerkens LJPM, Zaidi A, Wilde AAM, Smeding L. Predictive value of the PRAETORIAN score for defibrillation test success in patients with subcutaneous ICD: A subanalysis of the PRAETORIAN-DFT trial. Heart Rhythm 2024:S1547-5271(24)00115-2. [PMID: 38336193 DOI: 10.1016/j.hrthm.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The PRAETORIAN score estimates the risk of failure of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy by using generator and lead positioning on bidirectional chest radiographs. The PRospective randomized compArative trial of subcutanEous implanTable cardiOverter-defibrillatoR ImplANtation with and without DeFibrillation Testing (PRAETORIAN-DFT) investigates whether PRAETORIAN score calculation is noninferior to defibrillation testing (DFT) with regard to first shock efficacy in spontaneous events. OBJECTIVE This prespecified subanalysis assessed the predictive value of the PRAETORIAN score for defibrillation success in induced ventricular arrhythmias. METHODS This multicenter investigator-initiated trial randomized 965 patients between DFT and PRAETORIAN score calculation after de novo S-ICD implantation. Successful DFT was defined as conversion of induced ventricular arrhythmia in <5 seconds from shock delivery within 2 attempts. Bidirectional chest radiographs were obtained after implantation. The predictive value of the PRAETORIAN score for DFT success was calculated for patients in the DFT arm. RESULTS In total, 482 patients were randomized to undergo DFT. Of these patients, 457 (95%) underwent DFT according to protocol, of whom 445 (97%) had successful DFT and 12 (3%) had failed DFT. A PRAETORIAN score of ≥90 had a positive predictive value of 25% for failed DFT, and a PRAETORIAN score of <90 had a negative predictive value of 99% for successful DFT. A PRAETORIAN score of ≥90 was the strongest independent predictor for failed DFT (odds ratio 33.77; confidence interval 6.13-279.95; P < .001). CONCLUSION A PRAETORIAN score of <90 serves as a reliable indicator for DFT success in patients with S-ICD, and a PRAETORIAN score of ≥90 is a strong predictor for DFT failure.
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Affiliation(s)
- Reinoud E Knops
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands.
| | - Mikhael F El-Chami
- Division of Cardiology Section of Electrophysiology, Emory University, Atlanta, Georgia
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany
| | - Anne-Floor B E Quast
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Roland R Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tom F Brouwer
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Pier D Lambiase
- Office of the Director of Clinical Electrophysiology Research and Lead for Inherited Arrhythmia Specialist Services, University College London and Barts Heart Centre, London, United Kingdom
| | - Christopher J Cassidy
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Trust, Blackpool, United Kingdom
| | - Lucas V A Boersma
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Shari Pepplinkhuizen
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Jolien A de Veld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anouk de Weger
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Frank A L E Bracke
- Department of Electrophysiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Harish Manyam
- Department of Cardiology Erlanger Health System, University of Tennessee, Chattanooga, Tennessee
| | - Vincent Probst
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Timothy R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Nick R Bijsterveld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands; Department of Cardiology, Flevoziekenhuis, Almere, The Netherlands
| | - Pascal Defaye
- Service de Cardiologie, Centre hospitalier universitaire, Grenoble, France
| | - Thomas Demming
- Department of Internal Medicine III, Cardiology, Angiology, and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Elders
- Department of Cardiology, Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Duncan C Field
- Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom
| | - Abdul Ghani
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | | | - Nigel Lewis
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Naushad A Shaik
- Department of Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida
| | - Willeke van der Stuijt
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; First Department of Medicine-Cardiology, University Medical Center Mannheim, and the German Center for Cardiovascular Research Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Louise R A Olde Nordkamp
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dirk J van Doorn
- Department of Cardiology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Amir Zaidi
- Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Lonneke Smeding
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
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Gajendragadkar PR, Martin CA, Wijesurendra RS. Making the Right Diagnosis: Slowly but Surely. Circulation 2023; 148:1814-1818. [PMID: 38011246 PMCID: PMC10664777 DOI: 10.1161/circulationaha.123.067074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Parag R. Gajendragadkar
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom (P.R.G., C.A.M.)
- Nuffield Department of Population Health, University of Oxford, United Kingdom (P.R.G., R.S.W.)
| | - Claire A. Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom (P.R.G., C.A.M.)
- Division of Medicine, University of Cambridge, United Kingdom (C.A.M.)
| | - Rohan S. Wijesurendra
- Nuffield Department of Population Health, University of Oxford, United Kingdom (P.R.G., R.S.W.)
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (R.S.W.)
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Iwakawa H, Takigawa M, Yamaguchi J, Martin CA, Goya M, Yamamoto T, Amemiya M, Ikenouchi T, Negishi M, Kawamura I, Goto K, Shigeta T, Nishimura T, Takamiya T, Tao S, Miyazaki S, Watanabe H, Sasano T. Superiority of the Combination of Input and Output Parameters to the Single Parameter for Lesion Size Estimation. Circ J 2023; 87:1757-1764. [PMID: 37899173 DOI: 10.1253/circj.cj-23-0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND For lesion size prediction, each input parameter, including ablation energy (AE), and output parameter, such as impedance, is individually used. We hypothesize that using both parameters simultaneously may be more optimal.Methods and Results: Radiofrequency applications at a range of power (30-50 W), contact force (10 g and 20 g), duration (10-60 s), and catheter orientation with normal saline (NS)- or half-normal saline (HNS)-irrigation were performed in excised porcine hearts. The correlations, with lesion size of AE, absolute impedance drop (∆Imp-drop), relative impedance drop (%Imp-drop), and AE*%Imp-drop were examined. Lesion size was analyzed in 283 of 288 lesions (NS-irrigation, n=142; HNS-irrigation, n=141) without steam pops. AE*%Imp-drop consistently showed the strongest correlations with lesion maximum depth (NS-irrigation, ρ=0.91; HNS-irrigation, ρ=0.94), surface area (NS-irrigation, ρ=0.87; HNS-irrigation, ρ=0.86), and volume (NS-irrigation, ρ=0.94; HNS-irrigation, ρ=0.94) compared with the other parameters. Moreover, compared with AE alone, AE*%Imp-drop significantly improved the strength of correlation with lesion maximum depth (AE vs. AE*%Imp-drop, ρ=0.83 vs. 0.91, P<0.01), surface area (ρ=0.73 vs. 0.87, P<0.01), and volume (ρ=0.84 vs. 0.94, P<0.01) with NS-irrigation. This tendency was also observed with HNS-irrigation. Parallel catheter orientation showed a better correlation with lesion depth and volume using ∆Imp-drop, %Imp-drop, and AE*%Imp-drop than perpendicular orientation. CONCLUSIONS The combination of input and output parameters is more optimal than each single parameter for lesion prediction.
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Affiliation(s)
- Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Miki Amemiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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6
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Ikenouchi T, Takigawa M, Goya M, Yamaguchi J, Martin CA, Yamamoto T, Negishi M, Kawamura I, Goto K, Shigeta T, Nishimura T, Takamiya T, Tao S, Miyazaki S, Sasano T. The effect of half-normal saline irrigation on lesion characteristics in temperature-flow-controlled ablation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01678-7. [PMID: 37946002 DOI: 10.1007/s10840-023-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Radiofrequency (RF) ablation with half-normal saline (HNS) irrigation is reported to potentially enlarge local lesion compared to normal saline (NS) in power-controlled ablation (PC-Abl). However, the effect of HNS-irrigation in temperature-flow-controlled ablation (TFC-Abl) on lesion characteristics is unknown. We compared this between TFC-Abl with QDOT-Micro™ catheter and PC-Abl with Thermocool SmartTouch SF™ catheter (STSF). METHODS RF-application with NS (n = 480) and HNS (n = 480) irrigation were performed on swine myocardium placed in a circulating saline bath. Lesion characteristics without steam-pops under various conditions (target AI, 400/550; ablation power, 30/50 W; contact force, 10/20/30 g; catheter orientation, perpendicular/parallel) were assessed and compared between two irrigants. RESULTS After matching, 343 lesions without steam-pops in each group were evaluated. In PC-Abl, lesion size did not differ between two groups (NS, 188 ± 97 vs. HNS, 200 ± 95 mm3, p = 0.28 in volume; 33.9 ± 7.3 vs. 34.8 ± 9.5 mm2, p = 0.34 in surface area; and 4.0 ± 1.0 vs. 4.0 ± 1.0 mm, p = 0.81 in depth), but steam-pops were more frequently observed with HNS-irrigation (23.8% vs. 37.9%, p = 0.001). Contrary, in TFC-Abl, HNS-irrigation produced significantly larger (214 ± 106 vs. 243 ± 128 mm3, p = 0.017) and deeper (4.0 ± 1.0 vs. 4.3 ± 1.1 mm, p = 0.002) lesions without increasing the risk of steam-pops (15.0% vs 15.0%, p = 0.99). Automatic temperature-guided titration was more frequently observed in HNS-irrigation (54.8% vs. 78.5%, p < 0.001). CONCLUSIONS TFC-Abl with QDOT-Micro™ catheter utilizing HNS-irrigation might increase volume and depth of local lesion without increasing the risk of stem-pops compared to NS-irrigation. Power-controlled ablation with HNS-irrigation showed similar focal lesion with higher incidence of steam-pops (SPs) compared to normal saline (NS) irrigation. Contrary, temperature-flow-controlled ablation with HNS-irrigation provided larger and deeper lesion than NS-irrigation with similar incidence of SPs. ns, p > 0.05; *, 0.01 < p ≤ 0.05; **, 0.005 < p ≤ 0.01. HNS, half-normal saline; NS, normal saline.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
- Department of Clinical and Diagnostic Laboratory Science, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 OAY, UK
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Honarbakhsh S, Martin CA, Mesquita J, Herlekar R, Till R, Srinivasan NT, Duncan E, Leong F, Dulai R, Veasey R, Panikker S, Paisey J, Ramgopal B, Das M, Ahmed W, Sahu J, Earley MJ, Finlay MC, Schilling RJ, Hunter RJ. Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience. Europace 2023; 25:euad286. [PMID: 37738643 PMCID: PMC10629714 DOI: 10.1093/europace/euad286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). There are limited data on the PolarX Cryoballoon. The study aimed to establish the safety, efficacy, and feasibility of same day discharge for Cryoballoon PVI. METHODS AND RESULTS Multi-centre study across 12 centres. Procedural metrics, safety profile, and procedural efficacy of the PolarX Cryoballoon with the Arctic Front Advance (AFA) Cryoballoon were compared in a cohort large enough to provide definitive comparative data. A total of 1688 patients underwent PVI with cryoablation (50% PolarX and 50% AFA). Successful PVI was achieved with 1677 (99.3%) patients with 97.2% (n = 1641) performed as day case procedures with a complication rate of <1%. Safety, procedural metrics, and efficacy of the PolarX Cryoballoon were comparable with the AFA cohort. The PolarX Cryoballoon demonstrated a nadir temperature of -54.6 ± 7.6°C, temperature at 30 s of -38.6 ± 7.2°C, time to -40°C of 34.1 ± 13.7 s, and time to isolation of 49.8 ± 33.2 s. Independent predictors for achieving PVI included time to reach -40°C [odds ratio (OR) 1.34; P < 0.001] and nadir temperature (OR 1.24; P < 0.001) with an optimal cut-off of ≤34 s [area under the curve (AUC) 0.73; P < 0.001] and nadir temperature of ≤-54.0°C (AUC 0.71; P < 0.001), respectively. CONCLUSIONS This large-scale UK multi-centre study has shown that Cryoballoon PVI is a safe, effective day case procedure. PVI using the PolarX Cryoballoon was similarly safe and effective as the AFA Cryoballoon. The cryoablation metrics achieved with the PolarX Cryoballoon were different to that reported with the AFA Cryoballoon. Modified cryoablation targets are required when utilizing the PolarX Cryoballoon.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Claire A Martin
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joao Mesquita
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Rahul Herlekar
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Richard Till
- Department of Electrophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Department of Electrophysiology, Basildon and Thurrock University Hospital NHS Foundation Trust, Essex, UK
| | - Edward Duncan
- Department of Electrophysiology, The University Hospitals Bristol and Weston NHS Foundation trust, Bristol, UK
| | - Fong Leong
- Department of Electrophysiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rajdip Dulai
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Rick Veasey
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Sandeep Panikker
- Department of Electrophysiology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - John Paisey
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Balasubramanian Ramgopal
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Moloy Das
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Wissam Ahmed
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jonathan Sahu
- Department of Electrophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
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Takigawa M, Yamamoto T, Amemiya M, Martin CA, Ikenouchi T, Yamaguchi J, Negishi M, Goto K, Shigeta T, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T. Impact of baseline pool impedance on lesion metrics and steam pops in catheter ablation. J Cardiovasc Electrophysiol 2023; 34:1671-1680. [PMID: 37337433 DOI: 10.1111/jce.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Little is known about the impact of blood-pool local impedance (LI) on lesion characteristics and the incidence of steam pops. METHODS Radiofrequency applications at a range of powers (30, 40, and 50 W), contact forces (CF) (5, 15, and 25 g), and durations (15, 30, 45, and 120 s) using perpendicular/parallel catheter orientation were performed in 40 excised porcine preparations, using a catheter capable of monitoring LI (StablePoint©, Boston Scientific). To simulate the variability in blood-pool impedance, the saline-pool LI was modulated by calibrating saline concentrations. Lesion characteristics were compared under three values of saline-pool LI: 120, 160, and 200 Ω. RESULTS Of 648 lesions created, steam pops occurred in 175 (27.0%). When power, CF, time, and catheter orientation were adjusted, ablation at a saline-pool impedance of 160 or 200 Ω more than doubled the risk of steam pops compared with a saline-pool impedance of 120 Ω (Odds ratio = 2.31; p = .0002). Lesions in a saline-pool impedance of 120 Ω were significantly larger in surface area (50 [38-62], 45 [34-56], and 41 [34-60] mm2 for 120, 160, and 200 Ω, p < .05), but shallower in depth (4.0 [3-5], 4.4 [3.2-5.3], and 4.5 [3.8-5.5] mmfor 120, 160, and 200 Ω, respectively, p < .05) compared with the other two settings. The correlation between the absolute LI-drop and lesion size weakened as the saline-pool LI became higher (e.g., 120 Ω group (r2 = .30, r2 = .18, and r2 = .16, respectively for 120, 160, and 200 Ω), but the usage of %LI-drop (= absolute LI-drop/initial LI) instead of absolute LI-drop may minimize this effect. CONCLUSIONS In an experimental model, baseline saline-pool impedance significantly affects the lesion metrics and the risk of steam pops.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miki Amemiya
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Claire A Martin
- Royal Papworth Hospital, Cambridge University, Cambridge, UK
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
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9
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Martin CA, Zaw MT, Jackson N, Morris D, Costanzo P. First worldwide use of pulsed-field ablation for ventricular tachycardia ablation via a retrograde approach. J Cardiovasc Electrophysiol 2023; 34:1772-1775. [PMID: 37431271 DOI: 10.1111/jce.16002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION We present the first worldwide use of pulsed-field ablation (PFA) for ventricular tachycardia (VT) ablation via a retrograde approach. METHODS The patient had previously failed conventional ablation of an intramural circuit underneath the aortic valve. The same VT circuit was inducible during the procedure. The Farawave PFA catheter and Faradrive sheath were used to deliver PFA applications. RESULTS Post ablation mapping demonstrated scar homogenization. There was no evidence of coronary spasm during PFA applications and no other complications occurred. VT was non-inducible post ablation and the patient has remained free of arrhythmia at follow-up. CONCLUSION PFA for VT via a retrograde approach is feasible and effective.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital, Cambridge, UK
- University of Cambridge, Cambridge, UK
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10
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Takigawa M, Martin CA, Yamamoto T, Nakatani Y, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Nishimura T, Tao S, Miyazaki S, Goya M, Haïssaguerre M, Sasano T, Jaïs P. Demonstration of the discrepancy between AT-wave morphology on 12-lead ECG and AT mechanism in scar-related AT. Pacing Clin Electrophysiol 2023; 46:515-518. [PMID: 36690018 DOI: 10.1111/pace.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
The 12-lead electrocardiogram (ECG) is a fundamental modality to help determine the mechanism and the localization of atrial tachycardias (ATs). Although macroreentrant ATs and focal ATs typically show F-waves and discrete P-waves respectively on the 12-lead ECG, this is not universally the case in scar-related ATs.1, We present three cases clearly showing the discrepancy between the AT morphology on the 12-lead ECG and the AT-mechanism.
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Affiliation(s)
- Masateru Takigawa
- Tokyo Medical and Dental University, Tokyo, Japan
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | | | - Yosuke Nakatani
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Susumu Tao
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | - Pierre Jaïs
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
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11
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Ikenouchi T, Takigawa M, Goya M, Martin CA, Yamamoto T, Yamaguchi J, Goto K, Shigeta T, Nishimura T, Tao S, Miyazaki S, Sasano T. Comparison of lesion characteristics using temperature-flow-controlled versus conventional power-controlled ablation with fixed ablation index. J Cardiovasc Electrophysiol 2023; 34:908-917. [PMID: 36906814 DOI: 10.1111/jce.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION The QDOT-MicroTM catheter is a novel irrigated contact force (CF) sensing catheter which benefits from thermocouples for temperature monitoring, allowing temperature-flow-controlled (TFC) ablation. We compared lesion metrics at fixed ablation index (AI) value during TFC-ablation and conventional power-controlled (PC)-ablation. METHODS A total of 480 RF-applications were performed on ex-vivo swine myocardium with predefined AI targets (400/550) or until steam-pop occurred, using the QDOT-MicroTM (TFC-ablation) and Thermocool SmartTouch SFTM (PC-ablation). RESULTS Both TFC-ablation and PC-ablation produced similar lesions in volume (218 ± 116 vs. 212 ± 107 mm3 , p = .65); however, lesions using TFC-ablation were larger in surface area (41.3 ± 8.8 vs. 34.8 ± 8.0 mm2 , p < .001) and shallower in depth (4.0 ± 1.0 vs. 4.2 ± 1.1 mm, p = .044). Average power tended to be lower in TFC-alation (34.2 ± 8.6 vs. 36.9 ± 9.2, p = .005) compared to PC-ablation due to automatic regulation of temperature and irrigation-flow. Although steam-pops were less frequent in TFC-ablation (24% vs. 15%, p = .021), they were particularly observed in low-CF (10 g) and high-power ablation (50 W) in both PC-ablation (n = 24/240, 10.0%) and TFC-ablation (n = 23/240, 9.6%). Multivariate analysis revealed that high-power, low-CF, long application time, perpendicular catheter orientation, and PC-ablation were risk factors for steam-pops. Furthermore, activation of automatic regulation of temperature and irrigation-flow was independently associated with high-CF and long application time while ablation power had no significant relationship. CONCLUSIONS With a fixed target AI, TFC-ablation reduced the risk of steam-pops, producing similar lesions in volume, but with different metrics in this ex-vivo study. However, lower CF and higher power in fixed-AI ablation may increase the risk of steam-pops.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
- Department of Clinical and Diagnostic Laboratory Science, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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12
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Yamaguchi J, Takigawa M, Goya M, Martin CA, Yamamoto T, Ikenouchi T, Shigeta T, Nishimura T, Tao S, Miyazaki S, Sasano T. Comparison of three different approaches to very high-power short-duration ablation using the QDOT-MICRO catheter. J Cardiovasc Electrophysiol 2023; 34:888-897. [PMID: 36852902 DOI: 10.1111/jce.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND/OBJECTIVES The QDOT-MICRO™ catheter allows very high-power and short-duration (vHPSD) ablation. This study aimed to investigate lesion characteristics using different ablation settings. METHODS Radiofrequency applications (90 W/4 s, temperature-control mode with 55°C or 60°C target) were performed in excised porcine myocardium using three different approaches: single (SA), double nonrepetitive (DNRA), and double repetitive applications (DRA). Applications were performed with an interval of 1 min for DNRA, and without interval for DRA. RESULTS A total of 480 lesions were analyzed. Lesion depth and volume were largest for DRA followed by DNRA and SA regardless of catheter direction (depth: 3.8 vs. 3.3 vs. 2.6 mm, p < .001 for all comparisons; volume: 176.6 vs. 145.1 vs. 97.0 mm3 , p < .001 for all comparisons). Surface area was significantly larger for DRA than for SA (45.1 vs. 38.3 mm2 , p < .001) and larger for DNRA than for SA (44.5 vs. 38.3 mm2 , p < .001), but was similar between DRA and DNRA (45.1 vs. 44.5 mm2 , p = .54). Steam-pops more frequently occurred for DRA than for SA (15.6% vs. 4.4%, p = .004) and DNRA (15.6% vs. 6.9%, p = .061), but the incidence was similar between SA and DNRA (4.4% vs. 6.9%, p = 1). Although surface area and lesion volume were larger in lesions with steam-pops than without steam-pops (46.5 vs. 38.1 mm2 , p = .018 and 128.3 vs. 96.8 mm3 , p = .068, respectively), lesions were not deeper (pop(+): 2.5 mm vs. pop(-): 2.6 mm, p = .75). CONCLUSIONS DNRA produces larger lesions than SA without increasing the risk of steam-pops. DRA produces the largest lesions among the three groups, but with an increased risk of steam-pops. Even with steam-pops, lesions do not become deeper in vHPSD ablation.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan.,Department of Clinical and Diagnostic Laboratory Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Honarbakhsh S, Martin CA, Dhillon G, Gallagher M, Sohal M, Chow A, Ahsan S, Abbass H, Whittaker-Axon S, Lambiase PD, Davies MJ, Ginks M, Hunter RJ. Contact force and catheter stability are predictive metrics of successful pulmonary vein isolation with high-power short duration ablation in atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1141-1151. [PMID: 36808788 DOI: 10.1111/jce.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Preliminary data suggest that high power short duration (HPSD) ablation for pulmonary vein isolation (PVI) are safe. Limited data are available on its effectiveness. Aim was to evaluate HPSD ablation in AF ablation using a novel Qdot Micro catheter. METHODS AND RESULTS Prospective multi-centre study evaluating safety and efficacy of PVI with HPSD ablation. First pass isolation (FPI) and sustained PVI was assessed. If FPI was not achieved additional ablation index (AI)-guided ablation with 45W was performed and metrics predictive of this were determined. Sixty-five patients and 260 veins were treated. Procedural and LA dwell time was 93.9±30.4 and 60.5±23.1 minutes respectively. FPI was achieved in 47 (72.3%) patients and 231 veins (88.8%) with an ablation duration of 4.6±1.0 minutes. Twenty-nine veins required additional AI-guided ablation to achieve initial PVI with 24 anatomical sites ablated with the right posterior carina being the most common site (37.5%). A contact force of ≥8g (AUC 0.81; p<0.001) and catheter position variation of ≤1.2mm (AUC 0.79; p<0.001) with HPSD were strongly predictive of not requiring additional AI-guided ablation. Out of the 260 veins, only 5 (1.9%) veins showed acute reconnection. HPSD ablation was associated with shorter procedure times (93.9min vs.159.4min; p<0.001), ablation times (6.1min vs. 27.7min; p<0.001) and lower rates of PV reconnection (9.2% vs. 30.8%; p=0.004) compared to moderate power cohort. CONCLUSIONS HPSD ablation is an effective ablation modality which results in effective PVI whilst maintaining a safety profile. Its superiority needs to be evaluated in randomised controlled trials. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom.,Queen Mary's University of London, United Kingdom
| | | | - Gurpreet Dhillon
- St George's University Hospitals NHS foundation trust, London, UK
| | - Mark Gallagher
- St George's University Hospitals NHS foundation trust, London, UK
| | - Manav Sohal
- St George's University Hospitals NHS foundation trust, London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Syed Ahsan
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Hakam Abbass
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Sarah Whittaker-Axon
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Mark J Davies
- Oxford University Hospitals NHS foundation trust, Oxford, United Kingdom
| | - Matthew Ginks
- Oxford University Hospitals NHS foundation trust, Oxford, United Kingdom
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
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Martin CA, Tilz RRR, Anic A, Defaye P, Luik A, de Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht EM, Raybuck JD, Richards E, Cielen N, Yap SC. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol 2023; 34:833-840. [PMID: 36786515 DOI: 10.1111/jce.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Roland R R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ante Anic
- Klinicki Bolnicki Centar Split, Split, Croatia
| | - Pascal Defaye
- University Grenoble Alpes, INSERM unité 1039 and Grenoble university Hospital, Cardiology Department, Grenoble, France
| | - Armin Luik
- Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Cardiology Department, Caen, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology Herz und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | - Nele Cielen
- Boston Scientific, Arden Hills, Minnesota, USA
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Gupta D, Ding WY, Calvert P, Williams E, Das M, Tovmassian L, Tayebjee MH, Haywood G, Martin CA, Rajappan K, Bates MGD, Temple IP, Reichlin T, Chen Z, Balasubramaniam RN, Ronayne C, Clarkson N, Morgan M, Barton J, Kemp I, Mahida S, Sticherling C. Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter. Heart 2023; 109:364-371. [PMID: 36396438 DOI: 10.1136/heartjnl-2022-321729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER NCT03401099.
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Affiliation(s)
- Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK .,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Wern Yew Ding
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Emmanuel Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Moloy Das
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lilith Tovmassian
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospital NHS Foundation Trust, Leeds, UK
| | - Guy Haywood
- Department of Cardiology, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Kim Rajappan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew G D Bates
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Ian Peter Temple
- Department of Cardiology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhong Chen
- Department of Cardiology, Ashford and St Peter's Hospital NHS Foundation Trust, Surrey, UK
| | - Richard N Balasubramaniam
- Department of Cardiology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth, UK
| | - Christina Ronayne
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Nichola Clarkson
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Maureen Morgan
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Janet Barton
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Ian Kemp
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
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16
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Vlachos K, Letsas KP, Srinivasan NT, Frontera A, Efremidis M, Dragasis S, Martin CA, Martin R, Nakashima T, Bazoukis G, Kitamura T, Mililis P, Saplaouras A, Georgopoulos S, Sofoulis S, Kariki O, Koskina S, Takigawa M, Sacher F, Jais P, Santangeli P. The value of functional substrate mapping in ventricular tachycardia ablation. Heart Rhythm O2 2023; 4:134-146. [PMID: 36873315 PMCID: PMC9975018 DOI: 10.1016/j.hroo.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In the setting of structural heart disease, ventricular tachycardia (VT) is typically associated with a re-entrant mechanism. In patients with hemodynamically tolerated VTs, activation and entrainment mapping remain the gold standard for the identification of the critical parts of the circuit. However, this is rarely accomplished, as most VTs are not hemodynamically tolerated to permit mapping during tachycardia. Other limitations include noninducibility of arrhythmia or nonsustained VT. This has led to the development of substrate mapping techniques during sinus rhythm, eliminating the need for prolonged periods of mapping during tachycardia. Recurrence rates following VT ablation are high; therefore, new mapping techniques for substrate characterization are required. Advances in catheter technology and especially multielectrode mapping of abnormal electrograms has increased the ability to identify the mechanism of scar-related VT. Several substrate-guided approaches have been developed to overcome this, including scar homogenization and late potential mapping. Dynamic substrate changes are mainly identified within regions of myocardial scar and can be identified as local abnormal ventricular activities. Furthermore, mapping strategies incorporating ventricular extrastimulation, including from different directions and coupling intervals, have been shown to increase the accuracy of substrate mapping. The implementation of extrastimulus substrate mapping and automated annotation require less extensive ablation and would make VT ablation procedures less cumbersome and accessible to more patients.
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Affiliation(s)
- Konstantinos Vlachos
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
- Address reprint requests and correspondence: Dr Konstantinos Vlachos, Onassis Cardiac Surgery Center, Electrophysiology Department, Syggrou Avenue 356, PC 176 74, Athens, Greece.
| | | | - Neil T. Srinivasan
- Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Frontera
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Michael Efremidis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stelios Dragasis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Claire A. Martin
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Ruaridh Martin
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Takashi Nakashima
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - George Bazoukis
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
| | - Takeshi Kitamura
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Panagiotis Mililis
- Laboratory of Cardiac Electrophysiology, General Hospital of Athens Evangelismos, Athens, Greece
| | | | - Stamatios Georgopoulos
- Laboratory of Cardiac Electrophysiology, General Hospital of Athens Evangelismos, Athens, Greece
| | - Stamatios Sofoulis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ourania Kariki
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stavroula Koskina
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Masateru Takigawa
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Frédéric Sacher
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Pierre Jais
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Ciobotaru V, Tadros VX, Martin CA, Hascoet S. Complex transcatheter left atrial appendage closure using a tailored trans-jugular approach simulated by 3D printing: a case report. Eur Heart J Case Rep 2022; 6:ytac304. [PMID: 35965604 PMCID: PMC9366637 DOI: 10.1093/ehjcr/ytac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022]
Abstract
Background Transcatheter left atrial appendage (LAA) closure (LAAc) is less feasible in patients with unusual LAA anatomy. Case summary A 65-year-old woman with persistent atrial fibrillation was referred for LAAc. Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus; the LAA shape was tortuous and difficult to assess. A first LAAc procedure was unsuccessful given the unsuitable sheath position. Therefore, a soft three-dimensional (3D) model printing was performed by laser sintering and revealed excessive sheath kinking with an inferior approach, but successful deployment would be feasible using a superior approach. Successful trans-jugular implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved during the subsequent procedure. At 3-month follow-up, and after cessation of oral anticoagulation, the patient’s symptoms improved. Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis. Discussion This is the first-reported clinical case of a complex transcatheter LAAc through a trans-jugular approach. Simulating the patient’s anatomy with a laser sintering 3D-printed model showed why the transfemoral approach failed, validated the trans-jugular procedure, enabled selection of the simple curve access sheath that had the most direct trajectory towards the LAA, confirmed that transseptal puncture was possible, allowed determination of the angle of puncture, enabled selection of the most appropriate LAA device and had a very low cost compared with planning software or other printing methods.
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Affiliation(s)
- Vlad Ciobotaru
- Structural and Valvular Unit, Hôpital Privé les Franciscaines , 3 rue Jean Bouin, 30000 Nîmes , France
- Inserm UMR 999, Hôpital Marie Lannelongue, Faculté de Médecine, Université Paris Saclay , 92296 Chatenay-Malabry , France
| | - Victor-Xavier Tadros
- Structural and Valvular Unit, Hôpital Privé les Franciscaines , 3 rue Jean Bouin, 30000 Nîmes , France
| | - Claire A Martin
- Division of Cardiac Electrophysiology, Royal Papworth Hospital NHS Foundation Trust , Cambridge CB2 0AY , UK
| | - Sebastien Hascoet
- Inserm UMR 999, Hôpital Marie Lannelongue, Faculté de Médecine, Université Paris Saclay , 92296 Chatenay-Malabry , France
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph , 92350 Le Plessis-Robinson , France
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18
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Honarbakhsh S, Earley MJ, Martin CA, Creta A, Sohaib A, Ang R, Butcher C, Waddingham PH, Dhinoja M, Lim W, Srinivasan NT, Providencia R, Kanthasamy V, Sporton S, Chow A, Lambiase PD, Schilling RJ, Finlay MC, Hunter RJ. PolarX Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation. Europace 2022; 24:1420-1429. [PMID: 35737685 DOI: 10.1093/europace/euac100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. METHODS AND RESULTS This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. CONCLUSIONS The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | | | - Antonio Creta
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Afzal Sohaib
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard Ang
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Charles Butcher
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Peter H Waddingham
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mehul Dhinoja
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK
| | - Rui Providencia
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Vijayabharathy Kanthasamy
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Simon Sporton
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
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19
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Schleberger R, Schwarzl JM, Moser J, Nies M, Höller A, Münkler P, Dinshaw L, Jungen C, Lemoine MD, Maury P, Sacher F, Martin CA, Wong T, Estner HL, Jaïs P, Willems S, Eickholt C, Meyer C. The impact of ultra-high-density mapping on long-term outcome after catheter ablation of ventricular tachycardia. Sci Rep 2022; 12:9139. [PMID: 35650230 PMCID: PMC9160260 DOI: 10.1038/s41598-022-12918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
Ultra-high-density (UHD) mapping can improve scar area detection and fast activation mapping in patients undergoing catheter ablation of ventricular tachycardia (VT). The aim of the present study was to compare the outcome after VT ablation guided by UHD and conventional point-by-point 3D-mapping. The acute and long-term ablation outcome of 61 consecutive patients with UHD mapping (64-electrode mini-basket catheter) was compared to 61 consecutive patients with conventional point-by-point 3D-mapping using a 3.5 mm tip catheter. Patients, whose ablation was guided by UHD mapping had an improved 24-months outcome in comparison to patients with conventional mapping (cumulative incidence estimate of the combination of recurrence or disease-related death of 52.4% (95% confidence interval (CI) [36.9-65.7]; recurrence: n = 25; disease-related death: n = 4) versus 69.6% (95% CI [55.9-79.8]); recurrence: n = 31; disease-related death n = 11). In a cause-specific Cox proportional hazards model, UHD mapping (hazard ratio (HR) 0.623; 95% CI [0.390-0.995]; P = 0.048) and left ventricular ejection fraction > 30% (HR 0.485; 95% CI [0.290-0.813]; P = 0.006) were independently associated with lower rates of recurrence or disease-related death. Other procedural parameters were similar in both groups. In conclusion, UHD mapping during VT ablation was associated with fewer VT recurrences or disease-related deaths during long-term follow-up in comparison to conventional point-by-point mapping. Complication rates and other procedural parameters were similar in both groups.
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Affiliation(s)
- Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc D Lemoine
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Frederic Sacher
- LIRYC Institute, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Claire A Martin
- Royal Papworth Hospital, National Health Service Foundation Trust, Cambridge, UK
| | - Tom Wong
- Heart Rhythm Center, The Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Heidi L Estner
- Department of Internal Medicine I - Cardiology, University Hospital Munich, Ludwig-Maximilian University Munich, Munich, Germany
| | - Pierre Jaïs
- LIRYC Institute, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Stephan Willems
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany. .,Department of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany. .,Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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20
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Tilz R, Martin CA, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Background/Introduction
Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.
Purpose
The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.
Results
Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - CA Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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21
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Smith LK, Parmenter T, Kleinschmidt M, Kusnadi EP, Kang J, Martin CA, Lau P, Patel R, Lorent J, Papadopoli D, Trigos A, Ward T, Rao AD, Lelliott EJ, Sheppard KE, Goode D, Hicks RJ, Tiganis T, Simpson KJ, Larsson O, Blythe B, Cullinane C, Wickramasinghe VO, Pearson RB, McArthur GA. Adaptive translational reprogramming of metabolism limits the response to targeted therapy in BRAF V600 melanoma. Nat Commun 2022; 13:1100. [PMID: 35232962 PMCID: PMC8888590 DOI: 10.1038/s41467-022-28705-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Despite the success of therapies targeting oncogenes in cancer, clinical outcomes are limited by residual disease that ultimately results in relapse. This residual disease is often characterized by non-genetic adaptive resistance, that in melanoma is characterised by altered metabolism. Here, we examine how targeted therapy reprograms metabolism in BRAF-mutant melanoma cells using a genome-wide RNA interference (RNAi) screen and global gene expression profiling. Using this systematic approach we demonstrate post-transcriptional regulation of metabolism following BRAF inhibition, involving selective mRNA transport and translation. As proof of concept we demonstrate the RNA processing kinase U2AF homology motif kinase 1 (UHMK1) associates with mRNAs encoding metabolism proteins and selectively controls their transport and translation during adaptation to BRAF-targeted therapy. UHMK1 inactivation induces cell death by disrupting therapy induced metabolic reprogramming, and importantly, delays resistance to BRAF and MEK combination therapy in multiple in vivo models. We propose selective mRNA processing and translation by UHMK1 constitutes a mechanism of non-genetic resistance to targeted therapy in melanoma by controlling metabolic plasticity induced by therapy. Different adaptive mechanisms have been reported to reduce the efficacy of mutant BRAF inhibition in melanoma. Here, the authors show BRAF inhibition induces the translational regulation of metabolic genes leading to acquired therapy resistance.
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Affiliation(s)
- Lorey K Smith
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Tiffany Parmenter
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Eric P Kusnadi
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jian Kang
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Claire A Martin
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Lau
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Riyaben Patel
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Julie Lorent
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - David Papadopoli
- Lady Davis Institute for Medical Research and Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Anna Trigos
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Teresa Ward
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Aparna D Rao
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Emily J Lelliott
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Karen E Sheppard
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Australia
| | - David Goode
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Rodney J Hicks
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Tony Tiganis
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia
| | - Kaylene J Simpson
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Ola Larsson
- Lady Davis Institute for Medical Research and Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Benjamin Blythe
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Carleen Cullinane
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Vihandha O Wickramasinghe
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Richard B Pearson
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Australia
| | - Grant A McArthur
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. .,Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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22
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Li J, Christodoulidou A, Cranley J, Ara F, Costopoulos C, Costanzo P, Osullivan M, Davies W, Densem C, Martin CA. Identifying predictive risk factors for permanent pacemaker implantation up to 30 days post-TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Conduction system abnormalities, including AV block, are amongst the most common complications of transcatheter aortic valve implantation (TAVI). Post-TAVI high degree AV block necessitates permanent pacemaker (PPM) implantation.
Purpose
To assess the ability of standardly available pre-, intra- and post-TAVI factors to predict PPM implantation within 30-days post procedure.
Methods
Demographic and clinical (pre-, intra-, and post-procedural) data including ECG parameters were collected from all patients who underwent TAVI at our centre from August 2017 to November 2020. Patients with pre-existing PPM were excluded from the study. Predictive factors were selected through univariate analysis, and selected characteristics were incorporated into a multivariate binomial logistic regression model, in order to create a 30-day PPM risk-prediction model. The Akaike information criterion (AIC) and area under receiver operating curve (AUC/C-statistic) were used to assess discriminative performance.
Results
In total, data from a total of 446 patients were analysed. Of these, 40 (8.97%) received PPM implantation within 30 days of the procedure. The mean age of the patients was 81.5 (±7.3 SD) years; 99 (22.2%) had pre-existing first degree AV block, 55 (12.3%) had pre-existing left bundle branch block (LBBB) and 50 (11.2%) had pre-existing right bundle branch block (RBBB). Intra-procedurally 40 (9.0%) developed LBBB, 21 (4.7%) developed 3rd degree AV block, and 95 (21.3%) patients required temporary pacing wire (TPW) pacing. Post-procedurally, 138 (30.9%) exhibited AV block, 107 (24.0%) LBBB and 50 (11.2%) RBBB.
The following factors met significance at multivariate logistic regression analysis: pre-TAVI RBBB (OR 6.62 [95% CI, 1.37–36.51]), intra-TAVI 3rd degree AV block (OR 12.80 [95% CI, 3.44–53.34]), intra-TAVI LBBB (OR 4.02 [95% CI, 1.28–12.53]), use of TPW pacing (OR 8.58 [95% CI, 3.19–25.12]) and post-TAVI LBBB (OR 7.84 [95% CI, 2.75–24.46]) (Table).
Finally, variables were incorporated into a multivariate logistic regression model with the outcome variable of 30-day PPM implantation (Figure 1a). A model incorporating five factors (pre-TAVI RBBB, intra-TAVI 3rd degree AV block, intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB) demonstrated excellent discriminative ability (accuracy 0.925 and an AUC of 0.952) at predicting PPM implantation (Figure 1b).
Conclusions
Following variable selection, the best performing model incorporated five factors including pre-TAVI RBBB, intra-TAVI AV block (3rd degree), intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB. We aim to validate this model using an external cohort.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- J Li
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - A Christodoulidou
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - J Cranley
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - F Ara
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | | | - P Costanzo
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - M Osullivan
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - W Davies
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - C Densem
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - C A Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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23
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Reddy A, Nethercott SL, Teh W, De Bie EMD, Pepke-Zaba J, Sheares KK, Cannon J, Taboada D, Hadinnapola C, Martin CA, Toshner MR. Prevalence and clinical impact of atrioventricular conduction disease in patients with idiopathic pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although bradycardia-related sudden death is common in patients with idiopathic pulmonary arterial hypertension (IPAH), the prevalence and prognostic significance of atrioventricular (AV) conduction disease in this patient group is not well-established.
Objectives
– Determine the prevalence of AV conduction disorders in patients with IPAH
– Investigate the relationship between AV block and functional outcomes and mortality.
Method
12-lead electrocardiograms (ECGs) of patients with IPAH were analysed. Patients were categorised according to the presence or absence of AV block. Demographic, pulmonary haemodynamic, cardiac structural characteristics and expression of genes associated with cardiac conduction were compared and functional and mortality outcomes analysed between groups.
Student's t-tests and χ2 tests were used to compare data. Survival was estimated using Kaplan-Meier analyses. Initial exploratory covariates were included in a univariate analysis and those terms with P-value of <0.1 were then used to generate a Cox proportional-hazards multivariate model.
Results
135 IPAH patients (mean age 55±16 years, 28.1% male) were eligible for analysis. Median follow up was 9 years (interquartile range 4–14 years).
AV block was seen in 34.8% of patients with IPAH compared to 10.8% of matched comparators (p<0.001), drawn from patients attending hospital for non-PAH related reasons.
IPAH patients with conduction disease were more likely to be older (59±16 vs 53±17 years, p=0.038). AV block was associated with more severe right ventricular (RV) basal dilatation (5.1±1.0 vs 4.3±0.7cm, p=0.013) and worse RV function (fractional area change 26±9% vs 31±9%, p=0.14). Pulmonary haemodynamics, right atrial size and resting and exertional oxygen saturations were not significantly different. Expression of HCN1, HCN2, SCN1B, SCN5A, CAV1, and KCN2 genes in peripheral blood from a subcohort was similar between those with and without AV block.
Lower 6 minute walk distances (344±153 vs 408±140m, p=0.035) and worse CAMPHOR scores across all 3 domains were seen in those with AV block (figure 1), and mortality was significantly higher (36.2 vs 13.6%, p=0.002) (figure 2). On multivariate analysis the presence of bundle branch block (BBB) was independently associated with a 2.1-fold increased risk of death (95% CI 1.89–4.85, p=0.045).
Conclusions
AV conduction disorders are more prevalent in IPAH than the general population, and are associated with worse prognosis and functional status. Prospective study is required to validate this finding.
In our cohort AV block could not be explained by hypoxia, differences in pulmonary haemodynamics nor, in a small subgroup, by differential expression of specific transmembrane ion channels implicated in cardiac conduction. More detailed investigation into causal mechanisms of AV block in IPAH could establish whether improved prognosis could be achieved by treatment of AV block.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Reddy
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - W Teh
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - E M D De Bie
- University of Cambridge, Cambridge, United Kingdom
| | - J Pepke-Zaba
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - K K Sheares
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - J Cannon
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - D Taboada
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - C A Martin
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - M R Toshner
- Royal Papworth Hospital, Cambridge, United Kingdom
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24
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Fazmin IT, Zhang R, Martin CA. Pleuritic chest pain postcatheter ablation procedure. Heart 2021; 107:1543-1602. [PMID: 34521735 DOI: 10.1136/heartjnl-2021-319721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ibrahim Talal Fazmin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Roy Zhang
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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25
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Takigawa M, Kitamura T, Basu S, Bartal M, Martin CA, Martin R, Cheniti G, Vlachos K, Pillois X, Frontera A, Massoullié G, Thompson N, Bourier F, Lam A, Duchateau J, Pambrun T, Denis A, Derval N, Cochet H, Haïssaguerre M, Sacher F, Hocini M, Jaïs P. Effect of electrode size and spacing on electrograms: Optimized electrode configuration for near-field electrogram characterization. Heart Rhythm 2021; 19:102-112. [PMID: 34534699 DOI: 10.1016/j.hrthm.2021.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Detailed effects of electrode size on electrograms (EGMs) have not been systematically examined. OBJECTIVES We aimed to elucidate the effect of electrode size on EGMs and investigate an optimal configuration of electrode size and interelectrode spacing for gap detection and far-field reduction. METHODS This study included 8 sheep in which probes with different electrode size and interelectrode spacing were epicardially placed on healthy, fatty, and lesion tissues for measurements. Between 3 electrode sizes (0.1 mm/0.2 mm/0.5 mm) with 3 mm spacing. As indices of capability in gap detection and far-field reduction, in different electrode sizes (0.1 mm/0.2 mm/0.5 mm) and interelectrode spacing (0.1 mm/0.2 mm/0.3 mm/0.5 mm/3 mm) and the optimized electrode size and interelectrode spacing were determined. Compared between PentaRay and the optimal probe determined in study 2. RESULTS Study 1 demonstrated that unipolar voltage and the duration of EGMs increased as the electrode size increased in any tissue (P < .001). Bipolar EGMs had the same tendency in healthy/fat tissues, but not in lesions. Study 2 showed that significantly higher gap to lesion volume ratio and healthy to fat tissue voltage ratio were provided by a smaller electrode (0.2 mm or 0.3 mm electrode) and smaller spacing (0.1 mm spacing), but 0.3 mm electrode/0.1 mm spacing provided a larger bipolar voltage (P < .05). Study 3 demonstrated that 0.3 mm electrode/0.1 mm spacing provided less deflection with more discrete EGMs (P < .0001) with longer and more reproducible AF cycle length (P < .0001) compared to PentaRay. CONCLUSION Electrode size affects both unipolar and bipolar EGMs. Catheters with microelectrodes and very small interelectrode spacing may be superior in gap detection and far-field reduction. Importantly, this electrode configuration could dramatically reduce artifactual complex fractionated atrial electrograms and may open a new era for AF mapping.
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Affiliation(s)
- Masateru Takigawa
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takeshi Kitamura
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | | | - Claire A Martin
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ruairidh Martin
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Ghassen Cheniti
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Xavier Pillois
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Antonio Frontera
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | | | - Felix Bourier
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Anna Lam
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Arnaud Denis
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Frederic Sacher
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
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26
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Takigawa M, Goya M, Yamaguchi J, Shirai Y, Martin CA, Sasano T. Life-threatening junctional ectopic tachycardia storm after injury around the atrioventricular-node successfully treated by mini-pulse corticosteroid therapy. Europace 2021; 23:430. [PMID: 33068003 DOI: 10.1093/europace/euaa222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | | | - Yasuhiro Shirai
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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27
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Vlachos K, Efremidis M, Derval N, Martin CA, Takigawa M, Bazoukis G, Frontera A, Gkalapis C, Duchateau J, Nakashima T, Letsas KP, Mililis P, Pambrun T, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Kitamura T, Cheniti G, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation. Europace 2021; 23:1052-1062. [PMID: 33564832 DOI: 10.1093/europace/euaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS An incomplete understanding of the mechanism of atrial tachycardia (AT) is a major determinant of ablation failure. We systematically evaluated the mechanisms of AT using ultra-high-resolution mapping in a large cohort of patients. METHODS AND RESULTS We included 107 consecutive patients (mean age: 65.7 ± 9.2 years, males: 81 patients) with documented endocardial gap-related AT after left atrial ablation for persistent atrial fibrillation (AF). We analysed the mechanism of 134 AT (94 macro-re-entries and 40 localized re-entries) using high-resolution activation mapping in combination with high-density voltage and entrainment mapping. Voltage in the conducting channels may be extremely low, even <0.1 mV (0.14 ± 0.095 mV, 51 of 134 AT, 41%), and almost always <0.5 mV (0.03-0.5 mV, 133 of 134 AT, 99.3%). The use of multipolar Orion, HDGrid, and Pentaray catheters improved our accuracy in delineating ultra-low-voltage areas critical for maintenance of the circuit of endocardial gap-related AT. Conventional ablation catheters often do not detect any signal (noise level) even using adequate contact force, and only multipolar catheters of small electrodes and shorter interelectrode space can detect clear fractionated low-amplitude and high frequency signals, critical for re-entry maintenance. We performed a diagnosis in 112 out of 134 AT (83.6%) using only activation mapping and in 134 out of 134 AT (100%) using the combination of activation and entrainment mapping. CONCLUSION High-resolution activation mapping in combination with high-density voltage and entrainment mapping is the ideal strategy to delineate the critical part of the circuit in endocardial gap-related re-entrant AT after AF ablation.
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Affiliation(s)
- Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France.,Department of Electrophysiology-Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Charis Gkalapis
- Department of Electrophysiology-Cardiology, Klinikum Vest, Recklinghausen, Germany.,Department of Cardiology, Akademisches Lehrkrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
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Takigawa M, Goya M, Iwakawa H, Martin CA, Anzai T, Takahashi K, Kamata T, Matsumura Y, Amemiya M, Yamamoto T, Hirao T, Sekigawa M, Shirai Y, Tao S, Takahashi Y, Sasano T. Impact of a formula combining local impedance and conventional parameters on lesion size prediction. J Interv Card Electrophysiol 2021; 63:389-398. [PMID: 34156611 DOI: 10.1007/s10840-021-01013-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although ablation energy (AE) and force-time integral (FTI) are well-known active predictors of lesion characteristics, these parameters do not reflect passive tissue reactions during ablation, which may instead be represented by drops in local impedance (LI). This study aimed to investigate if additional LI data improves predicting lesion characteristics and steam pops. METHODS RF applications at a range of powers (30 W, 40 W, and 50 W), contact forces (8 g, 15 g, 25 g, and 35 g), and durations (10-180 s) using perpendicular/parallel catheter orientations were performed in excised porcine hearts (N = 30). The correlation between AE, FTI, and lesion characteristics was examined, and the impact of LI (%LI drop (%LID) defined by the ΔLI divided by the initial LI) was additionally assessed. RESULTS Three hundred seventy-five lesions without steam pops were examined. Ablation energy (W × s) and FTI (g × s) showed a positive correlation with lesion depth (ρ = 0.824:P < 0.0001 and ρ = 0.708:P < 0.0001), surface area (ρ = 0.507:P < 0.0001 and ρ = 0.562:P < 0.0001), and volume (ρ = 0.807:P < 0.0001 and ρ = 0.685:P < 0.0001). %LID also showed a positive correlation individually with lesion depth (ρ = 0.643:P < 0.0001), surface area (ρ = 0.547:P < 0.0001), and volume (ρ = 0.733:P < 0.0001). However, the combined indices of AE × %LID (AE multiplied by %LID) and FTI × %LID (FTI multiplied by %LID) provided significantly stronger correlation with lesion depth (ρ = 0.834:P < 0.0001 and ρ = 0.809:P < 0.0001), surface area (ρ = 0.529:P < 0.0001 and ρ = 0.656:P < 0.0001), and volume (ρ = 0.864:P < 0.0001 and ρ = 0.838:P < 0.0001). This tendency was observed regardless of the catheter placement (parallel/perpendicular). AE (P = 0.02) and %LID (P = 0.002) independently remained as significant predictors to predict steam pops (N = 27). However, the AE × %LID did not increase the predictive power of steam pops compared to the AE alone. CONCLUSION LI, when combined with conventional parameters (AE and FTI), may provide stronger correlation with lesion characteristics.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Akita University, Akita, Japan
| | | | - Tatsuhiko Anzai
- Department of Biostatistics M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuaki Kamata
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yu Matsumura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Miki Amemiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tatsuhiko Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Sekigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Shirai
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
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Gkalapis C, Papadakis M, Martin CA, Bazoukis G, Letsas KP, Vlachos K. A broad complex tachycardia suggesting global ischemia or repolarization abnormalities. J Arrhythm 2021; 37:1110-1113. [PMID: 34386141 PMCID: PMC8339110 DOI: 10.1002/joa3.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Charis Gkalapis
- Department of Electrophysiology-Cardiology Klinikum Vest Recklinghausen Germany
| | - Marios Papadakis
- Second Surgical Department University of Witten Herdecke Wuppertal Germany
| | | | - George Bazoukis
- Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Konstantinos Vlachos
- Department of Electrophysiology-Cardiology Klinikum Vest Recklinghausen Germany.,Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
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30
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Vlachos K, Denis A, Kitamura T, Takigawa M, Frontera A, Martin R, Bourier F, Martin CA, Cheniti G, Pambrun T, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. The role of marshall bundle epicardial connections in atrial tachycardias after atrial fibrillation ablation. Europace 2021. [DOI: 10.1093/europace/euab116.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial tachycardias (ATs) are often seen in the context of AF ablation.
Objectives
We evaluated the role of the Marshall bundle (MB) network in left atrial (LA) ATs using high-density high-spatial resolution 3D mapping.
Methods
199 post-AF ablation LA tachycardias were mapped in 140 consecutive patients (112 (80%) males, mean age: 61.8 years); 133 (66.8%) were macro-reentrant and 66 (33.2%) were scar-related re-entry. MB-dependent perimitral AT (PMAT) was diagnosed where the difference between the post pacing interval and the tachycardia cycle length (PPI-TCL) was <20ms in parts of the expected MB-dependent perimitral circuit (within the VOM, the ridge between the left pulmonary veins and LA appendage (LAA), the anterior LA and between 6- and 11-o’clock of the mitral annulus) and the PPI-TCL was >20ms in areas bypassed by the VOM (the distal coronary sinus (CS), the posterior LA and the mitral isthmus). MB-related re-entry was diagnosed by PPI-TCL <20ms at the left lateral ridge, posterior base of LAA, inferolateral LA or VOM ostium; and PPI-TCL >20ms in the septal annulus. Typically, in MB-dependent localized re-entry, the earliest activation was found along the MB-LA endocardial connection or MB-CS epicardial connection.
Results
The MB network was found to participate in 60 (30.2%) re-entrant ATs, 31 PMATs and 29 localized re-entries. High-frequency multiphasic fragmented electrograms with long duration were often recorded endocardially or epicardially at the MB-LA or MB-CS connections. The amplitude and duration of these signals were 0.5 ± 0.79 mV and 65 ± 40 ms for MB-PMATs and 0.26 ± 0.28mV and 122 ± 67 ms for MB-localized re-entries. Unipolar EGMs at the site of endocardial-epicardial breakthrough had a rS pattern in all MB-related ATs. Of 60 MB-related ATs, 49 (81.6%) terminated with RF ablation, 44 (73.3%) at the MB-LA junction and 5 (8.3%) at the MB-CS junction, while 9 (15%) terminated after 2.5-5 cc of alcohol infusion inside the vein of Marshall (VOM). Of the 31 MB-related macroreentrant ATs, 17 (54.8%) terminated at the MB-LA junction, 5 (16.1%) at the MB-CS junction and 7 (22.6%) with alcohol infusion inside the VOM. Two macroreentries (6.5%) using the MB did not terminate with RF energy either endocardially at the MB-LA junction or epicardially at the MB-CS junction, and we were unable to identify or cannulate the VOM for ethanol infusion. Of the 29 localized re-entrant ATs using the MB, 27 (93.1%) terminated at the MB-LA junction, none terminated at the MB-CS junction and 2 (6.9%) terminated after alcohol infusion. After a mean follow up of 12 months, only 4 patients (6.7%) had AT recurrence.
Conclusions
MB re-entrant ATs accounted for up to 29% of the left ATs after AF ablation. Ablation of the MB-LA or CS-MB connections or alcohol infusion inside the VOM is required to treat these arrhythmias. Abstract Figure.
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Affiliation(s)
- K Vlachos
- University of Bordeaux, Bordeaux, France
| | - A Denis
- University of Bordeaux, Bordeaux, France
| | - T Kitamura
- University of Bordeaux, Bordeaux, France
| | - M Takigawa
- University of Bordeaux, Bordeaux, France
| | - A Frontera
- University of Bordeaux, Bordeaux, France
| | - R Martin
- University of Bordeaux, Bordeaux, France
| | - F Bourier
- University of Bordeaux, Bordeaux, France
| | - CA Martin
- University of Bordeaux, Bordeaux, France
| | - G Cheniti
- University of Bordeaux, Bordeaux, France
| | - T Pambrun
- University of Bordeaux, Bordeaux, France
| | - F Sacher
- University of Bordeaux, Bordeaux, France
| | - M Hocini
- University of Bordeaux, Bordeaux, France
| | | | - P Jais
- University of Bordeaux, Bordeaux, France
| | - N Derval
- University of Bordeaux, Bordeaux, France
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31
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Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
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32
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Reddy SA, Nethercott SL, Khialani BV, Grace AA, Martin CA. Management of arrhythmias in pulmonary hypertension. J Interv Card Electrophysiol 2021; 62:219-229. [DOI: 10.1007/s10840-021-00988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
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33
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Bourier F, Takigawa M, Lam A, Vlachos K, Ramirez FD, Martin CA, Frontera A, Kitamura T, Duchateau J, Pambrun T, Derval N, Denis A, Cox J, Cabrita D, Babkin A, Constantin M, Jais P, Sacher F, Dubois R, Bernus O, Haissaguerre M, Hocini M. Ultralow temperature cryoablation: Safety and efficacy of preclinical atrial and ventricular lesions. J Cardiovasc Electrophysiol 2021; 32:570-577. [PMID: 33476463 DOI: 10.1111/jce.14907] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ultralow temperature cyroablation (ULTC) is designed to create focal, linear, and circumferential lesions. The aim of this study was to assess the safety, efficacy, and durability of atrial and ventricular ULTC lesions in preclinical large animal models. METHODS AND RESULTS The ULTC system uses nitrogen near its liquid-vapor critical point to cool 11-cm ablation catheters. The catheter can be shaped to specific anatomies using pre-shaped stylets. ULTC was used in 11 swine and four sheep to create atrial (pulmonary vein isolation and linear ablation) and ventricular lesions. Acute and 90-day success were evaluated by intracardiac mapping and histologic examination. Cryoadherence was observed during all ULTC applications, ensuring catheter stability at target locations. Local electrograms were completely eliminated immediately after the first single-shot ULTC application in 49 of 53 (92.5%) atrial and in 31 of 32 (96.9%) ventricular applications. Lesion depth as measured on histology preparations was 1.96 ± 0.8 mm in atrial and 5.61 ± 2.2 mm in ventricular lesions. In all animals, voltage maps and histology demonstrated transmural and durable lesions without gaps, surrounded by intact collagen fibers without injury to surrounding tissues. Transient coronary spasm could be provoked with endocardial ULTC in the left ventricle in close proximity to a coronary artery. CONCLUSIONS ULTC created effective and efficient atrial and ventricular lesions in vivo without procedural complications in two large animal models. ULTC lesions were transmural, contiguous, and durable over 3 months.
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Affiliation(s)
- Felix Bourier
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Anna Lam
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Takeshi Kitamura
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Jerry Cox
- ADAGIO Medical, Laguna Hills, California, USA
| | | | | | - Marion Constantin
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Rémi Dubois
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Oliver Bernus
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Michel Haissaguerre
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
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34
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Schwarzl JM, Schleberger R, Kahle AK, Höller A, Schwarzl M, Schaeffer BN, Münkler P, Moser J, Akbulak RÖ, Eickholt C, Dinshaw L, Dickow J, Maury P, Sacher F, Martin CA, Wong T, Estner HL, Jaïs P, Willems S, Meyer C. Specific electrogram characteristics impact substrate ablation target area in patients with scar-related ventricular tachycardia-insights from automated ultrahigh-density mapping. J Cardiovasc Electrophysiol 2021; 32:376-388. [PMID: 33368769 DOI: 10.1111/jce.14859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Substrate-based catheter ablation approaches to ventricular tachycardia (VT) focus on low-voltage areas and abnormal electrograms. However, specific electrogram characteristics in sinus rhythm are not clearly defined and can be subject to variable interpretation. We analyzed the potential ablation target size using automatic abnormal electrogram detection and studied findings during substrate mapping in the VT isthmus area. METHODS AND RESULTS Electrogram characteristics in 61 patients undergoing scar-related VT ablation using ultrahigh-density 3D-mapping with a 64-electrode mini-basket catheter were analyzed retrospectively. Forty-four complete substrate maps with a mean number of 10319 ± 889 points were acquired. Fractionated potentials detected by automated annotation and manual review were present in 43 ± 21% of the entire low-voltage area (<1.0 mV), highly fractionated potentials in 7 ± 8%, late potentials in 13 ± 15%, fractionated late potentials in 7 ± 9% and isolated late potentials in 2 ± 4%, respectively. Highly fractionated potentials (>10 ± 1 fractionations) were found in all isthmus areas of identified VT during substrate mapping, while isolated late potentials were distant from the critical isthmus area in 29%. CONCLUSION The ablation target area varies enormously in size, depending on the definition of abnormal electrograms. Clear linking of abnormal electrograms with critical VT isthmus areas during substrate mapping remains difficult due to a lack of specificity rather than sensitivity. However, highly fractionated, low-voltage electrograms were found to be present in all critical VT isthmus sites.
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Affiliation(s)
- Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Institute of Medical Biometry and Epidemiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schwarzl
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Benjamin N Schaeffer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Julia Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannis Dickow
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, National Health Service Foundation Trust, Cambridge, UK
| | - Tom Wong
- Heart Rhythm Center, Imperial College London, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Heidi L Estner
- Department of Internal Medicine I - Cardiology, University Hospital Munich, Ludwig-Maximilian University Munich, Munich, Germany
| | - Pierre Jaïs
- Department of Cardiac Electrophysiology, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Stephan Willems
- DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany.,Institute for Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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35
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Honarbakhsh S, Providencia R, Garcia-Hernandez J, Martin CA, Hunter RJ, Lim WY, Kirkby C, Graham AJ, Sharifzadehgan A, Waldmann V, Marijon E, Munoz-Esparza C, Lacunza J, Gimeno-Blanes JR, Ankou B, Chevalier P, Antonio N, Elvas L, Castelletti S, Crotti L, Schwartz P, Scanavacca M, Darrieux F, Sacilotto L, Mueller-Leisse J, Veltmann C, Vicentini A, Demarchi A, Cortez-Dias N, Antonio PS, de Sousa J, Adragao P, Cavaco D, Costa FM, Khoueiry Z, Boveda S, Sousa MJ, Jebberi Z, Heck P, Mehta S, Conte G, Ozkartal T, Auricchio A, Lowe MD, Schilling RJ, Prieto-Merino D, Lambiase PD. A Primary Prevention Clinical Risk Score Model for Patients With Brugada Syndrome (BRUGADA-RISK). JACC Clin Electrophysiol 2020; 7:210-222. [PMID: 33602402 DOI: 10.1016/j.jacep.2020.08.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The goal of this study was to develop a risk score model for patients with Brugada syndrome (BrS). BACKGROUND Risk stratification in BrS is a significant challenge due to the low event rates and conflicting evidence. METHODS A multicenter international cohort of patients with BrS and no previous cardiac arrest was used to evaluate the role of 16 proposed clinical or electrocardiogram (ECG) markers in predicting ventricular arrhythmias (VAs)/sudden cardiac death (SCD) during follow-up. Predictive markers were incorporated into a risk score model, and this model was validated by using out-of-sample cross-validation. RESULTS A total of 1,110 patients with BrS from 16 centers in 8 countries were included (mean age 51.8 ± 13.6 years; 71.8% male). Median follow-up was 5.33 years; 114 patients had VA/SCD (10.3%) with an annual event rate of 1.5%. Of the 16 proposed risk factors, probable arrhythmia-related syncope (hazard ratio [HR]: 3.71; p < 0.001), spontaneous type 1 ECG (HR: 3.80; p < 0.001), early repolarization (HR: 3.42; p < 0.001), and a type 1 Brugada ECG pattern in peripheral leads (HR: 2.33; p < 0.001) were associated with a higher risk of VA/SCD. A risk score model incorporating these factors revealed a sensitivity of 71.2% (95% confidence interval: 61.5% to 84.6%) and a specificity of 80.2% (95% confidence interval: 75.7% to 82.3%) in predicting VA/SCD at 5 years. Calibration plots showed a mean prediction error of 1.2%. The model was effectively validated by using out-of-sample cross-validation according to country. CONCLUSIONS This multicenter study identified 4 risk factors for VA/SCD in a primary prevention BrS population. A risk score model was generated to quantify risk of VA/SCD in BrS and inform implantable cardioverter-defibrillator prescription.
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Affiliation(s)
| | - Rui Providencia
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Jorge Garcia-Hernandez
- Farr Institute of Health Informatics Research, University College London, London, United Kingdom
| | - Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ross J Hunter
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wei Y Lim
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Claire Kirkby
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Adam J Graham
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Carmen Munoz-Esparza
- Inherited Cardiac Disease Unit, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Javier Lacunza
- Inherited Cardiac Disease Unit, University Hospital Virgen Arrixaca, Murcia, Spain
| | | | - Benedicte Ankou
- Rhythmology Department, Hôpital Cardiovasculaire Louis Pradel, Claude Bernard University, Lyon, France
| | - Philippe Chevalier
- Rhythmology Department, Hôpital Cardiovasculaire Louis Pradel, Claude Bernard University, Lyon, France
| | - Nátalia Antonio
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Luís Elvas
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Silvia Castelletti
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Lia Crotti
- Laboratory of Cardiovascular Genetics, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico, Italiano, Milan, Italy
| | - Peter Schwartz
- Laboratory of Cardiovascular Genetics, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico, Italiano, Milan, Italy
| | - Mauricio Scanavacca
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Darrieux
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Sacilotto
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Nuno Cortez-Dias
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Pedro Silverio Antonio
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - João de Sousa
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Pedro Adragao
- Cardiology Department, Santa Cruz Lisboa Hospital, Lisbon, Portugal
| | - Diogo Cavaco
- Cardiology Department, Santa Cruz Lisboa Hospital, Lisbon, Portugal
| | | | | | | | | | | | - Patrick Heck
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarju Mehta
- Addenbroke's Hospital, Cambridge, United Kingdom
| | - Giulio Conte
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tardu Ozkartal
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Angelo Auricchio
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Martin D Lowe
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | | | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pier D Lambiase
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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36
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Takigawa M, Kitamura T, Martin CA, Fuimaono K, Datta K, Joshi H, Constantin M, Bourier F, Cheniti G, Duchateau J, Pambrun T, Denis A, Derval N, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics. Heart Rhythm 2020; 18:553-561. [PMID: 33127542 DOI: 10.1016/j.hrthm.2020.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The QDOT MICRO catheter allows temperature- and flow-controlled (TFC) ablation and very-high-power short-duration (vHPSD) ablation. OBJECTIVE The purpose of this study was to compare lesion characteristics between TFC/vHPSD ablation and standard power-controlled (PC) ablation. METHODS Lesion characteristics in the right atrium, left atrium, and right ventricle (RV) of 6 sheep were compared between vHPSD (90 W/4 seconds, TC mode with 60°C target using QDOT) and standard radiofrequency settings (PC mode, 30 W/30 seconds with ThermoCool SmartTouch SF). Lesions in the left ventricle (LV) were compared, targeting 50 W for 60-second applications. RESULTS Forty-six focal atrial lesions, 50 RV focal lesions, and 12 linear lesions were created by vHPSD ablation and PC ablation in each group of 6 animals. vHPSD ablation produced significantly larger focal atrial lesions in length (8.3 [6.4-9.7] mm vs 6.3 [5.2-7.4] mm; P = .0002), width (6.0 [5.3-6.9] mm vs 4.6 [3.8-5.4] mm; P <.0001), and surface area (39.4 [25.4-52.4] mm2 vs 23.6 [16.0-31.1] mm2; P = .0001), with superior transmurality (89.1% vs 69.6%; P = .04) compared to PC ablation. vHPSD ablation produced significantly larger RV lesions in length (7.7 [7.0-8.7] mm vs 6.0 [4.8-6.9] mm; P <.0001), width (6.4 [5.4-7.5] mm vs 4.3 [3.6-5.2] mm; P <.0001), and area (39.4 [29.1-50.1] mm2 vs 19.9 [14.7-25.2] mm2; P <.0001) but similar volume (P = .97) with shallower lesions (2.7 [2.2-3.4] mm vs 3.8 [3.0-4.4] mm; P <.0001). Atrial linear lesions were more homogeneous (P = .02), with fewer gaps in each line (P = .003) with vHPSD ablation. LV focal lesions (15 TFC mode; 21 PC mode) were similar in volume and depth, but lesion size showed less deviation (P <.05) in TFC than PC mode. Fewer steam pops were observed in TFC mode (0% vs 28.6%; P = .03). Hemorrhagic rings around the lesion core were generally smaller with TFC/vHPSD ablation (P <.05). CONCLUSION TFC/vHPSD ablation produces larger, shallower, more homogeneous, and less hemorrhagic lesions. vHPSD Ablation produces more transmural and contiguous linear lesions compared to PC ablation. LV lesions are more homogeneous with fewer steam pops in TFC ablation.
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Affiliation(s)
- Masateru Takigawa
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takeshi Kitamura
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Claire A Martin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France; Royal Papworth Hospital, Cambridge, United Kingdom
| | | | | | | | - Marion Constantin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Felix Bourier
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Hubert Cochet
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Pessac, France
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37
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Takigawa M, Goya M, Yamaguchi J, Shirai Y, Martin CA, Sasano T. Perimitral flutter with a long epicardial bypass tract successfully treated by selective ethanol infusion to a branch of the vein of Marshall. Europace 2020; 22:1787. [DOI: 10.1093/europace/euaa119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan
| | | | - Yasuhiro Shirai
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan
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38
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Bourier F, Ramirez FD, Martin CA, Vlachos K, Frontera A, Takigawa M, Kitamura T, Lam A, Duchateau J, Pambrun T, Cheniti G, Derval N, Denis A, Sacher F, Hocini M, Haissaguerre M, Jais P. Impedance, power, and current in radiofrequency ablation: Insights from technical, ex vivo, and clinical studies. J Cardiovasc Electrophysiol 2020; 31:2836-2845. [PMID: 32757434 DOI: 10.1111/jce.14709] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Radiofrequency (RF) power is routinely considered during RF application. In contrast, impedance has been relatively poorly studied, despite also influencing RF lesion creation. The aim of this study was to examine the influence of electric impedance on RF lesion characteristics and on clinical RF ablation parameters. METHODS AND RESULTS In the first part of the study, power and impedance were systematically varied and the resulting current was calculated using custom-made software. In the second part of the study, ablation lesions (n = 40) were analyzed in a porcine ex vivo model. RF applications were delivered in cardiac muscle preparations with systematically varied values of electric impedance using a contact force ablation catheter. In the third part of the study, n = 3378 clinical RF applications were analyzed, power, impedance, and current data were exported and correlated with clinical patient data. 20 ± 3 W/80 Ω, 30 ± 3 W/120 Ω, 40 ± 3 W/160 Ω, and 50 ± 3 W/200 Ω RF applications resulted in 498 ± 40, 499 ± 26, 500 ± 20, and 500 ± 16 mA RF current, which were not significantly different (p = .32). Ablation lesions were significantly different in depth and diameter when applied with the same power but different impedances (p < .01); lesion sizes decreased when increasing impedance. In clinical data, a large range of delivered current (e.g., 39-40 W: 530-754 mA) was measured, due to variations in impedance. CONCLUSIONS RF lesion creation is determined by current rather than by power. During clinical RF ablation procedures, impedance significantly influences current delivery and varies considerably between patients. Impedance and current are clinically relevant parameters that should be considered during RF ablation.
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Affiliation(s)
- Felix Bourier
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Claire A Martin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Antonio Frontera
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Anna Lam
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Arnaud Denis
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,CHU Bordeaux, University of Bordeaux, Bordeaux, France
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39
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra-high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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40
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Takigawa M, Vlachos K, Martin CA, Bourier F, Denis A, Kitamura T, Cheniti G, Lam A, Martin R, Frontera A, Thompson N, Massoullié G, Wolf M, Escande W, André C, Zeng LJ, Nakatani Y, Nakashima T, Pillois X, Ramirez D, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter. Europace 2020; 22:1252-1260. [DOI: 10.1093/europace/euaa137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 05/24/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
We hypothesized that an epicardial approach using ethanol infusion in the vein of Marshall (EIVOM) may improve the result of ablation for perimitral flutter (PMF).
Methods and results
We studied 103 consecutive patients with PMF undergoing high-resolution mapping. The first 71 were treated with radiofrequency (RF) ablation alone (RF-group), and the next 32 underwent EIVOM followed by RF on the endocardial and epicardial mitral isthmus (EIVOM/RF-group). Contact force was not measured during ablation. Acute and 1-year outcomes were compared. Flutter termination rates were similar between the RF-group (63/71, 88.7%) and EIVOM/RF-group (31/32, 96.8%, P = 0.27). Atrial tachycardia (AT) terminated with EIVOM alone in 22/32 (68.6%) in the EIVOM/RF-group. Bidirectional block of mitral isthmus was always achieved in the EIVOM/RF-group, but significantly less frequently achieved in the RF-group (62/71, 87.3%; P = 0.05). Median RF duration for AT termination/conversion was shorter [0 (0–6) s in the EIVOM/RF-group than 312 (55–610) s in the RF-group, P < 0.0001], as well as for mitral isthmus block in the EIVOM/RF-group [246 (0–663) s] than in the RF-group [900 (525–1310) s, P < 0.0001]. Pericardial effusion was observed in 1/32 (3.2%) in EIVOM/RF-group and 5/71 (7.0%) in RF-group (P = 0.66); two in RF-group required drainage and one of them developed subsequent ischaemic stroke. One-year follow-up demonstrated fewer recurrences in the EIVOM/RF-group [6/32 (18.8%)] than in the RF-group [29/71 (40.8%), P = 0.04]. By multivariate analysis, only EIVOM was significantly associated with less AT recurrence (hazard ratio = 0.35, P = 0.018).
Conclusion
Ethanol infusion in the vein of Marshall may reduce RF duration required for PMF termination as well as for mitral isthmus block without severe complications, and the mid-term outcome may be improved by this approach.
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Affiliation(s)
- Masateru Takigawa
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
- Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138510, Japan
| | - Konstantinos Vlachos
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Claire A Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Felix Bourier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Arnaud Denis
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Takeshi Kitamura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Ghassen Cheniti
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Anna Lam
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Ruairidh Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Antonio Frontera
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Nathaniel Thompson
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Grégoire Massoullié
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Michael Wolf
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - William Escande
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Clémentine André
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Li-Jun Zeng
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Yosuke Nakatani
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Takashi Nakashima
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Xavier Pillois
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Josselin Duchateau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Thomas Pambrun
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Frederic Sacher
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Hubert Cochet
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
| | - Nicolas Derval
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, Avenue de Magellan, 33604 Bordeaux, France
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Zhang R, Fazmin IT, Porto A, Divulwewa K, Reddy A, Di Nubila B, Mausa MF, Mellor G, Agarwal S, Begley D, Fynn S, Grace A, Heck P, Virdee M, Martin CA. P1000Aetiology and efficacy of atrial fibrillation ablation in young adults. Europace 2020. [DOI: 10.1093/europace/euaa162.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Little is known regarding the aetiology or outcome of atrial fibrillation (AF) occurring in young adults. This retrospective analysis was performed to explore the demographics and efficacy of AF ablation in this population.
Methods
Patients were included who had undergone ≥1 AF ablation under the age of 40 between 2006-2018. Recurrence was defined as return of either documented AF or previous symptoms for >30s following a 3-month blanking period. Initial exploratory co-variates were included in a univariate analysis and those terms with P-value of <0.1 were then used to generate a Cox proportional-hazards multivariate model.
Results
124 patients (33.6 ± 4.7 yrs, 77% men), initially presenting with paroxysmal AF (pAF; n = 97) or persistent AF (n = 27), underwent 175 AF ablation procedures. 22.6% (n = 28) also had atrial flutter. Time from symptom onset to first ablation was 50.7 ± 46.2 months. Relevant cardiovascular-related demographics were analysed: hypertension in 8.9% (n = 11); diabetes in 1.6% (n = 2); positive family history of AF in 12.9% (n = 16); and family history of sudden cardiac death in 2.4% (n = 3). Mean CHA2DS2-VASc score was 0.35. Of those patients with documented echocardiogram imaging (n = 91), 26.4% (n = 24) had LA dilatation and 6.6% (n = 6) had LV dysfunction. Patients with LA dilatation underwent more ablations (2.3 ± 0.3) compared to controls (1.5 ± 0.1; p < 0.001).
Ablation strategy was pulmonary vein isolation (PVI) only in 67.2% (n = 119), with additional ablation in the remaining: roof line in 18.9% (n = 33); cavotricuspid isthmus line in 13.1% (n = 23); mitral isthmus line in 2.3% (n = 4); superior vena cava isolation in 2.3% (n = 4); complex fractionated atrial electrograms in 14.9% (n = 26). Mean procedure time was 155 ± 41 min, mean ablation time was 1657 ± 991 s and mean fluoroscopy time was 32.6 ± 23.4 min. General anaesthesia was used in 43.4% (n = 76). Complications included femoral haematoma (n = 2), tamponade (n = 1) and pulmonary vein stenosis (n = 2).
90 days of follow-up was available for 137 procedures performed for pAF (n = 105) and persistent AF (n = 32). For pAF, overall recurrence was 61.9% for first ablations and 62.9% overall. Recurrence was 56.3% for persistent AF.
Factors significantly associated with increased AF recurrence in univariate analysis were
male gender (hazard ratio (HR) 2.3, 95% confidence interval (CI): 1.2-4.4, p = 0.011), hypertension (HR 0.5, CI: 0.2-1.1, p = 0.067), family history of sudden cardiac death (HR 6.8, CI: 1.6-29.0 , p = 0.010) and enlarged LA size (HR 2.2, CI: 1.3-3.6, p = 0.003). In multivariate analysis, the only significant predictor of poor outcome was enlarged LA size (HR 2.0, 95% CI: 1.2-3.5, p = 0.011).
Conclusions
Young patients with AF may have structurally abnormal hearts, and therefore do not only present with lone AF. LA size may be used as a predictor for success. Surveillance imaging may be useful to detect future structural change, which will be the subject of future prospective studies.
Abstract Figure. AF ablation recurrence in young adults
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Affiliation(s)
- R Zhang
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - I T Fazmin
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Porto
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - K Divulwewa
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Reddy
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - B Di Nubila
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M F Mausa
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - G Mellor
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - S Agarwal
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - D Begley
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - S Fynn
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Grace
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - P Heck
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M Virdee
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - C A Martin
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
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Fazmin IT, Zhang RY, Porto A, Divulwewa K, Di Nubila B, Mausa MF, Reddy A, Agarwal S, Begley D, Fynn S, Heck P, Virdee M, Mellor G, Grace A, Martin CA. P1381Improved outcome in ablation of ventricular tachycardia in patients with structural heart disease under general anaesthetic. Europace 2020. [DOI: 10.1093/europace/euaa162.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation is an important adjunct to device implantation for secondary prevention of ventricular tachycardia (VT). However, several factors may influence the success of ablations in terms of long-term freedom from VT recurrence. A thus far little examined factor is the use of general anaesthetic (GA) versus conscious sedation during the procedure, which has been shown to improve outcomes in persistent atrial fibrillation (AF) ablation.
Methods
Patients with structural heart disease VT undergoing ablations from January 2015 to March 2019 were retrospectively followed up at a single centre. End points were recurrent VT or device therapy (shock or anti-tachycardia pacing) at one year. Hazard ratios (HR) were generated using a multivariate Cox-regression proportional hazards model including variables of age at ablation, sex, amiodarone use at time of ablation, scar age, left ventricular ejection fraction, use of GA, and diagnosis of: diabetes mellitus (DM), hypertension (HTN), renal impairment or AF.
Results
79 patients (74 male, mean age 68.2+/- 10.3 years) were included. A substrate-based strategy of late potential ablation was employed. 69 had ischaemic and 10 had non-ischaemic cardiomyopathy. Mean scar age was 13.8 +/- 9.8 years; EF was 40-50% in 27 patients, 30-40% in 26 and < 30% in 26. 37 patients had implantable cardioverter defibrillators and 30 had cardiac resynchronisation therapy (CRT) defibrillator devices, 1 had a CRT- pacemaker device and 4 had dual chamber pacemakers. Comorbidities were: DM (16), HTN (31), renal impairment (13), AF (31). 62 patients (79.5%) were on amiodarone at the time of ablation. Mean procedure duration was 234.8 +/- 44.5 min and mean radiofrequency energy application time was 2247 +/- 862 s. 61 were first procedures and 18 were repeat procedures. One patient suffered a complication of groin haematoma. 62 patients (78.5%) underwent VT ablation under GA and 17 (21.5%) under sedation of midazolam and fentanyl. Patient characteristics did not differ between groups. Significant factors which increased freedom from VT recurrence or device therapy were HTN (88.9% vs 59.4%, HR 0.72, 95% confidence interval (CI): 0.007-0.75, p= 0.028), amiodarone treatment (50.0% vs 76.3%, HR 0.036, 95% CI: 0.003-0.404, p = 0.036) and ablation under GA rather than sedation (50.0% vs 75.0%, HR 0.055, 95% CI: 0.006-0.495, p = 0.01) (Fig 1).
Conclusions
In patients with structural heart disease undergoing VT ablation, outcomes are improved with the use of GA over conscious sedation.
Abstract Figure 1
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Affiliation(s)
- I T Fazmin
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - R Y Zhang
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Porto
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - K Divulwewa
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - B Di Nubila
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M F Mausa
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Reddy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - S Agarwal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - D Begley
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - S Fynn
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - P Heck
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M Virdee
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - G Mellor
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Grace
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - C A Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
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Kitamura T, Takigawa M, Derval N, Denis A, Martin R, Vlachos K, Nakatani Y, Frontera A, Cheniti G, Martin CA, Bourier F, Lam A, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Atrial tachycardia circuits include low voltage area from index atrial fibrillation ablation relationship between RF ablation lesion and AT. J Cardiovasc Electrophysiol 2020; 31:1640-1648. [PMID: 32437007 DOI: 10.1111/jce.14576] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND No study to date has used high-density mapping to investigate the relationship between prior radiofrequency (RF) lesions for persistent atrial fibrillation (PsAF) ablation and subsequent atrial tachycardias (ATs). METHODS From 41 consecutive patients who underwent AT ablation at a second procedure using an ultrahigh-density mapping system, 22 patients (38 ATs) were included as they also had complete maps with a multipolar catheter and three-dimensional (3D) mapping system at the time of the first PsAF ablation procedure. We, therefore, compared voltage maps from the first AF ablation procedure to those from the subsequent AT ablation procedure, as well as the lesion sets used for AF ablation vs the activation patterns in AT during the second procedure. RESULTS In the 38 ATs, 211 of 285 analyzed atrial areas displayed low voltage area (LVA) (74%). Eighteen percent (38/211) existed before the index ablation for AF while 82% (173/211) were newly identified as LVA during the second procedure. Ninety-nine percent (172/173) of the newly developed LVA colocalized with RF lesions delivered for PsAF. Of the 38 ATs, 89.5% (34/38) AT circuits were associated with newly developed LVA due to RF lesions whilst 10.5% (4/38) AT circuits were associated with pre-existing LVA observed at the index procedure. No AT circuit was completely independent from index RF lesions in this series. CONCLUSIONS Analysis of detailed 3D electroanatomical mapping demonstrates that most ATs after PsAF ablation are involving LVAs due to index RF lesions.
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Affiliation(s)
- Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ruairidh Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Anna Lam
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Meleze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
| | | | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France
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44
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Bourier F, Vlachos K, Frontera A, Martin CA, Lam A, Takigawa M, Kitamura T, Cheniti G, Duchateau J, Pambrun T, Derval N, Denis A, Cochet H, Hocini M, Sacher F, Haïssaguerre M, Jaïs P. In silico analysis of the relation between conventional and high‐power short‐duration RF ablation settings and resulting lesion metrics. J Cardiovasc Electrophysiol 2020; 31:1332-1339. [DOI: 10.1111/jce.14495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Felix Bourier
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Antonio Frontera
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Claire A. Martin
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Anna Lam
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Masateru Takigawa
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Takeshi Kitamura
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Ghassen Cheniti
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Josselin Duchateau
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Thomas Pambrun
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Nicolas Derval
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Arnaud Denis
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Hubert Cochet
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Mélèze Hocini
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Frédéric Sacher
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
| | - Pierre Jaïs
- Electrophysiology and Ablation UnitBordeaux University Hospital (CHU)Bordeaux France
- IHU Liryc, Electrophysiology and Heart Modeling InstituteFondation Bordeaux Université Bordeaux France
- Université Bordeaux, INSERM U1045 Bordeaux France
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Vlachos K, Mascia G, Martin CA, Bazoukis G, Frontera A, Cheniti G, Letsas KP, Efremidis M, Georgopoulos S, Gkalapis C, Duchateau J, Parmbrun T, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. Atrial fibrillation in Brugada syndrome: Current perspectives. J Cardiovasc Electrophysiol 2020; 31:975-984. [DOI: 10.1111/jce.14361] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos Vlachos
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Giuseppe Mascia
- Cardiology and Electrophysiology UnitAzienda USL Toscana Florence Italy
| | - Claire A. Martin
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
- Department of Electrophysiology‐CardiologyRoyal Papworth Hospital Cambridge UK
| | - George Bazoukis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Antonio Frontera
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Konstantinos P. Letsas
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Micheal Efremidis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Stamatis Georgopoulos
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Charis Gkalapis
- Department of Electrophysiology‐CardiologyKlinikum Vest Recklinghausen Germany
- Department of Cardiology, Akademisches LehrkrankenhausRuhr‐Universität Bochum Bochum Germany
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Thomas Parmbrun
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Nicholas Derval
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Pierre Jais
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
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Takigawa M, Derval N, Martin CA, Vlachos K, Denis A, Nakatani Y, Kitamura T, Cheniti G, Bourier F, Lam A, Martin R, Frontera A, Thompson N, Massoullié G, Wolf M, Escande W, André C, Zeng LJ, Roux JR, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Mechanism of Recurrence of Atrial Tachycardia. Circ Arrhythm Electrophysiol 2020; 13:e007273. [PMID: 31937120 DOI: 10.1161/circep.119.007273] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation ablation–related atrial tachycardia (AT) is complex and may demonstrate several forms: anatomic macroreentrant AT (AMAT), non-AMAT, and focal AT. We aimed to elucidate the recurrence rate and mechanisms of atrial fibrillation ablation–related AT recurrence.
Methods:
Among 147 patients with ATs treated with the Rhythmia system, 68 (46.3%) had recurrence at mean 4.2 (2.9–11.6) months, and 44 patients received a redo procedure. AT circuits in the first procedure were compared with those in the redo procedure.
Results:
Although mappable ATs were not observed in 7 patients, 68 ATs were observed in 37 patients during the first procedure: perimitral flutter (PMF) in 26 patients, roof-dependent macroreentrant AT (RMAT) in 18, peritricuspid flutter in 10, non-AMAT in 14, and focal AT in 3. During the redo AT ablation procedure, 54 ATs were observed in 41/44 patients: PMF in 24, RMAT in 14, peritricuspid flutter in 1, non-AMAT in 14, and focal AT in 1. Recurrence of PMF and RMAT was observed in 15 of 26 (57.7%) and 8 of 18 (44.4%) patients, respectively, while peritricuspid flutter did not recur. Neither the same focal AT nor the same non-AMAT were observed except in 1 case with septal scar–related biatrial AT. Epicardial structure–related ATs were involved in 18 of 24 (75.0%) patients in PMF, 4 of 14 (28.6%) in RMAT, and 4 of 14 (28.6%) in non-AMAT. Of 21 patients with a circuit including epicardial structures, 6 patients treated with ethanol infusion in the vein of Marshall did not show any AT recurrence, although 8 of 15 (53.3%) treated with radiofrequency showed AT recurrence (
P
=0.04).
Conclusions:
Although high-resolution mapping may lead to correct diagnosis and appropriate ablation in the first procedure, the recurrence rate is still high. The main mechanism of atrial fibrillation ablation–related AT is the recurrence of PMF and RMAT or non-AMAT different from the first procedure. Epicardial structures (eg, coronary sinus/vein of Marshall system) are often involved, and ethanol infusion in the vein of Marshall may be an additional treatment.
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Affiliation(s)
- Masateru Takigawa
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
- Heart Rhythm Center, Tokyo Medical and Dental University, Japan (M.T.)
| | - Nicolas Derval
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Claire A. Martin
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
- Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.A.M.)
| | - Konstantinos Vlachos
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Arnaud Denis
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Yosuke Nakatani
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Takeshi Kitamura
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Ghassen Cheniti
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Felix Bourier
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Anna Lam
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Ruairidh Martin
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (R.M.)
| | - Antonio Frontera
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Nathaniel Thompson
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Grégoire Massoullié
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Michael Wolf
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - William Escande
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Clémentine André
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Li-jun Zeng
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | | | - Josselin Duchateau
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Thomas Pambrun
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Frederic Sacher
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Hubert Cochet
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Mélèze Hocini
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Michel Haïssaguerre
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
| | - Pierre Jaïs
- Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital (CHU), CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (M.T., N.D., C.A.M., K.V., A.D., Y.N., T.K., G.C., F.B., A.L., R.M., A.F., N.T., G.M., M.W., W.E., C.A., L.-j.Z., J.D., T.P., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J.)
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Kitamura T, Maury P, Lam A, Sacher F, Khairy P, Martin R, Vlachos K, Frontera A, Takigawa M, Nakatani Y, Thompson N, Massouillie G, Cheniti G, Martin CA, Bourier F, Duchateau J, Klotz N, Pambrun T, Denis A, Derval N, Cochet H, Hocini M, Haissaguerre M, Jais P. Does Ventricular Tachycardia Ablation Targeting Local Abnormal Ventricular Activity Elimination Reduce Ventricular Fibrillation Incidence? Circ Arrhythm Electrophysiol 2019; 12:e006857. [PMID: 31760821 DOI: 10.1161/circep.118.006857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Various strategies for ablation of ventricular tachycardia (VT) have been described, but their impact on ventricular fibrillation (VF) is largely unknown. The aim of our study was to assess the effect of substrate-based VT ablation targeting local abnormal ventricular activity (LAVA) on recurrent VF events in patients with structural heart disease. METHODS A retrospective 2-center study was performed on patients with structural heart disease and both VT and VF, with incident VT ablation procedures targeting LAVAs. Generalized estimating equations with a Poisson loglinear model were used to assess the impact of catheter ablation on VF episodes. The change in VF events before and after catheter ablation was compared with matched controls without ablation. RESULTS From a total of 686 patients with an incident VT ablation procedure targeting LAVAs, 21 patients (age, 57±14 years; left ventricular ejection fraction, 30±10%) had both VT and VF and met inclusion criteria. A total of 80 VF events were recorded in the implantable cardioverter-defibrillator logs the 6 months preceding ablation. Complete and partial LAVA elimination was achieved in 11 (52%) and 10 (48%) patients, respectively. Catheter ablation was associated with a highly significant reduction in VF recurrences (P<0.0001), which were limited to 3 (14%) patients at 6 months. The total number of VF events thereby decreased from 80 to 3, from a median of 1.0 (range, 1-29) to 0.0 (range, 0-1) in the 6 months before and after ablation, respectively. The reduction in VF events was significantly greater in patients with catheter ablation compared with 21 matched controls during 6-month periods following and preceding a baseline assessment (Poisson β-coefficient, 1.39; P=0.0003). CONCLUSIONS Substrate-guided VT ablation targeting LAVAs may be associated with a significant reduction in recurrent VF, suggesting that VT and VF share overlapping arrhythmogenic substrates in patients with structural heart disease.
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Affiliation(s)
- Takeshi Kitamura
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Philippe Maury
- University Hospital Rangueil, Toulouse, France (P.M.).,Unité Inserm U1048, Toulouse, France (P.M.)
| | - Anna Lam
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Frederic Sacher
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Paul Khairy
- Adult Congenital Heart Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (P.K.)
| | - Ruairidh Martin
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Konstantinos Vlachos
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Antonio Frontera
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Masateru Takigawa
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Yosuke Nakatani
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Nathaniel Thompson
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Gregoire Massouillie
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Ghassen Cheniti
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Claire A Martin
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Felix Bourier
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Josselin Duchateau
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Nicolas Klotz
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Thomas Pambrun
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Arnaud Denis
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Nicolas Derval
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Hubert Cochet
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Meleze Hocini
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Michel Haissaguerre
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
| | - Pierre Jais
- LIRYC, Bordeaux University, CHU de Bordeaux, France (T.K., A.L., F.S., R.M., K.V., A.F., M.T., Y.N., N.T., G.M., G.C., C.A.M., F.B., J.D., N.K., T.P., A.D., N.D., H.C., M. Hocini, M. Haissaguerre, P.J.)
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49
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Bourier F, Vlachos K, Lam A, Martin CA, Takigawa M, Kitamura T, Massoullié G, Cheniti G, Frontera A, Duchateau J, Pambrun T, Klotz N, Derval N, Denis A, Hocini M, Haïssaguerre M, Cochet H, Jaïs P, Sacher F. Three-dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures. J Cardiovasc Electrophysiol 2019; 30:2790-2796. [PMID: 31646698 DOI: 10.1111/jce.14249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D-mapping system image integration module and computed tomographic (CT)-derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. METHODS AND RESULTS CT left atrium-angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D-overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). CONCLUSION 3D-overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.
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Affiliation(s)
- Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Grégoire Massoullié
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Université de Bordeaux, INSERM U1045, Bordeaux, France
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50
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Honarbakhsh S, Providencia R, Garcia-Hernandez J, Martin CA, Hunter RJ, Lim WY, Kirkby C, Sharifzadehgan A, Waldmann C, Marijon E, Munoz-Esparza C, Lacunza J, Gimeno-Blanes JR, Lambiase PD. P6586Brugada syndrome risk stratification - Evaluation of clinical and ECG risk markers in a multicenter international primary prevention cohort. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Risk stratification for sudden cardiac death (SCD) in Brugada syndrome (BrS) is a significant challenge.
Purpose
To evaluate the importance of clinical and ECG factors in the likelihood of developing significant ventricular arrhythmias (VAs)/SCD in BrS patients.
Methods
VA occurrence during follow-up were assessed and the role of 16 proposed clinical or ECG risk markers evaluated in a multicenter international study of BrS patients and no history of cardiac arrest. Markers with predictive power were identified and incorporated into a risk score model.
Results
Across 15 international centers, 1084 patients were included. During a follow-up of 5.3 years (IQR 2.7–9.0 years)- 110 patients had VA occurrence (10.1%) with an annual event rate of 1.7% (95% CI 1.4–2.0). Of the 16 proposed risk factors, diagnosis by family screening of sudden cardiac death (HR 4.65; p<0.001), probable arrhythmia related syncope (HR 3.88, p<0.001), type 1 spontaneous ECG (HR 3.56; p<0.001), Early Repolarisation (HR 3.15; p<0.001) and type 1 Brugada pattern in peripheral leads (HR 2.42; p<0.001) were associated with a higher VA occurrence risk during follow-up. These 5 variables were incorporated into a risk score model whereby each variable was allocated a point score based on the variable's predictive strength. The total points obtained from the model for a patient could then be translated into the predicted VA occurrence risk during follow-up (Figure 1). The model showed a sensitivity of 63.5% (95% CI 50.0–76.9) and specificity of 84.2% (95% CI 81.1–87.1) in predicting VA occurrence at 5-years follow-up. The model showed a greater discriminative power compared to an existing model (AUC 0.83 vs. 0.71; p<0.001).
Figure 1
Conclusions
This multicenter study with longest reported follow-up to date identified 5 risk markers for VA occurrence. Utilizing these markers in a risk score model can aid BrS risk stratification to enable individualized risk prediction and ICD prescription.
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Affiliation(s)
- S Honarbakhsh
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R Providencia
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - J Garcia-Hernandez
- University College London, Farr Research Institute, London, United Kingdom
| | - C A Martin
- Papworth Hospital NHS Trust, Electrophysiology, Cambridge, United Kingdom
| | - R J Hunter
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - W Y Lim
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - C Kirkby
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - A Sharifzadehgan
- European Hospital Georges Pompidou, Electrophysiology, Paris, France
| | - C Waldmann
- European Hospital Georges Pompidou, Electrophysiology, Paris, France
| | - E Marijon
- European Hospital Georges Pompidou, Electrophysiology, Paris, France
| | - C Munoz-Esparza
- Hospital Clínico Univeristario Virgen de la Arrixaca, Electrophysiology, Murcia, Spain
| | - J Lacunza
- Hospital Clínico Univeristario Virgen de la Arrixaca, Electrophysiology, Murcia, Spain
| | - J R Gimeno-Blanes
- Hospital Clínico Univeristario Virgen de la Arrixaca, Electrophysiology, Murcia, Spain
| | - P D Lambiase
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
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