Safety and efficacy of pulmonary vein isolation using a circular, open-irrigated mapping and ablation catheter: A multicenter registry (original) (raw)
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Reproducibility of acute pulmonary vein isolation guided by the ablation index
Pacing and Clinical Electrophysiology, 2019
Background. Atrial fibrillation (AF) ablation outcome is still operator dependent. Ablation Index (AI) is a new lesion quality marker that has demonstrated to allow acute durable pulmonary vein (PV) isolation followed by a high single-procedure arrhythmia-free survival. Objectives. This prospective, multi-center study was designed to evaluate the inter-operator reproducibility of acute PV isolation guided by the AI. Methods. A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV encircling and were divided in four study groups according to operator preference in choosing the ablation catheter (a contact force (ST) or contact force sourrounding flow (STSF) catheter) and the AI setting (330 at posterior and 450 at anterior wall or 380 at posterior and 500 at anterior wall). Radiofrequency was delivered targeting interlesion distance ≤ 6 mm. Results. Procedure (ST330 129±44 min, ST380 144±44 min, STSF330 120±72 min, STSF380 125±73 min, p<0.001) and fluoroscopy time (ST330 542±285 s, ST380 540±416 s, STSF330 257±356 s, STSF380 379±454 s, p<0.001) significantly differed among the four study groups, whereas the rate of first-pass PV isolation (ST330 90±16 %, ST380 87±19 %, STSF330 90±17 %, STSF380 91±15 %, p=0.585) was similar. The difference in the rate of first pass isolation was not statistical different (p=0.06) among the 12 operators that performed at least 15 procedures. Conclusions. Ablation protocol respecting strict criteria for contiguity and quality lesion results in high and comparable rate of acute PV isolation among operators performing ablation with different catheters, AI settings, procedure and fluoroscopy times.
Initial Experience with the High-Density Mesh Ablation Catheter for Pulmonary Vein Isolation
Pace-pacing and Clinical Electrophysiology, 2009
Background: Pulmonary vein isolation (PVI) is usually performed with multiple point-by-point radiofrequency ablation with a second multielectrode circular mapping catheter to validate isolation. We evaluated a 30-mm high-density mesh electrode (HDMA) for mapping and PVI in patients with recurrent atrial fibrillation (AF).Methods: In 13 patients (validation group) up to three pulmonary veins (PVs) were targeted with the HDMA. A circular mapping catheter was used to validate PVI. PVI was completed with a CARTO-guided approach (Biosense Webster, Diamond Bar, CA, USA) followed by a voltage remap. In 11 patients (feasibility group) the HDMA catheter was evaluated as a stand-alone mapping and ablation tool.Results: The diagnostic accuracy of the HDMA catheter to evaluate PVI was 100%. The encircled low-voltage area (<0.15 mV) after HDMA-guided PVI was smaller compared to CARTO-guided PVI. In the feasibility group 76% of the PVs could be isolated. Complete isolation of all PVs was feasible in five patients (45%) with a mean procedure and fluoroscopy time of respectively 180 ± 39 minutes and 40 ± 14 minutes. After 1 year 64% of the patients were free of symptomatic AF.Conclusions: The HDMA electrode is a reliable mapping tool to validate PVI. The majority of PVs can be isolated, but on a patient basis touch-up ablations are necessary in more than 50% of the cases. Therefore, modifications in catheter design are required. The small area of voltage abatement points to an ostial left atrium-pulmonary vein disconnection. Initial clinical results in a small number of patients are promising.
Journal of Cardiovascular Electrophysiology, 2020
Aim. This prospective, multi-center study was designed to evaluate the reproducibility of PV isolation guided by the ablation index (AI). Methods. A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV encircling and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330-450 or 380-500 at posterior and anterior walls, respectively). Radiofrequency energy was delivered targeting interlesion distance ≤ 6 mm. Results. At 12 months follow-up a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%, p=0.039). There was no difference in the rate of atrial arrhythmias recurrence among the four study groups (4.5% in Group ST330-450, 12.2% in Group ST 380-500, 14.9% in Group STSF330-450, 9.4% in Group STSF380-500, p=0.083). Recurrence was also similar between patients treated with a ST (8.0%) or STSF catheter (12.1%, p=0.2), within patients targeting an AI settings of 330-450 (10.9%) or 380-500 (10.3%, p=0.64), and among operators (p=0.84 and p=0.75 in patients with paroxysmal and persistent AF, respectively). Conclusions. An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of one-year freedom from AF recurrence, both in patients with paroxysmal and persistent AF, irrespective of the ablation catheters, AI settings, and operator.
Technique of pulmonary vein isolation by catheter ablation
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2002
In selected patients with atrial fibrillation, the fibrillation episodes may be initiated by single or short bursts of ectopy often originating from one or more pulmonary veins (PVs). Therefore, electrical isolation of these veins by catheter ablation is currently being explored as a treatment modality for patients with paroxysmal and even more permanent types of atrial fibrillation. At present, two different techniques are used: 1) selective ablation of electrical connections between left atrium and myocardial sleeves inside the PVs; and 2) contiguous encircling lesions around and outside the PV ostia. With both techniques, moderate to high success rates have been reported with a limited follow-up duration. Both types of procedure are very complex and require a highly skilful team. With the variable anatomy of the PVs, non-invasively acquired angiographic images may serve as a roadmap for catheter manipulation. Modern three-dimensional catheter navigation techniques can be applied ...
International Journal of Medical Sciences, 2013
Background: Pulmonary Vein Isolation (PVI) is evolving as an established treatment option in atrial fibrillation (AF). Different fluoroscopy-guided ablation devices exist either on the basis of expandable circumferential and mesh designs with mapping and ablation of pulmonary vein potentials, or of a balloon technology, a "single shot" device with a purely anatomical approach. Systematic comparisons between procedure duration (PD), fluoroscopy time (FT) and clinical outcome in using different ablation tools are lacking in the literature. Methods: In a single center retrospective analysis, 119 PVI procedures were performed between August 2008 and March 2011 in paroxysmal AF (PAF, 59.7%) and persistent AF (persAF, 40.3%) patients with mean age of 59.4±10.3 years and history of AF since 8.1±9.7 months. The PVI procedures were evaluated by comparing PD and FT using I) the High Density Mesh Mapper (HDMM), II) the High Density Mesh Ablator (HDMA), and III) the Arctic Front® Cryoballoon. The primary endpoints were FT and PD, the secondary endpoint was procedural safety and efficacy in short-and longterm follow-up. Results: The procedures performed for 119 patients (63.0 % male) included 42 PVIs with the HDMM (35.3 %), 47 with the HDMA (39.5 %) and 30 with the cryoballoon (25.2 %). Comparing the 30 first procedures in groups of 10 in the HDMM and HDMA group, PD and FT fell in the HDMM group (PD from 257.5 to 220.9 min and FT from 80.5 to 67.3 min, both p < 0.05) as well as in the HDMA group (PD from 182.9 to 147.2 min and FT from 41.02 to 29.1 min, both p < 0.05). In the cryoballoon group, there was a steep learning curve with a steady state after the first 10 procedures (PD and FT decreased significantly from 189.5 to 138.1 min and 36.9 to 27.3 min, p values 0.005 and 0.05 respectively). With respect to recurrence of AF in a 24 months follow up, the HDMM and cryoballoon group showed comparable results with ~72% of patients free of arrhythmias. None of the patients died due to severe complications, or suffered a hemodynamic relevant pericardial effusion and/or stroke. Impairment of the phrenic nerve was observed in three patients. Conclusion: Use of the cryoballoon technology was associated with a steep learning curve and a reduced PD and FT; the long-term outcome was similar compared with the HDMM group. The efficacy and safety of the devices but also PD and FT should be respected as the strongest indicators of the quality of ablation. Further studies with long time follow-ups will show if the