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FONTAINE, G. "Cardiac Arrhythmias Treated by Catheter Ablation Methods." Annals of Internal Medicine 103, no. 5 (November 1, 1985): 803. http://dx.doi.org/10.7326/0003-4819-103-5-803_1.
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Calkins, Hugh, Andrea Natale, Tara Gomez, Alex Etlin, and Moe Bishara. "Comparing rates of atrioesophageal fistula with contact force-sensing and non-contact force-sensing catheters: analysis of post-market safety surveillance data." Journal of Interventional Cardiac Electrophysiology 59, no. 1 (November 22, 2019): 49–55. http://dx.doi.org/10.1007/s10840-019-00653-5.
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Abstract Purpose There is limited data on the specific incidence of serious adverse events, such as atrioesophageal fistula (AEF), associated with either contact force (CF) or non-CF ablation catheters. Since the actual number of procedures performed with each type of catheter is unknown, making direct comparisons is difficult. The purpose of this study was to assess the incidence of AEF associated with the use of CF and non-CF catheters. Additionally, we aimed to understand the workflow present in confirmed AEF cases voluntarily provided by physicians. Methods The number of AEFs for 2014–2017 associated with each type of catheter was extracted from an ablation device manufacturer’s complaint database. Proprietary device sales data, a proxy for the total number of procedures, were used as the denominator to calculate the incidence rates. Additional survey and workflow data were systematically reviewed. Results Both CF and non-CF ablation catheters have comparably low incidence of AEF (0.006 ± 0.003% and 0.005 ± 0.003%, respectively, p = 0.69). CF catheters are the catheter of choice for left atrium (LA) procedures which pose the greatest risk for AEF injury. Retrospective analysis of seven AEF cases demonstrated that high power and force and long RF duration were delivered on the posterior wall of the left atrium in all cases. Conclusions CF and non-CF ablation catheters were found to have similar AEF incidence, despite CF catheters being the catheter of choice for LA procedures. More investigation is needed to understand the range of parameters which may create risk for AEF.
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Haanschoten, Danielle M., Ahmet Adiyaman, Jaap Jan J. Smit, Peter Paul H. M. Delnoy, Anand R. Ramdat Misier, Fabiano Porta, Robert P. H. Storm van Leeuwen, and Arif Elvan. "Hybrid Ventricular Tachycardia Ablation after Failed Percutaneous Endocardial and Epicardial Ablation." Cardiology 145, no. 2 (November 8, 2019): 88–94. http://dx.doi.org/10.1159/000503251.
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Introduction: Recurrent ventricular tachycardia (VT) after percutaneous ablation is associated with a high morbidity and mortality. We assessed the feasibility of open chest extracorporeal circulation (ECC)-supported 3D multielectrode mapping and targeted VT substrate ablation in patients with previously failed percutaneous endocardial and epicardial VT ablations. Methods: In patients with previously failed percutaneous endocardial and epicardial VT ablations and a high risk of hemodynamic collapse during the procedure, open chest ECC-supported mapping and ablation were performed in a hybrid EP lab setting. Electro-anatomic maps (3D) were acquired during sinus rhythm and VT using a multielectrode mapping catheter (HD grid; Abbott or Pentaray, Biosense Webster). Irrigated radiofrequency ablations of all inducible VT were performed with a contact force ablation catheter. Results: Hybrid VT ablation was performed in 5 patients with structural heart disease (i.e., 3 with previous old myocardial infarction and 2 with nonischemic cardiomyopathy) and recurrent VT. Acute procedural success was achieved in all patients. Four patients were successfully weaned off the ECC. In 1 patient with a severely reduced LVEF (16%), damage to the venous graft occurred after sternotomy and that patient died after 1 month. Four patients (80%) remained VT free after a median follow-up of 6 (IQR 4–10) months. Conclusion: In high-risk patients with previously failed percutaneous endocardial and epicardial VT ablations, open chest ECC-supported multielectrode epicardial mapping revealed a VT substrate in all of the patients, and targeted epicardial ablation abolished VT substrate in these patients.
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Gupta, Dhiraj, Tom De Potter, Tim Disher, Kiefer Eaton, Laura Goldstein, Leena Patel, Daniel Grima, Maria Velleca, and Graça Costa. "Comparative effectiveness of catheter ablation devices in the treatment of atrial fibrillation: a network meta-analysis." Journal of Comparative Effectiveness Research 9, no. 2 (January 2020): 115–26. http://dx.doi.org/10.2217/cer-2019-0165.
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Atrial fibrillation (AF) ablation is most commonly performed using radiofrequency (RF) and cryoballoon (CB) catheters. Ablation Index is a novel lesion-quality marker associated with improved outcomes in RF ablation. Due to lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option. Aim: To conduct a network meta-analysis to evaluate the comparative effectiveness of RF with Ablation Index to other catheter ablation devices in the treatment of AF. Methods: Searches for randomized and nonrandomized prospective comparative studies of ablation catheters were conducted in multiple databases. The outcome of interest was 12-month freedom from atrial arrhythmias after a single ablation procedure. Studies were grouped as high-, low- and unclear-quality based on study design and balanced baseline patient characteristics. Bayesian hierarchical network meta-analysis was conducted and results presented as relative risk ratios with 95% credible intervals (CrIs). Results: 12 studies evaluating five different catheter ablation devices were included. Radiofrequency ablation with Ablation Index was associated with statistically significantly greater probability of 12-month freedom from atrial arrhythmias than Arctic Front (relative risk: 1.77; 95% CrI: 1.21–2.87), Arctic Front Advance™ (1.41; 1.06–2.47), THERMOCOOL™ (1.34; 1.17–1.48) and THERMOCOOL SMARTTOUCH™ (1.09; 1–1.3). Results were robust in multiple sensitivity analyses. Conclusion: Radiofrequency catheter with Ablation Index is superior to currently available options for 12-month freedom from atrial arrhythmias after AF ablation. This study provides decision-makers with robust, pooled, comparative evidence of the latest ablation technologies.
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Meshkova, M., and A. Doronin. "Analysis of Complications in 1000 Consecutive Radiofrequency Catheter Ablations of Atrial Fibrillation." Ukrainian Journal of Cardiovascular Surgery, no. 2 (43) (June 18, 2021): 67–71. http://dx.doi.org/10.30702/ujcvs/21.4306/m009067-071/844-037-08.
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Introduction. In patients with drug-refractory symptomatic atrial fibrillation (AF), radiofrequency catheter ablation has become the main treatment option. Despite advances in technology and experience, the incidence of complications for this procedure reported by researchers still varies. In the USA, irrigated catheters are used nearly always, mostly with contact force sensing. We used conventional catheters.
The aim. To analyze the complications in 1000 consecutive radiofrequency catheter ablations of atrial fibrillation.
Results and discussion. Non-irrigated 4 mm tip ablation catheters and two venous punctures were used. In total, 32 (3.2%) complications were observed. Pericardial tamponade was observed in 6 cases (0.6%), pericardial effusion in 7 (0.7%), pericardial puncture without effusion in 1 (0.1%), pericarditis in 1 (0.1%), complete atrioventricular (AV) block in 2 (0.2%), transient AV block in 1 (0.1%), stroke in 2 (0.2%), diaphragm paresis with pneumonia in 1 (0.1%), femoral artery aneurysm in 6 (0.6%), femoral hematoma requiring blood transfusion in 2 (0.2%), arteriovenous fistula in 2 (0.2%), hematuria in 1 (0.1%).
Similar frequency of iatrogenic AV block was reported in the literature.
There were 26 (3.4%) complications during 794 primary procedures. After 206 repeated procedures, we observed 2 femoral hematomas, 2 femoral artery aneurysms, 1 arteriovenous fistula and 1 complete AV block – a total of 6 (2.9%) complications.
In several reports the incidence of life-threatening complications was lower than that in our study. However, the total number of complications in our group is at the level of the best results, despite the fact that we do not use irrigated catheters, esophageal temperature probes and endovascular ultrasound probes.
Conclusions. The technique that we use is as safe as other methods of AF radiofrequency catheter ablation.
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Suorsa, Veijo T. "Ultrasound-guided ablation catheter and methods of use." Journal of the Acoustical Society of America 114, no. 1 (2003): 36. http://dx.doi.org/10.1121/1.1601114.
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Kim, Sang Hyun, Jae Min Lee, Kang Won Lee, Sang Hoon Kim, Se Hyun Jang, Han Jo Jeon, Seong Ji Choi, et al. "Irreversible electroporation of the bile duct in swine: A pilot study." Journal of Clinical Oncology 38, no. 4_suppl (February 1, 2020): 541. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.541.
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541 Background: Irreversible electroporation (IRE) is a relatively new ablative method. However, the application of IRE ablation has not been attempted for the treatment of biliary disease. Minimally invasive approach using endoscopic retrograde cholangio-pancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we investigated the feasibility and effect of endoscopic IRE for biliary tract in animal model. Methods: A new catheter electrode was developed for endoscopic IRE ablation of biliary tract. The electrode for IRE ablation has two band-shaped electrodes on catheter tip. We performed ERCP and endoscopic IRE ablations on normal common bile duct in 6 Yorkshire pigs. Experimental parameters of IRE were 500V/cm, 1000V/cm and 2000V/cm (under 50 pulses, 100 µs length). Animals were sacrificed after 24 hours and ablated bile duct were collected. H & E stain, immunohistochemistry and western blot were performed. Results: Well-demarcated focal color changes were observed on the mucosa of the common bile duct under all experimental parameters. After IRE ablation, bile duct epithelium was disappeared around ablated area and it showed fibrotic change in H&E stain. Depth of change after IRE was different between each experimental parameters. Apoptotic change of bile duct was localized around mucosa in 500V. Diffuse transmural fibrosis of bile duct was shown after IRE ablation with 2000V. TUNEL immunohistochemistry showed the cell death of bile duct mucosa and submucosa along the electrode. Within 24 hours, no complication was observed in pigs after endoscopic IRE ablation. Conclusions: Endoscopic IRE ablation using ERCP was successfully performed on common bile duct by using catheter-shaped electrode. It can be a potential therapeutic option as minimally invasive ablation for treatment of biliary tumors.
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Wehsener, Sandra, Matthias Heinke, Robin Müssig, Johannes Hörth, Stefan Junk, and Steffen Schrock. "3d print of heart rhythm model with cryoballoon catheter ablation of pulmonary vein." Current Directions in Biomedical Engineering 5, no. 1 (September 1, 2019): 235–38. http://dx.doi.org/10.1515/cdbme-2019-0060.
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AbstractThe visualization of heart rhythm disturbance and atrial fibrillation therapy allows the optimization of new cardiac catheter ablations. With the simulation software CST (Computer Simulation Technology, Darmstadt) electromagnetic and thermal simulations can be carried out to analyze and optimize different heart rhythm disturbance and cardiac catheters for pulmonary vein isolation. Another form of visualization is provided by haptic, three-dimensional print models. These models can be produced using an additive manufacturing method, such as a 3d printer. The aim of the study was to produce a 3d print of the Offenburg heart rhythm model with a representation of an atrial fibrillation ablation procedure to improve the visualization of simulation of cardiac catheter ablation. The basis of 3d printing was the Offenburg heart rhythm model and the associated simulation of cryoablation of the pulmonary vein. The thermal simulation shows the pulmonary vein isolation of the left inferior pulmonary vein with the cryoballoon catheter Arctic Front AdvanceTM from Medtronic. After running through the simulation, the thermal propagation during the procedure was shown in the form of different colors. The three-dimensional print models were constructed on the base of the described simulation in a CAD program. Four different 3d printers are available for this purpose in a rapid prototyping laboratory at the University of Applied Science Offenburg. Two different printing processes were used and a final print model with additional representation of the esophagus and internal esophagus catheter was also prepared for printing. With the help of the thermal simulation results and the subsequent evaluation, it was possible to draw a conclusion about the propagation of the cold emanating from the catheter in the myocardium and the surrounding tissue. It was measured that just 3 mm from the balloon surface into the myocardium the temperature dropped to 25 °C. The simulation model was printed using two 3d printing methods. Both methods, as well as the different printing materials offer different advantages and disadvantages. All relevant parts, especially the balloon catheter and the conduction, are realistically represented. Only the thermal propagation in the form of different colors is not shown on this model. Three-dimensional heart rhythm models as well as virtual simulations allow very clear visualization of complex cardiac rhythm therapy and atrial fibrillation treatment methods. The printed models can be used for optimization and demonstration of cryoballoon catheter ablation in patients with atrial fibrillation.
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Hafez, Mm, Mm Abu-Elkheir, M. Shokier, Hf Al-Marsafawy, Hm Abo-Haded, and M. Abo El-Maaty. "Radiofrequency Catheter Ablation in Children with Supraventricular Tachycardias: Intermediate Term Follow up Results." Clinical Medicine Insights: Cardiology 6 (January 2012): CMC.S8578. http://dx.doi.org/10.4137/cmc.s8578.
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The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children's Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.
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Reynolds, Matthew R., Guy David, Candace Gunnarsson, Jamie L. March, and Steven C. Hao. "The Effects of Catheter Ablation Therapy on Medication Use and Expenditures in Patients with Atrial Fibrillation." Journal of Health Economics and Outcomes Research 2, no. 1 (October 1, 2014): 15–28. http://dx.doi.org/10.36469/9881.
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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. Catheter ablation has become an important treatment option for many AF patients. Catheter ablation has been hypothesized to reduce the need for continued medical therapy for patients with AF, but there are few empirical data which demonstrate this. Objective: The objective of this study was to estimate the impact of catheter ablation on antiarrhythmic drug (AAD) utilization and total drug expenditures among AF patients. Methods: A retrospective analysis using the Truven Health Analytics MarketScan® Research Database was performed. Patients with AF and a catheter ablation procedure who had continuous enrollment in the database 6 months prior to their first ablation and a minimum of 1-year follow-up post first ablation were compared to AF patients who were treated with AADs and not ablation. Propensity matching was used to account for baseline differences between groups, and multivariable regression models adjusted for patient characteristics and baseline healthcare resource utilization. Sub-analyses were performed for patients age ≥65. Results: AF patients treated with catheter ablation had significantly lower AAD utilization and total prescription drug costs than those treated with AADs only. These results persisted for the subset of patients age ≥65. The effects were strongest in the matched sample, where approximately 30% of ablation patients discontinued use of rhythm medication after receiving catheter ablation. Per-patient total medication expenditures were reduced by $800 to $1,200 per year in the matched sample. Conclusion: Catheter ablation for AF reduced AAD utilization and total prescription drug expenditures in a sustainable fashion up to 3 years post ablation. This reduction was consistent and significant in both the non-Medicare and Medicare populations.
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Ioannou, Adam, Nikolaos Papageorgiou, Wei Yao Lim, Tanakal Wongwarawipat, Ross J. Hunter, Gurpreet Dhillon, Richard J. Schilling, et al. "Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis." EP Europace 22, no. 11 (August 30, 2020): 1659–71. http://dx.doi.org/10.1093/europace/euaa224.
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Abstract Aims Despite recent advances in catheter ablation for atrial fibrillation (AF), pulmonary vein reconnection (PVR), and AF recurrence remain significantly high. Ablation index (AI) is a new method incorporating contact force, time, and power that should optimize procedural outcomes. We aimed to evaluate the efficacy and safety of AI-guided catheter ablation compared to a non-AI-guided approach. Methods and results A systematic search was performed on MEDLINE (via PubMED), EMBASE, COCHRANE, and European Society of Cardiology (ESC) databases (from inception to 1 July 2019). We included only studies that compared AI-guided with non-AI-guided catheter ablation of AF. Eleven studies reporting on 2306 patients were identified. Median follow-up period was 12 months. Ablation index-guided ablation had a significant shorter procedural time (141.0 vs. 152.8 min, P = 0.01; I2 = 90%), ablation time (21.8 vs. 32.0 min, P < 0.00001; I2 = 0%), achieved first-pass isolation more frequently [odds ratio (OR) = 0.09, 95%CI 0.04–0.21; 93.4% vs. 62.9%, P < 0.001; I2 = 58%] and was less frequently associated with acute PVR (OR = 0.37, 95%CI 0.18–0.75; 18.0% vs 35.0%; P = 0.006; I2 = 0%). Importantly, atrial arrhythmia relapse post-blanking was significantly lower in AI compared to non-AI catheter ablation (OR = 0.41, 95%CI 0.25–0.66; 11.8% vs. 24.9%, P = 0.0003; I2 = 35%). Finally, there was no difference in complication rate between AI and non-AI ablation, with the number of cardiac tamponade events in the AI group less being numerically lower (OR = 0.69, 95%CI 0.30–1.60, 1.6% vs. 2.5%, P = 0.39; I2 = 0%). Conclusions These data suggest that AI-guided catheter ablation is associated with increased efficacy of AF ablation, while preserving a comparable safety profile to non-AI catheter ablation.
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Hung, Man, Evelyn Lauren, Eric Hon, Julie Xu, Bianca Ruiz-Negrón, Megan Rosales, Wei Li, Tanner Barton, Jacob O’Brien, and Weicong Su. "Using Machine Learning to Predict 30-Day Hospital Readmissions in Patients with Atrial Fibrillation Undergoing Catheter Ablation." Journal of Personalized Medicine 10, no. 3 (August 9, 2020): 82. http://dx.doi.org/10.3390/jpm10030082.
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Atrial fibrillation (AF) cases are expected to increase over the next several decades, due to the rise in the elderly population. One promising treatment option for AF is catheter ablation, which is increasing in use. We investigated the hospital readmissions data for AF patients undergoing catheter ablation, and used machine learning models to explore the risk factors behind these readmissions. We analyzed data from the 2013 Nationwide Readmissions Database on cases with AF, and determined the relative importance of factors in predicting 30-day readmissions for AF with catheter ablation. Various machine learning methods, such as k-nearest neighbors, decision tree, and support vector machine were utilized to develop predictive models with their accuracy, precision, sensitivity, specificity, and area under the curve computed and compared. We found that the most important variables in predicting 30-day hospital readmissions in patients with AF undergoing catheter ablation were the age of the patient, the total number of discharges from a hospital, and the number of diagnoses on the patient’s record, among others. Out of the methods used, k-nearest neighbor had the highest prediction accuracy of 85%, closely followed by decision tree, while support vector machine was less desirable for these data. Hospital readmissions for AF with catheter ablation can be predicted with relatively high accuracy, utilizing machine learning methods. As patient age, the total number of hospital discharges, and the total number of patient diagnoses increase, the risk of hospital readmissions increases.
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Neuwirth, Radek, Jakub Cvek, Lukas Knybel, Otakar Jiravsky, Lukas Molenda, Michal Kodaj, Martin Fiala, et al. "Stereotactic radiosurgery for ablation of ventricular tachycardia." EP Europace 21, no. 7 (May 23, 2019): 1088–95. http://dx.doi.org/10.1093/europace/euz133.
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Aims Stereotactic body radiotherapy (SBRT) for ventricular tachycardias (VTs) could be an option after failed catheter ablation. In this study, we analysed the long-term efficacy and toxicity of SBRT applied as a bail-out procedure. Methods and results Patients with structural heart disease and unsuccessful catheter ablations for VTs underwent SBRT. The planning target volume (PTV) was accurately delineated using exported 3D electroanatomical maps with the delineated critical part of re-entry circuits. This was defined by detailed electroanatomic mapping and by pacing manoeuvres during the procedure. Using the implantable cardioverter-defibrillator lead as a surrogate contrast marker for respiratory movement compensation, 25 Gy was delivered to the PTV using CyberKnife. We evaluated occurrences of sustained VT, electrical storm, antitachycardia pacing, and shock; time to death; and radiation-induced events. From 2014 until March 2017, 10 patients underwent radiosurgical ablation (mean PTV, 22.15 mL; treatment duration, 68 min). After radiosurgery, four patients experienced nausea and one patient presented gradual progression of mitral regurgitation. During the follow-up (median 28 months), VT burden was reduced by 87.5% compared with baseline (P = 0.012) and three patients suffered non-arrhythmic deaths. After the blanking period, VT recurred in eight of 10 patients. The mean time to first antitachycardia pacing and shock were 6.5 and 21 months, respectively. Conclusion Stereotactic body radiotherapy appears to show long-term safety and effectiveness for VT ablation in structural heart disease inaccessible to catheter ablation. We report one possible radiation-related toxicity and promising overall survival, warranting evaluation in a prospective multicentre clinical trial.
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Aksoy, Fatih. "Radiofrequency catheter ablation increases mean platelet volume." Revista da Associação Médica Brasileira 65, no. 8 (August 2019): 1080–85. http://dx.doi.org/10.1590/1806-9282.65.8.1080.
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SUMMARY OBJECTIVE Radiofrequency ablation (RFA) may increase the risk of thromboembolic events. The objective of this study was to evaluate the effect of RFA on mean platelet volume (MPV), an indicator of platelet activity. METHODS A total of 95 patients undergoing RFA were included in the study. MPV was measured before and one month after the procedure. The control group was formed by 83 individuals of the same sex and age as those in the study group. RESULTS Beta-blockers, non-dihydropyridine calcium channel blockers, and acetylsalicylic acid use was higher in the ablation group compared with the control group. Other baseline clinical characteristics and baseline hemoglobin, white blood cell count, platelet count, and MPV values were similar between the ablation and control groups. In the ablation group, baseline and post-procedural hemoglobin, white blood cell counts were similar. However, postprocedural MPV values were higher, and platelet counts were lower compared with the preprocedural values. CONCLUSION Our results indicate that MPV values are higher after RFA compared with baseline values.
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Kiser, Andy C., Mark D. Landers, Ker Boyce, Matjaž šinkovec, Andrej Pernat, and Borut Geršak. "Simultaneous Catheter and Epicardial Ablations Enable a Comprehensive Atrial Fibrillation Procedure." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6, no. 4 (July 2011): 243–47. http://dx.doi.org/10.1097/imi.0b013e31822ca15c.
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Objective Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues. Methods Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a “box” lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation. Results Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m2; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm. Conclusions Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.
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Baumert, Mathias, Prashanthan Sanders, and Anand Ganesan. "Quantitative-Electrogram-Based Methods for Guiding Catheter Ablation in Atrial Fibrillation." Proceedings of the IEEE 104, no. 2 (February 2016): 416–31. http://dx.doi.org/10.1109/jproc.2015.2505318.
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Ngo, Linh, Anna Ali, Anand Ganesan, Richard Woodman, Robert Adams, and Isuru Ranasinghe. "Gender differences in complications following catheter ablation of atrial fibrillation." European Heart Journal - Quality of Care and Clinical Outcomes 7, no. 5 (May 8, 2021): 458–67. http://dx.doi.org/10.1093/ehjqcco/qcab035.
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Abstract Aims Population studies that provide unbiased estimates of gender differences in risk of complications following catheter ablation of atrial fibrillation (AF) are sparse. We sought to evaluate the association of female gender and risk of complications following AF ablation in a nationwide cohort. Methods and results We identified 35 211 patients (29.5% females) undergoing AF ablations from 2008 to 2017 using national hospitalization data from Australia and New Zealand. The primary outcome was any procedural complication occurring up to 30-days after discharge. Logistic regression was used to adjust for differences in baseline characteristics between sexes. Compared with males, females were older (mean age 64.9 vs. 61.2 years), had higher rates of hypertension (14.0% vs. 11.6%) and haematological disorders (5.3% vs. 3.8%) and experienced a higher rate of procedural complications (6.96% vs. 5.41%) (all P < 0.001). This gender disparity remained significant after adjustment [odds ratio (OR) 1.25 (95% confidence interval 1.14–1.38), P < 0.001] and was driven by an increased risk of vascular injury [OR 1.86 (1.23–2.82), P = 0.003], pericarditis [OR 1.86 (1.16–2.67), P = 0.008], pericardial effusion [OR 1.71 (1.35–2.17), P < 0.001), and bleeding [OR 1.30 (1.15–1.46), P < 0.001]. Notably, the gender difference persisted over time [OR for the most recent period 1.19 (1.003-1.422), P = 0.046] despite a declining complication rate in both men and women. Conclusion Females undergoing AF ablations experienced a 25% higher risk of procedural complications compared with males, a disparity that has persisted over time despite a falling complication rate. Efforts to reduce this gender disparity should focus on reducing the incidence of pericardial effusion, pericarditis, vascular injury, and bleeding.
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Ke, Fusheng, Yinhui Huang, Zhexiu Jin, Lei Huang, Qiang Xiong, Fang Jia, Yu Chen, and Gang Chen. "Association between functional mitral regurgitation and recurrence of paroxysmal atrial fibrillation following catheter ablation: a prospective cohort study." Journal of International Medical Research 49, no. 5 (May 2021): 030006052110143. http://dx.doi.org/10.1177/03000605211014375.
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Objective The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. Methods This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. Results The median duration of PAF was 24 (3–60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191–3.004; hazard ratio=0.665, 95% confidence interval: 0.134–3.300, respectively). Kaplan–Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. Conclusions FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.
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Tesmann, J. "Radiofrequency ablation of varicose veins." Phlebologie 46, no. 03 (2017): 137–42. http://dx.doi.org/10.12687/phleb2373-3-2017.
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SummaryBackground: In the search of alternative techniques to high ligation and stripping (HL/S) in the treatment of varicose veins, catheter-ablation methods have been implemented since 1998. Besides endovenous laser techniques (ELT) radiofrequency ablation (RFA) is a successful device in treating insufficiency of the Great (GSV) and Small saphenous vein (SSV). Methods: This review article sums up publications on Closure Plus™, ClosureFAST™, RFITT® (Celon Method), and EVRF®. It discusses the actually favorized treatment protocols and study results. Results of meta-analysis are presented, too.Results: The Closure Plus™ catheter was the first radiofrequency technique to be licensed in Europe in 1998. Trials and meta-analyzes show occlusion rates of 81–89 % after 5 years. The consecutive technique was the ClosureFAST™ (CLF) catheter that was introduced in 2007 and offered more standardization in treatment. Published data show occlusion rates of 98 % after 5 years and low profile on complications. Also in 2007 a bipolar radiofrequency technique called RFITT was presented. Due to lack of standards in treatment protocol it could not get accepted as well as CLF despite of good treatment results (92–98 % occlusion rates after 12 months) and low complications. A new RFA device called EVRF® shows weak evidence so far.Conclusion: Radiofrequency ablation of varicose veins has become a well-established treatment alternative to HL/S mostly represented by CLF.
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Tischer, Tina S., Daniel Nitschke, Isabelle Krause, Günther Kundt, Alper Öner, Giuseppe D’Ancona, Erdal Şafak, Hüseyin Ince, Jasmin Ortak, and Evren Caglayan. "Prevalence and Progression of Cognitive Impairment in Atrial Fibrillation Patients after Treatment with Catheter Ablation or Drug Therapy." Cardiology Research and Practice 2019 (December 14, 2019): 1–8. http://dx.doi.org/10.1155/2019/7216598.
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Purpose. In atrial fibrillation (AF) patients, the effect of catheter ablation or drug therapy on cognition is currently not well investigated. Therefore, we prospectively evaluated AF patients who were either treated 'with drug therapy or underwent catheter ablation for the prevalence and progression of cognitive impairment (CI). Methods. Randomized participants of the CABANA trial (catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation) and the CASTLE-AF (catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation) study were assessed twice within 6 months by Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in our institution. Results. Forty-five patients from both trials were investigated, and twenty-eight patients received catheter ablation, whereas seventeen patients received drug therapy for rhythm or rate control. The mean age of the twenty-one CABANA trial patients (AF group) was 68.8 ± 7.0 years and of the twenty-four CASTLE-AF study patients (AF/HF group) was 66.8 ± 8.1 years, respectively. Mean time from ablation/randomization to the first interview was 16.8 ± 11 months in the AF group and 28.3 ± 18.4 months in the AF/HF group, respectively. All patients investigated were classified as cognitively impaired with mean cutoff scores <24 by MoCA. Overall, we could not detect significant differences in medically treated versus catheter ablation patients within both groups in mean MMSE or MoCA scores between the first and the second interview (p>0.09). Moreover, patients who received catheter ablation did not show statistically significant differences in the prevalence or progression of cognitive impairment compared to patients who were treated medically, neither within the two groups nor between AF and AF/HF patients (p>0.05). Conclusions. Prevalence of cognitive impairment in AF patients with comorbidities is substantial. However, in this preliminary prospective study, no apparent impact of AF pretreatment on the prevalence and course of cognitive impairment could be observed.
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Malagù, Michele, Francesco Vitali, Federico Marchini, Alessio Fiorio, Paolo Sirugo, Daniela Mele, Alessandro Brieda, Cristina Balla, and Matteo Bertini. "Ablation of Atrioventricular Nodal Re-Entrant Tachycardia Combining Irrigated Flexible-Tip Catheters and Three-Dimensional Electroanatomic Mapping: Long-Term Outcomes." Journal of Cardiovascular Development and Disease 8, no. 6 (May 25, 2021): 61. http://dx.doi.org/10.3390/jcdd8060061.
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Background: Transcatheter ablation is the standasrd treatment for atrioventricular nodal re-entrant tachycardia (AVNRT). However, different techniques are available. Data about the use of irrigated flexible-tip catheters and three-dimensional electroanatomical mapping (3D EAM) for AVNRT ablation are scant. The aim of this study was to evaluate in long-term follow-up efficacy and safety of a novel approach for AVNRT treatment. Methods: This is a cohort single arm study with long-term follow-up. Patients with AVNRT were treated with catheter ablation by means of irrigated flexible-tip catheters combined with 3D EAM. Results: One-hundred-and-fifty patients were enrolled and followed-up for a median of 38 months (minimum 12, maximum 74). Acute procedural success rate was 96.7% (145/150 patients). During follow-up, 11 patients had arrhythmia recurrences (7.3%). No patient developed atrioventricular conduction block with need for pacemaker implantation (0%). Fourteen patients died during follow-up (9.3%). Conclusions: Acute procedural success and long-term follow-up show that AVNRT could be safely and effectively treated with irrigated flexible-tip catheters and 3D EAM.
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Lozekoot, Pieter W. J., Monique M. J. de Jong, Orlando Parise, Francesco Matteucci, Fabiana Lucà, Narendra Kumar, Daniele Bani, et al. "The ABLA-BOX: An in Vitro Module of Hybrid Atrial Fibrillation Ablation." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 3 (May 2016): 201–9. http://dx.doi.org/10.1097/imi.0000000000000256.
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Objective We present the first testing study on the ABLA-BOX, a new in vitro module of hybrid atrial fibrillation ablation. Methods ABLA-BOX consists of two chambers that mimic the epicardial and endocardial sides of the heart. The septum between chambers provides catheter access on both sites of the cardiac tissue. A circuit, filled with freshly obtained porcine blood, including a pump, an oxygenator, and a heating device, circulate the blood inside the system. Left atrial fresh tissue is mounted on a tissue holder and magnetically fixed. Epicardial and endocardial catheters are fixed on the catheter holders and blocked with the locker knob. The system allows control of ablation force, flow rate, temperature, and flow pattern. Results Epicardial contact force of 100 g and endocardial force of 30 g resulted in larger lesion volumes (P < 0.001), areas (P < 0.001), and lesion diameters (P = 0.03 and P = 0.008), than the combination of 100/20 g. In addition, with a flow rate of 5 L/min, lesion volumes (P = 0.02), areas (P < 0.001), and diameters (both, P < 0.001) were significantly larger in comparison with those of 3 L/min. Furthermore, dimensions (both, P < 0.001), volume (P < 0.001), and area (P < 0.001) of the lesions at a circulating blood temperature of 38.0°C were larger than with a lower blood temperature (36.0°C). Finally, ablations made under stable flow pattern resulted in greater lesion diameters P = 0.04 and P = 0.03) as well as larger volumes (P = 0.02) and areas (P = 0.03) than under turbulent-like flow reproduced with the system rotor set to 400 rpm. Conclusions The ABLA-BOX allowed easy hybrid ablation with different setups, which can provide cardiologists and cardiac surgeons with reliable and more valuable insights.
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Hashem, Sabina, Mohsin Hossain, M. Atahar Ali, Amal Kumar Choudhury, SM Ahsan Habib, Md Khalequzzaman, Md Akhtaruzzaman, Shaila Nabi, Tarek Ahmed Choudhury, and Sharafat Nurul Islam. "Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites." University Heart Journal 8, no. 2 (August 5, 2013): 103–9. http://dx.doi.org/10.3329/uhj.v8i2.16081.
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Background: This study assessed the efficacy and safety of techniques used to ablate left-sided accessory atrioventricular pathways at atrial insertion sites by retrograde aortic approach. Radiofrequency catheter ablation of left-sided accessory pathways by way of retrograde aortic approach can be highly successful. Methods: This study were done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from June 2009 and March 2010, a total 30 patients with recurrent SVT who has left sided accessory atrioventricular pathways found after electrophysiological study, underwent attempted radiofrequency catheter ablation of one or more accessory atrioventricular pathways by retrograde aortic approach. The ablation catheter was inserted into the femoral artery and passed retrogradely across the aortic valve .Once an optimal target site has been identified, radiofrequency energy at a pre-selected temperature of 55 - 60 0 C and power output set at 50 watts was delivered through the ablation catheter. Loss of preexcitation or interruption of the tachycardia within 5 seconds of RF application was considered effective and RF current was continued in this location 30 to 60 seconds. Ablation success was defined at completion of procedure as acutely successful or unsuccessful on the basis of successful elimination of all ablation targets. Results: During EP study it was found that 9 patients had concealed accessory pathways and 21 had manifest pre-excitation. WPW left-lateral pathway was present in 10 (33.3%), concealed left lateral in 08 (26.7%) ,WPW left posterior in 11 (36.7%), concealed left posterior in 1 (3.3%). Out of 30 accessory pathways, 24 were successfully interrupted with radiofrequency catheter ablation with a primary success rate of 80 %. The ratio of atrial/ ventricular electrogram in successful sites was 0.83 ±0.27 (0.53-1.46). There were no major complications with retrograde aortic approach. Six failed patients were ablated via transseptal method. Conclusion: The retrograde atrial insertion approach to left-sided accessory pathway ablation is very safe and high effective, especially suitable for the failed patients by using retrograde ventricular insertion ablation procedure and by using single-catheter ablation of accessory pathway. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16081 University Heart Journal Vol. 8, No. 2, July 2012
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Hashem, S., M. Hossain, MA Ali, AK Chowdhury, Habib SM Ahsan, M. Khalequzzaman, M. Akhtaruzzaman, S. Nabi, TA Choudhury, and NI Sharafat. "Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites." University Heart Journal 9, no. 1 (July 14, 2014): 18–24. http://dx.doi.org/10.3329/uhj.v9i1.19507.
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Background: This study assessed the efficacy and safety of techniques used to ablate left-sided accessory atrioventricular pathways at atrial insertion sites by retrograde aortic approach. Radiofrequency catheter ablation of left-sided accessory pathways by way of retrograde aortic approach can be highly successful. Methods: This study were done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from June 2009 and March 2010, a total 30 patients with recurrent SVT who has left sided accessory atrioventricular pathways found after electrophysiological study, underwent attempted radiofrequency catheter ablation of one or more accessory atrioventricular pathways by retrograde aortic approach. The ablation catheter was inserted into the femoral artery and passed retrogradely across the aortic valve .Once an optimal target site has been identified, radiofrequency energy at a pre-selected temperature of 55 - 60 0 C and power output set at 50 watts was delivered through the ablation catheter. Loss of preexcitation or interruption of the tachycardia within 5 seconds of RF application was considered effective and RF current was continued in this location 30 to 60 seconds. Ablation success was defined at completion of procedure as acutely successful or unsuccessful on the basis of successful elimination of all ablation targets. Results: During EP study it was found that 9 patients had concealed accessory pathways and 21 had manifest pre-excitation. WPW left-lateral pathway was present in 10 (33.3%), concealed left lateral in 08 (26.7%), WPW left posterior in 11 (36.7%), concealed left posterior in 1 (3.3%). Out of 30 accessory pathways, 24 were successfully interrupted with radiofrequency catheter ablation with a primary success rate of 80 %. The ratio of atrial/ ventricular electrogram in successful sites was 0.83 ±0.27 (0.53-1.46). There were no major complications with retrograde aortic approach. Six failed patients were ablated via transseptal method. Conclusion: The retrograde atrial insertion approach to left-sided accessory pathway ablation is very safe and high effective, especially suitable for the failed patients by using retrograde ventricular insertion ablation procedure and by using single-catheter ablation of accessory pathway. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19507 University Heart Journal Vol. 9, No. 1, January 2013; 18-24
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Oberti, Carlos, John Ashton, Christopher Birchard, Oussama Wazni, and Walid Saliba. "Abstract 12271: Radiofrequency Ablation With Electrode in Contact With Circular Mapping Catheter: Coagulation, Char, and Pop Ocurrence Comparison With Two Types of Irrigated Ablation Catheters." Circulation 130, suppl_2 (November 25, 2014). http://dx.doi.org/10.1161/circ.130.suppl_2.12271.
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Introduction: A circular mapping catheter (CMC, Biosense Webster Lasso® Catheter) is frequently used in radiofrequency (RF) ablation treatment of atrial fibrillation to aid in determining ablation targets, such as the pulmonary vein ostia. During RF delivery, the ablation electrode is often in close proximity and may sometimes be in contact with one of the electrodes of the CMC. In this study, we compare coagulation, tissue char, and pop occurrence for ablations in contact with a CMC electrode versus ablations without a CMC. Ablations were performed with open-irrigation ablation electrodes of the Biosense Webster ThermoCool® Catheter (6 hole) and ThermoCool® SF Catheter (56 hole). Hypothesis: There will be more coagulation formation when there is contact with CMC. Methods: The thigh muscles of 4 anesthetized pigs were exposed and a skin cradle created. A 6 hole or 56 hole catheter was placed on the muscle with 10g of force in perpendicular orientation. Some ablations were performed with the ablation catheter alone, while others were performed with a CMC resting on the thigh muscle and the ablation electrode contacting one of the CMC electrodes on top or on the side. Heparinized autologous blood (activated clotting time > 350s) at 37°C was circulated in the thigh cradle at 275-300ml/min while ablations were performed at 50W for 60s with 30ml/min irrigation for 6 hole and 15ml/min for 56 hole. Pops during ablation were noted. After the ablation, the blood pool was removed while keeping the catheters in position, the ablation site was examined, and coagulation and tissue char was noted Results: See Table Conclusions: When comparing ablations with a CMC versus no CMC, there was more coagulation with a CMC. When comparing a 6 hole catheter with a CMC versus a 56 hole catheter with a CMC, there was more coagulation with the 6 hole ablation catheter. There was no significant difference in pop and tissue char in any comparison
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Waldmann, V., D. Amet, A. Zhao, M. Ladouceur, C. Karsenty, A. Maltret, F. Pontnau, et al. "Catheter ablation in adults with congenital heart disease: a 15-year perspective from a tertiary center." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.0437.
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Abstract Background With the growing population of adults with congenital heart disease (ACHD), the number of catheter ablation procedures is expected to increase over time. Purpose We aimed to describe temporal trends in volume and outcomes of catheter ablation procedures in ACHD patients in a large tertiary center. Methods Retrospective observational study including all consecutive ACHD patients undergoing catheter ablation in a tertiary reference center over a 15-year period. Acute procedural success rate (including complete success in case of non-inducibility of any arrhythmia at the end of the procedure) as well as freedom from recurrence at 12 months were analyzed. Results From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6±15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 by year (p<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common targeted arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.3% (p<0.001), including complete acute procedural success from 45.0% to 88.1% (p<0.001) (Figure 1). The use of irrigated catheters (30.0% to 94.8%, p<0.001), 3D-mapping systems (60.0% to 96.3%, p<0.001), contact force catheters (0.0% to 91.9%, <0.001), and high-density mapping (0.0% to 71.9%, p<0.01) increased significantly. Use of irrigated catheters (OR=3.96, 95% CI: 1.79–8.55), 3D-mapping system (OR=3.55, 95% CI: 1.62–7.55), contact force catheters (OR=3.46, 95% CI: 1.71–7.25), and high-density mapping (OR=3.85, 95% CI: 1.60–7.26) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (p=0.001). Seven (2.3%) non-fatal complications occurred. Conclusions The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Advances in ablative technologies appear to be associated with a low rate of complications and a significant improvement in acute and midterm outcomes. Evolution of acute procedural success Funding Acknowledgement Type of funding source: None
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Gallagher, Mark M., Gang Yi, Hanney Gonna, Lisa W. M. Leung, Idris Harding, Banu Evranos, Rachel Bastiaenen, et al. "Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial." EP Europace, November 14, 2020. http://dx.doi.org/10.1093/europace/euaa289.
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Abstract Aims Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.
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Weber, Stefan, Sabine Fredersdorf, Clemens Jilek, Norbert Heinicke, Carsten Jungbauer, Oliver Husser, and Andreas Jeron. "Abstract 4653: Isolation Of Pulmonary Veins Using A Novel Decapolar Catheter For Mapping And Ablation." Circulation 118, suppl_18 (October 28, 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_925-b.
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Background: Ablation of atrial fibrillation (AF) is one of the most time consuming procedures in interventional electrophysiology. Currently, the selection of catheters and ablation techniques is still a matter of debate. Due to the rapidly increasing demand of ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore we investigated the feasibility of a novel decapolar ablation catheter (PVAC) combined with a duty-cycled, low-power RF generator for pulmonary vein (PV) isolation. The system does not require 3D mapping and is the first to enable mapping, pacing and circular as well as segmental ablation with a single catheter. Methods: AF mapping and ablation was performed in 15 consecutive patients with intermittent AF (mean age 58±12 years, 6 males) using the PVAC- catheter. To visualize the pulmonary vein anatomy, CT or MRI scan was performed in addition to PV angiography before ablation procedure. Additionally all patients underwent transesophageal echocardiography to rule out left atrial (LA) thrombi. Ablation procedure was performed by introducing the PVAC to the LA via single transseptal puncture. An optimal and stable catheter position for mapping and ablation was achieved by using a steerable sheath and an over the wire technique. RF energy was typically delivered for 60s for circular and 30 to 60s for segmental ablations. Ablation success was defined by disappearance of PV signals and complete exit block obtained by PVAC stimulation. Results: Isolation of all four PVs could be achieved in 59/60 veins (98%). A very small and hypoplastic right inferior PV could not be reached. The median RF application time until all PV were isolated successfully was 23±7 min. First half of ablations were performed by circular RF application, second half with segmental applications until isolation. Procedure time for ablation was 81±14 min. Total fluoroscopy time was 31±9 min. There were no procedural complications. Conclusion: Mapping and ablation of pulmonary veins can be performed safe and fast, with low procedure times using a single catheter without 3D navigation or assisted steering. Thus this system may be of high interest not only for high volume but all centers performing AF ablation.
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Levine, J. L., K. Xiang, J. Su, S. Hsu, R. J. Kim, S. Elayi, and J. N. Catanzaro. "P1021Comparative efficacy of microfidelity technology vs standard ablation for atrioventricular nodal ablation." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz747.0612.
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Abstract Background Microfidelity Cateter Technology has proven efficacy in ablating atrial arrhythmias in multiple pilot studies. Closely spaced radial microelectrodes render a focused near-field electrogram. Case series suggest that this catheter design facilitates accurate ablations with fewer radiofrequency (RF) lesions. Atrioventricular junction (AVJ) ablation is regarded as a straightforward procedure, but case records show wide variance in procedure times and number of RF lesions required. Methods Twenty-four patients scheduled for AVJ ablation were randomized to treatment with either the Microfidelity technology or standard 8mm/8 French ablation catheter. Both groups located the AVJ by fluoroscopic landmarks and His electrograms, and the MiFi group used electroanatomical mapping to create the location of his electrograms. The primary endpoints were development of Junctional Rhythm (JR) or Complete Heart Block (CHB), and time from first RF lesion until rhythm change. Secondary endpoints included number of RF applications. Results Patients were randomized one-to-one to the MiFi arm or standard ablation arm. JR or CHB was achieved in all patients. Time from first RF lesion until JR/CHB was: (Median/IQR) 325 sec/250–1270 sec. vs 287 sec/101–406 sec. Number of RF applications was 5/3–15 applications vs 4.5/1–5 applications. Total procedure time in the lab was 134 min/73.5–172.5 min vs 58 min/52–146 min. Microfidelity Technology vs Standard Conclusion Analysis suggests that the MiFi catheter is efficacious in ablating the AVJ, but requires greater RF duration and number of lesions, with wider case-by-case variability to achieve JR or CHB. Microfidelity technology and electroanatomical mapping did not result in faster time to completion than using fluoroscopic landmarks and His electrograms alone. Preoperative choice of sheath for catheter stability and contact may also play a role in a more efficient timely successful ablation of the AV node. Acknowledgement/Funding Boston Scientific
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Sahn, David J., K. Kirk Shung, Jonathan Cannata, Douglas N. Stephens, Raymond Chia, Peter Chen, Kai Thomenius, et al. "Abstract 2242: Very High Resolution Near Field Imaging of Ablation with a Newly-Developed Forward-Looking Catheter Mounted Microlinear Intracardiac Imaging Array." Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_488-b.
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Background: We have developed the first forward-looking highly steerable intracardiac echo probe developed for ultrasound visualization of ablation. It is a 24-element forward-looking microlinear array on a 9 Fr catheter that has additional electrodes so it can be localized compared to separate ablation catheters through electrofield navigation by NavX. Methods: In 4 studies of closed-chest pigs, we have imaged ablation locations in the right atrium and the isthmus and on the right side of the septum and at the right ventricular apex, and also imaged across the septum at ablations in the left ventricle along the septum with this device. Results: Images at 150–170 frames/sec at 12–15 MHz give very high detail of the changes occurring during ablation, including liquefaction, heating changes, brightening and thickening of tissue, and thrombus formation in the adjacent region in unheparinized pigs. The devices are well enough shielded from RF energy that there is little interference, and yet an ablation is being performed. A catheter tip artifact makes it easy to see the actual location of the ablation catheter tip with the microlinear array. Tissue Doppler/strain rate imaging also yields the possibility of determining mechanical changes occurring in ablation where brightening of tissue associated with stiffening diminished mechanical strain deformations in ablated lesions, especially in the ventricles. Conclusions: This new technology provides a new method for guidance and, more importantly, a method for understanding the changes that occur with RF ablations in experimental animals and, eventually, in patients.
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Khaykin, Y., P. Alipour, Z. Azizi, A. Avoulov, C. Jansen, S. Donegan, S. Morris, et al. "P1409Effectiveness of atrial fibrillation ablation using a contact force stability module with contact force or non-contact force catheter." EP Europace 22, Supplement_1 (June 1, 2020). http://dx.doi.org/10.1093/europace/euaa162.092.
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Abstract Funding Acknowledgements This study was funded by Biosense Webster, Inc. Background Catheter ablation is a mainstream treatment option for atrial fibrillation (AF). Recently, contact force (CF) enabled ablation catheters and a stability module were developed to allow for real-time CF sensing and improvement of catheter-tissue stability, which is important for achieving an optimal clinical outcome. We assessed the relative effectiveness of these new technologies, as well as the optimal CF stability parameters, in a real-world setting. Purpose To compare the clinical effectiveness of AF ablations performed with a CF catheter using location stability settings of 2.5 mm maximum distance for 12 s minimum (2.5/12) vs. a non-CF catheter with settings of 3 mm for 7 s (3/7). Methods Within 1/14–4/18, 176 de novo AF ablations using either a CF catheter with stability settings of 2.5/12 (n = 92, 5/16–4/18) or a non-CF catheter with stability settings of 3/7 (n = 84, 1/14–3/14) were performed by a single operator at a Canadian medical center. Patients routinely wore 48 hour Holter monitors every three months through the first year. The primary measures of effectiveness were Kaplan-Meier (KM) survival estimates of freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) recurrence after a 3-month blanking period and reablation. Results The CF group was 62.9 ± 10.0 years old, 57.6% male, and 66.3% paroxysmal (PAF). The non-CF group was 61.6 ± 9.9 years old, 63.1% male, and 76.2% PAF. Procedural complications consisted of a single vascular access complication in the non-CF group. The 12-month estimate of freedom from AF/AT/AFL recurrence was 79.4% in the CF group vs. 64.8% in the non-CF group (p = 0.058 for difference in survival over time). 12-month freedom from reablation was 90.4% in the CF group vs. 70.5% in the non-CF group (p = 0.002). Conclusion CF ablation with more stringent stability settings of 2.5/12 was more effective than non-CF ablation with stability settings of 3/7, likely attributable to the CF catheter enabling visualization of catheter-tissue contact and the stability module facilitating maintenance of CF stability during ablation. Abstract Figure.
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Dickfeld, Timm, Martin Engelhardt, Katrina Read, Christopher Kocher, Jagan Akella, Anthony Johnson, Robert Peters, Magdi Saba, Stephen Shorosfsky, and Thorsten Fleiter. "Abstract 2243: Real-Time Computed Tomography (RT-CT) for Guidance of Catheter Navigation, Transseptal Puncture and Anatomically Targeted Radiofrequency Ablation." Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_489.
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Background: Recent ablation strategies for complex arrhythmias such as atrial fibrillation or ischemic ventricular tachycardia are increasingly based on anatomic considerations. While fluoroscopy and 3D-mapping systems are widely used to guide these ablations, they are limited by poor soft tissue visualization and the lack of real-time anatomic data. Therefore, this study sought to evaluate if real-time computed tomography (RT-CT) could overcome these limitations and guide catheter navigation, transseptal puncture and anatomically targeted ablation. Methods: Catheter real-time guidance was assessed in 5 swine (40kg) using a 40-slice RT-CT. First, right/left heart catheterization was performed from the femoral vein and artery with the goal to access all cardiac chambers and the great cardiac vessels. Second, transseptal puncture was attempted with targeted ablations at pre-specified locations at the left lateral wall. Third, targeted ablation at the pulmonary vein (PV) orifice and repeat ablations at the right lateral wall were created to assess accuracy and precision, respectively. Fourth, creation of a straight ventricular four-point line was attempted. Necropsy was performed to assess possible complications and to compare the location of the ablation sites with the CT images. Results: Catheter navigation was performed safely from the femoral vein to the pulmonary artery and the femoral artery to the left ventricle. Misguided catheters to the renal vein, jugular vein, and carotid artery were correctly identified and removed. Transseptal puncture using a Brocken-brough needle was successfully performed and confirmed with anatomically targeted ablations at the left lateral atrial wall. Accuracy as assessed by PV ablations was in the range of 1–3mm. Repeat ablations in the right atrial wall revealed a precision of 2–3mm. Maximum deviation from a straight 4-point ventricular line was 2.8mm. No complications were seen at necropsy. Conclusions: Catheter navigation (in all four cardiac chambers) as well as transseptal puncture can be performed guided exclusively by RT-CT. Anatomically targeted ablations can be created with good accuracy and precision under real-time guidance. This suggests a possible role of RT-CT to guide ablation procedures.
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Eijkenduijn, J., HB Van Den Nieuwenhof, LS Bannink, L. Feenstra, WH Nijhof, S. Vreemann, BC Hamans, M. Rier, VJHM Van Driel, and IAC Van Der Bilt. "Cardiac MRI-guided pulmonary vein isolation for atrial fibrillation: a time-driven-activity-based costing analysis." European Heart Journal - Cardiovascular Imaging 22, Supplement_2 (June 1, 2021). http://dx.doi.org/10.1093/ehjci/jeab090.082.
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Abstract Funding Acknowledgements Type of funding sources: None. Aims The number of people suffering from atrial fibrillation (AF) is increasing drastically, leading to a greater burden on the financial budget due to increased treatment. Fluoroscopy-guided pulmonary vein isolation (PVI) has become first-line treatment. However, long-term outcomes of PVI for AF are frequently unsuccessful, causing recurrences of AF and the need for redo procedures. Magnetic Resonance Imaging (MRI) guided catheter ablation might reduce subsequent ablation procedures and associated costs. Purpose The aim of this study was to perform a Value-Based Healthcare analysis using a Time-Driven Activity-Based Costing (TDABC) approach. As secondary endpoint, the percentage of redo procedures for MRI-guided ablation at which this treatment becomes equally costly was calculated. Methods The TDABC method was implemented for the MRI-guided and fluoroscopically-guided catheter ablations. The costs and time estimates for the resources (personnel and equipment) were allocated to each activity performed in the entire Care-Delivery Value Chain (CDVC) and aggregated to establish a complete cost overview. Results: The ablation procedure was most substantial within the cost overview 69% versus 77% for fluoroscopically-guided and MRI-guided ablation, respectively. The percentage of redo procedures for fluoroscopically-guided ablation was established to be 26%. For the MRI-guided ablation a virtual percentage of 15% redo was calculated to be equally costly. Conclusion A detailed in-house cost assessment with a refined understanding of the distribution of the costs was developed. The catheter ablation procedure was the main contributor to total cost. This was mainly due to the high costs of the single use ablation catheters.
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Hendriks, Astrid A., Ferdi Akca, Lara Dabiri Abkenari, Muchtiar Khan, Rohit E. Bhagwandien, Sing C. Yap, Sip Wijchers, and Tamas Szili-Torok. "Abstract 9860: Safety and Clinical Outcome of Catheter Ablation of Ventricular Arrhythmias Using Contact Force Sensing, Consecutive Case Series." Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.9860.
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Introduction: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachycardia (VT) ablations has not been studied for their long term efficacy. Hypothesis: The hypothesis is that CF ablation is superior to manual ablation (MAN) and non-inferior to remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long term outcome. Methods: A total of 249 consecutive patients underwent VT ablation, with the use of MAN, CF or RMN catheters were included in this single center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The average follow-up period was ± 20 months. Results: Acute success was achieved in 191 out of 249 procedures (75.9%). Acute success in manual ablation, CF ablation and RMN ablation was 70.1%, 72.3% and 85.2% respectively (P = 0.038). Major complications occurred in 3.2% and there was a trend towards less major complications (P = 0.055) in the RMN group. Thirty-six percent of the patients with an initially successful procedure had a recurrence during follow-up (CF 41.2% MAN 37.5% RMN 32.0% P = NS). Conclusions: The use of CF sensing catheters does not improve the procedural outcome or safety profile in comparison to non-CF sensing ablation in ventricular arrhythmias. RMN non-CF sensing ablation has the highest procedural success rate. Future studies are necessary to investigate the role of CF in VT ablation and to define the optimal force.
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Dickow, Jannis, Atsushi Suzuki, Benhur D. Henz, Malini Madhavan, H. Immo Lehmann, Songyun Wang, Kay D. Parker, et al. "Characterization of Lesions Created by a Heated, Saline Irrigated Needle-Tip Catheter in the Normal and Infarcted Canine Heart." Circulation: Arrhythmia and Electrophysiology 13, no. 12 (December 2020). http://dx.doi.org/10.1161/circep.120.009090.
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Background: Inability to eliminate intramural arrhythmogenic substrate may lead to recurrent ventricular tachycardia after catheter ablation. The aim of the present study was to evaluate intramural and full thickness lesion formation using a heated saline-enhanced radiofrequency (SERF) needle-tip catheter, compared with a conventional ablation catheter in normal and infarcted myocardium. Methods: Twenty-two adult mongrel dogs (30–40 kg, 15 normal and 7 myocardial infarct group) were studied. Lesions were created using the SERF catheter (40 W/50 °C) or a standard contact force (CF) catheter in both groups. Results: Comparing SERF to CF ablation, the SERF catheter produced larger lesion volumes than the standard CF catheter—even with >20 g of CF—in both normal (983.1±905.8 versus 461.9±178.3 mm 3 ; P =0.023) and infarcted left ventricular myocardium (1052.3±543.0 versus 340.3±160.5 mm 3 ; P =0.001). SERF catheter lesions were more often transmural than standard CF lesions with >20 g of CF in both groups (59.1% versus 7.7%; P <0.001 and 60.0% versus 12.5%; P =0.017, respectively). Using the SERF catheter, mean depth of ablated lesions reached 90% of the left ventricular wall in both normal and infarcted myocardium. Conclusions: The SERF catheter created more transmural and larger ablative lesions in both normal and infarcted canine myocardium. SERF ablation is a promising new approach for endocardial intramural and full thickness ablation of ventricular tachycardia substrate that is not accessible with current techniques.
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Qian, Pierre C., Michael A. Barry, Vu T. Tran, Juntang Lu, Alistair McEwan, Aravinda Thiagalingam, and Stuart P. Thomas. "Irrigated Microwave Catheter Ablation Can Create Deep Ventricular Lesions Through Epicardial Fat With Relative Sparing of Adjacent Coronary Arteries." Circulation: Arrhythmia and Electrophysiology 13, no. 5 (May 2020). http://dx.doi.org/10.1161/circep.119.008251.
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Background: Radiofrequency ablation depth can be inadequate to reach intramural or epicardial substrate, and energy delivery in the pericardium is limited by penetration through epicardial fat and coronary anatomy. We hypothesized that open irrigated microwave catheter ablation can create deep myocardial lesions endocardially and epicardially though fat while acutely sparing nearby the coronary arteries. Methods: In-house designed and constructed irrigated microwave catheters were tested in in vitro phantom models and in 15 sheep. Endocardial ablations were performed at 140 to 180 W for 4 minutes; epicardial ablations via subxiphoid access were performed at 90 to 100 W for 4 minutes at sites near coronary arteries. Results: Epicardial ablations at 90 to 100 W produced mean lesion depth of 10±4 mm, width 18±10 mm, and length 29±8 mm through median epicardial fat thickness of 1.2 mm. Endocardial ablations at 180 W reached depths of 10.7±3.3 mm, width of 16.6±5 mm, and length of 20±5 mm. Acute coronary occlusion or spasm was not observed at a median separation distance of 2.7 mm (IQR, 1.2–3.4 mm). Saline electrodes recorded unipolar and bipolar electrograms; microwave ablation caused reductions in voltage and changes in electrogram morphology with loss of pace-capture. In vitro models demonstrated the heat sink effect of coronary flow, as well as preferential microwave coupling to myocardium and blood as opposed to lung and epicardial fat phantoms. Conclusions: Irrigated microwave catheter ablation may be an effective ablation modality for deep ventricular lesion creation with capacity for fat penetration and sparing of nearby coronary arteries because of cooling endoluminal flow. Clinical translation could improve the treatment of ventricular tachycardia arising from mid myocardial or epicardial substrates.
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Nakatani, Yosuke, Soumaya Sridi-Cheniti, Ghassen Cheniti, F. Daniel Ramirez, Cyril Goujeau, Clementine André, Takashi Nakashima, et al. "Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation." EP Europace, July 8, 2021. http://dx.doi.org/10.1093/europace/euab155.
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Abstract Aims Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation. Methods and results Cardiac magnetic resonance was performed pre-ablation, acutely (<3 h), and 3 months post-ablation in 41 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 18) or thermal ablation (n = 23, 16 radiofrequency ablations, 7 cryoablations). Late gadolinium enhancement (LGE), T2-weighted, and cine images were analysed. In the acute stage, LGE volume was 60% larger after PFA vs. thermal ablation (P < 0.001), and oedema on T2 imaging was 20% smaller (P = 0.002). Tissue changes were more homogeneous after PFA than after thermal ablation, with no sign of microvascular damage or intramural haemorrhage. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after thermal ablation. The maximum strain on PV antra, the LA expansion index, and LA active emptying fraction declined acutely after both PFA and thermal ablation but recovered at the chronic stage only with PFA. Conclusion Pulsed field ablation induces large acute LGE without microvascular damage or intramural haemorrhage. Most LGE lesions disappear in the chronic stage, suggesting a specific reparative process involving less chronic fibrosis. This process may contribute to a preserved tissue compliance and LA reservoir and booster pump functions.
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Morgaenko, K., S. Noshin, W. Stevenson, and N. Mehta. "P2842Sequential application of horizontal and vertical orientation on radiofrequency ablation lesions produced by thermocool smarttouch SF catheter." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz748.1152.
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Abstract Background Ablation lesions represent a complex interaction between the ablation catheter configuration and tissue anatomy. An understanding of each variable can assist in determination of the optimal lesion set. One such variable is the catheter orientation. With an irrigated radiofrequency ablation catheter with 6 pores (6P) near the distal tip, lesion surface area and volumes are smaller in the horizontal catheter orientation compared to the vertical catheter orientation. This finding is explained by the 6P irrigation catheter design, where irrigation fluid is discharged from six ports around the circumference of the electrode. Introduced in 2015, the ThermoCool SmartTouch® SF catheter has a 56-pore (56P) distribution to provide high density low volume irrigation settings. Irrigation catheters create smaller lesions in horizontal orientation compared to vertical orientation, however this has not been studied for the 56P irrigated catheter. Purpose Evaluate the impact of catheter orientation with sequential application of 56P catheter. Methods Ablation lesions were created on additive-free chicken model in a saline bath heated to 37°C using the 56P catheter under standard flow rate (8cc/min) conditions. Ablation energy of 20W and 30W was delivered twice for 30 seconds with 3 minutes interval between applications. Contact force (CF) of 5, 10, 15, and 20g was applied with the following conditions: horizontal catheter orientation followed by horizontal (HH), vertical by vertical (VV), horizontal by vertical (HV), and vertical by horizontal catheter orientation (VH). Measurements were obtained by lesion dissection through the midpoint by 3 independent operators. Kruskal-Wallis test was used for comparison of lesion depth, surface area and volume. Results Ninety-six lesions were analyzed. No coagulum or steam pops were included in the analysis. The minimum and maximum lesion depth, surface area and volume were 1.5 & 6.0 mm, 14.1 & 117.7mm2, 47.1 & 471.0 mm3 respectively. There was no significant difference in the lesion depth, surface area or volume in HH, VV, HV or VH orientation at different CF with 20W and 30W. (Fig 1) Figure 1 Conclusion Unlike other irrigated catheters, catheter orientation with sequential application with different CF and power did not impact lesion depth, surface area and volume with 56P catheter. This finding could be considered useful in situations where the catheter orientation could be challenging owing to tissue anatomy to achieve adequate lesion size. Acknowledgement/Funding UVA Health System
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Cai, Chi, Jing Wang, Hongxia Niu, Wei Hua, Jianmin Chu, and Shu Zhang. "Multipolar mapping for catheter ablation of premature ventricular complexes originating from papillary muscles in the structurally normal heart: a case series." BMC Cardiovascular Disorders 20, no. 1 (October 28, 2020). http://dx.doi.org/10.1186/s12872-020-01747-z.
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Abstract Background Previous studies on radiofrequency catheter ablation of premature ventricular complexes (PVCs) arising from the left ventricle (LV) papillary muscles (PM) show a modest procedural success rate with higher recurrence rate. Our study sought to explore the utility of using a multipolar mapping with a steerable linear duodecapolar catheter for ablating the PM PVCs. Methods Detailed endocardial multipolar mapping was performed using a steerable linear duodecapolar catheter in 6 consecutive PM PVCs patients with structurally normal heart. The clinical features and procedural data as well as success rate were analysed. Results LV endocardial electroanatomic mapping was performed in all patients via a retrograde aortic approach using a duodecapolar mapping catheter. All patients displayed a PVC burden with 16.2 ± 5.4%. Duodecapolar catheter mapping demonstrated highly efficiency with an average procedure time (95.8 ± 7.4 min) and fluoroscopy time (14.2 ± 1.5 min). The mean number of ablation applications points was 6.8 ± 1.9 with an average overall ablation duration of 6.1 ± 3.0 min. The values of earliest activation time during mapping using duodecapolar catheter were 37.8 ± 7.2 ms. All patients demonstrated acute successful ablation, and the PVC burden in all patients after an average follow-up of 8.5 ± 2.0 months was only 0.7%. There were no complications during the procedures and after follow-up. Conclusions Mapping and ablation of PM PVCs using a duodecapolar catheter facilitated the identification of earliest activation potentials and pace mapping, and demonstrated a high success rate during follow-up.
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Tomala, J., S. Ulbrich, U. Richter, Y. Huo, and T. Gaspar. "Early results for iCMR in atrial flutter." European Heart Journal - Cardiovascular Imaging 22, Supplement_1 (January 1, 2021). http://dx.doi.org/10.1093/ehjci/jeaa356.256.
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Abstract Funding Acknowledgements Type of funding sources: None. Background As a standard of care, ablation of typical atrial flutter involves performing cardiac catheterization under x-ray fluoroscopy. The unique ability of magnetic resonance (MR) to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Real-time MR imaging-guided radiofrequency (RF) ablation has been used as a part of clinical trials. Objective To implement the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine. Methods From January to July 2020, 15 consecutive patients with typical atrial flutter have been referred for ablation. Patient preparation, conscious sedation and groin puncture took place inside the 1.5 Tesla MR scanner as a part of an MR-only workflow. The catheter advancement as well as the RF ablation procedure have been performed under direct visualisation of catheters with integrated micro-coils using an interactive sequence with active tip tracking and automatic slice positioning in the plane where the catheter tip has been detected. During catheter advancement a single frontal plane has been used to visualize the passage of the catheter through femoral veins and inferior vena cava. With both diagnostic and ablation catheters in the right atrium, an axial stack of balanced steady-state free precession acquisitions has been acquired and used to reconstruct planes in the short- and long cardiac axis. These have been used to provide a "left- and right anterior oblique" view familiar to an interventional electrophysiologist. The subsequent catheter placement and ablation have been performed under direct visualisation in these two planes (see figure). Results The ablation was successful in 14 patients, one patient had to undergo a conventional procedure on the following day. The mean time to reach right atrium and coronary sinus was 4 [3,5] and 7 [6,10] minutes, respectively. The mean total ablation duration and procedure time was 18 [12,26] and 43 [33,58] minutes, respectively. There were no adverse events. Conclusion The implementation of the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine is feasible and leads to similar success rates and procedure times as the conventional fluoroscopy-based ablation. Abstract Figure.
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"Abstract session 5: catheter ablation I: new methods and technologies for ablation." Heart Rhythm 1, no. 1 (May 2004): S8—S10. http://dx.doi.org/10.1016/j.hrthm.2004.03.005.
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Masnok, Kriengsak, and Nobuo Watanabe. "Catheter contact area strongly correlates with lesion area in radiofrequency cardiac ablation: an ex vivo porcine heart study." Journal of Interventional Cardiac Electrophysiology, September 9, 2021. http://dx.doi.org/10.1007/s10840-021-01054-3.
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Abstract Purpose Our previous study confirmed that not only force but also the catheter contact angle substantially impacted the contact area and its morphology. Therefore, in this study, we aimed to further investigate the relationship between the catheter contact area and the dimensions of the ablation lesion area as a function of catheter contact angle and force in radiofrequency catheter ablation. Methods The radiofrequency catheter ablation test was performed for 5 contact angles and 8 contact forces at a fixed ablation time of 30 s. The initial impedance was 92.5 ± 2.5 Ω, the temperature during ablation was 30 °C, and the power was 30 W. The irrigation rate during ablation was set to 17 mL/min. Each experiment was repeated 6 times. Results The catheter contact area showed a strong correlation with the ablation lesion area (r = 0.8507). When the contact area was increased, the lesion area also increased linearly in a monotonic manner. The relationships between catheter contact force and ablation lesion area and between catheter contact force and ablation lesion depth are logarithmic functions in which increased contact force was associated with increased lesion area and depth. The catheter contact angle is also an important determinant of the lesion area. The lesion area progressively increased when the contact angle was decreased. In contrast, the lesion depth progressively increased when the contact angle was increased. Conclusions The catheter contact area was strongly correlated with the ablation lesion area. Additionally, catheter contact force and contact angle significantly impacted the dimensions of the lesion in radiofrequency catheter ablation procedures.
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Abeln, B. G. S., T. A. Simmers, M. Maarse, V. F. Van Dijk, M. C. E. F. Wijffels, J. C. Balt, L. V. A. Boersma, and L. R. C. Dekker. "First clinical experience with KODEX-EPD: a novel dielectric imaging and navigation system for catheter ablation." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.0428.
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Abstract Background Current electroanatomic mapping systems for catheter ablation often require pre-procedural cardiac imaging, and special catheters. KODEX-EPD is a novel open-platform system that uses dielectric imaging to provide real-time, high-resolution cardiac images, with a potential for tissue characterisation and wall thickness to guide ablation. Purpose We report our initial experience with the KODEX-EPD system. Methods The KODEX-EPD uses body surface patches (“sensors”) to emit and receive radiofrequency waves across the thorax. Anatomical structures cause gradients in the electrical field, which are measured by a standard electrophysiology catheter and used to generate an anatomical shell of the cardiac chambers. The system requires no direct physical surface contact or fluoroscopy to acquire anatomical information. If direct physical surface contact is added, a voltage map can be created. After mapping with the KODEX-EPD, ablation was continued according to standard of care using radiofrequency or cryoablation. Results Since November 2019, 26 patients were included (mean age 57.7 (±13.2), 16 (61.5%) male). Ablations were performed for atrial fibrillation in 13 (50.0%) patients, atrial flutter in 10 (38.5%), atrial tachycardia in 1 (3.8%), AVNRT in 1 (3.8%), AVRT in 2 (7.7%) and ventricular extrasystole in 2 (7.7%). The median procedure time was 99.5 [68.8; 112.3] minutes, and fluoroscopy time 14.4 [10.0; 16.9] minutes. All procedures were successful. No adverse events occurred during follow up. Conclusion KODEX-EPD is a novel electroanatomic system for cardiac mapping as well as anatomical imaging that can be safely and effectively utilised for a variety of cardiac arrhythmia ablations. Future versions will allow wall thickness measurement and lesion quality to optimise the ablation process. KODEX-EPD CTI Ablation Funding Acknowledgement Type of funding source: None
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Heeger, CH, MS Sano, RMS Meyer-Saraei, CE Eitel, HL Phan, SH Hatahet, AT Traub, et al. "Very high-power short-duration temperature-controlled ablation for pulmonary vein isolation: The Fast-and-Furious study." EP Europace 23, Supplement_3 (May 1, 2021). http://dx.doi.org/10.1093/europace/euab116.216.
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Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable PVI associated with encouraging clinical outcome. The novel QDot ablation catheter with Qmode + ablation mode (90W/4sec, Figure 1) offers the ability to possibly improve safety and decrease ablation procedure times. Aims We aim to evaluate safety and efficacy of the very high-power short-duration (vHP-SD) temperature-controlled radiofrequency (RF) ablation Qmode + mode for pulmonary vein isolation (PVI) utilizing the novel QDot micro ablation catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI. Methods Twenty-five consecutive patients with paroxysmal or persistent AF were prospectively enrolled, underwent vHP-SD based PVI (vHP-SD group) and were compared to 25 consecutive patients treated with conventional CF-sensing catheters (control). Results All PVs were successfully isolated utilizing Qmode +. The total median RF ablation time was vHP-SD: 334 (282, 369) sec. vs control: 1567 (1250, 1756) sec. (p < 0.0001), the median procedure time was vHP-SD: 56 (48-62) vs. control: 104 (92-122) min (p < 0.0001). No differences in periprocedural complications were observed. Conclusions The novel Qmode + provides safe and effective PVI with impressive short RF time and short procedures times. Procedure time and RF time were substantial lower in the vHP-SD group. Abstract Figure 1
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Reichlin, Tobias, Samuel H. Baldinger, Etienne Pruvot, Laurence Bisch, Peter Ammann, David Altmann, Benjamin Berte, et al. "Impact of contact force sensing technology on outcome of catheter ablation of idiopathic pre-mature ventricular contractions originating from the outflow tracts." EP Europace, November 18, 2020. http://dx.doi.org/10.1093/europace/euaa315.
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Abstract Aims Catheter ablation of frequent idiopathic pre-mature ventricular contractions (PVC) is increasingly performed. While potential benefits of contact force (CF)-sensing technology for atrial fibrillation ablation have been assessed in several studies, the impact of CF-sensing on ventricular arrhythmia ablation remains unknown. This study aimed to compare outcomes of idiopathic outflow tract PVC ablation when using standard ablation catheters as opposed to CF-sensing catheters. Methods and results In a retrospective multi-centre study, unselected patients undergoing catheter ablation of idiopathic outflow tract PVCs between 2013 and 2016 were enrolled. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24 h Holter ECG during follow-up. Overall, 218 patients were enrolled (median age 52 years, 51% males). Baseline and procedural data were similar in the standard ablation (24%) and the CF-sensing group (76%). Overall, the median PVC burden decreased from 21% (IQR 10–30%) before ablation to 0.2% (IQR 0–3.0%) after a median follow-up of 2.3 months (IQR 1.4–3.9 months). The rates of both acute (91% vs. 91%, P = 0.94) and sustained success (79% vs. 74%, P = 0.44) were similar in the standard ablation and the CF-sensing groups. No differences were observed in subgroups according to arrhythmia origin from the RVOT (65%) or LVOT (35%). Complications were rare (1.8%) and evenly distributed between the two groups. Conclusion The use of CF-sensing technology is not associated with increased success rate nor decreased complication rate in idiopathic outflow tract PVC ablation.
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Joung, B., P. S. Yang, J. H. Sung, E. Jang, H. T. Yu, T. H. Kim, J. S. Uhm, J. Y. Kim, H. N. Pak, and M. H. Lee. "Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.0557.
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Abstract Background It is unclear whether catheter ablation is beneficial in frail patients with AF. Purpose This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF). Methods Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups. Results After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P<0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation. Conclussion Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies. Funding Acknowledgement Type of funding source: None
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Ritter, Oliver, Peter Nordbeck, Florian Fidler, Marcus Warmuth, Karl-Heinz Hiller, Matthias Nahrendorf, Michelle Maxfield, et al. "Abstract 2245: Interventional Electrophysiology Studies And Ablation Therapy Under Real Time MRI Guidance - Early Detection Of Complications." Circulation 118, suppl_18 (October 28, 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_693.
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Background: Cardiac magnetic resonance imaging (MRI) offers 3D real time imaging with unsurpassed soft tissue contrast without X-ray exposure. However, electrophysiological (EP) examinations of patients with rhythm disorders and ablation procedures are still not possible in the MRI environment. To minimize safety concerns and imaging artifacts, we aimed at developing a setup including catheters for interventional EP based on carbon technology. Methods and Results: The setup, which includes a steerable carbon catheter, was tested for safety, image distortion, pacing and sensing properties, and feasibility of ablation at 1.5 Tesla. MR imaging was performed in two different 1.5-T whole-body scanners. To assess unintentional heating of the catheters by radio frequency (RF) pulses of the MR scanner in vitro , a fluoroptic thermometry system was used to record heating at the catheter tip. In vivo tests for pacing and sensing properties and ablation therapy were performed in eight pigs. There was no significant heating of the carbon catheters while using short, repetitive RF pulses from the MR system. Since there was no image distortion when using the carbon catheters, exact targeting of the lesion sites was possible. During imaging, pacing of in vivo pig hearts and sensing the intra cardiac electrogram was possible without any artifacts. Several RF-ablation procedures, including AV node modulation were performed successfully in the scanner. Potential complications during ablation such as perforation of the RV free wall could be monitored in real time as well. Conclusion: Here we describe a newly developed EP technology for interventional electrophysiology based on carbon catheters. These catheters are suitable for electrophysiological diagnostic and ablation procedures. Their feasibility was demonstrated by performing safety EP studies and ablation therapy with carbon catheters in the MRI environment.
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Lima, F., K. Kennedy, A. Parulkar, W. Sheikh, E. Sharma, and A. Chu. "Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.0443.
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Abstract Background Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure. Purpose The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States. Methods The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups. Results The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p<0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure). Conclusions In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia. Causes of readmission Funding Acknowledgement Type of funding source: None
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Kim, Tae-Hoon, Jae-Sun Uhm, Jong-Youn Kim, Boyoung Joung, Moon-Hyoung Lee, and Hui-Nam Pak. "Abstract 17457: Does Additional Complex Fractionated Atrial Elecrogram Guided Ablation After Linear Ablation Improve Clinical Outcome of Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study." Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.17457.
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Introduction: Although long-lasting circumferential pulmonary vein isolation (CPVI) is a corner stone of catheter ablation for atrial fibrillation (AF), it is not clear whether additional linear or complex fractionated atrial electrogram (CFAE)-guided ablations improve clinical outcome in patients with long-standing persistent AF (L-PeAF). Hypothesis: The purposes of this study were to compare CFAE maps before and after linear ablation, and to test whether additional CFAE ablation after linear ablation improves clinical outcome of L-PeAF. Methods: This study enrolled 119 consecutive L-PeAF patients (male 72.8%, 61.7±10.6 years old) who underwent RFCA. After baseline CFAE mapping, we conducted CPVI and linear ablations (posterior box lesion and anterior line). If AF maintained after linear ablation, we mapped CFAE again, and randomly assigned the patients to linear ablation group (Line, n=45) and additional CFAE ablation group (CFAE+Line, n=48). The patients whose AF terminated or changed to AT were excluded from randomization and classified as AF-Stop group (n=26). We compared pre- and post-linear ablation CFAE maps and clinical outcomes of CFAE+Line, Line, and AF-Stop groups. Results: 1. Mean CFAE-cycle length (CL) was significantly prolonged (203.65±40.35 ms to 264.17±39.03 ms, p<0.001) and CFAE area was reduced (15.49±14.95% to 7.95±9.36%, p<0.001) after linear ablation. Post-linear ablation CFAE was mainly located at left atrial (LA) appendage, septum, and posterior inferior LA. 2. There were no differences in total procedure time (p=0.441), ablation time (p=0.144), and procedure-related complication rate (p=0.955) among three groups. 3. During 17.4±10.5 month follow-up period, clinical recurrence rates were 30.4% in CFAE+Line group, 12.8% in Line group, and 16.7% in AF-Stop groups, respectively (Log rank, p=0.138). 4. Additional CFAE ablation after linear ablation did not improve clinical outcome of catheter ablation at all in patients with L-PeAF (HR 2.11, 95% CI 0.91 - 4.89, p=0.082). Conclusions: Linear ablation prolonged CFAE-CL and localized CFAE area in patients with L-PeAF. However, CFAE guided ablation in addition to linear ablation and CPVI did not improve clinical outcome of catheter ablation.
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Christoph, Marian, David Poitz, Christian Pfluecke, Mathias Forkmann, Yan Huo, Thomas Gaspar, Steffen Schoen, Karim Ibrahim, Silvio Quick, and Carsten Wunderlich. "Simple periprocedural precautions to reduce Doppler microembolic signals during AF ablation." Journal of Interventional Cardiac Electrophysiology, May 31, 2021. http://dx.doi.org/10.1007/s10840-021-01010-1.
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Abstract Background Doppler microembolic signals (MES) occur during atrial fibrillation ablation despite of permanent flushed transseptal sheaths, frequent controls of periprocedural coagulation status and the use of irrigated ablation catheters Purpose To investigate the number and type of MES depending on the procedure time, prespecified procedure steps, the activated clotting time (ACT) during the ablation procedure and the catheter contact force. Methods In a prospective trial, 53 consecutive atrial fibrillation patients underwent pulmonary vein isolation by super-irrigated “point-by-point” ablation. All patients underwent a periinterventional, continuous transcranial Doppler examination (TCD) of the bilateral middle cerebral arteries during the complete ablation procedure. Results An average of 686±226 microembolic signals were detected by permanent transcranial Doppler. Thereby, 569±208 signals were differentiated as gaseous and 117±31 as solid MES. The number of MES with regard to defined procedure steps were as follows: gaseous: [transseptal puncture, 26 ± 28; sheath flushing, 24±12; catheter change, 21±11; angiography, 101±28; mapping, 9±9; ablation, 439±192; protamine administration, 0±0]; solid: [transseptal puncture, 8±8; sheath flushing, 9±5; catheter replacement, 6±6; angiography, not measurable; mapping, 2±5; ablation, 41±22; protamine administration, 0±0]. Significantly less MES occurred with shorter procedure time, higher ACT and the use of tissue contact force monitoring. Conclusion The current study demonstrates that during atrial fibrillation ablation using irrigated, “point-by-point” RF ablation, masses of microembolic signals are detected in transcranial ultrasound especially in the period of RF current application. The number of MES depends on the total procedure time and the reached ACT during ablation. The use of contact force monitoring might reduce MES during RF ablation.