1
|
Krimphoff A, Urbanek L, Bordignon S, Schaack D, Tohoku S, Chen S, Chun KRJ, Schmidt B. The impact of ultrasound-guided vascular access for catheter ablation of left atrial arrhythmias in a high-volume centre. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01779-x. [PMID: 38573537 DOI: 10.1007/s10840-024-01779-x] [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: 01/02/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies indicate that the utilization of ultrasound (US)-guided puncture may decrease the incidence of vascular complications; however, its routine use is not established in many centres. METHODS Patients undergoing catheter ablation for atrial fibrillation were included sequentially. All patients receiving US-guided punctures were prospectively enrolled (US group), while patients who underwent the procedure with standard puncture technique served as control group (No-US group). Periprocedural vascular complications requiring intervention within 30 days of the procedure were defined as the primary endpoint. RESULTS A total of 599 patients (average age: 69 ± 11 years, 62.9% male) were analysed. The incidence of vascular complications was lower with the US-guided puncture than with the anatomic landmark-guided puncture (14/299 [4.7%] vs. 27/300 [9%], p = 0.036). The US-guided vascular access significantly reduced the rate of false aneurysms (3/299 [1%] vs. 12/300 [4%], p = 0.019). In addition, the occurrence of arteriovenous fistula (2/299 [0.7%] vs. 4/300 [1.3%], p = 0.686) and haematoma requiring treatment (9/299 [3%] vs. 11/300 [3.7%], p = 0.655) were also lower in the US group. US-guided puncture did not prolong the procedure time (mean procedure time: 57.48 ± 24.47 min vs. 56.09 ± 23.36 min, p = 0.478). Multivariate regression analysis identified female gender (OR 2.079, CI 95% 1.096-3.945, p = 0.025) and conventional vascular access (OR 2.079, CI 95% 1.025-3.908, p = 0.042) as predictors of vascular complications. CONCLUSIONS The implementation of US-guided vascular access for left atrial catheter ablation resulted in a significant decrease of the overall vascular complication rate.
Collapse
Affiliation(s)
- Amelie Krimphoff
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany.
| |
Collapse
|
2
|
Scazzuso F, Ptaszyński P, Kaczmarek K, Chun KRJ, Khelae SK, Földesi C, Obidigbo V, van Bragt KA, On YK, Al-Kandari F, Okumura K. Regional variations in patient selection and procedural characteristics for cryoballoon ablation of atrial fibrillation in the cryo global registry. J Interv Card Electrophysiol 2024; 67:493-501. [PMID: 37505337 PMCID: PMC11016010 DOI: 10.1007/s10840-023-01582-0] [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: 03/28/2023] [Accepted: 05/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Cryoballoon ablation is a well-established anatomical approach for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Although widely adopted, regional variations in standards of care have not been well characterized. METHODS Patients with AF were enrolled in the Cryo Global Registry (NCT02752737) from May 2016 to Sept 2021 at 128 sites in 37 countries and treated with cryoballoon ablation according to local clinical practice. Baseline patient and procedural characteristics were summarized for 8 regions (Central Asia & Russia, East Asia, Europe, Middle East, North America, South Africa, South America, and Southeast Asia). Serious procedure-related adverse events (SAEs) were evaluated in a subset of patients with ≥ 7 days of follow-up. RESULTS A total of 3,680 patients undergoing initial PVI for AF were included. Cryoballoon ablation was commonly performed in patients with paroxysmal AF. Mean age ranged from 47 ± 12 years in the Middle East to 64 ± 11 years in East Asia. Mean procedure time was ≤ 95 min in all regions. Average freeze duration ranged from 153 ± 41 s in Southeast Asia to 230 ± 29 s in Central Asia & Russia. Acute procedural success was ≥ 94.7% in all geographies. In 3,126 subjects with ≥ 7 days of follow-up, 122 procedure-related SAEs were reported in 111 patients (3.6%) and remained low in all regions. One procedure-related death was reported during data collection. CONCLUSIONS Despite regional variations in patient selection and procedural characteristics, PVI using cryoballoon ablation was performed with high acute success and short procedural times around the world. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02752737.
Collapse
Affiliation(s)
| | | | | | | | | | - Csaba Földesi
- Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary
| | | | | | - Young Keun On
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| |
Collapse
|
3
|
Kueffer T, Bordignon S, Neven K, Blaauw Y, Hansen J, Adelino R, Ouss A, Füting A, Roten L, Mulder BA, Ruwald MH, Mené R, van der Voort P, Reinsch N, Boveda S, Albrecht EM, Schneider CW, Chun KRJ, Schmidt B, Reichlin T. Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry. JACC Clin Electrophysiol 2024; 10:698-708. [PMID: 38340118 DOI: 10.1016/j.jacep.2023.11.026] [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: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce. OBJECTIVES This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA. METHODS Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified. RESULTS Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50). CONCLUSIONS In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.
Collapse
Affiliation(s)
- Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jim Hansen
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Alexandre Ouss
- Heart Center Catharina Hospital, Eindhoven, the Netherlands
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H Ruwald
- Arrhythmia Unit, Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Roberto Mené
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany; Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | | | | | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
4
|
Schmidt B, Chun KRJ. The Burst Bubble: A Fairy Tale of Tissue Selective Ablation. JACC Clin Electrophysiol 2024; 10:716-717. [PMID: 38551552 DOI: 10.1016/j.jacep.2024.01.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
5
|
Krieger K, Park I, Althoff T, Busch S, Chun KRJ, Estner H, Iden L, Maurer T, Rillig A, Sommer P, Steven D, Tilz R, Duncker D. [Perioperative management for cardiovascular implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2024; 35:83-90. [PMID: 38289503 PMCID: PMC10879261 DOI: 10.1007/s00399-023-00989-6] [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: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
Cardiovascular implantable electronic devices (CIED) are an important part of modern cardiology and careful perioperative planning of these procedures is necessary. All information relevant to the indication, the procedure, and the education of the patient must be available prior to surgery. This provides the basis for appropriate device selection. Preoperative antibiotic prophylaxis and perioperative anticoagulation management are essential to prevent infection. After surgery, postoperative monitoring, telemetric control, and device-based diagnostics are required before discharge. These processes need to be adapted to the increasing trend towards outpatient care. This review summarises perioperative management based on practical considerations.
Collapse
Affiliation(s)
- Konstantin Krieger
- Klinik für Kardiologie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland.
| | - Innu Park
- Klinik für Kardiologie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
| | - Till Althoff
- Klinik für Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland, Charitéplatz 1, 10117
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien, C. de Villarroel, 170, 08036
| | - Sonia Busch
- Abteilung für Elektrophysiologie, Herz-Zentrum Bodensee, Konstanz, Deutschland, Luisenstraße 9A, 78464
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt am Main, Deutschland, Im Prüfling 23, 60389
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland, Ziemssenstraße 5, 80336
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland, Am Kurpark 1, 23795
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland, Lohmühlenstraße 5, 20099
| | - Andreas Rillig
- Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland, Martinistraße 52, 20251
| | - Philipp Sommer
- Med. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland, Georgstraße 11, 32545
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland, Kerpener Straße 62, 50937
| | - Roland Tilz
- Klinik für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland, Ratzeburger Allee 160, 23562
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland, Carl-Neuberg-Straße 1, 30625
| |
Collapse
|
6
|
Metzner A, Sultan A, Futyma P, Richter S, Perrotta L, Chun KRJ. Prevention and treatment of pericardial tamponade in the electrophysiology laboratory: a European Heart Rhythm Association survey. Europace 2023; 26:euad378. [PMID: 38163951 PMCID: PMC10787481 DOI: 10.1093/europace/euad378] [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: 11/29/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Pericardial tamponade (PT) is the most frequent severe complication during electrophysiology (EP) procedures and requires immediate, co-ordinated, and effective treatment. However, multiple aspects of PT treatment are either not standardized or are under ongoing debate. METHODS AND RESULTS An online questionnaire consisting of 26 multiple-choice questions was sent out to the European Heart Rhythm (EHRA) Research Network and also distributed via social media outputs. The EHRA survey was conducted between May and June 2023. A total of 213 replies were received from European (87%) and non-European countries. Ninety per cent of all participants perform interventions in dedicated EP labs equipped with different ablation platforms. In case of PT, most participants use X-ray as the main imaging modality guiding pericardial puncture, predominantly aiming for an anterior puncture site. Sheaths of different sizes are introduced into the pericardial space (84.3%), followed by a pigtail catheter. Application of protamine is an established but variable step in the majority (84.6%). Novel oral anticoagulants (NOAC) antidotes are not used by 73.3% of participants, while 15.2% routinely apply them. Re-transfusion of aspirated blood is performed by 72.1% [before protamine administration (18.2%), after protamine administration (13.5%), if pericardial effusion cannot be controlled (40.4%)]. A total of 72.4% re-transfuse without blood filter systems. A decision for surgical intervention is mostly taken if bleeding continues despite all interventional measures. CONCLUSION The current survey demonstrates that the management of PT is heterogeneous among centres. The findings of this survey may help to guide operators in their treatment and decisions in the setting of PT.
Collapse
Affiliation(s)
- Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 51, 20246 Hamburg, Germany
| | - Arian Sultan
- Department of Cardiology, University Heart Center Cologne, Cologne, Germany
| | - Piotr Futyma
- St. Joseph’s Heart Rhythm Center Rzeszow and Medical College, University of Rzeszow, Rzeszow, Poland
| | - Sergio Richter
- Heart Center Dresden, University Hospital, Technical University Dresden, Dresden, Germany
| | - Laura Perrotta
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | | |
Collapse
|
7
|
Plank K, Bordignon S, Urbanek L, Chen S, Tohoku S, Schaack D, Hirokami J, Efe T, Chun KRJ, Schmidt B. Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:2425-2433. [PMID: 37767744 DOI: 10.1111/jce.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 08/16/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Pulsed field ablation (PFA) is a new ablation technology for atrial fibrillation (AF). Data regarding early recurrences of atrial tachyarrhythmia (ERAT) after PFA-pulmonary vein isolation (PVI) are sparse. METHODS Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI. A dedicated catheter delivering bipolar energy (1.9-2.0 kV) was used. Late recurrence (LR) was defined as documented AF/atrial tachycardia (AT) lasting more than 30 s after a 90-day blanking period. RESULTS Two hundred and thirty-one patients (42% female, age 69 ± 12, 55% paroxysmal AF [PAF]) were included in this analysis. Median follow-up time was 367 days (interquartile range: 253-400). Forty-six patients (21%) experienced ERAT after a median of 23 days (46% in PAF and 54% in persistent AF [persAF]). Kaplan-Meier estimated freedom of AF/AT was 74.2% at 1 year, 81.8% for PAF, and 64.8% for persAF (p = .0079). Of patients experiencing ERAT, an LR was observed in 54%. There was no significant difference of LR between those who presented with very early ERAT (0-45 days) and those with ERAT (46-90 days) (p = .57). In multivariate analysis, ERAT (hazard ratio [HR]: 3.370; 95% confidence interval [95% CI]: 1.851-6.136; p < .001) and female sex (HR: 2.048; 95% CI: 1.114-3.768; p = .021) were the only independent predictors for LR. CONCLUSIONS ERAT could be recorded in 21% of patients after PFA-PVI and was an independent predictor for LR. We found no difference in the rate of LRs among patients experiencing ERAT before or after 45 days.
Collapse
Affiliation(s)
- Karin Plank
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Tolga Efe
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany
| |
Collapse
|
8
|
Tohoku S, Schmidt B, Schaack D, Bordignon S, Hirokami J, Chen S, Ebrahimi R, Efe TH, Urbanek L, Chun KRJ. Impact of Pulsed-Field Ablation on Intrinsic Cardiac Autonomic Nervous System After Pulmonary Vein Isolation. JACC Clin Electrophysiol 2023; 9:1864-1875. [PMID: 37480870 DOI: 10.1016/j.jacep.2023.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/09/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Although the autonomic reaction such as bradycardia is observed frequently during pulsed-field ablation (PFA)-guided pulmonary vein isolation (PVI), its mechanism and effect on the adjacent intrinsic cardiac autonomic nervous system (ICANS) are unclear. OBJECTIVES This study aimed to reveal the clinical impact of PFA on ICANS by investigating the serum S100 increase (ΔS100), a well-known denervation relevant biomarker. METHODS Pre- and postprocedural serum S100 analyses were systematically conducted in patients undergoing PVI using either the pentaspline PFA or cryoballoon ablation (CBA) system. ΔS100 release kinetics were compared between both technologies. Cerebral magnetic resonance imaging was conducted to eliminate the effect of central nervous system release. RESULTS A total of 97 patients (PFA: n = 54 and CBA: n = 43) were enrolled. Overall S100 increased in both groups with a lower amount in PFA (0.035 μg/L; IQR: 0.02-0.063 μg/L) compared with CBA (0.12 μg/L; IQR: 0.09-0.17 μg/L; P < 0.0001). In cerebral magnetic resonance imaging, silent emboli were detected in 10 patients (18.5%) in PFA and 7 patients (16.3%) in CBA (P = 0.773). Even after excluding patients with cerebral emboli, ΔS100 was lower in PFA. During PFA PVI, 30 patients (56%) demonstrated transient bradycardia in 70 of 210 PVs (35%). ΔS100 was similar between patients with or without transient bradycardia. CONCLUSIONS We report a significantly lower S100 release following PFA PVI vs CBA PVI even if silent cerebral emboli were excluded. Notably, vagal response during PFA was not associated with S100 release. These observations are in line with lower nervous tissue destruction of PFA compared with CBA.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Klinik für Rhythmologie, Universität zu Lübeck, Lübeck, Germany.
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Tolga Han Efe
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; Klinik für Rhythmologie, Universität zu Lübeck, Lübeck, Germany
| |
Collapse
|
9
|
Urbanek L, Bordignon S, Schaack D, Chen S, Tohoku S, Efe TH, Ebrahimi R, Pansera F, Hirokami J, Plank K, Koch A, Schulte-Hahn B, Schmidt B, Chun KRJ. Pulsed Field Versus Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation: Efficacy, Safety, and Long-Term Follow-Up in a 400-Patient Cohort. Circ Arrhythm Electrophysiol 2023:e011920. [PMID: 37254781 DOI: 10.1161/circep.123.011920] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The cryoballoon represents the gold standard single-shot device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Single-shot pulsed field PVI ablation (nonthermal, cardiac tissue selective) has recently entered the arena. We sought to compare procedural data and long-term outcome of both techniques. METHODS Consecutive AF patients who underwent pulsed field ablation (PFA) and cryoballoon-based PVI were enrolled. Cryoballoon PVI was performed using the second-generation 28-mm cryoballoon; PFA was performed using a 31/35-mm pentaspline catheter. Success was defined as no recurrence of atrial tachyarrhythmia after a 3-month blanking period. RESULTS Four hundred patients were included (56.5% men; 60.8% paroxysmal AF; age, 70 [interquartile range, 59-77] years), 200 in each group (cryoballoon and PFA), and baseline characteristics did not differ. Acute PVI was achieved in 100% of PFA and in 98% (196/200) of cryoballoon patients (P=0.123; 4 touch-up ablations). Median procedure time was significantly shorter in PFA (34.5 [29-40] minutes) versus cryoballoon (50 [45-60] minutes; P<0.001), fluoroscopy time was similar. Overall procedural complications were 6.5% in cryoballoon and 3.0% in PFA (P=0.1), driven by a higher rate of phrenic nerve palsies using cryoballoon. The 1-year success rates in paroxysmal AF (cryoballoon, 83.1%; PFA, 80.3%; P=0.724) and persistent AF (cryoballoon, 71%; PFA, 66.8%; P=0.629) were similar for both techniques. CONCLUSIONS PFA compared with cryoballoon PVI shows a similar procedural efficacy but is associated with shorter procedure time and no phrenic nerve palsies. Importantly, 12-month clinical success rates are favorable but not different between both groups.
Collapse
Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Tolga Han Efe
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Francesco Pansera
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Alexander Koch
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| |
Collapse
|
10
|
Zucchelli G, Chun KRJ, Khelae SK, Földesi C, Kueffer FJ, van Bragt KA, Scazzuso F, On YK, Al-Kandari F, Okumura K. Impact of first-line cryoablation for atrial fibrillation on healthcare utilization, arrhythmia disease burden and efficacy outcomes: real-world evidence from the Cryo Global Registry. J Interv Card Electrophysiol 2023; 66:711-722. [PMID: 36331681 DOI: 10.1007/s10840-022-01388-6] [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: 06/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is an effective first-line treatment for symptomatic atrial fibrillation (AF), as recently demonstrated by three randomized trials. This sub-analysis of the Cryo Global Registry aims to examine current clinical practices of first-line CBA. METHODS AF patients treated with first-line CBA were compared to CBA in antiarrhythmic drug (AAD)-refractory patients at 12 months. Efficacy was examined using time-to-first atrial arrhythmia recurrence following a 90-day blanking period. Healthcare utilization was evaluated by repeat ablations and hospitalizations. Disease burden was examined by assessing quality of life (QOL) and patients' reporting of symptoms. RESULTS Of 1394 patients, 433 (31.1%) were treated with first-line CBA, which was more frequent in high-volume centers. Serious procedure-related adverse event rates were similar. Efficacy at 12 months was higher in the first-line group (87.8 vs. 81.6%, HRunadj 0.64 (95% CI 0.47-0.88); p < 0.01) regardless of the centers' CBA experience; when controlling for baseline characteristics, the difference was not significant (HRadj 0.87 (95% CI 0.56-1.37); p = 0.55). No difference was observed in repeat ablations and hospitalizations between cohorts. First-line patients experienced a larger mean reduction in symptoms and were prescribed AADs at a lower rate at 12-month follow-up (9.7 vs. 29.9%). QOL improved in both cohorts from baseline to 12 months with no significant difference between groups (p = 0.29). CONCLUSIONS In this global real-world experience, first-line CBA in patients with symptomatic AF is effective, with a larger symptom reduction compared with CBA after AAD failure and without a difference in healthcare utilization at mid-term follow-up. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02752737.
Collapse
Affiliation(s)
- Giulio Zucchelli
- Second Division of Cardiology, Azienda Ospedaliero Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy.
| | | | | | - Csaba Földesi
- Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary
| | | | | | | | - Young-Keun On
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| |
Collapse
|
11
|
Gunawardene MA, Hartmann J, Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Willems S. [Focal atrial tachycardias: diagnostics and therapy]. Herzschrittmacherther Elektrophysiol 2022; 33:467-475. [PMID: 36342506 DOI: 10.1007/s00399-022-00907-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
In this article, typical characteristics of focal atrial tachycardias are described and a systematic approach regarding diagnostics and treatment options in the field of invasive cardiac electrophysiology (EP) is presented. Subjects of this article include the definition of focal atrial tachycardias, knowledge about localizing the origin of such, and guidance on how to approach an invasive EP study (e.g., administration of medication during the EP study to provoke tachycardias). Further, descriptions will be found on how to localize the origin of focal atrial tachycardias with the help of the 12-lead ECG and invasive three-dimensional mapping to successfully treat focal atrial tachycardias with catheter ablation.
Collapse
Affiliation(s)
- Melanie A Gunawardene
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Jens Hartmann
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CL.NIC-University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Klinik für Elektrophysiologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Stephan Willems
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| |
Collapse
|
12
|
Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Ewertsen C, Reents T. Erratum to: Atypical atrial flutter: Diagnostics and therapy. Herzschrittmacherther Elektrophysiol 2022; 33:486. [PMID: 36205786 PMCID: PMC9691488 DOI: 10.1007/s00399-022-00901-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- University Faculty of Health, Center for Clinical Medicine Witten-Herdecke, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | - Tilko Reents
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
| |
Collapse
|
13
|
Tohoku S, Chun KRJ, Bordignon S, Chen S, Schaack D, Urbanek L, Ebrahimi R, Hirokami J, Bologna F, Schmidt B. Findings from repeat ablation using high-density mapping after pulmonary vein isolation with pulsed field ablation. Europace 2022; 25:433-440. [PMID: 36427201 PMCID: PMC9935020 DOI: 10.1093/europace/euac211] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS Pulsed-field ablation (PFA) can offer a novel perspective for atrial fibrillation (AF) ablation. We aimed to characterize the incidence of pulmonary vein (PV) reconnection, types of recurrent atrial tachyarrhythmia (ATa) and lesion quality after PFA-guided PV isolation (PVI). METHODS AND RESULTS Patients undergoing second ablation for recurrent ATa following the initial PVI using the pentaspline PFA catheter were investigated. The rate of PV reconnection, the features of recurrent ATa, and the amount of isolated posterior wall (PW) surface area (ISAPW%) (ratio of the isolated- to total surface area on PW) were analyzed. RESULTS Among 360 patients treated with PFA, 25 patients (paroxysmal AF, n = 19) with 99 PVs underwent a second procedure 6.1 ± 4.0 months after the initial procedure. The rate of PV reconnection was 9.1% (9 PVs). Patients presented with atrial tachycardia (AT) (n = 16), AF (n = 8) and typical atrial flutter (n = 1). The mechanism of all but one AT was macro-reentry. The critical isthmus was found to be linked to the initial lesion set at the left atrial (LA) PW in eight patients and linked to pre-existing substrate at the LA anterior wall in four patients. One AT had a focal origin at the septum. In three patients, AT were unmappable. Mean ISAPW% was 72.7 ± 19.0%. CONCLUSION We revealed a remarkable low reconnection rate with a large antral lesion at the PW after pentaspline PFA catheter-guided PVI. However, macro-reentrant AT with a critical isthmus at the LAPW linked to the PVI lesion set was commonly observed.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany,Die Sektion Medizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany,Die Sektion Medizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Boris Schmidt
- *Corresponding author. Tel: +49 69 9450280; Fax: +49 69 945028119. E-mail address:
| |
Collapse
|
14
|
Lawin D, Stellbrink C, Chun KRJ, Lim HE, Obidigbo V, Selma JM, Peytchev P, Nguyen DQ, Foldesi C, Lawrenz T. Cryoballoon ablation of atrial fibrillation in octogenarians: one year results from the Cryo Global Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.596] [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: 11/13/2022] Open
Abstract
Abstract
Background
A few studies have demonstrated the safety and efficacy of cryoballoon ablation (CBA) in elderly patients (≥75 years old) with atrial fibrillation (AF). However, global utilization and outcomes of CBA in the octogenarian population (≥80 years old) have not been reported.
Purpose
To evaluate the efficacy and safety of CBA of AF in patients ≥80 years old.
Methods
The Cryo Global Registry (NCT02752737) is an ongoing, prospective, multicenter registry. In this analysis, 1674 patients with paroxysmal or persistent AF were included in 37 global centers who treated at least one octogenarian with CBA. Analysis cohorts were defined as patients ≥80 and patients <80 years old (control). To address safety issues of CBA in octogenarians, serious procedure-related complications were assessed. Utilizing Kaplan-Meier estimates, 12-month freedom from a ≥30sec AF/atrial flutter (AFL)/atrial tachycardia (AT) recurrence following a 90-day blanking period was evaluated.
Results
The average age of the octogenarians (n=101) was 82±2 years vs 62±10 years in the control group (n=1573). More females were found in the octogenarian population (51.5% vs 35.7%, p<0.01). The ≥80-year-old cohort had lower BMI (26±4 kg/m2 vs 27±5 kg/m2), higher CHA2DS2-VASc-Scores (4.2±1.3 vs 2.0±1.5), and a higher proportion of heart failure (all p<0.01). The patient cohort ≥80 years was similar compared to the control group regarding the AF history (70.3% vs 74.4% paroxysmal AF), years diagnosed with AF (2.9±4.9 vs 3.2±4.8), and left atrial diameter (43±8 mm vs 42±8 mm) (all p>0.05). Success rates of acute pulmonary vein isolation did not differ between the groups (95.0% vs 96.2%, p=0.59). No differences were observed between ≥80- (5.9%) and <80-year-old patients (3.5%) with respect to serious adverse events (p=0.26). Rhythm monitoring, comprising of Holter and 12-lead ECG, was performed on average 3.1±3.1 times in the elder population and 3.2±3.1 times in the control group through 12 months (p=0.84). Efficacy at 12 months was not different between groups, resulting in 80.6% (95% CI: 71.0–87.3%) freedom from AF/AFL/AT recurrence at 12 months in the octogenarians compared to 78.9% (95% CI: 76.7–80.9%) in the control group (p=0.70). Fewer patients were prescribed AADs at 12 months (32.2%, 23.7%) compared to discharge (47.8%, 49.1%), octogenarians and control, respectively. Further, octogenarians were less likely to receive a repeat ablation 3.3% (95% CI: 1.1–9.7%) in comparison to the control cohort 9.2% (95% CI: 7.8–10.8%) (p=0.052). The 12-month Kaplan-Meier estimate of freedom from cardiovascular-related hospitalization was 81.1% (95% CI: 71.7–87.7%) in the octogenarian and 84.8% (95% CI: 82.9–86.6%) in the control group, respectively (p=0.21).
Conclusion
Cryoballoon ablation for the treatment of AF is a safe procedure in octogenarians, with efficacy and complication rates comparable to younger patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
Collapse
Affiliation(s)
- D Lawin
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Department of Cardiology and Intensive Care Medicine , Bielefeld , Germany
| | - C Stellbrink
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Department of Cardiology and Intensive Care Medicine , Bielefeld , Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien , Frankfurt , Germany
| | - H E Lim
- Hallym University Sacred Heart Hospital , Anyang , Korea (Republic of)
| | - V Obidigbo
- Medtronic, Inc. , Minneapolis , United States of America
| | - J M Selma
- Medtronic, Inc. , Minneapolis , United States of America
| | - P Peytchev
- Onze-Lieve-Vrouwziekenhuis , Aalst , Belgium
| | - D Q Nguyen
- St. Vinzenz-Hospital Köln , Köln , Germany
| | - C Foldesi
- Gottsegen György Országos Kardiovaszkuláris Intézet , Budapest , Hungary
| | - T Lawrenz
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Department of Cardiology and Intensive Care Medicine , Bielefeld , Germany
| |
Collapse
|
15
|
Scazzuso F, Ptaszynski P, Kaczmarek K, Chun KRJ, Khelae SK, Foldesi C, Obidigbo V, Kaplon R, On YK, Al-Kandari F, Okumura K. Regional variations in patient selection and procedural characteristics for cryoballoon ablation of atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.587] [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
Cryoballoon ablation is a well-established anatomical approach for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Although widely adopted, regional variations in standards of care have not been well characterized.
Purpose
To evaluate regional variations in patient selection and procedural characteristics for PVI with cryoablation in the Cryo Global Registry (NCT02752737).
Methods
Patients with AF were enrolled from May 2016 to October 2021 at 128 sites in 37 countries. Patients were treated with cryoballoon ablation according to local clinical practice. Baseline subject and procedural characteristics were summarized for 8 regions (Central Asia and Russia, East Asia, Europe, Middle East, North America, South Africa, South America, and Southeast Asia). Procedure-related serious adverse events (SAEs) were evaluated in a subset of patients with ≥7 days of follow-up.
Results
A total of 3680 patients undergoing initial PVI for AF were included. Cryoballoon ablation was more commonly performed in patients with paroxysmal vs. persistent AF in all regions, and in males vs. females in all regions except Central Asia and Russia. Mean age ranged from 47±12 in the Middle East to 64±11 in East Asia. Regional variations were observed in the proportion of patients with common AF comorbidities undergoing cryoablation (Table 1). Median procedure time ranged from 61 (49–68) minutes in Central Asia and Russia to 95 (76–120) minutes in Southeast Asia. Median fluoroscopy time was ≤20 minutes in all regions. The use of 3D mapping was relatively uncommon except in North America (63.3%). Large variation was observed in the use of esophageal monitoring, whereas phrenic nerve monitoring was used in ≥97.7% of cases in all regions (Table 2). Same-day discharge was uncommon except in North and South America (37.8% and 26.5% of cases, respectively). Average freeze duration ranged from 153±41 seconds in Southeast Asia to 230±29 seconds in Central Asia and Russia. Mean number of applications per vein ranged from 1.2±0.4 in Central Asia and Russia to 2.1±1.0 in North America. Acute procedural success was ≥94.7% in all geographies and focal radiofrequency touch-up was required in ≤13.0% of cases. In 3126 subjects with ≥7 days of follow-up, 122 procedure-related SAEs were reported in 111 patients (3.6%), and 1 procedure-related death was reported during data collection.
Conclusion(s)
Despite regional variations in patient selection and procedural characteristics, PVI using cryoballoon ablation is performed with high acute success and short procedural times around the world.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
Collapse
Affiliation(s)
- F Scazzuso
- Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
| | | | | | - K R J Chun
- Cardioangiologisches Centrum Bethanien , Frankfurt , Germany
| | - S K Khelae
- Institut Jantung Negara , Kuala Lumpur , Malaysia
| | - C Foldesi
- Gottsegen Gyorgy Orszagos Kardiologiai Intezet , Budapest , Hungary
| | - V Obidigbo
- Medtronic, Cardiac Ablation Solutions , Mounds View , United States of America
| | - R Kaplon
- Medtronic, Cardiac Ablation Solutions , Mounds View , United States of America
| | - Y K On
- Samsung Medical Center, Sungkyunkwan University School of Medic , Seoul , Korea (Republic of)
| | | | - K Okumura
- Saiseikai Kumamoto Hospital , Kumamoto , Japan
| |
Collapse
|
16
|
Schmidt B, Chun KRJ. Peridevice Leaks: The Plot Hole of Left Atrial Appendage Closure for Stroke Prophylaxis. J Am Coll Cardiol 2022; 80:484-485. [PMID: 35902170 DOI: 10.1016/j.jacc.2022.04.063] [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] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Academic Teaching Hospital of Goethe University, Frankfurt, Germany.
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Academic Teaching Hospital of Goethe University, Frankfurt, Germany. https://twitter.com/jongichun
| |
Collapse
|
17
|
Schmidt B, Bordignon S, Tohoku S, Chen S, Bologna F, Urbanek L, Pansera F, Ernst M, Chun KRJ. 5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation. Circ Arrhythm Electrophysiol 2022; 15:e010817. [PMID: 35617232 DOI: 10.1161/circep.121.010817] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [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: 12/30/2022]
Abstract
BACKGROUND Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology. METHODS All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. In the validation phase (n=25), device electrogram quality was compared with a circular mapping catheter to assess pulmonary vein isolation and esophageal temperature monitoring was used. In the streamline phase (n=166), a single-catheter approach was implemented. Postprocedural cerebral magnetic resonance imaging was performed in 53 patients. In 52 patients, esophageal endoscopy was performed at day 1 after the procedure. Follow-up was performed using 72 hours Holter ECGs. RESULTS On a pulmonary vein basis, pulmonary vein isolation rate was 100% including a single shot isolation rate of 99.5%. The electrogram information of the pulsed field ablation catheter and the circular mapping catheter were 100% congruent. Neither esophageal temperature rises nor esophageal thermal injury were observed. Two minor strokes occurred, presumable due to air embolism during catheter exchanges through the large bore sheath (13.8 F ID). In the streamline phase, reduced procedure times (46±14 versus 38±13 minutes, P=0.004), no further strokes and a low incidence of silent cerebral injury (10/53 patients; 19%) were noted. During short-term follow-up, 17/191 patients (9%) had a atrial tachyarrhythmia recurrence. CONCLUSIONS The pulsed field ablation device allows for simple and safe simple single shot pulmonary vein isolation using standard sedation protocols. Procedural speed and efficacy are remarkable and streamlining measures have added safety.
Collapse
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie (B.S.), Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Francesco Pansera
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - Matthias Ernst
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany
| |
Collapse
|
18
|
Zucchelli G, Chun KRJ, Khelae SK, Foldesi C, Kueffer FJ, Van Bragt K, Scazzuso F, On YK, Kandari FA, Okumura K. Quality of life after first-line cryoablation of atrial fibrillation: results from the Cryo AF Global Registry. Europace 2022. [DOI: 10.1093/europace/euac053.198] [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): The registry was sponsored Medtronic, Inc., Minneapolis, MN.
Background
Atrial fibrillation (AF), the most common cardiac arrhythmia, burdening patients with a myriad of symptoms. Three recent randomized trials demonstrated that cryoballoon ablation (CBA) is superior to antiarrhythmic drugs (AADs) as a first-line treatment for the prevention of arrhythmia reoccurrence in patients with paroxysmal AF. However, the global outcome of CBA performed according to local standard of care as a first-line therapy for AF is not reported.
Purpose
To compare safety, efficacy, and quality of life outcomes in patients treated with CBA for first-line management of AF against patients treated with CBA following failed AAD therapy.
Methods
The Cryo AF Global Registry, an ongoing, prospective, multicenter registry, of AF patients undergoing index CBA performed according to local standards at 58 centers in 26 countries worldwide. In this analysis, subjects undergoing first-line cryoablation were compared to patients who were refractory to AAD therapy and/or taking AADs at baseline. Safety was assessed utilizing a composite of serious procedure-related complications. To evaluate efficacy, time-to-first atrial fibrillation, -flutter and/or -tachycardia (AF/AFL/AT) recurrence post a 90-day blanking period was compared between groups using Kaplan-Meier estimates. Quality of life was evaluated using the EQ-5D-3L questionnaire at baseline and at 12 months following CBA. Log-rank, two-sample t-test, and exact binomial tests were utilized to test difference between groups.
Results
Of 1,394 total patients, 433 (31.1%) were drug naïve prior to CBA. Patients in the AAD therapy cohort failed a mean of 1.2 ± 0.5 AADs before CBA. Freedom from AF/AFL/AT recurrence at 12 months was 87.8% in first-line patients compared to 81.6% in AAD-refractory patients (p<0.01). Serious adverse event rates were not statistically different (p=0.32) between first-line (2.3%) and AAD-refractory (3.4%) patients. First-line CBA resulted in a larger mean decline in symptoms upon follow-up, with 81% of patients reported to be symptom-free at 12 months. Further, first-line patients were prescribed AADs at a lower rate at discharge (18.6% vs.62.8%) and at 12-months (9.7% vs.29.9%) in comparison to patients in the AAD cohort. However, cryoablation did result in AAD prescriptions being reduced by approximately 50% in both cohorts from discharge to 12-months. As determined by the EQ-5D-3L score, quality of life improved for patients in both groups, with no significant difference between first-line and AAD-refractory patients (p=0.29).
Conclusion
This real-world global evaluation supports CBA as a safe and efficacious first-line treatment that improves the quality of life for patients with symptomatic AF.
Collapse
Affiliation(s)
- G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, Pisa, Italy
| | - KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - SK Khelae
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - C Foldesi
- Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary
| | - FJ Kueffer
- Medtronic, Inc., Minneapolis, United States of America
| | - K Van Bragt
- Medtronic, Inc., Minneapolis, United States of America
| | - F Scazzuso
- Instituto Cardiovascular De Buenos Aires, Buenos Aires, Argentina
| | - YK On
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (Republic of)
| | | | - K Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| |
Collapse
|
19
|
Tohoku S, Schmidt B, Bordignon S, Chen S, Pansera F, Chun KRJ. The triangle correlation among the impact on serum S100B protein release, incidence of the silent cerebral ischemic phenomena and pulsed field ablation for patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.202] [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
Funding Acknowledgements
Type of funding sources: None.
Backgrounds: Pulsed field ablation (PFA) represents a cardiac specific energy source for atrial fibrillation (AF) ablation. The correlation among this remarkable technique, the incidence of silent cerebral ischemic phenomena (SCIP), and the clinical impact on serum S100B release, a well-known neural injury relevant biomarker concomitant to denervation of the intrinsic cardiac autonomic nervous system during AF ablation, has been unclear.
Aims
This study thought to reveal the "triangle correlation" by investigating the serum S100B increase, incidence of SCIP on cerebral magnetic resonance imaging (MRI), and its interactive correlation in PFA using the FARAPULSE system.
Methods and Results
Pre- and postprocedural serum S100B was analyzed in a total of 85 patients who underwent AF ablation using the FARAPULSE PFA device. Cerebral MRI was performed subsequently 24-48 hours after procedure. All PVs (332 PVs) were successfully isolated solely with PFA. No additional left atrial mapping using other catheters was performed.
The median overall serum S100B increase from the preprocedural value was 0.01μg/l (-0.02 – 0.04μg/l). Asymptomatic SCIP were detected on MRI in 10/53 patients (18.9 %). Of those, the patients with SCIP demonstrated a significantly higher S100B release (0.04, 0.02 – 0.16μg/l vs. without SCIP:0.01, -0.04 – 0.03μg/l, p = 0.0038). Receiver operating characteristic curve revealed a predictive cut-off point for SCIP of 0.04 μg/l (sensitivity:0.7, specificity: 0.49).
Conclusions
We revealed no clear detectable impact of PFA on S100B release, highlighting the cardioselectivity with limited concomitant denervation. SCIP was detected approximately in a one-fifth after procedures and was a potential confounder of the higher S100B increase.
Collapse
Affiliation(s)
- S Tohoku
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Bordignon
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Chen
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - F Pansera
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - KRJ Chun
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| |
Collapse
|
20
|
Tohoku S, Schmidt B, Bordignon S, Chen S, Bologna F, Julian Chun KR. Initial clinical experience of pulmonary vein isolation using the ultra-low temperature cryoablation catheter for patients with atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1371-1379. [PMID: 35488736 DOI: 10.1111/jce.15519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The iCLAS ultra-low temperature cryoablation (ULTC) system has recently brought to the market. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation in atrial fibrillation (AF) ablation. The use of an esophageal warming balloon is recommended when using the system to reduce the potential for collateral esophageal injury. OBJECTIVE To describe the initial clinical experience when using ULTC in the AF treatment without general anesthesia (GA). METHODS Consecutive patients undergoing AF ablation using ULTC under deep sedation without GA were enrolled. We assessed the procedural data focusing on "single-shot isolation" defined as successful pulmonary vein (PV) isolation after the first application. Esophagogastroduodenoscopy was systematically performed the day after ablation. RESULTS A total of 27 AF patients (67% paroxysmal AF) were analyzed. One-hundred-four out of 106 PVs (98.1%) were isolated solely using ULTC. The mean procedure time was 79 ± 30 min. The mean number of applications per PV was 2.6 ± 1.0. Single-shot isolation was achieved in 57 PVs (54%) varying across PVs from left superior- to inferior PVs (40-64%). Single procedure six-month recurrence free rate was 84%. No major complication (cerebrovascular event, pericardial effusion/tamponade, esophageal damage on esophagogastroduodenoscopy) occurred. A single transient phrenic nerve palsy occurred during the right superior PV ablation which had recovered by the 3-month follow up appointment. CONCLUSIONS AF ablation using the novel ULTC system seemed feasible without GA and enabled >50% single-shot isolation rate. The promising safety profile has to be confirmed in large-scaled studies. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | | | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| |
Collapse
|
21
|
Urbanek L, Bordignon S, Chen S, Bologna F, Thohoku S, Dincher M, Schulte-Hahn B, Schmidt B, Julian Chun KR. Impact of Body Mass Index on Cryoablation of atrial fibrillation: Patient characteristics, procedural data and long-term outcomes. J Cardiovasc Electrophysiol 2022; 33:1106-1115. [PMID: 35355367 DOI: 10.1111/jce.15478] [Citation(s) in RCA: 2] [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: 02/03/2022] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ablation of atrial fibrillation in the context of obesity can be challenging. We sought to evaluate the role of cryoballoon pulmonary vein isolation (CB-PVI) in obese patients with symptomatic atrial fibrillation (AF). METHODS Patients with a BMI≥25 kg/m2 and symptomatic AF who underwent CB-PVI were retrospectively enrolled. Three groups were defined (G1: BMI of 25-29 kg/m2 ; G2: BMI of 30-34 kg/m2 ; G3: BMI≥35 kg/m2 ). RESULTS 600 patients were included (59% male; 66±11 years old); 337, 149, 114 were assigned to G1, G2 and G3, respectively. Acute procedural success was recorded in 99,7% of patients. Procedural and fluoroscopy time were comparable but radiation dose was significantly higher in G3. Procedural complications were 3% in G1, 5,4% in G2 and 8,8% in G3 (p=0,01). The overall freedom from AF after 1-year was 77%. G3 had a significantly worse 1-year success rate compared to G1 and G2 (G3:66,5% vs. G1:78,4%; p=0,015 and vs. G2:82,5%; p=0,008) with a reduced 1-year success in paroxysmal AF (G1:84,0%; G2:86,3% and G3:69,6%) but not in persistent AF (G1:68,7%; G2:77,4% and G3:62,1%). G3 showed similar success rates irrespective of AF form (PAF 69,6% vs. persAF 62,1%; p=0,501). CONCLUSION Cryoballoon ablation in obese patients can be effective with an acceptable safety profile, 77% of patients were in stable SR at one year. Severe obese patients (BMI≥35) showed reduced procedural safety and 1-year success rate. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Shota Thohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Matthias Dincher
- Johannes Gutenberg University Mainz, Gutenberg School of Management and Economics, Jakob-Welder-Weg 9, 55128, Mainz, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, 60431, Frankfurt/M., Germany
| |
Collapse
|
22
|
Schmidt B, Chun KRJ. Preliminary or Premature?: The Dilemma of Early Data Reporting Leaving Questions Unanswered. JACC Cardiovasc Interv 2021; 14:2375-2376. [PMID: 34736736 DOI: 10.1016/j.jcin.2021.08.064] [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] [Received: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Frankfurt, Germany.
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
| |
Collapse
|
23
|
Tohoku S, Bordignon S, Chen S, Zanchi S, Bianchini L, Trolese L, Operhalski F, Urbanek L, Chun KRJ, Schmidt B. Back Cover Image, Volume 32, Issue 11. J Cardiovasc Electrophysiol 2021. [DOI: 10.1111/jce.15284] [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: 11/28/2022]
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
- Die Sektion Medizin Universität zu Lübeck Lübeck Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
| | | | - Luca Trolese
- Universitäts Herzzentrum Freiburg‐Bad Krozingen Klinik für Kardiologie und Angiologie I Freiburg Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt Medizinische Klinik 3‐Klinik für Kardiologie Frankfurt Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
- Die Sektion Medizin Universität zu Lübeck Lübeck Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Frankfurt Germany
- Universitätsklinikum Frankfurt Medizinische Klinik 3‐Klinik für Kardiologie Frankfurt Germany
| |
Collapse
|
24
|
Tohoku S, Bordignon S, Chen S, Schmidt B, Chun KRJ. Initial clinical experience of pulmonary vein isolation using the novel ultra-low temperature cryoablation catheter for patients with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0355] [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: 11/13/2022] Open
Abstract
Abstract
Background
The high cooling power and ultra-low temperature cryoablation (ULTC) catheter called “Adagio” has been recently launched. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation applicable not only for atrial fibrillation (AF) but also for other tachyarrhythmia by optimizing catheter shape. The exclusive esophageal warming balloon in order to preserve esophageal temperature is encouraged to prevent the potential risk of esophageal complication during procedure.
Aim
To assess the initial clinical data on pulmonary vein (PV) isolation for patients with AF using the novel ULTC catheter.
Methods
Consecutive patients who underwent AF ablation using ULTC in our center were enrolled. We assessed the acute procedural data focusing on procedural feasibility and safety comprising “first-pass isolation” defined as successful PV isolation after the initial application.
Results
A total of 16 AF patients (53% male, age 67 years, 59% paroxysmal AF) were analyzed. Sixty-six out of 67 PVs (98.5%) were isolated with ULTC. The mean number of applications per PV was 2.3 1.1. Touch-up catheter was needed in one case at left inferior PV. The mean total procedure and fluoroscopy times were 79±30 and 14±7 mins, respectively. First-pass isolation was achieved in 34 PVs (50.7%) varying across PVs from left superior PV (43.8%) to right superior PV (58.8%). In none of the patients an acute thromboembolic event (stroke or transient ischemic attack), a pericardial effusion/tamponade and postprocedural esophageal complication occurred. A single transient phrenic nerve weakening was observed at right superior PV.
Conclusion
Sequential PV isolation using the novel ULTC catheter was achieved feasibly without compromising safety. First-pass isolation was accomplished about in a half of PVs.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Tohoku
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Bordignon
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Chen
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - K R J Chun
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| |
Collapse
|
25
|
Tohoku S, Bordignon S, Chen S, Chun KRJ, Schmidt B. Evolution in lesion index durability using the new third generation laser balloon catheter for pulmonary vein isolation – does the mechanical innovation mean also clinical innovation? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0358] [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: 11/13/2022] Open
Abstract
Abstract
Background
The new second- and third-generation endoscopic ablation systems (EAS 2 and EAS 3) have been launched in recent years. We aimed to assess the index lesion durability as well as gap localization using the multigenerational novel technologies in patients with recurrent atrial fibrillation (AF).
Methods
Consecutive patients who underwent the second ablation for recurrent AF following the initial pulmonary vein isolation (PVI) with EAS 2 or EAS 3 were investigated. The persistent durability of PVI and gap localization at the second procedure were analyzed using spiral mapping catheter and three-dimensional mapping system.
Results
A total of 34 patients (EAS3: N=13, 50 PVs, EAS2: N=21, 82 PVs) were enrolled. Repeat procedure was performed mean 11.9±9.3 months after the initial procedure. Persistent durable isolation of all four PVs was recorded in 6 (46.2%) patients in EAS3 and 4 (19.1%) patients in EAS2 (P=0.130). Ninety-one out of 132 (68.9%) PVs were persistently isolated with a higher rate in EAS3 (EAS3: 82.0% vs. EAS2: 61.0%, P=0.0113). A total of 45 gaps were recorded in 41 PVs, of which right superior PV (RSPV) was the predominantly common reconnected vein (15 gaps in 14 PVs) irrespective of generation difference (EAS 3: 4 gaps in 3 PVs and EAS 2: 12 gaps in 11 PVs). Anterior-segment of RSPV was the most common gap distribution (EAS 3: 2 gaps and EAS 2: 6 gaps). Logistic multivariate regression analysis revealed high-dose (≥8.5W) only ablation as an independent predictor of durable PVI (adjusted OR: 3.70, 95% CI [1.408 - 10.003], P=0.008)
Conclusion
The multigenerational technical innovation resulted in a higher index lesion durability in EAS3 guided PVI in patients with recurrent AF. The specific gap patterns frequent at RSPV, especially at the anterior-superior segment, and the feasibility of high-dose ablation were confirmed in successor EASs.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Tohoku
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Bordignon
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Chen
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - K R J Chun
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| |
Collapse
|
26
|
Tohoku S, Bordignon S, Chen S, Zanchi S, Bianchini L, Trolese L, Operhalski F, Urbanek L, Chun KRJ, Schmidt B. Single-sweep pulmonary vein isolation using the new third-generation laser balloon-Evolution in ablation style using endoscopic ablation system. J Cardiovasc Electrophysiol 2021; 32:2923-2932. [PMID: 34535929 DOI: 10.1111/jce.15245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [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: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode). AIM To determine the feasibility of single-shot fashioned ablation using X3. METHODS Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on "Single-sweep PVI" defined as successful PVI with a single RAPID mode energy application, and on "first-pass isolation" defined as successful PVI after initial circular lesion set. RESULTS One hundred AF patients (56% male, age: 68 ± 10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep PVI and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep PVI rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs: 49.5%, p = .0239) and at PVs with maximal ostial diameter <24 mm (57.6% vs. >24 mm: 36.8%, p = .0151). The mean total procedure and fluoroscopy times were 43.0 ± 10 and 4.0 ± 2 min, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed. CONCLUSION The new X3 EAS allows for single-shot fashioned ablation in terms of single-sweep PVI in half or more of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Luca Trolese
- Universitäts Herzzentrum Freiburg-Bad Krozingen, Klinik für Kardiologie und Angiologie I, Freiburg, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| |
Collapse
|
27
|
Schmidt B, Chen S, Tohoku S, Bordignon S, Bologna F, Chun KRJ. Single shot electroporation of premature ventricular contractions from the right ventricular outflow tract. Europace 2021; 24:597. [PMID: 34536008 DOI: 10.1093/europace/euab212] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Academic Teaching Hospital of Goethe University of Frankfurt, Wilhelm Epstein Str. 4, 60431 Frankfurt, Germany
| |
Collapse
|
28
|
Bianchini L, Bordignon S, Chen S, Zanchi S, Tohoku S, Bologna F, Tondo C, Schmidt B, Chun KRJ. Increased procedural safety of cryoballoon pulmonary vein isolation with a double 120 s freeze protocol. Pacing Clin Electrophysiol 2021; 44:1371-1379. [PMID: 34152640 DOI: 10.1111/pace.14299] [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] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/22/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently a double 120 s freeze cryoballoon (CB) pulmonary vein isolation (PVI) protocol proved to be non inferior to a double 240 s freeze protocol in terms of atrial fibrillation (AF) recurrences. We hypothesized that this approach could also result in an increased procedure safety. METHODS Eighty consecutive patients treated with a double 120 s freeze protocol (Group CB120) were compared with 80 previous consecutive patients treated with a single 240 s freeze protocol (Group CB240). Procedures were performed with a temperature probe to monitor the luminal esophageal temperature (LET), using a cut off for cryoenergy interruption of 15°C. During ablation at the septal pulmonary veins (PVs), the phrenic nerve (PN) function was monitored by pacing. RESULTS In CB120 and CB240 the rate of single shot isolation was similar in all PVs. Time to isolation was not different between the two groups. Mean minimal esophageal temperature was lower in LSPV and LIPV of the CB240 group. A total of 4/80 patients (5%) of the CB120 group experienced a PN injury, but no persistent form was recorded; 11/80 patients (14%) of the CB240 group experienced a PN injury, three in a persistent form (p = .10). A LET <15°C was recorded in 3/80 patients (4%) in the CB120 group and in 16/80 patients (20%) in the CB240 group (p < .01). Composite rate of energy-related safety events (LET <15°C and PN injury) was significantly lower in the CB120 (34% vs. 9%, p < .01). CONCLUSIONS Safety of second generation CB PVI can be increased using a double 120 s freeze protocol.
Collapse
Affiliation(s)
- Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB)/Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
29
|
Chen S, Zanchi S, Bordignon S, Bianchini L, Tohoku S, Bologna F, Chun KRJ, Schmidt B. Ablation Index guided high power (50W) short duration for anterior line and roof line ablation: feasibility, procedural data and lesion analysis. Europace 2021. [DOI: 10.1093/europace/euab116.068] [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
Funding Acknowledgements
Type of funding sources: None.
Objectives
To evaluate the feasibility, procedural data, and lesion characteristics of anterior line (AL) and roof line (RL) ablation by using ablation index (AI) guided high-power(50W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI).
Methods
35 consecutive patients with macro-reentrant left atrial tachycardia (LAT) or substrate at LA anterior wall or roof after previous PVI were enrolled. Ablation power was set to 50W, targeting AI 500 for AL and 400 for RL. First-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into 3(caudal, middle and cranial) segments to analyze the location of conduction gaps in non-FPB patients.
Results
A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them respectively. In non-FPB group, the most frequent gap location along the AL was the middle third. Final block of AL was achieved in 97%, and block of RL was achieved in 100%. The RF ablation time was short (2,9 ± 0,8 min for AL and 46,2 ± 15,6 sec for RL). For AL, female gender was significantly more frequent in FPB than in non-FPB patients(p 0,028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 sec vs 161 ± 41 sec; p = 0,02). No procedural complications occurred.
Conclusion
AI guided high-power(50W) ablation appears to be a feasible, effective and fast technique for AL and RL ablation.
Collapse
Affiliation(s)
- S Chen
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Zanchi
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Bordignon
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - L Bianchini
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - S Tohoku
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - F Bologna
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - KRJ Chun
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| |
Collapse
|
30
|
Bordignon S, Tohoku S, Chen S, Bologna F, Throm C, Urbanek L, Hilbert M, Chun KRJ, Schmidt B. First insight into a novel irrigated radiofrequency ablation balloon. Europace 2021. [DOI: 10.1093/europace/euab116.092] [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
A novel irrigated RF balloon (RFB) for pulmonary vein isolation (PVI) was recently released in selected centers . It is a 28 mm open irrigated balloon with 10 unipolar electrodes on its surface to deploy a circular ostial lesion set around the PVs. An inner lumen spiral catheter allows for real time PVI visualization during the ablation.
Methods
Data from consecutive RFB procedures were collected and analysed. After a single transseptal puncture and selective PV angiograms a 3D map of the left atrium was acquired. Sequential PVI was performed using the RFB: each application lasted 60 seconds, the posterior electrodes were identified to stop the energy delivery after 20 seconds. Real time to isolation data were acquired. A 3D bipolar remap was finally performed to observe the level of isolation. A temperature probe was used to monitor the local esophageal temperature (LET) with a cut off of 39°C. Acute procedural data and complication were collected. Endoscopy was scheduled the day after procedure.
Results
Data from 10 consecutive RFB procedures were analyzed: 6/10 patients were male, 67 ± 9 years old, 8/10 with history of paroxysmal AF. A total of 36 PVs were targeted and isolated with the RFB, with a mean of 7,3 ± 4,0 applications per patient and 2,0 ± 1,2 applications per PV. First pass "single shot" isolation was achieved in 22/36 (61%), time to isolation during the first application was observed in 29/36 (80%) PVs, but an acute reconnection was observed in 10/29 (35%) isolated PVs. Mean time to sustained isolation was 13 ± 5 sec., mean time to non-sustained isolation was significantly longer (29 ± 17 sec; p = 0,001). Procedure time was 57 ± 16 min., left atrial dwell time 50 ± 14 min, ablation phase time 29 ± 14 min and fluoroscopy time was 10 ± 4 minutes. An esophageal temperature above 39°C was recorded in 2/36 PVs. No phrenic nerve palsy was recorded. 7/10 patients underwent endoscopy and no thermal lesions were detected. No other complications were recorded.
Conclusion
The novel irrigated RFB seems to allow an effective, safe and fast pulmonary vein isolation. More studies are needed to optimize energy dosing to possibly increase the rate of durable single shot PVI.
Collapse
Affiliation(s)
- S Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - C Throm
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - L Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - M Hilbert
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| |
Collapse
|
31
|
Rordorf R, Scazzuso F, Chun KRJ, Kaur Khelae S, Kueffer FJ, Braegelmann K, Okumura K, Al-Kandari F, Keun On Y, Foldesi C. Healthcare utilization after cryoballoon ablation for treatment of atrial fibrillation in patients with heart failure: real-world results from the Cryo AF Global Registry. Europace 2021. [DOI: 10.1093/europace/euab116.074] [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
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
OnBehalf
Cryo AF Global Registry Investigators
Background
Heart failure (HF) concomitant to atrial fibrillation (AF) can exacerbate the risk of hospitalization, morbidity, mortality, and impairment in quality of life posed by each condition alone. While the reciprocal relationship between HF and AF challenges effective treatment for these patients, catheter ablation for treatment of AF is reasonable for select patients with AF and HF according to guidelines. Purpose: Assess real-world usage and healthcare utilization outcomes of cryoablation for patients with AF and HF. Methods: The Cryo AF Global Registry (NCT02752737) is an ongoing, prospective, multicenter registry. Patients with AF were enrolled and treated with cryoballoon ablation (Arctic Front Advance, Medtronic) according to clinical practice at 56 sites in 26 countries world-wide. Subjects with NYHA class I-III at baseline comprised the HF cohort and were compared to patients without HF (No-HF). Freedom from atrial arrhythmia recurrence ≥30 sec, adverse events associated with the AF ablation procedure, repeat ablations, AAD usage, and cardiovascular rehospitalization over a 12-month follow-up were compared between cohorts. Results: A total of 1,303 patients (318 HF, 985 No-HF) were included. The HF cohort included patients with NYHA Class I (56.3%) and II/III (43.7%) with either preserved (81.6%) or mid/reduced (18.4%) left ventricular ejection fraction. HF patients were more often female (45.6% vs 33.6%) with persistent AF (25.8% vs 14.3%), larger left atrial diameter (4.4 ± 0.9 vs 4.0 ± 0.7 cm), and higher rates of hypertension (67.9% vs 49.1%) and prior myocardial infarction (3.8% vs 1.7%; all, P < 0.05). The rate of serious procedure-related complications was 5.3% in HF and 3.0% in No-HF (P = 0.08). Freedom from atrial arrhythmia recurrence at 12-months was not different between HF and No-HF patients with either paroxysmal (84.2% (95% CI:78.6-88.4) vs 86.8% (95% CI: 84.2 – 89.0)) or persistent AF (69.6% (95% CI: 58.1 – 78.5) vs 71.8% (95% CI: 63.2-78.7)), respectively (p = 0.32, HF vs No-HF). AF-related symptoms and antiarrhythmic drug use were significantly reduced after cryoablation in the HF and No-HF cohorts (P < 0.05). Freedom from repeat ablation at 12-months was similar between HF and No-HF patients. Of patients who had a cardiovascular rehospitalization after cryoablation, 78% presented with a supraventricular tachyarrhythmia. Persistent AF and HF at baseline both increased the risk of cardiovascular rehospitalization after cryoballoon ablation (P < 0.05). Conclusion: Cryoablation is used to treat patients with AF and concomitant HF in real-world practice and is similarly safe and effective at 12-months in patients with and without HF.
Collapse
Affiliation(s)
- R Rordorf
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - F Scazzuso
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - S Kaur Khelae
- Institut Jantung Negara, National Heart Institute, Kuala Lumpur, Malaysia
| | - FJ Kueffer
- Medtronic, Inc., Minneapolis, United States of America
| | - K Braegelmann
- Medtronic, Inc., Minneapolis, United States of America
| | - K Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Y Keun On
- Samsung Medical Center, Seoul, Korea (Republic of)
| | - C Foldesi
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
| |
Collapse
|
32
|
Chun KRJ, Foldesi C, Misikova S, Ptaszynski P, Todd D, Herzet JM, Braegelmann K, Kueffer FJ, Drephal C, Steinwender C, Zucchelli G, Neuzil P. Safety of cryoballoon ablation for the treatment of atrial fibrillation: first European results from the Cryo AF Global Registry. Europace 2021. [DOI: 10.1093/europace/euab116.205] [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: Other. Main funding source(s): Medtronic, Inc.
OnBehalf
Cryo AF Global Registry Investigators
Background
Since introduced in Europe over 15 years ago, cryoballoon ablation for the treatment of
patients with atrial fibrillation (AF) has proven to be safe and effective.
Purpose
Report on patient and procedural characteristics, ablation techniques, and outcomes. Also,
determine the independent predictors of a procedural adverse event in real-world usage.
Methods
Patients with AF were enrolled in the prospective, multicenter Cryo AF Global Registry
(NCT02752737) and treated with cryoballoon ablation at 38
European centers according to standard-of-care. The primary efficacy endpoint was freedom from a ≥30 sec episode of AF/atrial flutter (AFL)/atrial tachycardia (AT) at 12-months. The primary safety endpoint was the rate of serious adverse events related to the device and/or procedure. Univariate and
multivariable models identified baseline patient and procedural characteristics that predicted a serious
procedure-related complication. Results: Of 1,418 subjects who completed an index procedure, the cohort was 62 ± 11 years of age, 37.7% female, and 72.2% paroxysmal AF (PAF). In total, 32.2% of patients were treated with cryoablation as a first-line therapy. Non-general anesthesia was used in 76.0% of procedures. Ablation adjunctive to the cryoballoon pulmonary vein isolation was applied in few cases: 2.0% of patients were treated with a cavotricuspid isthmus (CTI) line with focal radiofrequency ablation and 0.8% of patients received other non-PVI ablation. The mean procedure, left atrial dwell, and fluoroscopy times were 81 ± 34, 54 ± 25, and 14 ± 13 minutes, respectively. Among the 766 patients with 12-month follow-up, freedom from AF/AFL/AT recurrence ≥30 sec was 83.3% (95% CI: 79.8-86.3%) and 71.6% (95% CI: 64.6-77.4%) in patients with PAF and persistent AF, respectively. The serious procedure- and device-related adverse event rates were 4.7% and 2.0%, respectively. Female sex was significantly associated with the occurrence of an adverse event in univariate analysis (P < 0.05), but (after accounting for patient age and NYHA status) no baseline patient characteristic independently predicted a procedure-related adverse event. However, prolonged procedure duration (OR = 1.01 (95% CI: 1.00-1.01)), use of general anesthesia (OR = 1.71 (95% CI: 1.01 – 2.92)), and delivery of a CTI line (OR = 3.04 (95% CI: 1.01-9.20) were each independently associated with the occurrence of a serious procedural safety event (all P < 0.05). Conclusion: Cryoablation treated patients across the AF disease spectrum with one-third of patients treated prior to antiarrhythmic drug usage and another third treated for persistent AF. The results indicate extra diligence is warranted in patients under general anesthesia and for those who receive adjunctive CTI ablation. Cryoballoon ablation is consistently safe for patients independent of baseline patient characteristics and comorbidities in real-world use.
Collapse
Affiliation(s)
- KRJ Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - C Foldesi
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
| | - S Misikova
- Východoslovenský ústav srdcovych a cievnych chorôb, a.s., Košice, Slovakia
| | - P Ptaszynski
- Medical University of Lódz, Central University Hospital, Lódz, Poland
| | - D Todd
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | | | - K Braegelmann
- Medtronic, Inc., Minneapolis, United States of America
| | - FJ Kueffer
- Medtronic, Inc., Minneapolis, United States of America
| | - C Drephal
- Sana Klinikum Lichtenberg , Berlin, Germany
| | | | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Neuzil
- Na Homolce Hospital, Prague, Czechia
| |
Collapse
|
33
|
Duncker D, Sommer P, Busch S, Tilz RR, Althoff T, Iden L, Metzner A, Rillig A, Chun KRJ, Bourier F, Maurer T, Shin DI. [Puncture techniques in invasive cardiac electrophysiology]. Herzschrittmacherther Elektrophysiol 2021; 32:274-284. [PMID: 34009451 DOI: 10.1007/s00399-021-00761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 02/03/2023]
Abstract
Due to good results, increasing standardization and lack of equivalent alternatives, catheter ablation has been established as an increasingly common procedure in clinical routine. This article describes common and necessary puncture techniques in catheter ablation (puncture of the groin vessels, transseptal puncture, pericardial puncture) and represents a practical instruction for the catheter laboratory. This article is part of a series of manuscripts presenting topics of interventional electrophysiology in the course of electrophysiology training.
Collapse
Affiliation(s)
- David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Sonia Busch
- Medizinische Klinik II, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- CCB, Cardioangiologisches Centrum Bethanien -, Frankfurt, Deutschland
| | - Felix Bourier
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie und Internistische Intensivmedizin, , Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,University Faculty of Health, Center for Clinical Medicine Witten-Herdecke, Wuppertal, Deutschland
| |
Collapse
|
34
|
Chen S, Chun KRJ, Bordignon S, Tohoku S, Schmidt B. Epicardial mapping and ablation for ventricular arrhythmias in experienced center without onsite cardiac surgery. Glob Cardiol Sci Pract 2021; 2021:e202103. [PMID: 34036089 PMCID: PMC8133788 DOI: 10.21542/gcsp.2021.3] [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] [Indexed: 11/22/2022] Open
Abstract
Objective: Epicardial access is sometimes required to effectively treat ventricular arrhythmias, but it can be associated with increased risk of procedural complications needing surgical intervention. The present study aimed to evaluate the feasibility and safety of epicardial mapping/ablation in experienced center without onsite cardiac surgery. Methods: Patients who had drug-refractory, recurrent ventricular arrhythmias were scheduled for catheter ablation. All operators (SC, JC, SB, BS) had at least fifty pericardial puncture experiences. Epicardial puncture and perioperative anticoagulation were carried out based on institutional protocol. Phrenic nerve was mapped by 3-D mapping system. Coronary anatomy was delineated by coronary angiography. Results: A total of 44 patients (63.3 years, male 86.4%) received epicardial access. Of them 7 (15.9%) were scheduled for PVC ablation, 37 (84.1%) for VT ablation (ICM: 25%, NICM: 59.1%). Mean LVEF was 41.3%. Acute ablation success rate was 35 (79.5%). Procedural adverse events included: pericardial effusion occurred in 3 (6.8%) patients who all well treated with pericardial drainage; and pericardial tamponade in 1 (2.3%) patient requiring transfer to surgical intervention. No death, stroke, phrenic nerves palsy, or coronary artery injury were observed. Median hospitalization was 4 (3–6) days. Univariable analysis and ROC curve showed that patients’ age was a significant predictor of epicardial procedural complication (area under curve (AUC): 0.813, P = 0.041). Conclusions: Guided by a tailored procedural protocol, the majority of the epicardial access related complications can be treated conservatively without needing onsite surgery. Older age is a risk factor associated with epicardial access related complications.
Collapse
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
35
|
Zanchi S, Chen S, Bordignon S, Bianchini L, Tohoku S, Bologna F, Tondo C, Chun KRJ, Schmidt B. Ablation Index-guided high-power (50 W) short-duration for left atrial anterior and roofline ablation: Feasibility, procedural data, and lesion analysis (AI High-Power Linear Ablation). J Cardiovasc Electrophysiol 2021; 32:984-993. [PMID: 33634549 DOI: 10.1111/jce.14973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/11/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the feasibility, procedural data, and lesion characteristics of the anterior line (AL) and roofline (RL) ablation by using ablation index (AI)-guided high power (50 W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI). METHODS Data from 35 consecutive patients with macro-reentrant left atrial tachycardia or substrate at the left atrium anterior wall or roof after previous PVI were collected. Ablation power was set to 50 W, targeting AI 500 for AL and 400 for RL. The first-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into three (caudal, middle, and cranial) segments to analyze the location of conduction gaps in non-FPB patients. RESULTS A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them, respectively. In the non-FPB group, the most frequent gap location along the AL was the middle third. The final block of AL was achieved in 97%, and the block of RL was achieved in 100%. The radiofrequency (RF) ablation time was short (2.9 ± 0.8 min for AL and 46.2 ± 15.6 s for RL). For AL, the female gender was significantly more frequent in FPB than in non-FPB patients (p = .028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 s vs. 161 ± 41 s; p = .02). No procedural complications occurred. CONCLUSION AI-guided high-power (50 W) ablation appears to be a feasible, effective, and fast technique for AL and RL ablation.
Collapse
Affiliation(s)
- Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Università degli Studi di Milano, Milan, Italy
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
36
|
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Jan Petru
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Lucie Sediva
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Petr Neuzil
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| |
Collapse
|
37
|
Chen S, Schmidt B, Bordignon S, Tohoku S, Urban VC, Schulte-Hahn B, Chun KRJ. Catheter ablation of atrial fibrillation using ablation index-guided high-power technique: Frankfurt AI high-power 15-month follow-up. J Cardiovasc Electrophysiol 2021; 32:616-624. [PMID: 33484215 DOI: 10.1111/jce.14912] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/10/2020] [Revised: 09/21/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency (RF) high-power ablation appears to be a novel concept in treating atrial fibrillation (AF). The ablation-index (AI) has been linked with the durability of pulmonary vein isolation (PVI). To report the midterm clinical results of a new ablation strategy using AI-guided high-power (50 W) ablation (AI-HP). METHODS AND RESULTS Symptomatic AF patients were included and underwent wide-area circumferential PVI. Contact-force catheters were used, RF power was set to 50 W targeting AI values (550/400 for anterior/posterior) and interlesion distance 6 mm. Luminal esophageal temperature (LET) was monitored during the procedure; patients with LET ≥39°C underwent post-ablation esophageal-endoscopy. Seventy-two-hour-Holter ECGs were scheduled during follow-up. Procedural PVI was achieved in all (N = 122; mean age, 68.2 years; male, 71.3%) patients, rate of first-pass PVI was 96.7% per patient. Procedural mean RF time was 11.5 min, and mean RF time during posterior wall segment was 3.1 min. Per RF-lesion, the mean contact force, RF duration, AI, and impedance-drop at anterior/posterior wall were 26 ± 14 g/23 ± 12 g, 16.2 ± 7.5 s/8.8 ± 3.6 s, 552 ± 53/438 ± 47, and 13 ± 6 Ω/9 ± 5 Ω, respectively. Mean PVI procedural-time, 55.8 min; mean procedural fluoroscopic time, 5.6 min. Three (2.5%) patients had asymptomatic endoscopic small erosion/erythema esophageal lesions, no serious adverse events were observed. During a 15-month follow-up, overall single-procedure freedom from clinical recurrence of AF/atrial tachycardia (AT) off antiarrhythmic drug after blanking period was 85.2% (89.4% for paroxysmal AF, 80.4% for persistent AF). CONCLUSION The AI-HP (50 W) appears as an efficient ablation technique in treating AF and leads to a high single-procedure arrhythmia-free survival at 15 months.
Collapse
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Verena C Urban
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.,Medizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck, Germany
| |
Collapse
|
38
|
Chen S, Schmidt B, Bordignon S, Tohoku S, Chun KRJ. Pulmonary vein isolation using cryoballoon technique in atrial fibrillation patient after Greenfield vena cava filter implantation. Glob Cardiol Sci Pract 2020; 2020:e202021. [PMID: 33426038 PMCID: PMC7768625 DOI: 10.21542/gcsp.2020.21] [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] [Indexed: 11/05/2022] Open
Abstract
Background: Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patient with vena cava filter undergoing pulmonary vein isolation (PVI) were seldom reported. Case presentation: We describe an AF ablation technique using the second generation cryoballoon in a patient after vena cava filter implantation. All pulmonary veins were successfully isolated without complication. Conclusions: For AF patient with previously implanted vena cava filter, cryoballoon based PVI appears feasible and safe.
Collapse
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| |
Collapse
|
39
|
Tsianakas N, Bordignon S, Bologna F, Tohoku S, Chen S, Konstantinou A, Chun KRJ, Schmidt B. Holter ECG diagnosis of nicotine-spray induced ventricular fibrillation. An unusual case of Prinzmetal variant angina. J Electrocardiol 2020; 63:17-20. [PMID: 33022429 DOI: 10.1016/j.jelectrocard.2020.09.004] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
We report on an interesting case of resuscitated sudden cardiac death (SDC) in a 51-year-old with hypertension and positive family history for SDC. The patient was resuscitated and an emergency angiogram ruled out coronary artery disease. Cardio-MRT ruled structural disease or infection. Holter and telemetry monitoring revealed premature ventricular complexes and transient ST-changes followed by anginaepisodes in correlation with the use of the nicotine-replacement-spray. The patient was urged to quit smoking and smoking-substitutes. Medical therapy with calcium-channelblocker and a long acting nitrate was administered. One-month follow up reported no arrhythmic or angina events.
Collapse
Affiliation(s)
- N Tsianakas
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany.
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - S Tohoku
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - S Chen
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - A Konstantinou
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany
| |
Collapse
|
40
|
Tohoku S, Chen S, Last J, Bordignon S, Bologna F, Trolese L, Zanchi S, Bianchini L, Schmidt B, Chun KRJ. Phrenic nerve injury in atrial fibrillation ablation using balloon catheters: Incidence, characteristics, and clinical recovery course. J Cardiovasc Electrophysiol 2020; 31:1932-1941. [DOI: 10.1111/jce.14567] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/16/2020] [Accepted: 05/12/2020] [Indexed: 08/29/2023]
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| |
Collapse
|
41
|
Chen S, Schmidt B, Bordignon S, Tohoku S, Urbanek L, Plank K, Willems F, Throm C, Konstantinou A, Hilbert M, Zanchi S, Bianchini L, Bologna F, Tsianakas N, Kreuzer C, Nagase T, Perrotta L, Last J, Chun KRJ. Cryoballoon pulmonary vein isolation in treating atrial fibrillation using different freeze protocols: The “ICE‐T 4 minutes vs 3 minutes” propensity‐matched study (Frankfurt ICE‐T 4 vs. 3). J Cardiovasc Electrophysiol 2020; 31:1923-1931. [DOI: 10.1111/jce.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Christina Throm
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Max Hilbert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Claudia Kreuzer
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Medizinische Klinik II, Kardiologie/Angiologie/IntensivmedizinUniversitätsklinikum Schleswig‐Holstein, Universität zu Lübeck Lübeck Germany
| |
Collapse
|
42
|
Chen S, Schmidt B, Bordignon S, Bologna F, Lindhoff-Last E, Chun KRJ. Thrombus Formation in Isolated Left Atrial Appendage After Multiple Atrial Fibrillation Ablations Despite Oral Anticoagulation Followed by Percutaneous Appendage Closure. JACC Clin Electrophysiol 2020; 5:398-400. [PMID: 30898245 DOI: 10.1016/j.jacep.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Edelgard Lindhoff-Last
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| |
Collapse
|
43
|
Chen S, Schmidt B, Bordignon S, Bologna F, Chun KRJ. Short tip–more function? Atrial fibrillation ablation using the novel third-generation cryoballoon in resected pulmonary vein. Int J Arrhythm 2019. [DOI: 10.1186/s42444-019-0006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patients who had previous pulmonary surgery undergoing pulmonary vein isolation (PVI) were seldom reported.
Case presentation
We describe an AF ablation using the novel short-tip third-generation cryoballoon in a patient with resected pulmonary vein. All pulmonary veins were successfully isolated without complication. The short-tip third-generation cryoballoon shows advantageous profile in PVI for AF patients with previous pulmonary surgery.
Conclusions
This report indicates that for AF patient who had previous resected PV surgery, the short-tip CB 3 provides an ideal device option for real-time PVI.
Collapse
|
44
|
Chen S, Schmidt B, Tohoku S, Trolese L, Bordignon S, Chun KRJ. Transesophageal echocardiography-guided closure of electrically isolated left atrial appendage to constrain a rapidly growing thrombus despite anticoagulation and sinus rhythm. J Cardiovasc Electrophysiol 2019; 31:247-249. [PMID: 31749201 DOI: 10.1111/jce.14284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 10/09/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
45
|
Kuck KH, Brugada J, Schlüter M, Braegelmann KM, Kueffer FJ, Chun KRJ, Albenque JP, Tondo C, Calkins H. The FIRE AND ICE Trial: What We Know, What We Can Still Learn, and What We Need to Address in the Future. J Am Heart Assoc 2019; 7:e010777. [PMID: 30561258 PMCID: PMC6405614 DOI: 10.1161/jaha.118.010777] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Karl-Heinz Kuck
- 1 Department of Cardiology Asklepios Klinik St Georg Hamburg Germany
| | | | - Michael Schlüter
- 1 Department of Cardiology Asklepios Klinik St Georg Hamburg Germany
| | | | | | | | - Jean-Paul Albenque
- 5 Cardiologie Générale, Interventionnelle - Rhythmologie Clinique Pasteur Toulouse France
| | - Claudio Tondo
- 6 Heart Rhythm Center Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy.,7 Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Hugh Calkins
- 8 Department of Arrhythmia Services Johns Hopkins Medical Institutions Baltimore MD
| | | |
Collapse
|
46
|
Chen S, Schmidt B, Bordignon S, Urbanek L, Tohoku S, Bologna F, Angelkov L, Garvanski I, Tsianakas N, Konstantinou A, Trolese L, Weise F, Perrotta L, Chun KRJ. Ablation index‐guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study. J Cardiovasc Electrophysiol 2019; 30:2724-2731. [DOI: 10.1111/jce.14219] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 06/28/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Lazar Angelkov
- Department of Cardiology and ElectrophysiologyAcibadem City Clinic Cardiovascular CenterSofia Bulgaria
| | - Iskren Garvanski
- Department of Cardiology and ElectrophysiologyAcibadem City Clinic Cardiovascular CenterSofia Bulgaria
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Felix Weise
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB)Frankfurt Academy For Arrhythmias (FAFA)Frankfurt am Main Germany
- Department of Cardiology, Medizinische Klinik IIIAgaplesion Markus KrankenhausFrankfurt am Main Germany
| |
Collapse
|
47
|
Chen S, Schmidt B, Sommer P, Liu S, Krucoff MW, Kiuchi MG, Andrea B, Acou WJ, Schratter A, Nagase T, Ling Z, Yin Y, Hindricks G, Puererfellner H, Chun KRJ. P1022Upstream therapy using preoperative renin-angiotensin system inhibitors in prevention of postoperative atrial fibrillation and adverse events: a collaborative pooled-analysis over 27,000 patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0613] [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
Renin-angiotensin-system inhibitors (RASIs) have been suggested as an upstream therapy for selected AF patients; however, the evidence in surgical setting is limited.
Objective
We aimed to evaluate the role of preoperative RASIs in prevention of postoperative atrial fibrillation (POAF) and adverse events for patients undergoing cardiac surgery.
Methods
In this collaborative pooled-analysis, both randomized and nonrandomized controlled trials comparing preoperative RASIs with no preoperative RASIs treatment on the incidence of POAF were identified. Sensitivity and subgroup analyses of RCTs were performed to test the stability of the overall-effect, and meta-regression to explore the potential risk of bias. The primary outcome was POAF, and the secondary outcomes includes rate of stroke, mortality and duration of hospitalization.
Results
Eleven trials involving 27885 patients (male 74%, median age 65yrs) were included. As compared to the control group, preoperative RASIs did not significantly reduce the risk of POAF (OR: 1.04, 95% CI: 0.91–1.19), stroke (OR: 0.86, 95% CI: 0.62–1.19), death (OR: 1.07, 95% CI: 0.85–1.35), composite adverse cardiac events (OR: 1.04, 95% CI: 0.91–1.18), and hospital stay (WMD: −0.04, 95% CI: −1.05 to 0.98). Pooled-analysis of randomized trials showed consistent results. The primary overall-effect was maintained in sensitivity and subgroup analyses. Meta-regression showed that male-gender was a significant risk-factor of POAF and use of Beta-blockers was associated with a significantly reduced risk in developing POAF.
Conclusion and relevance
This study demonstrates that preoperative RASIs do not offer additional benefit in reducing the risk of postoperative AF, stroke, death and hospitalization in the setting of cardiac surgery. The results provide no support for use of RASIs for the prevention of POAF and adverse events in patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- S Chen
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - P Sommer
- Heart Center of Leipzig, Leipzig, Germany
| | - S Liu
- Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China
| | - M W Krucoff
- Duke Clinical Research Institute, Durham, United States of America
| | - M G Kiuchi
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Andrea
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - T Nagase
- Saitama Medical University, Saitama, Japan
| | - Z Ling
- The Second Affiliated Hospital- Chongqing Medical University, Chongqing, China
| | - Y Yin
- The Second Affiliated Hospital- Chongqing Medical University, Chongqing, China
| | | | | | - K R J Chun
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
48
|
Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Chun KRJ. P1921Impact of cryoballoon freeze duration on long-term durability of pulmonary vein isolation in atrial fibrillation: insights from Re-mapping procedures (the ICE Re-map study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0668] [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
Second-generation cryoballoon (CB2) represents a powerful pulmonary vein isolation (PVI) tool. Recently, the randomized time-to-effect guided (ICE-T) CB2 strategy targeting a 240s single freeze demonstrated fast and efficient PVI. To further optimize safety and efficacy, a shortened 3min freeze duration has been suggested but PVI durability remains unclear.
Methods
Between May 2013 and December 2017 all CB2 ablations followed the ICE-T concept (target-freeze: 240s or 180s). Patients undergoing a second procedure for arrhythmia recurrence were analyzed. Two groups were defined based on the index freeze duration (group 240s vs. group 180s). In all repeat procedures a 3D left-atrial map was obtained. Durability of PVI and localization of conduction gaps were compared.
Results
A total of 106/788 (13%) patients underwent a second procedure (group 240s: 80/604 vs. group 180s: 26/184) after a mean of 377 days. There was no difference regarding PV occlusion and time-to-isolation in the index procedure between two groups. No major complications occurred. During the second procedure significantly more patients demonstrated durable isolation of all PVs in group 240 (61% vs 35%, p=0.02) along with a significantly increased rate of PVI durability (88% vs. 69%, per vein, p<0.001). Left sided PVs did significantly benefit from 240s freezes (reconnection LSPV: 6% vs 27%, p=0.004, LIPV: 14 vs. 39%, p=0.006).
Conclusions
The ICE-T strategy is associated with a high rate of durable PVI in patients with arrhythmia recurrence. Target freeze duration of 240s vs. 180s is associated with significantly increased lesion durability, particularly at left sided PVs, without increasing complications.
Collapse
Affiliation(s)
- S Chen
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - L Perrotta
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - F Bologna
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
49
|
Chen S, Schmidt B, Bordignon S, Chun KRJ. P2841Atrial fibrillation ablation using ablation index guided high power (50W) smart touch technology for quantifiable and efficient circumferential pulmonary vein lesions (the FAFA power-touch study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1151] [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: 11/13/2022] Open
Abstract
Abstract
Background
High-power short-duration ablation appears a promising concept. The so-called ablation index (AI) integrating power, contact force and time have demonstrated increased pulmonary vein isolation (PVI) durability. However, feasibility and safety of AI guided high-power ablation is unknown.
Methods and results
Symptomatic AF patients (n=50) underwent circumferential PVI using AI guided high-power point-by-point ablation (CARTO Smart-Touch). Ablation was set to 50W targeting AI values (550: anterior wall/roof, 400: posterior wall) with an inter-lesion distance of 6mm using a non-steerable sheath. An esophageal probe monitored luminal temperature rises (limit: 39°C).
Acute PVI was obtained in all patients; first-pass efficacy was 92%. Mean ablation time per procedure was 11.2±2.2 min, mean procedure time was 55.6±6.6 min.
A total of 2105 lesions were analyzed, comparing left anterior wall vs. left posterior wall and right anterior wall vs. right posterior wall, the mean ablation time (sec.) was 20.5±8.2 vs. 8.6±3.2, and 12.2±4 vs 9.3±3.4; the mean contact force (g): 17.1±12 vs 25.4±14.2 and 33.7±13.1 vs 21.0±10.5, the mean AI: 546.8±48.2 vs 444.6±55 and 554.8±56 vs. 439.8±47.1 (all P<0.0001). Audible steam pops were noted in in 4 (8%) patients. Esophageal temperature rise >39°C were noted in 25 (50%) patients. In 1/50 (2%) patient a minor esophageal lesion after ablation was observed without requiring specific therapy. No major complications such as death, stroke, tamponade or atria-esophageal -fistula occurred.
Conclusion
The novel AI guided high power ablation appears to be a feasible, safe, quantifiable and efficient strategy for PVI.
Collapse
Affiliation(s)
- S Chen
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - B Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - S Bordignon
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R J Chun
- Cardioangiologisches Centrum Bethanien (CCB) am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
50
|
Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, Schlüter M, Elvan A, Braegelmann KM, Kueffer FJ, Arentz T, Albenque JP, Kühne M, Sticherling C, Tondo C. Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006204. [PMID: 29700058 DOI: 10.1161/circep.118.006204] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 01/08/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on predictors of long-term clinical outcomes after catheter ablation of atrial fibrillation (AF) are limited. We sought to assess the association of baseline covariates with clinical outcomes in the 750 patients with drug-refractory paroxysmal AF enrolled in FIRE AND ICE. METHODS In a 2-part analysis, univariate and multivariable Cox regression models were first used to identify baseline patient characteristics predictive of catheter ablation efficacy determined by the clinical end points of (1) atrial arrhythmia recurrence (primary efficacy failure), (2) cardiovascular rehospitalization, and (3) repeat ablation. Propensity score stratification methods were then used to account for differences in baseline characteristics between sexes. RESULTS Female sex (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.08-1.73; P=0.010) and prior direct current cardioversion (HR, 1.40; 95% CI, 1.07-1.82; P=0.013) were independently associated with atrial arrhythmia recurrence. Female sex (HR, 1.36; 95% CI, 1.02-1.80; P=0.035) and hypertension (HR, 1.48; 95% CI, 1.09-2.00; P=0.013) independently predicted cardiovascular rehospitalization. A longer history of AF (HR, 1.03; 95% CI, 1.00-1.06; P=0.039) increased the rate of repeat ablation. Women continued to have higher rates of primary efficacy failure and cardiovascular rehospitalization after propensity score adjustment, with adjusted HRs of 1.51 (95% CI, 1.16-2.18; P<0.05) and 1.40 (95% CI, 1.15-2.17; P<0.05), respectively. CONCLUSIONS After catheter ablation of paroxysmal AF, female sex was associated with an almost 40% increase in the risks of primary efficacy failure and cardiovascular rehospitalization. Primary efficacy failure was also adversely impacted by a history of direct current cardioversion, whereas hypertension had a negative impact on cardiovascular rehospitalization. History of AF was the only predictor of repeat ablation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01490814.
Collapse
Affiliation(s)
- Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.).
| | - Josep Brugada
- Hospital Clinic, University of Barcelona, Spain (J.B.)
| | - Alexander Fürnkranz
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.).,Dr Fürnkranz's current affiliation: Department of Cardiology, Pneumology, and Angiology, University Hospital Düsseldorf, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.)
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Michael Schlüter
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Arif Elvan
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.E.)
| | | | | | - Thomas Arentz
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany (T.A.)
| | | | - Michael Kühne
- Abteilung für Kardiologie, Universitätsspital Basel, Switzerland (M.K., C.S.)
| | | | - Claudio Tondo
- Monzino Sport Center Arrhythmia Unit, Centro Cardiologico Monzino, University of Milan, Italy (C.T.)
| | | |
Collapse
|