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Anic A. Top stories on pulsed field ablation (2024). Heart Rhythm 2024; 21:705-706. [PMID: 38692817 DOI: 10.1016/j.hrthm.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Ante Anic
- Department of Cardiology and Vascular Diseases, University Hospital Center Split, Split, Croatia.
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De Potter T, Grimaldi M, Duytschaever M, Anic A, Vijgen J, Neuzil P, Van Herendael H, Verma A, Skanes A, Scherr D, Pürerfellner H, Rackauskas G, Jais P, Reddy VY. Predictors of Success for Pulmonary Vein Isolation With Pulsed-field Ablation Using a Variable-loop Catheter With 3D Mapping Integration: Complete 12-month Outcomes From inspIRE. Circ Arrhythm Electrophysiol 2024; 17:e012667. [PMID: 38655693 DOI: 10.1161/circep.123.012667] [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: 12/01/2023] [Accepted: 02/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND We previously presented the safety and early efficacy of the inspIRE study (Study for Treatment of Paroxysmal Atrial Fibrillation [PAF] by Pulsed-field Ablation [PFA] System With Irreversible Electroporation [IRE]). With the study's conclusion, we report the outcomes of the full pivotal study cohort, with an additional analysis of predictors of success. METHODS InspIRE was a prospective, multicenter, single-arm clinical trial of drug-refractory paroxysmal atrial fibrillation. Pulmonary vein isolation was performed with a variable-loop circular catheter integrated with a 3-dimensional mapping system. Follow-up with 24-hour Holter was at 3, 6, and 12 months, as well as remote rhythm monitoring: weekly from 3 to 5 months, monthly from 6 to 12 months, and for symptoms. The primary effectiveness end point (PEE) was acute pulmonary vein isolation plus freedom from any atrial arrhythmia at 12 months. Additional subanalyses report predictors of PEE success. RESULTS The patient cohort included 186 patients: aged 59±10 years, female 30%, and CHA2DS2-VASc 1.3±1.2. The previously reported primary adverse event rate was 0%. One serious procedure-related adverse event, urinary retention, was reported. The PEE was achieved in 75.6% (95% CI, 69.5%-81.8%). The clinical success of freedom from symptomatic recurrence was 81.7% (95% CI, 76.1%-87.2%). Simulating a monitoring method used in standard real-world practice (without protocol-driven remote rhythm monitoring), this translates to a freedom from all and symptomatic recurrence of 85.8% (95% CI, 80.8%-90.9%) or 94.0% (95% CI, 90.6%-97.5%), respectively. Multivariate analyses revealed that left ventricular ejection fraction ≥60% (adjusted odds ratio, 0.30) and patients receiving ≥48 PFA applications (adjusted odds ratio, 0.28) were independent predictors of PEE success. Moreover, PEE success was 79.2% in patients who received ≥12 PFA applications per vein compared with 57.1% in patients receiving fewer PFA applications. CONCLUSIONS The inspIRE study confirms the safety and effectiveness of pulmonary vein isolation using the novel 3-dimensional mapping integrated circular loop catheter. An optimal number of PFA applications (≥48 total or ≥12 per vein) resulted in an improved 1-year success rate of ≈80%. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04524364.
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Affiliation(s)
- Tom De Potter
- OLV Hospital, Dienst Cardiologie, Aalst, Belgium (T.D.P.)
| | - Massimo Grimaldi
- Ospedale Generale Regionale "F. Miulli" UOC Cardiologia, Bari, Italy (M.G.)
| | | | - Ante Anic
- University Hospital Center Split, Split, Croatia (A.A.)
| | | | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.)
| | | | - Atul Verma
- McGill University Health Center, Montréal, Canada (A.V.)
| | - Allan Skanes
- University of Western Ontario, London, Canada (A.S.)
| | | | | | - Gediminas Rackauskas
- Centre for Cardiology & Angiology, Department of Cardiovascular Diseases, Vilnius University, Lithuania (G.R.)
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France (P.J.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY; Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (V.Y.R.)
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Doshi SK, Flaherty MC, Laughner J, Quan M, Anic A. Catheter-tissue contact optimizes pulsed electric field ablation with a large area focal catheter. J Cardiovasc Electrophysiol 2024; 35:765-774. [PMID: 38357859 DOI: 10.1111/jce.16208] [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: 11/16/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pulsed electric field (PEF) ablation relies on the intersection of a critical voltage gradient with tissue to cause cell death. Field-based lesion formation with PEF technologies may still depend on catheter-tissue contact (CTC). The purpose of this study was to assess the impact of CTC on PEF lesion formation with an investigational large area focal (LAF) catheter in a preclinical model. METHODS PEF ablation via a 10-spline LAF catheter was used to create discrete right ventricle (RV) lesions and atrial lesion sets in 10 swine (eight acute, two chronic). Local impedance (LI) was used to assess CTC. Lesions were assigned to three cohorts using LI above baseline: no tissue contact (NTC: ≤∆10 Ω, close proximity to tissue), low tissue contact (LTC: ∆11-29 Ω), and high tissue contact (HTC: ≥∆30 Ω). Acute animals were infused with triphenyl tetrazolium chloride (TTC) and killed ≥2 h post-treatment. Chronic animals were remapped 30 days post-index procedure and stained with infused TTC. RESULTS Mean (± SD) RV treatment sizes between LTC (n = 14) and HTC (n = 17) lesions were not significantly different (depth: 5.65 ± 1.96 vs. 5.68 ± 2.05 mm, p = .999; width: 15.68 ± 5.22 vs. 16.98 ± 4.45 mm, p = .737), while mean treatment size for NTC lesions (n = 6) was significantly smaller (1.67 ± 1.16 mm depth, 5.97 ± 4.48 mm width, p < .05). For atrial lesion sets, acute and chronic conduction block were achieved with both LTC (N = 7) and HTC (N = 6), and NTC resulted in gaps. CONCLUSIONS PEF ablation with a specialized LAF catheter in a swine model is dependent on CTC. LI as an indicator of CTC may aid in the creation of consistent transmural lesions in PEF ablation.
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Affiliation(s)
- Shephal K Doshi
- Cardiology Electrophysiology, Pacific Heart Institute, Santa Monica, California, USA
| | - Mary Clare Flaherty
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Jacob Laughner
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Melinda Quan
- Electrophysiology, Galvanize Therapeutics, Redwood City, California, USA
- CardioFocus, Marlborough, Massachusetts, USA
| | - Ante Anic
- Department for Cardiovascular Diseases, Klinički Bolnički Centar (KBC) Split, Split, Croatia
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Mestrovic IP, Breskovic T, Markovic M, Kurtic E, Mestrovic T, Anic A. Ablation of epicardial ventricular focus through coronary sinus using pulsed-field ablation. A case report. J Cardiovasc Electrophysiol 2024; 35:856-861. [PMID: 38297424 DOI: 10.1111/jce.16195] [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: 10/23/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION With the entry of pulsed-field ablation (PFA) into electrophysiology, new possibilities for ablation of different substrates such as epicardial foci of premature ventricular contractions (PVCs) from coronary venous system (CVS) have been opened. METHODS This article focuses on a case of a 27-year-old patient with frequent monomorphic PVCs of epicardial origin, treated by radiofrequency ablation, followed by PFA. RESULTS After unsuccessful focus ablation through CVS with RFA, successful ablations from the same region with PFA were achieved. CONCLUSION This is the first described case of successful ablation of epicardial PVCs using PFA, which we hope will help in defining indications for this novel technology and enhance quality of treatment for patients with different arrhythmias.
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Affiliation(s)
| | - Toni Breskovic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Matija Markovic
- Department of Cardiology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Ena Kurtic
- Department of Cardiology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Tomislav Mestrovic
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ante Anic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
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Guerra JM, Moreno Weidmann Z, Perrotta L, Sultan A, Anic A, Metzner A, Providencia R, Boveda S, Chun J. Current management of atrial fibrillation in routine practice according to the last ESC guidelines: an EHRA physician survey-how are we dealing with controversial approaches? Europace 2024; 26:euae012. [PMID: 38227804 PMCID: PMC10869216 DOI: 10.1093/europace/euae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
AIMS Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm Association (EHRA) community according to last guidelines. METHODS AND RESULTS A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions. CONCLUSION There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.
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Affiliation(s)
- Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Laura Perrotta
- Arrhythmia Unit, Careggi University Hospital, Florence, Italy
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre, Split, Croatia
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Serge Boveda
- Department of Cardiology, Heart Rhythm Management, Clinique Pasteur, Toulouse, France
- Brussels University VUB, Brussels, Belgium
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Sultan A, Futyma P, Metzner A, Anic A, Richter S, Roten L, Badertscher P, Conte G, Chun JKR. Management of ventricular tachycardias: insights on centre settings, procedural workflow, endpoints, and implementation of guidelines-results from an EHRA survey. Europace 2024; 26:euae030. [PMID: 38363995 PMCID: PMC10872712 DOI: 10.1093/europace/euae030] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
Ventricular tachycardia (VT), and its occurrence, is still one of the main reasons for sudden cardiac death and, therefore, for increased mortality and morbidity foremost in patients with structural heart [Kahle A-K, Jungen C, Alken F-A, Scherschel K, Willems S, Pürerfellner H et al. Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. Europace 2022;24:538-51]. Catheter ablation has become a safe and effective treatment option in patients with recurrent VT [Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2020;17:e2-154]. Previous and current guidelines provide guidance on indication for VT ablation and risk assessment and evaluation of underlying disease. However, no uniform recommendation is provided regarding procedural strategies, timing of ablation, and centre setting. Therefore, these specifics seem to differ largely, and recent data are sparse. This physician-based European Heart Rhythm Association survey aims to deliver insights on not only infrastructural settings but also procedural specifics, applied technologies, ablation strategies, and procedural endpoints. Therefore, these findings might deliver a real-world scenario of VT management and potentially are of guidance for other centres.
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Affiliation(s)
- Arian Sultan
- Department of Electrophysiology, Heart Centre University Hospital Cologne, Germany
| | - Piotr Futyma
- St. Joseph’s Heart Rhythm Centre, Rzeszów, Poland
- Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Spilt, Croatia
| | - Sergio Richter
- Division of Electrophysiology, Department of Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, Department of Electrophysiology University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Inselspital-Bern University Hospital, Department of Electrophysiology University of Bern, Bern, Switzerland
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reinsch N, Reddy VY. Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00030-6. [PMID: 38430087 DOI: 10.1016/j.jacep.2024.01.017] [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: 01/09/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. OBJECTIVES This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). METHODS In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. RESULTS Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). CONCLUSIONS In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France; I2MC, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic; Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nico Reinsch
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic.
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Sikiric I, Jurisic Z, Breskovic T, Juric-Paic M, Berovic N, Kedzo J, Pletikosic I, Aksu T, Anic A. Focal pulsed field ablation for guiding and assessing the acute effect of cardioneuroablation. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01716-4. [PMID: 38285282 DOI: 10.1007/s10840-023-01716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/03/2023] [Indexed: 01/30/2024]
Affiliation(s)
- Ivan Sikiric
- Department of Cardiology, University Hospital Centre Split, Split, Croatia.
| | - Zrinka Jurisic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Toni Breskovic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Marina Juric-Paic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Nina Berovic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Josip Kedzo
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Ivan Pletikosic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Ante Anic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reddy VY. Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation. JAMA Cardiol 2023; 8:1142-1151. [PMID: 37910101 PMCID: PMC10620676 DOI: 10.1001/jamacardio.2023.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
Importance Previous studies evaluating the association of patient sex with clinical outcomes using conventional thermal ablative modalities for atrial fibrillation (AF) such as radiofrequency or cryoablation are controversial due to mixed results. Pulsed field ablation (PFA) is a novel AF ablation energy modality that has demonstrated preferential myocardial tissue ablation with a unique safety profile. Objective To compare sex differences in patients undergoing PFA for AF in the Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation (MANIFEST-PF) registry. Design, Setting, and Participants This was a retrospective cohort study of MANIFEST-PF registry data, which included consecutive patients undergoing postregulatory approval treatment with PFA to treat AF between March 2021 and May 2022 with a median follow-up of 1 year. MANIFEST-PF is a multinational, retrospectively analyzed, prospectively enrolled patient-level registry including 24 European centers. The study included all consecutive registry patients (age ≥18 years) who underwent first-ever PFA for paroxysmal or persistent AF. Exposure PFA was performed on patients with AF. All patients underwent pulmonary vein isolation and additional ablation, which was performed at the discretion of the operator. Main Outcomes and Measures The primary effectiveness outcome was freedom from clinically documented atrial arrhythmia for 30 seconds or longer after a 3-month blanking period. The primary safety outcome was the composite of acute (<7 days postprocedure) and chronic (>7 days) major adverse events (MAEs). Results Of 1568 patients (mean [SD] age, 64.5 [11.5] years; 1015 male [64.7%]) with AF who underwent PFA, female patients, as compared with male patients, were older (mean [SD] age, 68 [10] years vs 62 [12] years; P < .001), had more paroxysmal AF (70.2% [388 of 553] vs 62.4% [633 of 1015]; P = .002) but had fewer comorbidities such as coronary disease (9% [38 of 553] vs 15.9% [129 of 1015]; P < .001), heart failure (10.5% [58 of 553] vs 16.6% [168 of 1015]; P = .001), and sleep apnea (4.7% [18 of 553] vs 11.7% [84 of 1015]; P < .001). Pulmonary vein isolation was performed in 99.8% of female (552 of 553) and 98.9% of male (1004 of 1015; P = .90) patients. Additional ablation was performed in 22.4% of female (124 of 553) and 23.1% of male (235 of 1015; P = .79) patients. The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was similar in male and female patients (79.0%; 95% CI, 76.3%-81.5% vs 76.3%; 95% CI, 72.5%-79.8%; P = .28). There was also no significant difference in acute major AEs between groups (male, 1.5% [16 of 1015] vs female, 2.5% [14 of 553]; P = .19). Conclusion and Relevance Results of this cohort study suggest that after PFA for AF, there were no significant sex differences in clinical effectiveness or safety events.
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Affiliation(s)
- Mohit K. Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Boris Schmidt
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- I2MC Institute, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
- Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Julian Chun
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D. Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A. Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Kueffer
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
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Musikantow DR, Neuzil P, Anic A, Balin P, Petru J, Funasako M, Lisica L, Jurisic Z, Jais P, Reddy VY. Long-Term Clinical Outcomes of Pulsed Field Ablation in the Treatment of Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:2001-2003. [PMID: 37565951 DOI: 10.1016/j.jacep.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 08/12/2023]
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Anic A, Bakovic D, Jurisic Z, Farkowski M, Lisica L, Breskovic T, Nielsen-Kudsk JE, Perrotta L, de Asmundis C, Boveda S, Chun J. Diagnostic and therapeutic pathways for the malignant left atrial appendage: European Heart Rhythm Association physician survey. Europace 2023; 25:euad204. [PMID: 37440757 PMCID: PMC10359107 DOI: 10.1093/europace/euad204] [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: 01/17/2023] [Accepted: 05/29/2023] [Indexed: 07/15/2023] Open
Abstract
AIMS Patients with atrial fibrillation who despite taking oral anti-coagulant therapy (OAT) suffer a stroke or systemic embolism (SSE) without vascular cause or who develop left atrial appendage (LAA) thrombus (LAAT) should be considered as having malignant LAA. The optimal treatment strategy to reduce SSE risk in such patients is unknown. The aim of the study is to investigate the diagnostic and therapeutic pathways for malignant LAA practiced in European cardiac centres. METHODS AND RESULTS An 18-item online questionnaire on malignant LAA was disseminated by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee. A total of 196 physicians participated in the survey. There seems to be high confidence in transoesophageal echocardiography (TEE) imaging, considering LAAT diagnosis. Switching to another direct oral anti-coagulant (DOAC) is the preferred initial step for the treatment of malignant LAA followed by a switch to vitamin K antagonist (VKA), low-molecular-weight heparin, or continued/optimized DOAC dosage, whereas LAA closure is the last option. Left atrial appendage closure is a viable option in patients with embolic stroke despite OAT and no evidence of thrombus at TEE (empty LAA) after comprehensive diagnostic measures to exclude other sources of embolism. CONCLUSION This EHRA survey provides a snapshot of the contemporary management of patients diagnosed with malignant LAA. Currently, the majority of patients are treated on an outpatient basis with either shifting from VKA to DOAC or from one DOAC to another. Left atrial appendage closure in this population seems to be reserved for patients with higher bleeding risk or complications of malignant LAA, such as stroke.
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Affiliation(s)
- Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Soltanska 1, 21000 Split, Croatia
| | - Darija Bakovic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Soltanska 1, 21000 Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Soltanska 1, 21000 Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Michal Farkowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
- II Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Lucija Lisica
- Department for Cardiovascular Diseases, University Hospital Centre Split, Soltanska 1, 21000 Split, Croatia
| | - Toni Breskovic
- Department for Cardiovascular Diseases, University Hospital Centre Split, Soltanska 1, 21000 Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | | | | | - Carlo de Asmundis
- Heart Rhythm Management Centre, University Hospital (UZ) Brussels, Brussels, Belgium
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Julian Chun
- CCB, Cardiology, Med. Klinik III, Markus Krankenhaus, Frankfurt, Germany
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12
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Rahe G, Reddy VY. Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry. Circulation 2023. [PMID: 37199171 DOI: 10.1161/circulationaha.123.064959] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pulsed field ablation is a novel nonthermal cardiac ablation modality using ultra-rapid electrical pulses to cause cell death by a mechanism of irreversible electroporation. Unlike the traditional ablation energy sources, pulsed field ablation has demonstrated significant preferentiality to myocardial tissue ablation, and thus avoids certain thermally mediated complications. However, its safety and effectiveness remain unknown in usual clinical care. METHODS MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-Approval Clinical Use of Pulsed Field Ablation) is a retrospective, multinational, patient-level registry wherein patients at each center were prospectively included in their respective center registries. The registry included all patients undergoing postapproval treatment with a multielectrode 5-spline pulsed field ablation catheter to treat atrial fibrillation (AF) between March 1, 2021, and May 30, 2022. The primary effectiveness outcome was freedom from clinical documented atrial arrhythmia (AF/atrial flutter/atrial tachycardia) of ≥30 seconds on the basis of electrocardiographic data after a 3-month blanking period (on or off antiarrhythmic drugs). Safety outcomes included the composite of acute (<7 days postprocedure) and latent (>7 days) major adverse events. RESULTS At 24 European centers (77 operators) pulsed field ablation was performed in 1568 patients with AF: age 64.5±11.5 years, female 35%, paroxysmal/persistent AF 65%/32%, CHA2DS2-VASc 2.2±1.6, median left ventricular ejection fraction 60%, and left atrial diameter 42 mm. Pulmonary vein isolation was achieved in 99.2% of patients. After a median (interquartile range) follow-up of 367 (289-421) days, the 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 78.1% (95% CI, 76.0%-80.0%); clinical effectiveness was more common in patients with paroxysmal AF versus persistent AF (81.6% versus 71.5%; P=0.001). Acute major adverse events occurred in 1.9% of patients. CONCLUSIONS In this large observational registry of the postapproval clinical use of pulsed field technology to treat AF, catheter ablation using pulsed field energy was clinically effective in 78% of patients with AF.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Jim Hansen
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- I2MC, INSERM UMR 1297, ToulouseFrance (P.M.)
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | - Frederic Anselme
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
- Neuron Medical, Brno, Czech Republic (M.F.)
| | - Daniel Scherr
- Medical University of Graz, Austria (D. Scherr, M.M.)
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Pierre Jais
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Jan Petru
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Anna Füting
- Department of Cardiology, Rouen Hospital, France (F.A., C.C.)
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Martin Ruwald
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | | | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Nicolas Derval
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Gilbert Rahe
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Pulmonology, Gastroenterology and Internal Medicine, Alfried Krupp Hospital, Essen, Germany (G.R.)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
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Martin CA, Tilz RRR, Anic A, Defaye P, Luik A, de Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht EM, Raybuck JD, Richards E, Cielen N, Yap SC. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol 2023; 34:833-840. [PMID: 36786515 DOI: 10.1111/jce.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Roland R R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ante Anic
- Klinicki Bolnicki Centar Split, Split, Croatia
| | - Pascal Defaye
- University Grenoble Alpes, INSERM unité 1039 and Grenoble university Hospital, Cardiology Department, Grenoble, France
| | - Armin Luik
- Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Cardiology Department, Caen, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology Herz und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | - Nele Cielen
- Boston Scientific, Arden Hills, Minnesota, USA
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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Duytschaever M, De Potter T, Grimaldi M, Anic A, Vijgen J, Neuzil P, Van Herendael H, Verma A, Skanes A, Scherr D, Pürerfellner H, Rackauskas G, Jaïs P, Reddy VY. Paroxysmal AF Ablation Using a Novel Variable-Loop Biphasic Pulsed Field Ablation Catheter Integrated With a 3D Mapping System: 1-Year Outcomes of the Multicenter inspIRE Study. Circ Arrhythm Electrophysiol 2023; 16:e011780. [PMID: 36735937 PMCID: PMC10026968 DOI: 10.1161/circep.122.011780] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background - The inspIRE study evaluated safety and effectiveness of a fully integrated biphasic pulsed field ablation (PFA) system with a variable loop circular catheter for the treatment of drug-refractory paroxysmal atrial fibrillation (AF). Methods - Subjects underwent pulmonary vein isolation (PVI) with the PFA system, using at least 12 applications per vein; adenosine/isoproterenol was administered to confirm entrance block. Wave I assessed initial safety, including for esophageal lesions, silent cerebral lesions (SCLs), and PV stenosis. Wave II (pivotal phase) tested i) primary safety - incidence of early onset primary adverse events (PAEs), and primary effectiveness - confirmed PVI with freedom from documented atrial arrhythmia at 12-months (12M). The study design specified an interim analysis to determine early success once 30 subjects reached 12M follow-up (FU) and all subjects reached 3M FU. Results - Across 13 centers in Europe/Canada, 226 subjects were enrolled, met criteria for safety and effectiveness evaluations and received PFA (Wave I: 40; Wave II: 186). Wave I demonstrated no esophageal thermal lesions or PV stenosis. Among 39 subjects with cerebral MRI, SCLs were detected in 4 of the first 6 subjects, after which workflow enhancements, including a 10s pause between PFA applications was implemented; subsequently, only 4 of 33 subjects had SCLs. In the Wave II phase, no PAE was reported. Upon declaring early success, 83 subjects reached 12M FU. With 100% entrance block, PVI without acute reconnection was achieved in 97.1% of targeted veins. For Wave II, the primary effectiveness endpoint per Kaplan Meier at the time of interim analysis was 70.9%; 12M freedom from symptomatic AF/atrial flutter/atrial tachycardia recurrence and repeat ablation was 78.9% and 92.3%, respectively. Total procedure and transpired PFA times were 70.1 ± 27.7 min and 26.7 ± 14.0 min, respectively. Conclusions - The inspIRE trial confirmed the safety and effectiveness of the novel mapping-integrated PFA system.
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Affiliation(s)
| | | | - Massimo Grimaldi
- Ospedale Generale Regionale "F. Miulli" UOC Cardiologia, Acquaviva delle Fonti - Bari, Italy
| | - Ante Anic
- University Hospital Center Split, Split, Croatia
| | | | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | | | - Atul Verma
- McGill University Health Centre, Montrėal, QC, Canada
| | - Allan Skanes
- University of Western Ontario, London, ON, Canada
| | | | | | - Gediminas Rackauskas
- Centre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Vilnius, Lithuania
| | - Pierre Jaïs
- Centre Hospitalier Universitaire (CHU) de Bordeaux (Main), Pesac, France
| | - Vivek Y Reddy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic & Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Kircanski B, Boveda S, Prinzen F, Sorgente A, Anic A, Conte G, Burri H. Conduction system pacing in everyday clinical practice: EHRA physician survey. Europace 2022; 25:682-687. [PMID: 36413604 PMCID: PMC9935001 DOI: 10.1093/europace/euac201] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
With the increasing interest in conduction system pacing (CSP) over the last few years and the inclusion of this treatment modality in the current guidelines, our aim was to provide a snapshot of current practice across Europe. An online questionnaire was sent to physicians participating in the European Heart Rhythm Association research network as well as to national societies and over social media. Data on previous experience with CSP, current indications, preferred tools, unmet needs, and perceptions for the future are reported and discussed.
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Affiliation(s)
- Bratislav Kircanski
- University Clinical Centre of Serbia, Pacemaker Centre, Belgrade, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France,Universitair Ziekenhuis Brussel—VUB, Heart Rhythm Management Centre, Brussels, Belgium,INSERM U970, 75908 Paris Cedex 15, France
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | | | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Haran Burri
- Corresponding author. Tel: +41 22 372 72 00, E-mail address:
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16
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Schwab AC, Anic A, Farkowski MM, Guerra J, Iliodromitis KE, Jubele K, Providencia R, Chun JKR, Boveda S. Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey. Europace 2022; 25:676-681. [PMID: 36372986 PMCID: PMC9934999 DOI: 10.1093/europace/euac194] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/15/2022] Open
Abstract
Atrial fibrillation (AF) is a major challenge for the healthcare field. Pulmonary vein isolation is the most effective treatment for the maintenance of sinus rhythm. However, clinical endpoints for the procedure vary significantly among studies. There is no consensus on the definition of recurrence and no clear roadmap on how to deal with recurrences after a failed ablation. The purpose of this study was to perform a survey in order to show how clinicians currently approach this knowledge gap. An online survey, supported by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, was conducted between 1 April 2022 and 8 May 2022. An anonymous questionnaire was disseminated via social media and EHRA newsletters, for clinicians to complete. This consisted of 18 multiple-choice questions regarding rhythm monitoring, definitions of a successful ablation, clinical practices after a failed AF ablation, and the continuance of anticoagulation. A total of 107 replies were collected across Europe. Most respondents (82%) perform routine monitoring for AF recurrences after ablation, with 51% of them preferring a long-term monitoring strategy. Cost was reported to have an impact on the choice of monitoring strategy. Self-screening was recommended by most (71%) of the respondents. The combination of absence of symptoms and recorded AF was the definition of success for most (83%) of the respondents. Cessation of anticoagulation after ablation was an option mostly for patients with paroxysmal AF and a low CHA2DS2-VASc score. The majority of physicians perform routine monitoring after AF ablation. For most physicians, the combination of the absence of symptoms and electrocardiographic endpoints defines a successful result after AF ablation.
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Affiliation(s)
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jose Guerra
- Department of Cardiology, Hospital de la Santa Creu I Sant Pau, IIB SANT PAU, CIBERCV, Universitat Autonòma de Barcelona, Barcelona, Spain
| | | | - Kristine Jubele
- Arrhythmia Department, P. Stradins Clinical University Hospital, Riga, Latvia,Arrhythmia Department, Riga Stradins University Riga, Latvia
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK,Institute of Health Informatics, University College of London, London, UK
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus Frankfurt, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France,Universitair Ziekenhuis Brussel - VUB, Heart Rhythm Management Centre, Brussels, Belgium,Paris Cardiovascular Research Center, INSERM U970, 75908 Paris Cedex 15, France
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17
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Bordignon S, Barra S, Providencia R, de Asmundis C, Marijon E, Farkowski MM, Anic A, Guerra JM, Kosiuk J, Iliodromitis K, Schmidt B, Conte G, Chun JKR, Boveda S. The blanking period after atrial fibrillation ablation: an European Heart Rhythm Association survey on contemporary definition and management. Europace 2022; 24:1684-1690. [PMID: 35942585 DOI: 10.1093/europace/euac131] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023] Open
Abstract
The use of a blanking period (BP) after an atrial fibrillation (AF) ablation procedure is a common practice, but recent data questions the benign nature of early recurrences of atrial tachyarrhythmias (ERATs). A physician-based survey was carried out by the European Heart Rhythm Association (EHRA) to investigate the current definition and applicability of BP and ERAT management. An online questionnaire was sent to clinical and interventional electrophysiologists. A total of 436 respondents (88% interventional electrophysiologists) reported observing ERATs in 25% (interquartile range 15-35) of patients, less commonly in paroxysmal AF (PAF) compared with persistent AF (persAF). The median reported duration of BP used by respondents was 90 days, with 22% preferring a shorter BP duration for PAF patients compared with persAF. Half of the patients with ERATs are expected to also experience late recurrences (LR). Isolated episodes of ERATs are treated conservatively by 99% of the respondents, but repeat ablation during the BP is preferred by 20% of electrophysiologists for multiple ERATs and by 16% in patients with organized atrial tachyarrhythmias. In conclusion, ERATs are commonly observed after AF ablation, particularly in persAF patients, and are perceived as predictors of LR by half of the respondents. A general adherence to a 90-day BP duration was observed. During this time period, ERAT is mainly treated conservatively, but repeat ablation during the BP is occasionally offered to patients with multiple ERATs and those with organized atrial tachyarrhythmias.
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Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia 4400, Portugal.,Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB20AY, UK
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK.,Institute of Health Informatics, University College of London, London NW1 2DA, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium
| | - Eloi Marijon
- University of Paris, Paris 75006, France.,Cardiology Department & Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris 75015, France
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split 21000, Croatia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona 08025, Spain
| | - Jedrzej Kosiuk
- Department of Rhythmology, Helios Clinic Köthen, Köthen 06366, Germany
| | - Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Hagen 58135, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano 6900, Switzerland
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium.,Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France.,INSERM U970 75908, Paris, France
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18
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Boussuge-Roze J, Boveda S, Mahida S, Anic A, Conte G, Chun JKR, Marijon E, Sacher F, Jais P. Current practices and expectations to reduce environmental impact of electrophysiology catheters: results from an EHRA/LIRYC European physician survey. Europace 2022; 24:1300-1306. [PMID: 35943366 DOI: 10.1093/europace/euac085] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 01/13/2023] Open
Abstract
The healthcare sector accounts for nearly 5% of global greenhouse gas emissions (GHG) and is a significant contributor to complex waste. Reducing the environmental impact of technology-heavy medical fields such as cardiac electrophysiology (EP) is a priority. The aim of this survey was to investigate the practice and expectations in European centres on EP catheters environmental sustainability. A 24-item online questionnaire on EP catheters sustainability was disseminated by the EHRA Scientific Initiatives Committee in collaboration with the Lyric Institute. A total of 278 physicians from 42 centres were polled; 62% were motivated to reduce the environmental impact of EP procedures. It was reported that 50% of mapping catheters and 53% of ablation catheters are usually discarded to medical waste, and only 20% and 14% of mapping and ablation catheters re-used. Yet, re-use of catheters was the most commonly cited potential sustainability solution (60% and 57% of physicians for mapping and ablation catheters, respectively). The majority of 69% currently discarded packaging. Reduced (42%) and reusable (39%) packaging also featured prominently as potential sustainable solutions. Lack of engagement from host institutions was the most commonly cited barrier to sustainable practices (59%). Complexity of the process and challenges to behavioral change were other commonly cited barriers (48% and 47%, respectively). The most commonly cited solutions towards more sustainable practices were regulatory changes (31%), education (19%), and product after-use recommendations (19%). In conclusion, EP physicians demonstrate high motivation towards sustainable practices. However, significant engagement and behavioural change, at local institution, regulatory and industry level is required before sustainable practices can be embedded into routine care.
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Affiliation(s)
- Julie Boussuge-Roze
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
- Universiteit Ziekenhuis Brussel - VUB, Brussels, Belgium
| | - Saagar Mahida
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, NHS Trust, UK
| | - Ante Anic
- University Hospital Centre Split, Department for Cardiovascular diseases, Split, Croatia
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Eloi Marijon
- European Georges Pompidou Hospital and Paris City University, Cardiology Department, Paris, France
| | - Frederic Sacher
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
| | - Pierre Jais
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
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19
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Farkowski MM, Karlinski M, Pytkowski M, de Asmundis C, Lewandowski M, Mugnai G, Conte G, Marijon E, Anic A, Boveda S, Providencia R. Mexiletine for recurrent ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter defibrillator: an EHRA systematic review. Europace 2022; 24:1504-1511. [DOI: 10.1093/europace/euac101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The aim of the study was to systematically review evidence on the effectiveness and safety of oral mexiletine administered in monotherapy or in combination with other antiarrhythmic drugs for recurrent ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation, VT/VF) in adult patients with structural heart disease (SHD) and implantable cardioverter defibrillators (ICDs). We systematically searched MEDLINE, Embase, and CENTRAL databases from inception to 27 August 2021 for prospective and retrospective studies investigating mexiletine in the target population. The main outcome was the reduction of ICD therapy. The main safety outcome was the presence of any serious adverse events (SAEs) leading to mexiletine discontinuation. Study quality was assessed using the Cochrane risk of bias tool or the Newcastle–Ottawa scale. Four studies comprising 86 mexiletine recipients were included in the review. We also obtained individual data of 50 patients from two studies. Ischaemic cardiomyopathy (ICM) was present in 86% of patients. The quality of included studies was moderate/low. A narrative review was undertaken as studies varied widely in terms of study population and treatment. Across studies, mexiletine treatment (with or without amiodarone) seemed to consistently reduce the number of ICD therapies especially in a population where catheter ablation (CA) was unsuccessful or contraindicated. In ICM patients deemed eligible for CA, mexiletine seemed to be inferior to CA. Mexiletine was discontinued in 14% of cases, mainly for gastrointestinal or neurological SAE. Mexiletine seems to be an option for the long-term treatment of recurrent VT/VF in adult patients with SHD, especially ICM, and ICD in whom CA was unsuccessful or not suitable.
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Affiliation(s)
- Michal Miroslaw Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology , Alpejska 42, 04-628 Warsaw , Poland
| | - Michal Karlinski
- II Department of Neurology, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Mariusz Pytkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology , Alpejska 42, 04-628 Warsaw , Poland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel , Brussels , Belgium
| | - Michal Lewandowski
- II Department of Heart Arrhythmia, National Institute of Cardiology , Alpejska 42, 04-628 Warsaw , Poland
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospitals , Arzignano (Vicenza) , Italy
- Division of Cardiology, Department of Medicine, University Hospital of Verona , Verona , Italy
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute , Lugano , Switzerland
| | - Eloi Marijon
- Département de Cardiologie, Université Paris-Descartes, Hôpital Européen Georges Pompidou , Paris , France
| | - Ante Anic
- Department of Cardiology, University Clinical Hospital Split , Split , Croatia
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel , Brussels , Belgium
- Heart Rhythm Management Department, Clinique Pasteur , Toulouse , France
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust , London , UK
- Institute of Health Informatics, University College of London , London , UK
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20
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Yap SC, Anic A, Breskovic T, Haas A, Bhagwandien RE, Jurisic Z, Szili-Torok T, Luik A. Correction to: Comparison of the 1-year clinical outcome of a novel cryoballoon to an established cryoballoon technology. J Interv Card Electrophysiol 2022; 64:565. [PMID: 35829863 DOI: 10.1007/s10840-022-01300-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Ante Anic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Toni Breskovic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Annika Haas
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Zrinka Jurisic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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21
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Yap SC, Anic A, Breskovic T, Haas A, Bhagwandien RE, Jurisic Z, Szili-Torok T, Luik A. Comparison of the 1-year clinical outcome of a novel cryoballoon to an established cryoballoon technology. J Interv Card Electrophysiol 2022; 64:563-564. [PMID: 35672621 DOI: 10.1007/s10840-022-01262-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Ante Anic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Toni Breskovic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Annika Haas
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Zrinka Jurisic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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22
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Ekanem E, Reddy VY, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Rillig A, Mulder BA, Johannessen A, Rollin A, Lehrmann H, Sohns C, Jurisic Z, Savoure A, Combes S, Nentwich K, Gunawardene M, Ouss A, Kirstein B, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Turagam MK, Neuzil P. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace 2022; 24:1256-1266. [PMID: 35647644 PMCID: PMC9435639 DOI: 10.1093/europace/euac050] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 01/11/2023] Open
Abstract
AIMS Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement.
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Affiliation(s)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Jim Hansen
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Yuri Blaauw
- Universitair Medish Groningen, Groningen, The Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France,I2MC, INSERM UMR 1297, Toulouse, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Roland Tilz
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic,Neuron Medical, Brno, Czech Republic
| | | | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Rillig
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Bart A Mulder
- Universitair Medish Groningen, Groningen, The Netherlands
| | | | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Stephanes Combes
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | | | - Jan Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
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23
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Lisica L, Sikiric I, Katic J, Komic L, Breskovic T, Jurisic Z, Anic A. Additional left atrial posterior wall ablation using pulsed field ablation as a safe and feasible treatment option for persistent atrial fibrillation patients. Europace 2022. [DOI: 10.1093/europace/euac053.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Center Split
Background
Catheter ablation in persistent (PeAF), and especially long-standing persistent AF (ls-PeAF) patients often requires ablation beyond pulmonary vein isolation (PVI) (1). Adjunctive ablation of the left atrial posterior wall (LAPW) may improve outcomes of PeAF patients but has been limited by the difficulty of achieving lesion durability and concerns of thermal damage of nearby structures. Pulsed field ablation (PFA) is a new, nonthermal ablative modality, with proven myocardial ablative efficacy, quick energy delivery, and a favorable safety profile, which makes PFA suitable for the LAPW ablation (2).
Purpose
We aimed to report the safety profile, intraprocedural parameters, and acute success rate of LAPW ablation in a regular clinical setting with the CE-marked PFA platform.
Methods
This was a prospective observational study on the safety and feasibility aspects of LAPW ablation with the PFA in PeAF and ls-PeAF patients. The safety endpoints included the percentage of clinically relevant complications, including stroke/TIA, atrioesophageal fistula, cardiac tamponade, myocardial infarction, diaphragmatic paralysis, and death in the first 30-days post-procedure. Acute ablation success was confirmed with electroanatomical mapping (EAM).
Ablation was performed using 2.0 kV biphasic waveforms, 2 deliveries for each application site. The lesion set depended on the patient’s AF ablation history, LA size, and anatomy. After LA mapping and PVI or PVI touch-up (index or re-do procedure), 2 anchor lesions per vein extending to the LAPW were deployed. A lesion set was then performed between the anchor lesions on the LAPW (upper and lower row) with the catheter in a flower configuration and the intention of 75% overlap for the neighbouring application sites at 3D EAM.
Results
Twenty-three patients (87% men) received PFA LAPW ablation. The age median was 64 (Q1-Q3: 56.5-71) years. 52% had ls-PeAF and 65% had previous ablation. The median LA diameter was 47 mm (Q1-Q3: 46-52 mm). The safety endpoints did not occur in any of the patients. The LA ablation catheter dwell time median for the index and re-do procedure was 39.5 (Q1-Q3: 31-42.25) and 18 (Q1-Q3: 16-21) minutes. The median time for LAPW ablation was 10 (Q1-Q3: 8-12) minutes. The median number of application sites on the upper and lower posterior wall was 6 (Q1-Q3: 5-7) and 6 (Q1-Q3: 5-7), respectively. Acute ablation success was 100% in terms of completed box lesion, and LAPW electrical activity loss. In a single case, first-pass ablation was not achieved, but additional delivery under intracardiac echocardiography guidance resulted in the electrical silence of the targeted segment.
Conclusion
LAPW ablation with PFA is safe, quick and results in excellent acute isolation rates in PeAF patients. Posterior wall ablation with PFA is not a time-consuming procedure which is an important aspect for real-world PeAF and ls-PeAF patients who are often fragile.
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Affiliation(s)
- L Lisica
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - I Sikiric
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - J Katic
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - L Komic
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - T Breskovic
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - Z Jurisic
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
| | - A Anic
- University Hospital Center Split, Heart and Vascular center, Split, Croatia
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24
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Boussuge-Roze J, Boveda S, Anic A, Conte J, Chun JKR, Marijon E, Legentil X, Mekongo V, Sacher F, Jais P. Current practices and expectations to reduce Electrophysiology catheters environmental impact: a large EHRA/LIRYC European survey. Europace 2022. [DOI: 10.1093/europace/euac053.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Background
Despite aiming at improving patients’ health, healthcare consumes a large amount of resources and contributes to 4.6% of the global GHG/carbon emissions, 71% of the footprint being due the supply chain. It also produces millions of tons of complex waste per year. Yet, sustainability in EP remains a complex challenge as the performance and safety for patients are critical.
Objective
To set the ground to reduce electrophysiology (EP) catheters’ environmental impact.
Methods
A survey was conducted to poll European EP centers on 24 questions on sustainability practices and expectations.
Results
278, mostly EP doctors (84%, 76% male, 43yo), working in a public environment (89%, >100 procedures/year in 53% and > 500 in 36%) participated. A majority of EP doctors uses 2 to 4 more catheters/sheath per paroxysmal AF ablation procedure. MAPPING/ABLATION catheters are discarded after the procedure (73&78%), with partial re-cycling (electrodes) in 23&26 %. Local/external sterilization is rarely used (12% & 9%).
Catheters’ packaging are discarded in medical or general waste (38 & 31%) while it is recycled in only 19%.
EP Healthcare professionals are highly motivated in being environment friendly in their personal (82%) and in EP practice (62%). They identify a lack of interest from their hospital in 59% (only 16% having an executive in charge). Other barriers are the complexity of sustainability processes (48%), the effort required to change practice (47%), infectious risk (41%), lack of training (37%) and cost (33%). EP Healthcare professionals would favor sustainable mapping /ablation catheters if performances were preserved (60 & 50%). They consider re-use as the most relevant solution (60%) while being currently illegal in some European countries. Packaging should be reduced in size or made reusable. Finally, they consider that regulatory (31%), education (19%) and recommendations by companies (19%) would encourage the field to transition to more environmentally friendly practices. Interestingly, age, gender, type of practice, country or experience did not impact the results.
Conclusion
EP Healthcare professionals demonstrate a willingness to adopt sustainable practices. They consider re-use as the most relevant approach as of today. 60/50 % would favour sustainable mapping/ablation catheters providing preserved performances. Leaping to the next level of sustainability will request development of new sustainable solutions, models and technologies. Reaching this urgent goal will require governments, industry, hospitals and doctors to work closely in a coordinated approach.
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Affiliation(s)
| | - S Boveda
- Clinic Pasteur, Heart Rhythm Department, Toulouse, France
| | - A Anic
- University Hospital Center Split, Department for Cardiovascular diseases, Split, Croatia
| | - J Conte
- Cardiocentro Ticino Foundation, Cardiology Department, Lugano, Switzerland
| | - JKR Chun
- Med. Klinik III, CCB, Cardiology, Frankfurt, Germany
| | | | - X Legentil
- Boston Scientific, Voisin-le-Bretonneux, France
| | - V Mekongo
- Boston Scientific, Voisin-le-Bretonneux, France
| | | | - P Jais
- IHU Liryc, Bordeaux, France
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25
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Martin C, Tilz RR, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Biophysical parameters and time to isolation of pulmonary veins with a novel cryoballoon: results of POLAR ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Introduction
Low nadir temperatures and long thaw times with cryoballoon ablation are associated with successful pulmonary vein isolation (PVI). Recently, a system that maintains uniform pressure and size has been introduced to improve catheter stability during cryoballoon ablation. The present results examine the relationship between cryoballoon time to isolation (TTI) and other biophysical parameters; time to -40ºC (TT-40), nadir temperature, time to thaw (TT0), and first pass isolation success in patients with paroxysmal AF (PAF).
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. Cryodosing regimen was left to the operator and not specified by study protocol. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, nadir temperature, and occlusion grade were recorded. PVI was confirmed via entrance block. Biophysical parameters for ablations longer than 120s were evaluated.
Results
Data on 389 PVI procedures (n=2303 ablations) were collected. Of those ablations, 1914 (83%) had a duration of at least 120s and were included in this analysis. Isolation was attempted using the CB alone. TTI was reported in 1335 ablations with the majority (64%) occurring within 60s. Biophysical parameters and single shot success rates were examined based on TTI. Ablations with TTI<60s had significantly faster TT-40 (30.6±7.4s), lower nadir temperatures (-58.3±5.8ºC), longer thaw times (21.1±6.7s), and a greater proportion of grade 4 occlusions (88%) than longer TTIs or ablation with no TTI reported (Table 1). In TTIs<60s single shot success was 95%, significantly greater than TT≥60s, or No TTI. Procedure-related complications included: phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
These data suggest a correlation between cryoballoon biophysical parameters and single shot success. Good occlusion likely drives faster freeze and lower nadir temperatures, resulting in longer thaw times with this novel cryoballoon. Future research should examine the relationship between these parameters to drive optimization of cryoablation techniques and provide guidance toward improved workflow.
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Affiliation(s)
- C Martin
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - RR Tilz
- University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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26
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Katic J, Sikiric I, Lisica L, Zaja I, Puljiz Z, Jurisic Z, Breskovic T, Anic A. Pulsed field ablation as the first choice regarding oesophageal safety for atrial fibrillation ablation? Europace 2022. [DOI: 10.1093/europace/euac053.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The occurrence of endoscopy-detected oesophageal lesions has been reported in patients with atrial fibrillation (AF) after thermal-based pulmonary vein isolation (PVI) with even higher risk in patients undergoing ablation of the left atrial posterior wall (LAPW) (1). The main mechanism of oesophageal injury is thermal, resulting in oesophageal dysmotility, ulceration, perforation, or left atrio-oesophageal fistula formation, which are rare but life-threatening sequelae. Pulsed-field ablation (PFA) is a non-thermal ablation technology that uses high amplitude pulsed electrical fields to ablate tissues through cell membrane disruption (2). Precommercial experience with PFA reported no injury to the oesophagus for both PVI and LAPW ablation (3).
Purpose
To assess oesophageal safety in AF patients treated with three different PFA platforms.
Methods
In this single-centre experience we retrospectively analysed a total of 72 upper gastrointestinal (GI) endoscopies performed by a certified gastroenterologist one day after left atrial PFA. GI analysis focused on detection of oesophageal lesions nearest the left atrium and evidence of gastric hypomotility. PVI was performed using focal or single shot PFA catheters. Focal PFA catheters achieved PVI using the wide antral circumferential ablation (WACA) technique. LAPW ablation was performed exclusively by using single shot PFA devices.
Results
The patient characteristics were summarized in Table 1. Focal PFA catheters were used in 78% of patients. Post-procedure endoscopies revealed no mucosal lesions in any patient. Gastroparesis and perioesophageal vagal nerve injury were not found (Table 2).
Conclusion
PFA, whether applied by single shot devices or focal catheters, seems to be a safe ablation option with respect to oesophageal injury resulting from PVI and LAPW ablation in paroxysmal and persistent AF patients. Irrespective of catheter design, PFA configuration (monopolar versus bipolar, maximum output), or LA lesion set, we found absolute GI safety of PFA as class effect.
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Affiliation(s)
- J Katic
- University Hospital Center Split, Split, Croatia
| | - I Sikiric
- University Hospital Center Split, Split, Croatia
| | - L Lisica
- University Hospital Center Split, Split, Croatia
| | - I Zaja
- University Hospital Center Split, Split, Croatia
| | - Z Puljiz
- University Hospital Center Split, Split, Croatia
| | - Z Jurisic
- University Hospital Center Split, Split, Croatia
| | - T Breskovic
- University Hospital Center Split, Split, Croatia
| | - A Anic
- University Hospital Center Split, Split, Croatia
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27
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Tilz R, Martin CA, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Background/Introduction
Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.
Purpose
The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.
Results
Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - CA Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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Simovic S, Providencia R, Barra S, Kircanski B, Guerra JM, Conte G, Duncker D, Marijon E, Anic A, Boveda S. The use of remote monitoring of cardiac implantable devices during the COVID-19 pandemic: an EHRA physician survey. Europace 2022; 24:473-480. [PMID: 34410364 PMCID: PMC8499732 DOI: 10.1093/europace/euab215] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
It is unclear to what extent the COVID-19 pandemic has influenced the use of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs). The present physician-based European Heart Rhythm Association (EHRA) survey aimed to assess the influence of the COVID-19 pandemic on RM of CIEDs among EHRA members and how it changed the current practice. The survey comprised 27 questions focusing on RM use before and during the pandemic. Questions focused on the impact of COVID-19 on the frequency of in-office visits, data filtering, reasons for initiating in-person visits, underutilization of RM during COVID-19, and RM reimbursement. A total of 160 participants from 28 countries completed the survey. Compared to the pre-pandemic period, there was a significant increase in the use of RM in patients with pacemakers (PMs) and implantable loop recorders (ILRs) during the COVID-19 pandemic (PM 24.2 vs. 39.9%, P = 0.002; ILRs 61.5 vs. 73.5%, P = 0.028), while there was a trend towards higher utilization of RM for cardiac resynchronization therapy-pacemaker (CRT-P) devices during the pandemic (44.5 vs. 55%, P = 0.063). The use of RM with implantable cardioverter-defibrillators (ICDs) and CRT-defibrillator (CRT-D) did not significantly change during the pandemic (ICD 65.2 vs. 69.6%, P = 0.408; CRT-D 65.2 vs. 68.8%, P = 0.513). The frequency of in-office visits was significantly lower during the pandemic (P < 0.001). Nearly two-thirds of participants (57 out of 87 respondents), established new RM connections for CIEDs implanted before the pandemic with 33.3% (n = 29) delivering RM transmitters to the patient's home address, and the remaining 32.1% (n = 28) activating RM connections during an in-office visit. The results of this survey suggest that the crisis caused by COVID-19 has led to a significant increase in the use of RM of CIEDs.
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Affiliation(s)
- Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Bratislav Kircanski
- University Clinical Centre of Serbia, Pacemaker Centre, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- University of Paris, Paris, France
- European Georges Pompidou Hospital, Cardiology Department and Cardiovascular Research Center, Paris, France
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
| | - Ante Anic
- Department for Cardiovascular diseases, University Hospital Center Split, Split, Croatia
| | - Serge Boveda
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Universitair Ziekenhuis Brussel—VUB, Heart Rhythm Management Centre, Brussels, Belgium
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Martin A, Fowler M, Breskovic T, Ouss A, Dekker L, Yap SC, Bhagwandien R, Albrecht EM, Cielen N, Richards E, Tran BC, Lever N, Anic A. Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: long-term outcomes in a multicentre clinical study. J Interv Card Electrophysiol 2022; 65:609-616. [PMID: 35412168 PMCID: PMC9726810 DOI: 10.1007/s10840-022-01200-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, a novel cryoballoon ablation catheter has demonstrated acute safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (PAF). However, there are limited studies demonstrating the long-term efficacy. The aim of this study was to evaluate the long-term safety and efficacy of this novel cryoballoon in treating PAF. METHODS This was a non-randomized, prospective, multicentre study enrolling 58 consecutive patients. Cryoablation was delivered for 180 s if time to isolation was ≤ 60 s. Otherwise a 240-s cryoablation was performed. One centre performed pre- and post-ablation high-density mapping (n = 9) to characterize lesion formation. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia. All patients were followed for 1 year. RESULTS Acute PVI was achieved in 230 of 231 pulmonary veins (99.6%) with 5.3 ± 1.6 cryoablations per patient (1.3 ± 0.7 cryoablations per vein). Forty-three (77%) patients remained arrhythmia-free at 1-year follow-up. Four patients (6.9%) experienced phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post-index procedure. For patients who underwent high-density mapping, cryoablation was antral with 50% of the posterior wall ablated. CONCLUSIONS Initial multicentre clinical experience with a novel cryoballoon has demonstrated safety and efficacy of PVI in patients with PAF. Ablation with this cryoballoon provides a wide, antral lesion set with significant debulking of the posterior wall of the left atrium.
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Affiliation(s)
- Andrew Martin
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Marina Fowler
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Toni Breskovic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
| | - Alexandre Ouss
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Lukas Dekker
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Sing-Chien Yap
- grid.5645.2000000040459992XErasmus MC, Rotterdam, Netherlands
| | | | - Elizabeth M. Albrecht
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nele Cielen
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Elizabeth Richards
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Binh C. Tran
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nigel Lever
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Ante Anic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
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De Potter T, Reddy V, Neuzil P, Rackauskas G, Anic A, Grimaldi M, Di Biase L, Natale A. Acute safety and performance outcomes from the inspIRE trial using a novel pulsed field ablation system for the treatment of paroxysmal atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0380] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The inspIRE clinical trial was designed to assess the safety and efficacy of a fully integrated biphasic pulsed field ablation (PFA) system comprised of a multi-channel generator, variable decapolar irrigated loop circular catheter, and mapping system (Figure A) for the treatment of paroxysmal atrial fibrillation (PAF).
Purpose
Using this novel PFA system in a multicentre clinical trial, we present the initial feasibility of electrical pulmonary vein isolation (PVI), procedural performance, and acute safety results.
Methods
inspIRE is a prospective, non-randomized, multi-centre study, planned to enrol up to 550 patients. PVI is performed with the novel, variable loop circular catheter, compatible mapping system and generator. Acute procedural effectiveness (entrance block in all clinically targeted PVs post adenosine/isoproterenol challenge) and the incidence of primary adverse events (PAEs) were assessed. PAEs are defined as the occurrence of cardiac tamponade/perforation, myocardial infarction, stroke/cerebrovascular accident, thromboembolism, transient ischemic attack, permanent phrenic nerve paralysis, pulmonary edema, pericarditis, and any major vascular access complications within 7 days of the ablation procedure. Additionally, any incidence of procedure or device related death, atrio-esophageal fistula, or PV stenosis (related to the ablation procedure or study catheter) within the 12M follow-up period is classified as a PAE.
Results
A total of 35 PAF subjects (age 59.7±10.7 years, 54.3% male) were treated across 5 European sites by 6 operators. Acute procedural success was achieved in 100% of study subjects (Figure B) with zero incidence of PAEs. Mean total procedure time was 82.9±19.9 minutes with 27.0±11.9 minutes of PFA from first to last application. Average fluoroscopy use was 10.6±6.8 minutes and LA dwell time was 45.6±15.3 minutes.
Conclusion
Initial results of the inspIRE trial demonstrate the acute safety and effectiveness of the new integrated IRE circular catheter, mapping system and generator for PVI in PAF patients.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): inspIRE is a company-sponsored study funded by Biosense Webster, Inc. Figure 1. (A) PFA System; (B) PVI Voltage Map
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Affiliation(s)
| | - V Reddy
- Na Homolce Hospital, Department of Cardiology, Prague, Czechia
| | - P Neuzil
- Na Homolce Hospital, Department of Cardiology, Prague, Czechia
| | - G Rackauskas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - A Anic
- University Hospital Center Split, Split, Croatia
| | - M Grimaldi
- Ospedale Generale Regionale “F. Miuli” UOC, Cardiologia - Arrhythmias Unit, Bari, Italy
| | - L Di Biase
- Ospedale Generale Regionale “F. Miuli” UOC, Cardiologia - Arrhythmias Unit, Bari, Italy
| | - A Natale
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Martin A, Breskovic T, Ouss A, Dekker L, Yap SC, Bhagwandien R, Cielen N, Albrecht EM, Richards E, Tran B, Lever N, Anic A. Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: one-year outcomes in a multicenter study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, a novel cryoballoon (CB; POLARx) has been developed with increased steerability which maintains size and pressure throughout the ablation. Initial clinical data has demonstrated acute procedural safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (AF). However, there are limited studies demonstrating the long-term efficacy of the CB.
Purpose
To evaluate the long-term safety and efficacy of the novel CB in treating paroxysmal AF.
Methods
This was a non-randomized, prospective, multi-center study. Fifty-eight consecutive patients with paroxysmal AF were enrolled at 4 centers for de novo PVI procedures. Cryoablation was delivered for 180s if time to isolation was ≤60s. Otherwise a 240s cryoablation was performed. PVI was confirmed with entrance and exit block testing. Patients were followed for 1 year with 24-hour Holter monitoring at 3, 6, and 12 months. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia.
Results
Acute isolation with the CB was achieved in 230 of 231 pulmonary veins (99.6%) with 5.2±1.5 cryoapplications per patient (1.3±0.6 cryoapplications per vein). There were 4 patients (6.9%) with phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months follow-up). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post index procedure (1.7%). Of the 56 patients that had complete 12-month follow-up, 43 (76.8%) were free from recurrent atrial arrhythmias.
Conclusion
Initial multicenter clinical experience with the novel CB has demonstrated long-term safety and efficacy of PVI in patients with paroxysmal AF. Further studies are underway to confirm these findings.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- A Martin
- Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - T Breskovic
- University Hospital Center Split, Split, Croatia
| | - A Ouss
- Catharina Hospital, Eindhoven, Netherlands (The)
| | - L Dekker
- Catharina Hospital, Eindhoven, Netherlands (The)
| | - S C Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - R Bhagwandien
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - N Cielen
- Boston Scientific, Brussels, Belgium
| | - E M Albrecht
- Boston Scientific, St. Paul, United States of America
| | - E Richards
- Boston Scientific, St. Paul, United States of America
| | - B Tran
- Boston Scientific, St. Paul, United States of America
| | - N Lever
- Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - A Anic
- University Hospital Center Split, Split, Croatia
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Neuzil P, Morrow B, Eggert C, Anic A, Jais P, Reddy VY. B-AB06-01 PULSED FIELD ABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION USING AN OPTIMIZED BIPHASIC WAVEFORM: RECURRENCE OF ATRIAL ARRHYTHMIAS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.036] [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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Farkowski MM, Karlinski M, Barra S, Providencia R, Golicki D, Pytkowski M, Anic A, Chun JKR, de Asmundis C, Lane DA, Boveda S. Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis. Europace 2021; 24:58-69. [PMID: 34297839 DOI: 10.1093/europace/euab133] [Citation(s) in RCA: 3] [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: 03/16/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double ('bonus') freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98-1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53-0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37-1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double ('bonus') freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).
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Affiliation(s)
- Michal Miroslaw Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Michal Karlinski
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Pytkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Split, Split, Croatia
| | - Julian Kyoung Ryul Chun
- CCB Frankfurt/Med. Klinik III, Markuskrankenhaus, Frankfurt am Main, Germany
- Med. Klinik II, Universtätsklinikum Schleswig Holstein, Campus Lübeck, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Deirdre Anne Lane
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
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Zeljkovic I, Brusich S, Scherr D, Velagic V, Traykov V, Pernat A, Anic A, Szavits Nossan J, Jan M, Bakotic Z, Pezo Nikolic B, Radeljic V, Bojko A, Benko I, Manola S, Pavlovic N. Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy. Clin Cardiol 2021; 44:1177-1182. [PMID: 34196416 PMCID: PMC8364723 DOI: 10.1002/clc.23681] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. Methods We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi‐center, registry‐based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. Results Total of 873 patients were included (median age 61 years, IQR 53–66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). Conclusion There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban.
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Affiliation(s)
- Ivan Zeljkovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Daniel Scherr
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Vedran Velagic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Andrej Pernat
- Department of Cardiology, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Ante Anic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | | | - Matevz Jan
- Department of Cardiac Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Zoran Bakotic
- Department of Cardiology, General Hospital Zadar, Zadar, Croatia
| | - Borka Pezo Nikolic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vjekoslav Radeljic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Bojko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
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35
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Reddy VY, Dukkipati SR, Neuzil P, Anic A, Petru J, Funasako M, Cochet H, Minami K, Breskovic T, Sikiric I, Sediva L, Chovanec M, Koruth J, Jais P. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol 2021; 7:614-627. [PMID: 33933412 DOI: 10.1016/j.jacep.2021.02.014] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to determine whether durable pulmonary vein isolation (PVI) using pulsed field ablation (PFA) translates to freedom from atrial fibrillation recurrence without an increase in adverse events. BACKGROUND PFA is a nonthermal ablative modality that, in preclinical studies, is able to preferentially ablate myocardial tissue with minimal effect on surrounding tissues. Herein, we present 1-year clinical outcomes of PFA. METHODS In 3 multicenter studies (IMPULSE [A Safety and Feasibility Study of the IOWA Approach Endocardial Ablation System to Treat Atrial Fibrillation], PEFCAT [A Safety and Feasibility Study of the FARAPULSE Endocardial Ablation System to Treat Paroxysmal Atrial Fibrillation], and PEFCAT II [Expanded Safety and Feasibility Study of the FARAPULSE Endocardial Multi Ablation System to Treat Paroxysmal Atrial Fibrillation]), paroxysmal atrial fibrillation patients underwent PVI using a basket or flower PFA catheter. Invasive remapping was performed at ∼2 to 3 months, and reconnected PVs were reisolated with PFA or radiofrequency ablation. After a 90-day blanking period, arrhythmia recurrence was assessed over 1-year follow-up. RESULTS In 121 patients, acute PVI was achieved in 100% of PVs with PFA alone. PV remapping, performed in 110 patients at 93.0 ± 30.1 days, demonstrated durable PVI in 84.8% of PVs (64.5% of patients), and 96.0% of PVs (84.1% of patients) treated with the optimized biphasic energy PFA waveform. Primary adverse events occurred in 2.5% of patients (2 pericardial effusions or tamponade, 1 hematoma); in addition, there was 1 transient ischemic attack. The 1-year Kaplan-Meier estimates for freedom from any atrial arrhythmia for the entire cohort and for the optimized biphasic energy PFA waveform cohort were 78.5 ± 3.8% and 84.5 ± 5.4%, respectively. CONCLUSIONS PVI with a "single-shot" PFA catheter results in excellent PVI durability and acceptable safety with a low 1-year rate of atrial arrhythmia recurrence. These data mitigate concern that the nonthermal ablative mechanism of PFA might mask undiscovered compromises to clinical success. (IMPULSE: A Safety and Feasibility Study of the IOWA Approach Endocardial Ablation System to Treat Atrial Fibrillation, NCT03700385; A Safety and Feasibility Study of the FARAPULSE Endocardial Ablation System to Treat Paroxysmal Atrial Fibrillation, NCT03714178; PEFCAT II Expanded Safety and Feasibility Study of the FARAPULSE Endocardial Multi Ablation System to Treat Paroxysmal Atrial Fibrillation [PEFCAT II], NCT04170608).
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Affiliation(s)
- Vivek Y Reddy
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Ante Anic
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Jan Petru
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | | | - Hubert Cochet
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kentaro Minami
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Toni Breskovic
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Ivan Sikiric
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Lucie Sediva
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Milan Chovanec
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France
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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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Yap SC, Anic A, Breskovic T, Haas A, Bhagwandien RE, Jurisic Z, Szili-Torok T, Luik A. Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technologies for pulmonary vein isolation: Insights from an initial multicenter experience. J Cardiovasc Electrophysiol 2021; 32:580-587. [PMID: 33492749 PMCID: PMC7986676 DOI: 10.1111/jce.14915] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 01/14/2023]
Abstract
Introduction Recently a novel cryoballoon system (POLARx, Boston Scientific) became available for the treatment of atrial fibrillation. This cryoballoon is comparable with Arctic Front Advance Pro (AFA‐Pro, Medtronic), however, it maintains a constant balloon pressure. We compared the procedural efficacy and biophysical characteristics of both systems. Methods One hundred and ten consecutive patients who underwent first‐time cryoballoon ablation (POLARx: n = 57; AFA‐Pro: n = 53) were included in this prospective cohort study. Results Acute isolation was achieved in 99.8% of all pulmonary veins (POLARx: 99.5% vs. AFA‐Pro: 100%, p = 1.00). Total procedure time (81 vs. 67 min, p < .001) and balloon in body time (51 vs. 35 min, p < .001) were longer with POLARx. After a learning curve, these times were similar. Cryoablation with POLARx was associated with shorter time to balloon temperature −30°C (27 vs. 31 s, p < .001) and −40°C (32 vs. 54 s, p < .001), lower balloon nadir temperature (−55°C vs. −47°C, p < .001), and longer thawing time till 0°C (16 vs. 9 s, p < .001). There were no differences in time‐to‐isolation (TTI; POLARx: 45 s vs. AFA‐Pro 43 s, p = .441), however, POLARx was associated with a lower balloon temperature at TTI (−46°C vs. −37°C, p < .001). Factors associated with acute isolation differed between groups. The incidence of phrenic nerve palsy was comparable (POLARx: 3.5% vs. AFA‐Pro: 3.7%). Conclusion The novel cryoballoon is comparable to AFA‐Pro and requires only a short learning curve to get used to the slightly different handling. It was associated with faster cooling rates and lower balloon temperatures but TTI was similar to AFA‐Pro.
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Affiliation(s)
- Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ante Anic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Toni Breskovic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Annika Haas
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Zrinka Jurisic
- Department of Cardiology, Clinical Hospital Center Split, Split, Croatia
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Yavin H, Brem E, Zilberman I, Shapira-Daniels A, Datta K, Govari A, Altmann A, Anic A, Wazni O, Anter E. Circular Multielectrode Pulsed Field Ablation Catheter Lasso Pulsed Field Ablation: Lesion Characteristics, Durability, and Effect on Neighboring Structures. Circ Arrhythm Electrophysiol 2021; 14:e009229. [PMID: 33417475 DOI: 10.1161/circep.120.009229] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a nonthermal energy with potential safety advantages over radiofrequency ablation. This study investigated a novel PFA system-a circular multielectrode catheter (PFA lasso) and a multichannel generator designed to work with Carto 3 mapping system. METHODS A 7.5F bidirectional circular catheter with 10 electrodes and variable expansion was designed for PFA (biphasic, 1800 Volts). This study included a total of 16 swine used to investigate the following 3 experimental aims: Aim 1 examined the feasibility to create a right atrial ablation line of block from the superior vena cava to the inferior vena cava. Aim 2 examined the effect of PFA on lesion maturation including durability after a 30-day survival period. Aim 3 examined the effect of high-intensity PFA (10 applications) on esophageal and phrenic nerve tissue in comparison to normal intensity radiofrequency ablation (1-2 applications). Histopathologic analysis of all cardiac, esophageal, and phrenic nerve tissue was performed. RESULTS Acute line of block was achieved in 12/12 swine (100%) and required a total PFA time of 14 seconds (interquartile range [IQR], 9-24.5) per line. Ablation line durability after 28±3 days was maintained in 11/12 (91.7%) swine. PFA resulted in transmural lesions in 179/183 (97.8%) sections and a median lesion width of 14.2 mm. High-intensity PFA (9 [IQR, 8-14] application) had no effect on the esophagus while standard intensity radiofrequency ablation (1.5 [IQR, 1-2] applications) resulted in deep esophageal tissue injury involving the muscularis propria and adventitia layers. High-intensity PFA (16 [IQR, 10-28] applications) has no effect on phrenic nerve function and structure while standard dose radiofrequency ablation (1.5 [IQR, 1-2] applications) resulted in acute phrenic nerve paralysis. CONCLUSIONS In this preclinical model, a multielectrode circular catheter and multichannel generator produced durable atrial lesions with lower vulnerability to esophageal or phrenic nerve damage.
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Affiliation(s)
- Hagai Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
| | - Erez Brem
- Research and Development Division, Biosense Webster, Johnson and Johnson, Irwindale, CA (E.B., K.D.)
| | - Israel Zilberman
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.)
| | - Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.S.-D.)
| | - Keshava Datta
- Research and Development Division, Biosense Webster, Johnson and Johnson, Irwindale, CA (E.B., K.D.)
| | - Assaf Govari
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.)
| | - Andres Altmann
- Advanced Research and Development Biosense Webster, Johnson and Johnson, Yokneam, Israel (I.Z., A.G., A.A.).,University Clinical Hospital Split, Croatia (A.A.)
| | | | - Oussama Wazni
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., O.W., E.A.)
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Reddy VY, Anic A, Koruth J, Petru J, Funasako M, Minami K, Breskovic T, Sikiric I, Dukkipati SR, Kawamura I, Neuzil P. Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation. J Am Coll Cardiol 2020; 76:1068-1080. [DOI: 10.1016/j.jacc.2020.07.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
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Potpara T, Music L, Dan GA, Goda A, Manola S, Trendafilova E, Kusljugic Z, Gjini V, Polovina M, Pojskic B, Kamenova D, Asanovic D, Georgescu CA, Anic A, Lip GY. 136-28: Contemporary patterns of rhythm control in patients with non-valvular atrial fibrillation in the Balkan Region: Insight from the BALKAN-AF Survey. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i97a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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