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Younis A, Santangeli P, Garrott K, Buck E, Tabaja C, Wass SY, Lehn L, Kleve R, Hussein AA, Nakhla S, Nakagawa H, Taigen T, Kanj M, Sroubek J, Saliba WI, Wazni OM. Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter. Circ Arrhythm Electrophysiol 2024:e012723. [PMID: 38690671 DOI: 10.1161/circep.123.012723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Conventional focal radiofrequency catheters may be modified to enable multiple energy modalities (radiofrequency or pulsed field [PF]) with the benefit of contact force (CF) feedback, providing greater flexibility in the treatment of arrhythmias. Information on the impact of CF on lesion formation in PF ablations remains limited. METHODS An in vivo study was performed with 8 swine using an investigational dual-energy CF focal catheter with local impedance. Experiment I: To evaluate atrial lesion formation, contiguity, and width, a point-by-point approach was used to create an intercaval line. The distance between the points was prespecified at 4±1 mm. Half of the line was created with radiofrequency energy, whereas the other half utilized PF (single 2.0 kV application with a proprietary waveform). Experiment II: To evaluate single application lesion dimensions with a proprietary waveform, discrete ventricular lesions were performed with PFA (single 2.0 kV application) with targeted levels of CF: low, 5 to 15 g; medium, 20 to 30 g; and high, 35 to 45 g. Following 1 week of survival, animals underwent endocardial/epicardial remapping, and euthanasia to enable histopathologic examination. RESULTS Experiment I: Both energy modalities resulted in a complete intercaval line of transmural ablation. PF resulted in significantly wider lines than radiofrequency: minimum width, 14.9±2.3 versus 5.0±1.6 mm; maximum width, 21.8±3.4 versus 7.3±2.1 mm, respectively; P<0.01 for each. Histology confirmed transmural lesions with both modalities. Experiment II: With PF, lesion depth, width, and volume were larger with higher degrees of CF (depth: r=0.82, P<0.001; width: r=0.26, P=0.052; and volume: r=0.55, P<0.001), with depth increasing at a faster rate than width. The mean depths were as follows: low (n=17), 4.3±1.0 mm; medium (n=26), 6.4±1.2 mm; and high (n=14), 9.1±1.4 mm. CONCLUSIONS Using the same focal point CF-sensing catheter, a novel PF ablation waveform with a single application resulted in transmural atrial lesions that were significantly wider than radiofrequency. Lesion depth showed a significant positive correlation with CF with depths of 6.4 mm at moderate CF.
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Affiliation(s)
- Arwa Younis
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Kara Garrott
- Boston Scientific Corporation, St. Paul, MN (K.G., E.B., L.L., R.K.)
| | - Eric Buck
- Boston Scientific Corporation, St. Paul, MN (K.G., E.B., L.L., R.K.)
| | - Chadi Tabaja
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Sojin Y Wass
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Lauren Lehn
- Boston Scientific Corporation, St. Paul, MN (K.G., E.B., L.L., R.K.)
| | - Ryan Kleve
- Boston Scientific Corporation, St. Paul, MN (K.G., E.B., L.L., R.K.)
| | - Ayman A Hussein
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Shady Nakhla
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Hiroshi Nakagawa
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Tyler Taigen
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Jakub Sroubek
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Walid I Saliba
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, OH (A.Y., P.S., C.T., S.Y.W., A.A.H., S.N., H.N., T.T., M.K., J.S., W.I.S., O.M.W.)
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Farwati M, Braghieri L, Abdulhai FA, Dabbagh M, Alkhalaileh FA, Younis A, Tabaja C, Farwati A, Amin M, Santangeli P, Nakagawa H, Saliba WI, Kanj M, Callahan TD, Bhargava M, Baranowski B, Rickard J, Sroubek J, Lee J, Tchou PJ, Wazni OM, Hussein AA. Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient-reported outcomes. Pacing Clin Electrophysiol 2024; 47:595-602. [PMID: 38523591 DOI: 10.1111/pace.14943] [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: 08/08/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Data are lacking on patient-reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO-PVI-ONLY) versus RFA with PVI and posterior wall isolation (RF-PVI+PWI) in a large prospective PRO registry. METHODS Patients who underwent AF ablation (2013-2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO-PVI-ONLY patients were matched (1:1) with RF-PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1-year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient-reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). RESULTS A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO-PVI-ONLY and RF-PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO-PVI-ONLY) vs. 92.8% (RF-PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO-PVI-ONLY group (39.7%) compared to RF-PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. CONCLUSION CRYO-PVI-ONLY and RF-PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF-PVI+PWI being more effective at reducing recurrences.
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Affiliation(s)
- Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Farah A Abdulhai
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marwan Dabbagh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Firas A Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Younis A, Buck E, Santangeli P, Tabaja C, Garrott K, Lehn L, Hussein AA, Nakhla S, Nakagawa H, Yavin HD, Kanj M, Sroubek J, Saliba WI, Wazni OM. Efficacy of Pulsed Field vs Radiofrequency for the Reablation of Chronic Radiofrequency Ablation Substrate: Redo Pulsed Field Ablation. JACC Clin Electrophysiol 2024; 10:222-234. [PMID: 37978965 DOI: 10.1016/j.jacep.2023.09.015] [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: 03/20/2023] [Revised: 08/25/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The efficacy of pulsed field ablation (PFA) for redo procedures is unknown. OBJECTIVES In this study, the authors aimed to evaluate the effectiveness of PFA when performing PFA over chronic RFA (redo environment). METHODS This was a 3-step in vivo study. In step 1 (creation of redo environment), 6 swine underwent radiofrequency ablation (RFA) with a local impedance measuring catheter and a contact force-enabled catheter in 3 different sites: the right atrium (RA) (intercaval line with intentional gaps), the left atrium (LA) (pulmonary vein isolation [PVI] with intentional gaps and superficial posterior wall ablations), and the left ventricle (LV) (short RFA applications [chronic RFA]). In step 2 (re-ablation), following a survival period of ≈5 weeks, animals were retreated as follows: in the RA, a focal PFA catheter over the prior intercaval line; in the LA, PVI using a pentaspline PFA catheter; and in the LV, animals were randomized to focal PFA or RFA. In each arm, 2 types of lesions were performed: acute or acute over chronic. In step 3 (remapping and euthanization), following an additional 3 to 5 days, all animals were remapped and sacrificed. RESULTS In the RA, re-ablation with PFA resulted in a complete intercaval block in all animals, expanding and homogenizing the disparate chronic RFA lesions from a width of 4 to 7 mm (chronic RFA) to a width of 16 to 28 mm (PFA over chronic RFA). In the LA, re-ablation with PFA resulted in complete PVI and transmural ablation of the PW. In the LV, the mean depth for acute RFA (post 2-5 days survival) was 7.6 ± 1.3 mm vs 3.9 ± 1.6 mm in the acute over chronic RFA lesions (P < 0.01). In contrast, the mean depth for acute PFA was 7.0 ± 1.6 mm, similar to when ablating with PFA over RFA (7.1 ± 1.3 mm; P = 0.94). CONCLUSIONS PFA is highly efficient for ablation following prior RFA, which may be beneficial in patients presenting for redo procedures. In the ventricle, PFA resulted in lesions that are deeper than RFA when ablating over chronic superficial RFA lesions.
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Affiliation(s)
- Arwa Younis
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Eric Buck
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kara Garrott
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lauren Lehn
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hagai D Yavin
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Nakagawa H, Sugawara M, Saliba WI, Hussein AA. Pulsed-Field Ablation of AV Nodal Re-Entrant Tachycardia: Are We Shooting the AV Node? JACC Clin Electrophysiol 2024; 10:93-95. [PMID: 38032578 DOI: 10.1016/j.jacep.2023.10.020] [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: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Masafumi Sugawara
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Nakagawa H, Castellvi Q, Neal R, Girouard S, Laughner J, Ikeda A, Sugawara M, An Y, Hussein AA, Nakhla S, Taigen T, Srounbek J, Kanj M, Santangeli P, Saliba WI, Ivorra A, Wazni OM. Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries. Circ Arrhythm Electrophysiol 2024; 17:e012026. [PMID: 38152949 DOI: 10.1161/circep.123.012026] [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: 04/25/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model. METHODS A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4-13 g; median, 9.5 g); (2) moderate (15-30 g; median, 21.5 g); (3) high (34-55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining. RESULTS Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact. CONCLUSIONS Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.
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Affiliation(s)
- Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Quim Castellvi
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Q.C., A. Ivorra)
| | - Robert Neal
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Steven Girouard
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Jacob Laughner
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Atsushi Ikeda
- Department of Cardiology, Nihon University, Tokyo, Japan (A. Ikeda)
| | - Masafumi Sugawara
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Yoshimori An
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Shady Nakhla
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Jakub Srounbek
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Antoni Ivorra
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Q.C., A. Ivorra)
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
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Braghieri L, Younis A, Tabaja C, Santangeli P, Taigen T, Saliba WI, Wazni OM, Hussein AA. Quality of Life Outcomes of Atrial Fibrillation Ablation in Heart Failure With Preserved or Mildly Reduced Left Ventricular Systolic Function. Am J Cardiol 2023:S0002-9149(23)01414-5. [PMID: 38160919 DOI: 10.1016/j.amjcard.2023.12.030] [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: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chadi Tabaja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Tabaja C, Younis A, Santangeli P, Madden R, Taigen T, Farwati M, Hayashi K, Braghieri L, Rickard J, Klein BM, Paul A, Dresing TJ, Martin DO, Bhargava M, Kanj M, Sroubek J, Nakagawa H, Saliba WI, Wazni OM, Hussein AA. Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01659-w. [PMID: 37848806 DOI: 10.1007/s10840-023-01659-w] [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: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. METHODS All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculate quality of life (QoL) metrics: the AF severity score as well as the AF burden. RESULTS A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. CONCLUSION Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Katsuhide Hayashi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Benjamin M Klein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Aritra Paul
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - David O Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA.
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8
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Alkhalaileh F, Wazni OM, Kiang A, Parker J, Ellis S, Kanj M, Farwati M, Menon V, Callahan T, Baranowski B, Nakhla S, Taigen T, Santangeli P, Kewan T, Cantillon D, Sroubek J, Rickard J, Zmaili M, Bhargava M, Saliba WI, Nakagawa H, Hussein AA. Ischemic or Coronary Evaluations in Patients With Monomorphic VT Electrical Storm Undergoing VT Ablation. JACC Clin Electrophysiol 2023; 9:1890-1899. [PMID: 37542488 DOI: 10.1016/j.jacep.2023.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Monomorphic ventricular tachycardia (VT) electrical storm (ES) in patients with coronary artery disease is dependent on scarred myocardium. The role of routine ischemic or coronary evaluations before ablation in patients presenting with monomorphic VT storm, without acute coronary syndrome (ACS), remains unknown. OBJECTIVES This study sought to assess the impact of ischemic or coronary evaluations on procedural outcomes and post-ablation mortality in monomorphic VT storm patients. METHODS All patients undergoing VT ablation at the Cleveland Clinic from 2014 to 2020 after presenting with monomorphic VT storm were enrolled in a prospectively maintained registry. The associations among ischemic or coronary evaluations and short-term procedural efficacy, acute outcomes, and mortality during follow-up were assessed. RESULTS A total of 97 consecutive patients with monomorphic VT storm in the absence of ACS underwent VT ablations. This cohort was characterized by severe LV systolic dysfunction (mean left ventricular ejection fraction 30.3%, 67% with known ischemic cardiomyopathy) with moderately severe heart failure (median NYHA functional class II); 45% of patients underwent ischemic or coronary evaluations via coronary angiography (10%), noninvasive myocardial perfusion (26%), or both (9%). The yield of these evaluations was low: No acute coronary occlusions were identified. There was no association between ischemic evaluation and acute ablation outcomes or mortality during follow-up. Similarly, in a secondary analysis, the yield of ischemic or coronary evaluations in patients with monomorphic VT storm and known coronary disease (regardless of ablation status) was found to be low. CONCLUSIONS Ischemic evaluations in patients with monomorphic VT storm without ACS may not improve procedural outcomes or mortality after ablation.
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Affiliation(s)
- Feras Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan Kiang
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Parker
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Ellis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Venugopal Menon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tariq Kewan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Cantillon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohammad Zmaili
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Tabaja C, Younis A, Hussein AA, Taigen TL, Nakagawa H, Saliba WI, Sroubek J, Santangeli P, Wazni OM. Catheter-Based Electroporation: A Novel Technique for Catheter Ablation of Cardiac Arrhythmias. JACC Clin Electrophysiol 2023; 9:2008-2023. [PMID: 37354168 DOI: 10.1016/j.jacep.2023.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/26/2023]
Abstract
Catheter ablation of arrhythmias is now standard of care in invasive electrophysiology. Current ablation strategies are based on the use of thermal energy. With continuous efforts to optimize thermal energy delivery, effectiveness has greatly improved; however, safety concerns persist. This review focuses on a novel ablation technology, irreversible electroporation (IRE), also known as pulsed-field ablation which may be a safer alternative for arrhythmia management. Pulsed-field ablation is thought to be a nonthermal ablation that applies short-duration high-voltage electrical fields to ablate myocardial tissue with high selectivity and durability while sparing important neighboring structures such as the esophagus and phrenic nerves. There are multiple ongoing studies investigating the potential superior outcomes of IRE compared to radiofrequency ablation in treating patients with atrial and ventricular arrhythmias. In this review, we describe the current evidence of preclinical and clinical trials that have shown promising results of catheter-based IRE.
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Affiliation(s)
- Chadi Tabaja
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler L Taigen
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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Sroubek J, Vajapey R, Sipko JJ, Soltesz EG, Weiss AJ, Bhargava M, Hussein AA, Kanj M, Saliba WI, Taigen TL, Wazni OM, Santangeli P. First-in-Human Experience With Impella 5.0/5.5 for High-Risk Patients With Advanced Heart Failure Undergoing VT Ablation. J Am Coll Cardiol 2023; 82:469-471. [PMID: 37495284 DOI: 10.1016/j.jacc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/28/2023]
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Saliba WI, Kawai K, Sato Y, Kopesky E, Cheng Q, Ghosh SKB, Herbst TJ, Kawakami R, Konishi T, Virmani R, Jaber WA, Gibson DN, Shah M, Natale A, Gibson M, Holmes DR, Finn AV. Enhanced Thromboresistance and Endothelialization of a Novel Fluoropolymer-Coated Left Atrial Appendage Closure Device. JACC Clin Electrophysiol 2023; 9:1555-1567. [PMID: 37204356 DOI: 10.1016/j.jacep.2023.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/04/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) procedures is a rare but potentially serious event. Thrombogenicity and delayed endothelialization play a role in the development of DRT. Fluorinated polymers are known to have thromboresistant properties that may favorably modulate the healing response to an LAAC device. OBJECTIVES The goal of this study was to compare the thrombogenicity and endothelial coverage (EC) after LAAC between the conventional uncoated WATCHMAN FLX (WM) and a novel fluoropolymer-coated WATCHMAN FLX (FP-WM). METHODS Canines were randomized for implantation with WM or FP-WM devices and given no postimplant antithrombotic/antiplatelet agents. The presence of DRT was monitored by using transesophageal echocardiography and verified histologically. The biochemical mechanisms associated with coating were assessed by using flow loop experiments to quantify albumin adsorption, platelet adhesion, and porcine implants to quantify EC and the expression of markers of endothelial maturation (ie, vascular endothelial-cadherin/p120-catenin). RESULTS Canines implanted with FP-WM exhibited significantly less DRT at 45 days than those implanted with WM (0% vs 50%; P < 0.05). In vitro experiments showed significantly greater albumin adsorption (52.8 [IQR: 41.0-58.3] mm2 vs 20.6 [IQR: 17.2-26.6] mm2; P = 0.03) and significantly less platelet adhesion (44.7% [IQR: 27.2%-60.2%] vs 60.9% [IQR: 39.9%-70.1%]; P < 0.01) on FP-WM. Porcine implants showed significantly greater EC by scanning electron microscopy (87.7% [IQR: 83.4%-92.3%] vs 68.2% [IQR: 47.6%-72.8%]; P = 0.03), and higher vascular endothelial-cadherin/p120-catenin expression after 3 months on FP-WM compared with WM. CONCLUSIONS The FP-WM device showed significantly less thrombus and reduced inflammation in a challenging canine model. Mechanistic studies indicated that the fluoropolymer-coated device binds more albumin, leading to reduced platelet binding, less inflammation, and greater EC.
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Affiliation(s)
- Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenji Kawai
- CVPath Institute, Gaithersburg, Maryland, USA
| | - Yu Sato
- CVPath Institute, Gaithersburg, Maryland, USA
| | - Edward Kopesky
- Boston Scientific Corporation, Maple Grove, Minnesota, USA
| | - Qi Cheng
- CVPath Institute, Gaithersburg, Maryland, USA
| | | | | | | | | | | | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas N Gibson
- Prebys Cardiovascular Institute, Scripps Clinic, San Diego, California, USA
| | - Manish Shah
- Department of Medicine, MedStar Georgetown Washington Hospital Center, Washington, DC
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Gibson
- Department of Medicine, Beth Israel Medical Center, Boston, Massachusetts, USA
| | - David R Holmes
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, Maryland, USA; University of Maryland, School of Medicine, Baltimore, Maryland, USA.
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12
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Tabaja C, Younis A, Santageli P, Farwati M, Braghieri L, Nakagawa H, Saliba WI, Madden R, Bouscher P, Kanj M, Callahan TD, Martin D, Bhargava M, Chung M, Baranowski B, Nakhla S, Sroubek J, Lee J, Taigen T, Wazni OM, Hussein AA. Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life. J Cardiovasc Electrophysiol 2023; 34:1648-1657. [PMID: 37493505 PMCID: PMC11078572 DOI: 10.1111/jce.15987] [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: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). METHODS All consecutive patients undergoing AF ablation (2013-2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter. RESULTS A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio, 1.30; confidence interval, 1.06-1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5-16) versus 15 (10-21). In all groups, CA resulted in a significant improvement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups. CONCLUSION AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santageli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Bouscher
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Johnson BM, Wazni OM, Farwati M, Saliba WI, Santangeli P, Madden R, Bouscher P, Chung M, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Sroubek J, Nakagawa H, Hussein AA. Atrial Fibrillation Ablation in Young Adults: Measuring Quality of Life Using Patient-Reported Outcomes Over 5 Years. Circ Arrhythm Electrophysiol 2023; 16:e011565. [PMID: 37183675 PMCID: PMC11093280 DOI: 10.1161/circep.122.011565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Ablation is used for both rhythm control and improved quality of life (QoL) in atrial fibrillation (AF). It has been suggested that young adults may experience high recurrence rates after ablation and data remain lacking regarding QoL benefits. We aimed to investigate AF ablation outcomes and QoL benefits in young adults undergoing AF ablation using a large prospectively maintained registry and automated patient-reported outcomes (PRO). METHODS All patients undergoing AF ablation (2013-2016) at our center were prospectively enrolled. Patients aged 50 years or younger were included. For PROs, QoL measures and symptoms were assessed at baseline, 3 months after ablation, and every 6 months thereafter. The AF severity score served as the main assessment of QoL. RESULTS A total of 241 young adults (age, 16-50 years) were included (17% female, 40.3% persistent AF). In all, 77.2% of patients remained arrhythmia-free during the first year of follow-up (80% in nonstructural AF and 66% in structural AF). Using PROs, 90% of patients reported improvement in QoL throughout all survey time points up to 5 years postablation (P<0.0001). The baseline median AF severity score was 14 and improved to between 2 and 4 on all follow-up after ablation (P<0.0001). Patients also reported fewer and shorter AF episodes, fewer emergency room visits secondary to AF, and fewer hospitalizations (P<0.0001). CONCLUSIONS Ablation remains an effective rhythm-control strategy in young adults with AF. Young adults also experience significant improvement in QoL with reduction of the frequency and duration of AF episodes and AF-related healthcare utilization.
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Affiliation(s)
- Brett M Johnson
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Patricia Bouscher
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | | | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
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Wang TKM, Liao BYW, Chan N, Cremer P, Baranowski B, Kanj MH, Saliba WI, Wazni OM, Jaber WA. IMPACT AND ASSOCIATED FACTORS ON MITRAL REGURGITATION SEVERITY IN ATRIAL FIBRILLATION PATIENTS AFTER CATHETER PULMONARY VEIN ISOLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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15
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Farwati M, Amin M, Saliba WI, Nakagawa H, Tarakji KG, Diab M, Scandinaro A, Madden R, Bouscher P, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Sroubek J, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Wazni OM, Hussein AA. Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life. J Cardiovasc Electrophysiol 2023; 34:54-61. [PMID: 36259719 DOI: 10.1111/jce.15710] [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: 05/18/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry. METHODS All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations. RESULTS A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow-up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p < .0001 for all variables). CONCLUSION Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.
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Affiliation(s)
- Medhat Farwati
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mohamed Diab
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna Scandinaro
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Madden
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Bouscher
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shunsuke Kuroda
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas J Dresing
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Patrick J Tchou
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Nakagawa H, Ikeda A, Yokoyama K, An Y, Hussein AA, Saliba WI, Wazni OM, Castellvi Q. Improvement in Lesion Formation with Radiofrequency Energy and Utilization of Alternate Energy Sources (Cryoablation and Pulsed Field Ablation) for Ventricular Arrhythmia Ablation. Card Electrophysiol Clin 2022; 14:757-767. [PMID: 36396191 DOI: 10.1016/j.ccep.2022.08.003] [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] [Indexed: 06/16/2023]
Abstract
Current ablation systems rely on thermal energy to produce ablation lesions (heating: RF, laser and ultrasound, and cooling: cryo-thermia). While thermal ablation has been proven to be effective, there are several limitations: 1) relatively long procedural times; 2) high recurrence rate of ventricular arrhythmias; and 3) excessive heating potentially leading to serious complications, including steam pop (perforation), coronary arterial injury and thrombo-embolism. Pulsed field ablation (PFA)/irreversible electroporation (IRE) offers a unique non-thermal ablation strategy which has the potential to overcome these limitations. Recent pre-clinical studies suggest that PFA/IRE might be effective and safe for the treatment of cardiac arrhythmias.
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Affiliation(s)
- Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Atsushi Ikeda
- Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuaki Yokoyama
- Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshimori An
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Quim Castellvi
- Department of Information and Communications Technologies, Pompeu Fabra University, Barcelona, Spain
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Abdelfattah OM, Sayed A, Munir M, Almotawally S, Wilson K, Gad MM, Abushouk AI, Elsayed M, Wazni OM, Saliba WI, Elgendy IY, Jneid H, Kapadia S. Meta-Analysis Comparing Left Atrial Appendage Occlusion, Direct Oral Anticoagulants, and Warfarin for Nonvalvular Atrial Fibrillation. Am J Cardiol 2022. [DOI: 10.1016/j.amjcard.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Aguilera J, Hutt E, Kaur S, Saliba WI, Tarakji KG, Baranowski B, Bhargava M, Kanj M, Cantillon DJ, Rickard J, Sroubek J, Nakagawa H, Wazni OM, Hussein AA. Outcomes of atrial fibrillation ablation in patients with or without silent pulmonary veins from prior ablation procedure. J Cardiovasc Electrophysiol 2022; 33:1994-2000. [PMID: 35689504 DOI: 10.1111/jce.15592] [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: 03/15/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pulmonary venous (PV) electrical recovery underlies most arrhythmia recurrences after atrial fibrillation (AF) ablation. Little is known about procedural profiles and outcomes of patients with electrically silent PVs upon redo ablation for AF. METHODS In a prospectively maintained registry, we enrolled 838 consecutive patients (2013-2016) undergoing redo ablation procedures. Ablation procedures targeted the PVs, the PV antra, and non-PV sites at operators' discretion. Procedural profiles and clinical outcomes were assessed. The primary outcome was freedom from AF after a 3-month blanking period. The secondary outcome was improvement in quality of life. RESULTS Most patients undergoing redo AF ablation (n = 684, 82%) had PV reconnection while the remaining 154 (18%) had electrically silent PVs. Patients with recurrent AF and electrically silent PVs were older (66 vs. 64 years, p = .02), had more prior ablation procedures (median 2 IQR 1-3 vs 1 IQR 1-2 p = .001), were more likely to have non-paroxysmal AF (62% vs. 49%, p = .004) and atrial flutter (48% vs. 29%, p = .001) and had significantly larger left atrial volumes (89 vs. 81 ml, p = .003). Patients with silent PVs underwent a more extensive non-PV ablation strategies with antral extension of prior ablation sets in addition to ablation of the roof, appendage, inferior to the right PVs, peri-mitral flutter lines, cavotricuspid isthmus lines and ablation in the coronary sinus. Upon one year of follow-up, patients with electrically silent PVs were less likely to remain free from recurrent atrial arrhythmias (64% vs. 76%, p = .008). Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. CONCLUSION Rhythm control with extensive ablation allowed maintenance of sinus rhythm in about two thirds of patients with silent PVs during redo AF ablation procedures. Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. This remains a challenging group of patients, highlighting the need to better understand non-PV mediated AF.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erika Hutt
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
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Aguilera J, Cantillon DJ, Kiang A, Hutt E, Madden RA, Bouscher P, Kanj M, Saliba WI, Rickard J, Callahan TD, Chung MK, Baranowski B, Dresing TJ, Nakhla S, Wazni OM, Hussein AA, Taigen TL. PO-649-07 SAFETY OF SAME-DAY DISCHARGE AFTER PULMONARY VEIN ISOLATION: CONTEMPORARY SINGLE CENTER EXPERIENCE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abdelfattah O, Elsayed M, sayed A, Prasad R, Barakat AF, Elgendy I, Andrade JG, Bunch TJ, Thosani AJ, Saliba WI, Nakagawa H, Wazni OM, Hussein AA. PO-711-07 NETWORK META-ANALYSIS OF OPTIMAL INITIAL ATRIAL FIBRILLATION THERAPIES: CRYOABLATION, RADIOFREQUENCY ABLATION, AND ANTI-ARRHYTHMIC DRUGS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nakagawa H, Castellvi Q, Neal RE, Girouard S, An Y, Hussein AA, Saliba WI, Wazni OM. PO-710-03 TEMPORAL AND SPATIAL EVOLUTION OF REVERSIBLE AND IRREVERSIBLE VENTRICULAR LESION BOUNDARIES PRODUCED BY PULSED ELECTRIC FIELD ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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alkhalaileh F, Wazni OM, Farwati M, William AD, Kanj M, Zmaili M, Saliba WI, Nakagawa H, Hussein AA. PO-651-05 ISCHEMIC EVALUATIONS IN PATIENTS PRESENTING WITH MONOMORPHIC VENTRICULAR TACHYCARDIA ELECTRICAL STORM. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nakagawa H, Castellvi Q, Neal RE, Girouard S, An Y, Hussein AA, Saliba WI, Wazni OM. PO-710-06 ASSESSMENT OF LESION DURABILITY PRODUCED BY PULSED ELECTRIC FIELD ABLATION: EVALUATION IN A SWINE ATRIAL LINEAR LESION MODEL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parker J, Bennett AJ, Incognito C, Gangidi SR, Hedley J, Tarakji KG, Saliba WI, Nakagawa H, Wazni OM, Hussein AA. PO-700-05 USE OF MECHANICAL CIRCULATORY SUPPORT IN ELECTRICAL STORM. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Farwati M, Amin M, Nakagawa H, Saliba WI, Tarakji KG, Diab M, Zmaili M, alkhalaileh F, Madden RA, Bouscher P, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Wazni OM, Hussein AA. PO-650-07 CRYOBALLOON VERSUS RADIOFREQUENCY ABLATION FOR ATRIAL FIBRILLATION: ASSESSMENT OF QUALITY OF LIFE AND CLINICAL OUTCOMES USING PATIENT-REPORTED OUTCOMES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Younis A, Yavin HD, Higuchi K, Zilberman I, Sroubek J, Tchou P, Bubar ZP, Barkagan M, Leshem E, Shapira-Daniels A, Kanj M, Cantillon DJ, Hussein AA, Tarakji KG, Saliba WI, Koruth JS, Anter E. Increasing Lesion Dimensions of Bipolar Ablation by Modulating the Surface Area of the Return Electrode. JACC Clin Electrophysiol 2022; 8:498-510. [PMID: 35450605 DOI: 10.1016/j.jacep.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/21/2021] [Accepted: 01/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to examine the effect of the return electrode's surface area on bipolar RFA lesion size. BACKGROUND Bipolar radiofrequency ablation (RFA) is typically performed between 2 3.5-mm tip catheters serving as active and return electrodes. We hypothesized that increasing the surface area of the return electrode would increase lesion dimensions by reducing the circuit impedance, thus increasing the current into a larger tissue volume enclosed between the electrodes. METHODS In step 1, ex vivo bipolar RFA was performed between 3.5-mm and custom-made return electrodes with increasing surface areas (20, 80, 180 mm2). In step 2, ex vivo bipolar RFA was performed between 3.5-mm and 3.5-mm or 8-mm electrode catheters positioned perpendicular or parallel to the tissue. In step 3, in vivo bipolar RFA was performed between 3.5-mm and either 3.5-mm or 8-mm parallel electrode at the: 1) left ventricular summit; 2) interventricular septum; and 3) healed anterior infarction. RESULTS In step 1, increasing the surface area of the return electrode resulted in lower circuit impedance (R = -0.65; P < 0.001), higher current (R = +0.80; P < 0.001), and larger lesion volume (R = +0.88; P < 0.001). In step 2, an 8-mm return electrode parallel to tissue produced larger and deeper lesions compared with a 3.5-mm return electrode (P = 0.014 and P = 0.02). Similarly, in step 3, compared with a 3.5-mm, bipolar RFA with an 8-mm return electrode produced larger (volume: 1,525 ± 871 mm3 vs 306 ± 310 mm3, respectively; P < 0.001) and more transmural lesions (88% vs 0%; P < 0.001). CONCLUSIONS Bipolar RFA using an 8-mm return electrode positioned parallel to the tissue produces larger lesions in comparison with a 3.5-mm return electrode.
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Affiliation(s)
- Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, USA
| | - Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, USA
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Israel Zilberman
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Tchou
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary P Bubar
- Biosense Webster of Johnson and Johnson, Irvine, California, USA
| | - Michael Barkagan
- Cardiac Electrophysiology Section, Assaf Harofeh Hospital, Be'er Ya'akov, Israel
| | - Eran Leshem
- Davidai Arrhythmia Center, Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | | | - Mohamad Kanj
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, USA.
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Frankel DS, Dechert-Crooks BE, Campbell K, DeSimone CV, Etheridge S, Harvey M, Lampert R, Nayak HM, Saliba WI, Shea J, Thomas J, Zado E, Daubert JP. 2021 HRS Educational Framework for Clinical Cardiac Electrophysiology. Heart Rhythm O2 2022; 3:120-132. [PMID: 35496459 PMCID: PMC9043382 DOI: 10.1016/j.hroo.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Elsayed M, Abdelfattah OM, Sayed A, Prasad RM, Barakat AF, Elgendy IY, Andrade J, Jared Bunch T, Thosani A, Saliba WI, Wazni OM, Hussein AA. Bayesian network meta-analysis comparing cryoablation, radiofrequency ablation, and antiarrhythmic drugs as initial therapies for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:197-208. [PMID: 34855270 DOI: 10.1111/jce.15308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) and catheter ablation are first line treatments of paroxysmal atrial fibrillation (PAF), however, there exists a paucity of data regarding the potential benefit of different catheter ablation technologies versus AADs as an early rhythm strategy. OBJECTIVE To assess the safety and efficacy of cryoablation versus radiofrequency ablation (RFA) versus AADs as a first line therapy of PAF. METHODS MEDLINE, Embase, Scopus and CENTRAL were searched to retrieve randomized clinical trials (RCTs) comparing cryoablation, RFA or AADs to one another as first line therapies for atrial fibrillation (AF). The primary outcome was overall freedom from arrhythmia recurrence (AF, atrial flutter [AFL], atrial tachycardia). Secondary outcomes included freedom from symptomatic arrhythmia recurrence, hospitalization, and serious adverse events. A random-effects Bayesian network meta-analysis was used to calculate odds ratios (OR) and 95% credible intervals (CrI). RESULTS Six RCTs (N = 1212) met the inclusion criteria (605 AADs, 365 Cryoablation, and 245 RFA). Compared with AADs, overall recurrence was reduced with RFA (OR: 0.31; 95% CrI: 0.10-0.71) and cryoablation (OR: 0.39; 95% CrI: 0.16-1.00). Comparing ablation (cryoablation and RFA) with AADs in respect to freedom from symptomatic AF recurrence, neither cryoablation (OR: 0.35; 95% CrI: 0.06-1.96) nor RFA (OR: 0.34; 95% CrI: 0.07-1.27) resulted in statistically significant reductions individually compared to AADs, though pooled ablation with both technologies showed lower odds of arrhythmia recurrence (OR: 0.35; 95% CrI: 0.13-0.79). In terms of serious adverse events rates, neither cryoablation (OR: 0.77; 95% CrI: 0.44-1.39) nor RFA (OR: 1.45; 95% CrI: 0.67-3.23) were significantly different to AADs. RFA resulted in a statistically significant reduction in hospitalizations compared to AAD (OR: 0.08; 95% CrI: 0.01-0.99), whereas cryoablation did not (OR: 0.77; 95% CrI: 0.44-1.39). The surface under the cumulative ranking curve showed RFA to be the most effective treatment at reducing overall rates of recurrence, symptomatic recurrence and hospitalizations; whereas cryoablation was most likely to reduce serious adverse events. CONCLUSION Cryoablation and RFA are both effective and safe first line therapies for AF compared to AADs, with RFA being the most effective at reducing recurrences.
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Affiliation(s)
- Mahmoud Elsayed
- Department of Cardiovascular Medicine, Cardiovascular Institute at Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Omar M Abdelfattah
- Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmed Sayed
- Department of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rohan Madhu Prasad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Amr F Barakat
- Division of Cardiovascular Disease, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Jason Andrade
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Jared Bunch
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amit Thosani
- Division of Cardiac Electrophysiology, Department of Cardiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Yavin HD, Bubar ZP, Higuchi K, Sroubek J, Kanj M, Cantillon D, Saliba WI, Tarakji KG, Hussein AA, Wazni O, Anter E. Impact of High-Power Short-Duration Radiofrequency Ablation on Esophageal Temperature Dynamic. Circ Arrhythm Electrophysiol 2021; 14:e010205. [PMID: 34706551 DOI: 10.1161/circep.121.010205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies. METHODS In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8-10 s) and MP-MD (25 W, 15-20 s) between adjacent applications (distance, ≤4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury. RESULTS In 20 patients (68.9±5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 °C [1.4-3] versus 2.0 °C [1.5-3]; P=0.22), maximal temperature (38.4 °C [37.8-39.3] versus 38.5 °C [37.9-39.4]; P=0.17), time to maximal temperature (24.9±7.5 versus 26.3±6.8 s; P=0.1), and time of temperature to return to baseline (110±23.2 versus 111±25.1 s; P=0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies. CONCLUSIONS Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications.
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Affiliation(s)
- Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.).,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, OH (H.D.Y., Z.P.B., K.H., J.S., E.A.)
| | - Zachary P Bubar
- Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, OH (H.D.Y., Z.P.B., K.H., J.S., E.A.).,Biosense Webster of Johnson & Johnson, Irvine, CA (Z.P.B.)
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.).,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, OH (H.D.Y., Z.P.B., K.H., J.S., E.A.)
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.).,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, OH (H.D.Y., Z.P.B., K.H., J.S., E.A.)
| | - Mohamed Kanj
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Daniel Cantillon
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Walid I Saliba
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Khaldoun G Tarakji
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Ayman A Hussein
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Oussama Wazni
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.)
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.).,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Lerner Research Institute, OH (H.D.Y., Z.P.B., K.H., J.S., E.A.)
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Matta M, Ayoub C, Abou Hassan OK, Layoun H, Cremer PC, Hussein A, Schoenhagen P, Saliba WI, Rodriguez LL, Griffin BP, Kapadia SR, Harb SC. Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1943765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Zmaili M, Alkhayyat M, Alzubi J, Farwati M, Alkhodari T, Saliba WI, Tarakji KG, Nakagawa H, Anter E, Wazni OM, Hussein AA. B-PO01-086 PHARMACOLOGICAL THERAPIES AND DEVICE IMPLANTATION IN CARDIAC SARCOIDOSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harwood S, Sun H, Youn Wass S, Axtell A, LeMaitre V, Nkashama L, Roach T, Lin C, McHale M, Cantlay C, Wilner B, Rajesh Patel D, Cantillon DJ, Wazni OM, Tarakji KG, Louis Taigen T, Saliba WI, Kanj M, Hussein AA, Rickard J, Barnard J, Chung MK. B-PO05-201 IMMEDIATE RECURRENCE OF ATRIAL FIBRILLATION AS A PREDICTOR OF LONG TERM ATRIAL FIBRILLATION RECURRENCE FOLLOWING DIRECT CURRENT CARDIOVERSION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Donnellan E, Wazni OM, Saliba WI, Patel DR, Hedley J, Nemer DM, Anter E, Wilner B, Cantillon DJ, Jaber WA. B-PO03-146 MAJOR BLEEDING IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS AND ATRIAL FIBRILLATION AND IMPLICATIONS FOR SUBSEQUENT CEREBROVASCULAR EVENTS AND MORTALITY: A PROPENSITY MATCHED ANALYSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Anter E, Yavin H, Higuchi K, Biton D, Sroubek J, Saliba WI. B-PO05-088 SINGLE-SHOT LATTICE TIP CATHETER FOR PULMONARY VEIN ISOLATION WITH PULSED FIELD ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nakagawa H, Yamazaki M, Tomii N, Seno H, Kuroda S, Basu S, Bar-tal M, Takamiya N, Malinaric JL, Tsukihra H, Hussein AA, Saliba WI, Wazni OM, Sakuma I, Jackman WM. B-PO05-081 SIMULTANEOUS ULTRA-HIGH RESOLUTION OPTICAL MAPPING AND CATHETER MAPPING IN A LANGENDORFF-PERFUSED SWINE HEART MODEL TO IDENTIFY ATRIAL FIBRILLATION ROTORS BY CATHETER MAPPING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nakagawa H, Castellvi Q, Neal R, Girouard S, Ikeda A, Kuroda S, Hussein AA, Saliba WI, Wazni OM. B-PO03-131 EFFECTS OF CONTACT FORCE ON LESION SIZE DURING PULSED FIELD ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yavin H, Kanj M, Cantillon DJ, Wazni OM, Saliba WI, Tarakji KG, Hussein AA, Sroubek J, Biton D, Nakagawa H, Higuchi K, Bubar Z, Anter E. B-PO01-054 IMPACT OF HIGH-POWER SHORT-DURATION RADIOFREQUENCY ABLATION ON ESOPHAGEAL THERMODYNAMICS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuroda S, Wazni OM, Saliba WI, Tarakji KG, Baranowski B, Tchou PJ, Dresing TJ, Bhargava M, Cantillon DJ, Taigen TL, Sroubek J, Chung MK, Varma N, Callahan TD, Rickard J, Nakagawa H, Anter E, Hussein AA. B-PO04-082 ELECTROPHYSIOLOGICAL FINDINGS UNDERLYING RECURRENT ATRIAL TACHYARRHYTHMIAS AFTER SURGICAL ATRIAL FIBRILLATION ABLATION IN THE ERA OF HIGH DENSITY MAPPING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Donnellan E, Wazni OM, Saliba WI, Rajesh Patel D, Hedley J, Higuchi K, Anter E, Hanna M, Jaber WA. B-PO02-149 INCIDENCE, PREDICTORS, AND NATURAL HISTORY OF LEFT ATRIAL APPENDAGE THROMBI IN TRANSTHYRETIN CARDIAC AMYLOIDOSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakagawa H, Kuroda S, Govari A, Beeckler CT, Gliner V, Zliberman I, Keyes JT, Herrera K, Ikeda A, Hussein AA, Saliba WI, Wazni OM, Jackman WM. B-PO04-081 IMPROVED ACCURACY OF COMPLEX ATRIAL MAPPING USING CLOSE-UNIPOLAR ELECTROGRAMS IN A NOVEL ULTRA-HIGH RESOLUTION CATHETER MAPPING SYSTEM. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kochar AS, Donnellan E, Vincenzo LD, Wazni OM, Tanaka-Esposito C, Saliba WI, Baranowski B, Dresing TJ, Tchou PJ, Chung R. B-PO05-050 OUTCOMES OF HIS BUNDLE VS LEFT BUNDLE BRANCH PACING FOLLOWING AV NODE ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kuroda S, Wazni OM, Saliba WI, Tarakji KG, Baranowski B, Tchou PJ, Dresing TJ, Bhargava M, Cantillon DJ, Taigen TL, Sroubek J, Chung MK, Varma N, Callahan TD, Rickard J, Nakagawa H, Anter E, Hussein A. B-PO02-107 INDICES OF CONTACT FORCE GUIDED CATHETER ABLATION AND PULMONARY VEIN RECONNECTION DURING REPEAT ATRIAL FIBRILLATION ABLATION PROCEDURES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Farwati M, Wazni OM, Tarakji KG, Diab M, Scandinaro A, Amin M, Zmaili M, Bazarbashi N, Dikilitas O, Nakagawa H, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Saliba WI, Hussein AA. Super and Nonresponders to Catheter Ablation for Atrial Fibrillation: A Quality-of-Life Assessment Using Patient Reported Outcomes. Circ Arrhythm Electrophysiol 2021; 14:e009938. [PMID: 34279998 DOI: 10.1161/circep.121.009938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Medhat Farwati
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Oussama M Wazni
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mohamed Diab
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Anna Scandinaro
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mustapha Amin
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mohammad Zmaili
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Najdat Bazarbashi
- Department of Internal Medicine, University of Maryland, Baltimore (N.B.)
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.D.)
| | - Hiroshi Nakagawa
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Shunsuke Kuroda
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | | | - Thomas J Dresing
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Thomas D Callahan
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mandeep Bhargava
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Bryan Baranowski
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - John Rickard
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Daniel J Cantillon
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Patrick J Tchou
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Walid I Saliba
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Ayman A Hussein
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
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Kuroda S, Wazni OM, Saliba WI, Hilow H, Baranowski B, Tarakji KG, Higuchi K, Tchou P, Dresing T, Lopez JO, Bhargava M, Cantillon DJ, Callahan T, Rickard J, Nakagawa H, Anter E, Hussein AA. The utility of a novel mapping algorithm utilizing vectors and global pattern of propagation for scar-related atrial tachycardias. J Cardiovasc Electrophysiol 2021; 32:1909-1917. [PMID: 33955116 DOI: 10.1111/jce.15074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/15/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Activation maps of scar-related atrial tachycardias (AT) can be challenging to interpret due to difficulty in inaccurate annotation of electrograms, and an arbitrarily predefined mapping window. A novel mapping software integrating vector data and applying an algorithmic solution taking into consideration global activation pattern has been recently described (Coherent™, Biosense Webster "Investigational"). OBJECTIVE We aimed to assess the investigational algorithm to determine the mechanism of AT compared with the standard algorithm. METHODS This study included patients who underwent ablation of scar-related AT using the Carto 3 and the standard activation algorithm. The mapping data were analyzed retrospectively using the investigational algorithm, and the mechanisms were evaluated by two independent electrophysiologists. RESULTS A total of 77 scar-related AT activation maps were analyzed (89.6% left atrium, median tachycardia cycle length of 273 ms). Of those, 67 cases with a confirmed mechanism of arrhythmia were used to compare the activation software. The actual mechanism of the arrhythmia was more likely to be identified with the investigational algorithm (67.2% vs. 44.8%, p = .009). In five patients with dual-loop circuits, 3/5 (60%) were correctly identified by the investigational algorithm compared to 0/5 (0%) with the standard software. The reduced atrial voltage was prone to lead to less capable identification of mechanism (p for trend: .05). The investigational algorithm showed higher inter-reviewer agreement (Cohen's kappa .62 vs. .47). CONCLUSIONS In patients with scar-related ATs, activation mapping algorithms integrating vector data and "best-fit" propagation solution may help in identifying the mechanism and the successful site of termination.
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Affiliation(s)
- Shunsuke Kuroda
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Henry Hilow
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John O Lopez
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elad Anter
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Anic A, Lever N, Martin A, Breskovic T, Sulkin MS, Duffy E, Saliba WI, Niebauer MJ, Wazni OM, Varma N. Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience. Europace 2021; 23:1237-1243. [PMID: 33729470 PMCID: PMC8350865 DOI: 10.1093/europace/euab018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (PVI) is a safe and effective treatment for atrial fibrillation (AF). Current limitations include incomplete vein occlusion due to balloon rigidity and inconsistent electrogram recording, which impairs identification of isolation. We aimed to evaluate the acute safety and performance of a novel cryoballoon system. METHODS AND RESULTS The system includes a steerable sheath, mapping catheter, and a balloon that maintains uniform inflation pressure and size following initiation of ablation. Protocol-directed cryoablation was delivered for 180 s for isolation documented in ≤60 s, otherwise freeze duration was 240 s. Primary endpoints were acute safety and vein isolation. Pulmonary vein isolation was confirmed at ≥30 min post-isolation. Data were compared across vein locations. Thirty patients with paroxysmal AF were enrolled at two centres and underwent PVI. Pulmonary vein isolation was achieved with cryoablation only in 100% of veins (120/120). Nadir temperature was -53.1 ± 5.3°C. The number of applications to achieve PVI was 1.4 ± 0.4 per vein. Of the 120 veins, 89 were isolated with a single cryothermal application (10/30 patients required only 4 total cryoablations). There were no procedural- or device-related serious adverse events at 30 days post-procedure. A subset (24/30) of patients was followed for 1-year and 71% (17/24) remained free of atrial arrhythmias. Six patients with arrhythmia recurrence were remapped and three had durable PVI for all four veins. CONCLUSION In this first human experience, the novel cryoballoon platform was safe, efficacious, and demonstrated a high proportion of successful single ablation isolation.
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Affiliation(s)
- Ante Anic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | - Nigel Lever
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Martin
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Toni Breskovic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | | | - Elizabeth Duffy
- Electrophysiology, Boston Scientific Corp., St. Paul, MN, USA
| | - Walid I Saliba
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Mark J Niebauer
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Oussama M Wazni
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Niraj Varma
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
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Nazir S, Ahuja KR, Kolte D, Isogai T, Michihata N, Saad AM, Ramanathan PK, Krishnaswamy A, Wazni OM, Saliba WI, Gupta R, Kapadia SR. Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2021; 14:554-561. [PMID: 33663783 DOI: 10.1016/j.jcin.2020.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/28/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes. BACKGROUND Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown. METHODS Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. RESULTS This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003). CONCLUSIONS Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
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Affiliation(s)
- Salik Nazir
- Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Keerat Rai Ahuja
- Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Toshiaki Isogai
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nobuaki Michihata
- Department of Health Services Research, University of Tokyo, Tokyo, Japan
| | - Anas M Saad
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Amar Krishnaswamy
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rajesh Gupta
- Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Samir R Kapadia
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Donnellan E, Wazni OM, Kanj M, Baranowski B, Cremer P, Harb S, McCarthy CP, McEvoy JW, Elshazly MB, Aagaard P, Tarakji KG, Jaber WA, Schauer PR, Saliba WI. Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation. Europace 2020; 21:1476-1483. [PMID: 31304532 DOI: 10.1093/europace/euz183] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. METHODS AND RESULTS In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05-0.39; P = 0.002). CONCLUSION Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John W McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip Aagaard
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip R Schauer
- Department of Bariatric Surgery, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
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Donnellan E, Wazni OM, Harb S, Kanj M, Saliba WI, Jaber WA. Higher baseline cardiorespiratory fitness is associated with lower arrhythmia recurrence and death after atrial fibrillation ablation. Heart Rhythm 2020; 17:1687-1693. [DOI: 10.1016/j.hrthm.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/07/2023]
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Mandsager KT, Phelan DM, Diab M, Baranowski B, Saliba WI, Tarakji KG, Jaber WA, Kanj M, Tchou P, Lindsay BD, Wazni OM, Hussein AA. Outcomes of Pulmonary Vein Isolation in Athletes. JACC Clin Electrophysiol 2020; 6:1265-1274. [DOI: 10.1016/j.jacep.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
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Ouyang Z, Schoenhagen P, Wazni O, Tchou P, Saliba WI, Suh JH, Xia P. Analysis of cardiac motion without respiratory motion for cardiac stereotactic body radiation therapy. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32918386 PMCID: PMC7592981 DOI: 10.1002/acm2.13002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/31/2020] [Revised: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose/objective(s) To study the heart motion using cardiac gated computed tomographies (CGCT) to provide guidance on treatment planning margins during cardiac stereotactic body radiation therapy (SBRT). Materials/methods Ten patients were selected for this study, who received CGCT scans that were acquired with intravenous contrast under a voluntary breath‐hold using a dual source CT scanner. For each patient, CGCT images were reconstructed in multiple phases (10%–90%) of the cardiac cycle and the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), ostia of the right coronary artery (O‐RCA), left coronary artery (O‐LCA), and left anterior descending artery (LAD) were contoured at each phase. For these contours, the centroid displacements from their corresponding average positions were measured at each phase in the superior–inferior (SI), medial–lateral (ML), and anterior–posterior (AP). The average volumes as well as the maximum to minimum ratios were analyzed for the LV and RV. Results For the six contoured substructures, more than 90% of the measured displacements were <5 mm. For these patients, the average volumes ranged from 191.25 to 429.51 cc for LV and from 91.76 to 286.88 cc for RV. For each patient, the ratios of maximum to minimum volumes within a cardiac cycle ranged from 1.15 to 1.54 for LV and from 1.34 to 1.84 for RV. Conclusion Based on this study, cardiac motion is variable depending on the specific substructure of the heart but is mostly within 5 mm. Depending on the location (central or peripheral) of the treatment target and treatment purposes, the treatment planning margins for targets and risk volumes should be adjusted accordingly. In the future, we will further assess heart motion and its dosimetric impact.
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Affiliation(s)
- Zi Ouyang
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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