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Parreira L, Rossillo A, Del Greco M, Mantovan R, Fantinel M, Bottoni N, Bianco E, Bacchiega E, Tao C, Rossi P. Visualization of pulmonary vein reconnections using dynamic mapping in redo procedures for patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.199] [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/Introduction
Pulmonary vein (PV) reconnection is commonly associated with recurrence of atrial fibrillation (AF) after the initial catheter ablation procedure. Visualization and identification of PV reconnections are critical during repeat procedures.
Purpose
To examine the use of dynamic mapping (LiveView) in combination with a high-density mapping catheter (HD Grid) in the recognition of PV reconnections in redo AF ablation procedures.
Methods
Acute procedure data from 81 patients were prospectively collected. Mapping catheter selection and the use of LiveView was determined at the physician’s discretion. For cases where LiveView was used, the location and number of gaps from the previous procedure were identified using both standard mapping and dynamic mapping separately.
Results
Most of the patients included in the analysis were treated for paroxysmal AF (PAF: n=63/81, 77.8%). Dynamic mapping data was incorporated in 50 PAF cases and 15 persistent AF cases. Within these 65 cases, standard mapping identified a total of 120 PV gaps whereas LiveView identified a total of 138 PV gaps; gaps were most frequently identified on the right PVs, especially in the anterior region (Table1). A contact force-sensing ablation catheter was commonly (n=64/81, 79%) used by the operators. The right anterior region was ablated with an average contact force of 13.8±3.1g and Lesion index (LSI) of 5.2±0.7 at a power of 35.8±8.4W. Non-PV ablation was performed in 38 (46.9%) patients; the most common lesion sets were roofline, cavotricuspid isthmus (CTI) line, and mitral isthmus line. Acute PV isolation was achieved in all patients at the end of the procedure.
Conclusion
Data from this analysis suggest the incorporation of dynamic mapping data may help reveal more PV reconnections compared to standard mapping. Additional study is needed to assess the long-term clinical outcomes when regional dynamic mapping data is used to identify PV reconnections in repeat procedures.
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Affiliation(s)
- L Parreira
- Centro Hospitalar Setubal, Setubal, Portugal
| | | | | | - R Mantovan
- Ospedale S. Maria dei Battuti, Conegliano, Italy
| | | | - N Bottoni
- Santa Maria Nuova, Reggio Emilia, Italy
| | - E Bianco
- Ospedale Cattinara di Trieste, Azienda Ospedaliero Universitaria dell’Area Giuliano Isontina, Cardiologia, Trieste, Italy
| | | | - C Tao
- Abbott, Plymouth, United States of America
| | - P Rossi
- S. Giovanni Calibita Hospital, Isola Tiberina, Roma, Italy
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Zoppo F, Bacchiega E, Bottazzo V, Brazzolotto A, Carraro C, Lago L, Lupo A, Mugnai G, Piccoli E, Zerbo F. P2882Sustainable organization of a management model for CIED remote control: data from a single tertiary center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1190] [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
Introduction
The remote control (RC) of CIED has become necessary, though the human resources and technical facilities needed are limited. In most of Centers, the ratio of RC CIED /CIED with in-office follow up, is continuously increasing and is expected to reach the 100% of CIED remotely controlled.
We sought assess an organizational model based on available facilities and a long-term projection of RC data burden. Pacemakers, ICD and implantable loop recorders were considered.
Methods
The total population served by the Hospital area has been obtained (271.260 citizens), timed at December 31st 2014. By checking our Hospital data files, the total number of followed up CIED patients timed at January 1st 2011 (3995; 1.47% of all population), was compared with the same data timed at January 1st 2015 (3902; 1.43% of all population), in order to the check for the “stability” of that data over time.
At the analyzed time 1582/3902 (40,5%) of CIED were followed by RC.
We have then considered an yearly average of 465 CIEDs implanted/replaced (yearly implants 2012 to 2015) and excluded a roughly 10% of them because not provided of RC facilities (unwilling patients or CIED not RC “ready”); all the other patients were provided with RC. On these basis, we can assume a ratio of RC CIEDs /non-RC CIED, deemed to increase by 10 to 11% per year, to reach the break-even of 100% of RC CIEDs, in 2021 (projection).
The number of RC transmissions (Tx) have been gathered in 5 types of events (Fig. left upper).
The timing of RC patient managing from opening the CIED web site to complete patient file assessment (RC file analysis) performed by expert nurses, was arbitrarily calculated over a sample of 10 Tx per day in 3 different days.
Results
Of 3902 CIED patient, 1582 (40.5%) were RC followed up (3261 pacemakers, 594 ICDs and 47 implantable loop recorder); the CIED brands were represented as follows: Medtronic 685 (43.3%); St. Jude 180 (11.4%), Boston Sc. 330 (20.8%), Biotronik 318 (20.1%) and Livanova (previously SorinGroup) 69 (4.4%).
During the year 2015 we received a total number of 10396 Tx: 128 (1.2%) red alert; 1944 (18.6%) yellow alert, 141 (1.3%) atrial fibrillation; 403 (3.9%) lost Tx (disconnected transmitters or un-compliant patients for remote interrogation) and 7780 (75%) Tx “OK” with NO events. (Fig. right upper).
The projection model at 2021 with 100% RC patients (break-even) shows a total 25990 Tx: 320 red alert; 1944 yellow alert, 352 atrial fibrillation; 1007 lost Tx and 19459 Tx “OK”. The 2021 monthly Tx would be 2320 (26 red alert; 405 yellow alert, 29 atrial fibrillation; 91 lost Tx and 1769 (75%) Tx “OK”) (Fig. both lower panels)
The RC file analysis was roughly calculated around 3 minutes (116 hours/month); 5.8 hours/business day (Monday–Friday).
Conclusion
The rate of RC followed up CIEDs will inexorably increase by time. The projection management model presented could help to build a sustainable organization.
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Affiliation(s)
- F Zoppo
- Cardiology - Electrophysiology, Gorizia, Italy
| | | | | | | | | | - L Lago
- Dept of Cardiology, Mirano, Italy
| | - A Lupo
- Dept of Cardiology, Mirano, Italy
| | - G Mugnai
- Dept of Cardiology, Mirano, Italy
| | | | - F Zerbo
- Dept of Cardiology, Mirano, Italy
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De Groot NMS, Atary JZ, Blom NA, Van Kuijk JP, Schalij MJ, Tomaske M, Candinas R, Weiss M, Bauersfeld U, Fassa AA, Ashrafpoor G, Sunthorn H, Burri H, Gentil-Baron P, Shah D, Wijnmaalen AP, Delgado V, Schalij MJ, Holman ER, Bax JJ, Zeppenfeld K, Kuhne M, Oral H, Morady F, Bogun F, Schwagten B, Szili-Torok T, Knops P, Kimman G, Thornton A, Jordaens L, Satomi K, Roland T, Kamakura S, Kuck K, Ouyang F, Nowak S, Wnuk-Wojnar AM, Hoffmann A, Czerwinski C, Szydlo K, Rybicka-Musialik A, Wozniak-Skowerska I, Trusz-Gluza M, Krynski T, Stec SM, Stec SM, Hachiya H, Hirao K, Sasaki T, Higuchi K, Isobe M, Etsadashvili K, Hintringer F, Stuehlinger X, Berger T, Dichtl W, Roithinger FX, Pachinger O, Stuehlinger M, Tanno K, Onuki T, Minoura Y, Kawamura M, Asano T, Kobayashi Y, Bonet A, Merce Klein J, De Castro R, Valdovinos P, Colomer I, Garcia MI, Serrano I, Bardaji A, Peichl P, Cihak R, Polasek R, Kucera P, Bytesnik J, Kautzner J, Schlueter S, Grebe O, Vester EV, Maury P, Fourcade J, Duparc A, Hebrard A, Mondoly P, Rollin A, Rumeau P, Delay M, De Boeck BWL, Teske AJ, Mohamed Hoesein FAA, Van Driel VJH, Loh P, Cramer MJM, Prinzen FW, Doevendans PAF, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Wojta J, Binder T, Goessinger H, Kettering K, Mollnau H, Gramley F, Weiss C, Berkowitsch A, Neumann T, Kuniss M, Zaltsberg S, Wojcik M, Pitschner HF, Wichterle D, Peca M, Bulkova V, Cihak R, Peichl P, Kautzner J, Suzuki A, Yamauchi Y, Okada H, Obayashi T, Sekiguchi Y, Aonuma K, Isobe M, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Zoppo F, Bertaglia E, Zerbo F, Brandolino G, Bacchiega E, Lickfett L, Bellmann B, Linhart M, Schrickel JW, Lewalter T, Schwab JO, Nickenig G, Mittmann-Braun EL, Dabrowski P, Kozluk E, Stefanczyk P, Kleinrok A, Opolski G, Andronache M, Abdelaal A, Magnin-Poull I, Cedano J, Groben L, Mandry D, Aliot E, De Chillou C, Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA, Manfai B, Faludi R, Fodi E, Rausch P, Simor T, Sciarra L, Rebecchi M, De Ruvo E, De Luca L, Zuccaro LM, Fagagnini A, Delise P, Calo L, Mikhaylov E, Van Belle Y, Janse P, Lebedev D, Kanidieva A, Jordaens L, Szili-Torok T, Patel D, Shaheen M, Sonne K, Mohanty P, Di-Biase L, Popova L, Burkhardt D, Natale A, Mccann CJ, Gal B, Goethals P, Peychev P, Geelen P, Vatasescu RG, Iorgulescu C, Ieremciuc I, Alexandru R, Dorobantu M, Insulander P, Bastani H, Braunschweig F, Jensen-Urstad M, Schwieler J, Tabrizi F, Kenneback G, Foldesi CSABA, Kardos A, Mihalcz A, Abraham PAL, Som ZOLTAN, Borbola JOZSEF, Vanyi JOZSEF, Szili-Torok TAMAS, Pastor Fuentes A, Nunez A, Tur N, Berzal B, G Cosio F, Mujovic N, Grujic M, Mrdja S, Kocijancic A, Potpara T, Polovina M, Vujisic-Tesic B, Petrovic M, Hayashi T, Hachiya H, Hirao K, Higuchi K, Sasaki T, Furukawa T, Kawabata M, Isobe M, Lavalle C, Ficili S, Galeazzi M, Russo M, Pandozi A, Pandozi C, Venditti F, Santini M, Wichterle D, Pavlikova K, Psenicka M, Anger Z, Linhart A, Sonne K, Narten A, Gamelin A, Mittag J, Patel D, Raffa S, Geller JC, Mocini D, Russo M, Venditti F, Ficili S, Galeazzi M, Lavalle C, Pandozi C, Santini M, Groenveld HF, Rienstra M, Van Den Berg MP, Hillege HL, Van Veldhuisen DJ, Van Gelder IC, Morani G, Manica A, Angheben C, Cicoira MA, Pozzani L, Tomasi L, Zanotto G, Vassanelli C, Ahmed S, Ranchor AV, Rienstra M, Wiesfeld ACP, Van Veldhuisen DJ, Van Gelder IC. Poster Session 1: Ablation of SVT and VT. Europace 2009. [DOI: 10.1093/europace/euq212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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