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Khaing E, Aroudaky A, Dircks D, Almerstani M, Alziadin N, Frankel S, Hollenberg B, Limsiri P, Schleifer W, Easley A, Tsai S, Anderson D, Windle J, Khan F, Haynatzki G, Peeraphatdit T, Goyal N, Dunbar Matos CL, Naksuk N. Representation of Women in Atrial Fibrillation Ablation Randomized Controlled Trials: Systematic Review. J Am Heart Assoc 2025; 14:e035181. [PMID: 39791402 PMCID: PMC12054437 DOI: 10.1161/jaha.124.035181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 09/16/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND Sex inequality in randomized controlled trials (RCTs) related to cardiovascular disease has been observed. This study examined the proportion of women enrolled in atrial fibrillation (AF) ablation RCTs and the potential risks of underrepresentation of women. METHODS AND RESULTS We systematically searched PubMed and Embase for AF ablation RCTs published from 2015 to 2022. Participant characteristics were compared among trials with higher and lower proportions of women. Of 147 AF ablation RCTs (30,055 participants), only 10 trials had enrolled women ≥50% of the total participants. Additionally, 42 trials (28.57%) excluded pregnant/breastfeeding women; 6 (4.1%) excluded reproductive-age women without reliable birth control. The proportion of women in AF RCTs ranged from 9% to 71% (median 31.5%), whereas the median proportion of men was 67.7%. The rate of women included in the trials was stable from 2015 to 2022 (P=0.49). Study characteristics, including funding source, showed no correlation with the rate of inclusion of women. RCTs with a higher proportion of female participants enrolled older patients with AF, had a higher prevalence of hypertension but less persistent AF, and smaller left atrium size (P<0.05 for all). Biological sex was evaluated as a risk factor or in a subgroup analysis in 28 RCTs; 10.7% of these trials observed the implication of sex on their results. CONCLUSION Women were underrepresented in contemporary AF ablation RCTs. Additionally, women enrolled in AF RCTs were likely to have more comorbidities but less advanced AF, limiting the applicability of the results to women with AF.
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Affiliation(s)
- Eh Khaing
- University of Nebraska OmahaOmahaNEUSA
| | - Ahmad Aroudaky
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Danielle Dircks
- College of Medicine, University of Nebraska Medical CenterOmahaNEUSA
| | - Muaaz Almerstani
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Nmair Alziadin
- Hospital Corporation of America Healthcare/Tufts University School of Medicine: Portsmouth Regional Hospital Internal Medicine Residency ProgramPortsmouthNHUSA
| | - Samuel Frankel
- College of Medicine, University of Nebraska Medical CenterOmahaNEUSA
| | | | - Pattarawan Limsiri
- Department of Obstetrics and GynecologyFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | - William Schleifer
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Arthur Easley
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Shane Tsai
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Daniel Anderson
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - John Windle
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Faris Khan
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Gleb Haynatzki
- Department of BiostatisticsUniversity of Nebraska Medical CenterOmahaNEUSA
| | | | - Neha Goyal
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | | | - Niyada Naksuk
- Division of Cardiovascular MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
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Dzhinsov KR. Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation. Folia Med (Plovdiv) 2023; 65:713-719. [PMID: 38351752 DOI: 10.3897/folmed.65.e103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/16/2023] [Indexed: 02/16/2024] Open
Abstract
The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure.
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Rowe MK, Claughton A, Davis J, Yee L, Kaye GC, Dauber K, Hill J, Gould PA. Ablation of typical atrial flutter using mini electrode measurements for maximum voltage-guided ablation: A randomized, controlled trial. J Arrhythm 2022; 38:106-114. [PMID: 35222756 PMCID: PMC8851573 DOI: 10.1002/joa3.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Novel ablation catheters with mini electrode (ME) sensing have become available but their utility is unclear. We investigated whether ablation of the cavotricuspid isthmus (CTI) for atrial flutter (AFL) would be improved using ME signals. METHODS Sixty-one patients (76% male, 63 ± 10 years) with CTI-dependent AFL underwent ablation using a maximum voltage-guided approach, randomized to either standard 8 mm non-irrigated catheter with bipolar signals or IntellaTip MiFi catheter using ME signals alone. RESULTS Acute bidirectional block was achieved in 97%. Mean follow-up was 16.7 ± 10 months. The median number of ablation lesions was 13 in both groups (range 3-62 vs. 1-43, p = .85). No significant differences were observed in AFL recurrences (17% vs. 11%, p = .7), median procedure durations (97 min [interquartile range (IQR), 71-121] vs. 87 min [IQR, 72-107], p = .55) or fluoroscopy times (31 min [IQR, 21-52] vs. 38 min [IQR, 25-70], p = .56). Amplitudes of ME signals were on average 160% greater than blinded bipolar signals. In 23.7% of lesions where bipolar signals were difficult to interpret, 13.6% showed a clear ME signal. CONCLUSIONS There was no difference in the effectiveness of CTI ablation guided by ME signals, compared with using bipolar signals from a standard 8 mm ablation catheter. While ME signal amplitudes were larger and sometimes present when the bipolar signal was unclear, this did not improve procedural characteristics or outcomes. The results suggest future research should focus on lesion integrity rather than signal sensing.
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Affiliation(s)
- Matthew K. Rowe
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Andrew Claughton
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Jason Davis
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Lauren Yee
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Gerald C. Kaye
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Kieran Dauber
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - John Hill
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Paul A. Gould
- Department of CardiologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
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Schlögl S, Schlögl KS, Bengel P, Bergau L, Haarmann H, Rasenack E, Hasenfuss G, Zabel M. Impact of open-irrigated radiofrequency catheter with contact force measurement on the efficacy and safety of atrial fibrillation ablation: a single-center direct comparison. J Interv Card Electrophysiol 2022; 65:685-693. [PMID: 35907108 PMCID: PMC9726666 DOI: 10.1007/s10840-022-01316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In atrial fibrillation (AF) patients, catheter ablation of pulmonary veins (PVI) is the most effective therapeutic option to maintain sinus rhythm. To improve successful PVI, contact force-sensing (CF) catheters became routinely available. Previous studies did not clearly show superior clinical efficacy in comparison with non-CF catheters. METHODS We investigated consecutive patients, who underwent index PVI for AF at our hospital between 2012 and 2018. Three hundred and fifty-four patients were ablated without CF. After availability of CF catheters in 2016, 317 patients were ablated using CF. In case of crossover between the groups, follow-up was censored. The primary endpoint was any documented atrial tachycardia (AT) or atrial fibrillation > 30 s after a 3-month blanking period. Secondary endpoints were procedural characteristics and periprocedural complications. RESULTS There was no significant difference between the groups at baseline except hyperlipidemia. After 365 days of follow-up, 67% of patients in the CF group remained free from AF/AT recurrence compared to 59% in non-CF group (P = 0.038). In multivariable Cox regression analysis, non-CF ablation was an independent risk factor for AF recurrence besides age and persistent AF. Total fluoroscopy time (15 ± 7.6 vs. 28 ± 15.9 min) and total procedure time (114 ± 29.6 vs. 136 ± 38.5 min) were significantly lower for CF-guided PVI (P < 0.001). Complication rates did not differ between groups (P = 0.661). CONCLUSIONS In our study, the AT/AF recurrence rate and pulmonary vein reconnection rate is lower after CF PVI with a similar complication rate but lower total procedure time and total fluoroscopy time compared to non-CF PVI.
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Affiliation(s)
- Simon Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Klaudia Stella Schlögl
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Philipp Bengel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Leonard Bergau
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Helge Haarmann
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Eva Rasenack
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuss
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Markus Zabel
- grid.411984.10000 0001 0482 5331Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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Does merged three-dimensional mapping improve contact force and long-term procedure outcome in atrial fibrillation ablation? (MICRO-AF study): a prospective randomized controlled study. Int J Cardiovasc Imaging 2021; 37:3431-3438. [PMID: 34255269 DOI: 10.1007/s10554-021-02335-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/29/2021] [Indexed: 01/01/2023]
Abstract
Integration of electroanatomical map (EAM) with preacquired three-dimensional (3D) cardiac images provides detailed appreciation of the complex anatomy of the left atrium (LA) and pulmonary vein (PV). High-density (HD) multi-electrode mapping catheters have enabled creating more accurate EAM reflecting real-time volume-rendered LA-PV geometry during atrial fibrillation (AF) ablation. However, no study has compared the outcomes of AF ablation using HD-EAM versus 3D-merged map. We aimed to investigate the procedural and clinical outcomes of AF ablation with HD-EAM (HD-EAM group) versus 3D-merged map (Merge group). One hundred patients (59.5 ± 11.5 years, 53% with paroxysmal AF [PAF]) were randomly assigned (1:1) to HD-EAM or Merged group. HD multi-electrode mapping and contact force (CF)-sensing catheters were used to create virtual LA-PV chamber and to perform wide antral circumferential ablation (WACA), respectively. The two groups showed no significant differences in baseline characteristics and procedural data including ablation time, fluoroscopy time, LA voltage, and CF. PV isolation with a single WACA line was achieved in 21 (42%) and 27 (54%) patients in the Merge and HD-EAM groups, respectively (P = NS). CF was significantly lower in lesions with gap than lesions without gap after a single WACA (7.3 ± 7.3 g vs. 16.0 ± 8.3, respectively, P < 0.001). During the 12-month follow-up, no significant difference in AF recurrence was observed between two groups, irrespective of AF type. In multivariate analysis, non-PAF was an independent risk factor for AF recurrence. Integration of 3D cardiac imaging did not improve procedural and clinical outcomes. HD-EAM provides an accurate real-time LA geometry.
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6
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Shi LB, Wang YC, Chu SY, De Bortoli A, Schuster P, Solheim E, Chen J. The impacts of contact force, power and application time on ablation effect indicated by serial measurements of impedance drop in both conventional and high-power short-duration ablation settings of atrial fibrillation. J Interv Card Electrophysiol 2021; 64:333-339. [PMID: 33891228 PMCID: PMC9399015 DOI: 10.1007/s10840-021-00990-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022]
Abstract
Background This study aimed to clarify the interrelationship and additive effects of contact force (CF), power and application time in both conventional and high-power short-duration (HPSD) settings. Methods Among 38 patients with paroxysmal atrial fibrillation who underwent first-time pulmonary vein isolation, 787 ablation points were collected at the beginning of the procedure at separate sites. Energy was applied for 60 s under power outputs of 25, 30 or 35 W (conventional group), or 10 s when using 50 W (HPSD group). An impedance drop (ID) of 10 Ω was regarded as a marker of adequate lesion formation. Results ID ≥ 10 Ω could not be achieved with CF < 5 g under any power setting. With CF ≥ 5 g, ID could be enhanced by increasing power output or prolonging ablation time. ID for 30 and 35 W was greater than for 25 W (p < 0.05). Ablation with 35 W resulted in greater ID than with 30 W only when CF of 10–20 g was applied for 20–40 s (p < 0.05). Under the same power output, ID increased with CF level at different time points. The higher the CF, the shorter the time needed to reach ID of 10 Ω and maximal ID. ID correlated well with ablation index under each power, except for lower ID values at 25 W. ID with 50 W for 10 s was equivalent to that with 25 W for 40 s, but lower than that with 30 W for 40 s or 35 W for 30 s. Conclusions CF of at least 5 g is required for adequate ablation effect. With CF ≥ 5g, CF, power output, and ablation time can compensate for each other. Time to reach maximal ablation effect can be shortened by increasing CF or power. The effect of HPSD ablation with 50 W for 10 s is equivalent to conventional ablation with 25 W for 40 s and 30–35 W for 20–30 s in terms of ID.
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Affiliation(s)
- Li-Bin Shi
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Yu-Chuan Wang
- Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway.,Peking University First Hospital, Beijing, China
| | - Song-Yun Chu
- Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway.,Peking University First Hospital, Beijing, China
| | | | - Peter Schuster
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Jian Chen
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway.
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7
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Hong KL, Borges J, Glover B. Catheter ablation for the management of atrial fibrillation: current technical perspectives. Open Heart 2020; 7:openhrt-2019-001207. [PMID: 32393656 PMCID: PMC7223467 DOI: 10.1136/openhrt-2019-001207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 01/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
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Affiliation(s)
- Kathryn Lauren Hong
- Cardiology, University of Toronto, Toronto, Canada.,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jazlyn Borges
- Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benedict Glover
- Cardiology, University of Toronto, Toronto, Canada .,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
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8
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Virk SA, Ariyaratnam J, Bennett RG, Kumar S. Updated systematic review and meta-analysis of the impact of contact force sensing on the safety and efficacy of atrial fibrillation ablation: discrepancy between observational studies and randomized control trial data. Europace 2020; 21:239-249. [PMID: 30544134 DOI: 10.1093/europace/euy266] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Despite widespread adoption of contact force (CF) sensing technology in atrial fibrillation (AF) ablation, randomized data suggests lack of improvement in clinical outcomes. We aimed to assess the safety and efficacy of CF-guided vs. non CF-guided AF ablation. Methods and results Electronic databases were searched for randomized controlled trials (RCTs) and controlled observational studies (OS) comparing outcomes of AF ablation performed with vs. without CF guidance. The primary efficacy endpoint was freedom from AF at follow-up. The primary safety endpoint was major peri-procedural complications. Secondary endpoints included procedural, fluoroscopy, and ablation duration. Subgroup analyses were performed by AF type and study design. Nine RCTs (n = 903) and 26 OS (n = 8919) were included. Overall, CF guidance was associated with improved freedom from AF [relative risk (RR) 1.10; 95% confidence interval (CI) 1.02-1.18], and reduced total procedure duration [mean difference (MD) 15.33 min; 95% CI 6.98-23.68], ablation duration (MD 3.07 min; 95% CI 0.29-5.84), and fluoroscopy duration (MD 5.72 min; 95% CI 2.51-8.92). When restricted to RCTs however, CF guidance neither improved freedom from AF (RR 1.03; 95% CI 0.95-1.11), independent of AF type, nor did it reduce procedural, fluoroscopy, or ablation duration. Contact force guidance did not reduce the incidence of major peri-procedural complications (RR 0.89; 95% CI 0.64-1.24). Conclusion Meta-analysis of randomized data demonstrated that CF guidance does not improve the safety or efficacy of AF ablation, despite initial observational data showing dramatic improvement. Rigorous evaluation in randomized trials is needed before widespread adoption of new technologies.
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Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | | | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia
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9
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Du Z, Hu F, Wu L, Zheng L, Ding L, Liang E, Chen G, Yao Y. Single transseptal puncture technique and contact force catheter: A simplified ablation strategy for paroxysmal atrial fibrillation. Exp Ther Med 2020; 20:2611-2616. [PMID: 32793307 PMCID: PMC7418501 DOI: 10.3892/etm.2020.9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/01/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to evaluate the safety and efficacy of an optimized single transseptal puncture technique and contact force sensing atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) strategy within a clinical setting. Fast anatomic mapping and contact force sensing ablation was applied to patients with paroxysmal AF (PAF) ablation between September 2014 and December 2016 using a single trans-septal sheath. Pulmonary vein isolation (PVI) and linear ablation were performed in PAF individually with a 10-20 g contact force with minimal fluoroscopy. Stimulation with 10 mA outputs on the lesions without capture was used as endpoint. A total of 419 consecutive patients who underwent first-time RFCA were enrolled in the current study, and acute PVI was achieved in all patients. The average procedure time was 74.5±9.7 min, with an average ablation time of 27.3±7.8 min. The average fluoroscopy time was 4.7±3.3 min and the average radiation dose was 24.3±25.2 mGy. At a mean follow-up time of 14.5 ± 4.1 months, sinus rhythm was maintained at 85.0%. Cardiac tamponade occurred in one case. The results indicated that this simplified technique was a simple, safe and effective approach for PAF ablation therapy.
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Affiliation(s)
- Zhongpeng Du
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Feng Hu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lingmin Wu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Ligang Ding
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Erpeng Liang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Gang Chen
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, Beijing 100037, P.R. China
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10
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Virk SA, Bennett RG, Trivic I, Campbell T, Kumar S. Contact Force and Ablation Index. Card Electrophysiol Clin 2020; 11:473-479. [PMID: 31400871 DOI: 10.1016/j.ccep.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Radiofrequency ablation of arrhythmias depends on durable lesion formation. Catheter tip-tissue contact force (CF) is a key determinant of lesion quality; excessive CF is associated with major complications, whereas insufficient CF increases the risk of electrical reconnection and arrhythmia recurrence. In recent years, CF-sensing catheters have emerged with the ability to directly measure CF and provide operators with real-time feedback. CF-guided ablation has been associated with improved outcomes in observational studies. However, randomized controlled trials have not shown any reduction in procedural durations, fluoroscopy exposure, incidence of major complications, or long-term arrhythmia recurrence with use of CF-sensing catheters.
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Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
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11
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Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias: Evolution or History Repeating Itself? JACC Clin Electrophysiol 2019; 4:707-723. [PMID: 29929663 DOI: 10.1016/j.jacep.2018.03.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)-sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.
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Affiliation(s)
- Nilshan Ariyarathna
- Cardiology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - William G Stevenson
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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12
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Mallow PJ, Chen J, Moore M, Gunnarsson C, Rizzo JA. Incremental direct healthcare expenditures of valvular heart disease in the USA. J Comp Eff Res 2019; 8:879-887. [DOI: 10.2217/cer-2019-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To quantify the healthcare expenditures for valvular heart disease (VHD) in the USA. Patients & methods: Direct annual incremental healthcare expenditures were estimated using multiple logistic and linear regression models. Results were stratified by age cohorts (18–64 years, ≥65 and ≥75 years) and disease status: symptomatic aortic valve disease (AVD), asymptomatic AVD, symptomatic mitral valve disease (MVD) and asymptomatic MVD. Results: A total of 1463 VHD patients were identified. The overall aggregated incremental direct expenditures were $56.62 billion ($26.48 billion for patients ≥75 years). Individuals ≥75 years with symptomatic AVD had the largest incremental effect on annual, per-patient healthcare expenditure of $30,949. The annualized incremental costs of VHD were greatest for individuals ≥75 years with AVD. Conclusion: Identification of VHD at an earlier stage may reduce the economic burden.
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Affiliation(s)
- Peter J Mallow
- Xavier University, Department of Health Services Administration, Cincinnati, OH 45207, USA
| | - Jie Chen
- University of Maryland, Department of Health Services Administration, College Park, MD 20742, USA
| | - Matt Moore
- Edwards Lifesciences, Global Health Economics and Reimbursment, Irvine, CA 92614, USA
| | - Candace Gunnarsson
- CTI Clinical Trial & Consulting Services, Real World Evidence, Covington, KY 41011, USA
| | - John A Rizzo
- Stony Brook University, Department of Family, Population & Preventive Medicine & Department of Economics, Stony Brook, NY 11790, USA
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13
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Chinitz LA, Melby DP, Marchlinski FE, Delaughter C, Fishel RS, Monir G, Patel AM, Gibson DN, Athill CA, Ming Boo L, Stagg R, Natale A. Safety and efficiency of porous-tip contact-force catheter for drug-refractory symptomatic paroxysmal atrial fibrillation ablation: results from the SMART SF trial. Europace 2019; 20:f392-f400. [PMID: 29016769 DOI: 10.1093/europace/eux264] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/18/2017] [Indexed: 01/02/2023] Open
Abstract
Aims THERMOCOOL SMARTTOUCH® SF Catheter is a new contact-force (CF)-sensing catheter with 56-hole porous tip designed for improved cooling and reduced fluid delivery compared with a standard 6-hole open-irrigated catheter. The SMART SF study examined the periprocedural safety, acute effectiveness, and procedural efficiency of the catheter for drug-refractory symptomatic paroxysmal atrial fibrillation (PAF) ablation. Methods and results The prospective, open-label, non-randomized SMART-SF was conducted at 17 US sites. Circumferential pulmonary vein (PV) isolation was performed with confirmation of entrance block in all PVs. Stable ablation sites were identified using CARTO VISITAG™ Module. Primary adverse events (AEs; ≤1 week of index procedure), periprocedural AEs within 30 days of ablation procedure, acute effectiveness (confirmation of entrance block for targeted PVs), CF, and procedural parameters were assessed. Overall, 165 patients were enrolled (mean age, 62.7 years; male, 57.9%; white, 97%; left ventricular ejection fraction, 60.1 ± 7%; left atrium diameter, 38.8 ± 6 mm); 159 underwent radiofrequency ablation and comprised the safety cohort. Primary safety performance criteria were met: primary AE rate was 2.5% (4/159; cardiac tamponade [n = 2], thrombo-embolism [n = 1], transient ischaemic attack [n = 1]). All primary AEs resolved/improved within the 1-month follow-up period. Acute procedural effectiveness was attained in 96.2% (95% confidence interval: 92.0-98.6%) of patients. Procedure time, fluoroscopy time, and fluid delivered were observed in comparison to predecessor catheters. Conclusion In the SMART-SF trial, the predetermined safety performance goal was met, demonstrating the safety and acute effectiveness of the THERMOCOOL SMARTTOUCH® SF Catheter for PAF ablation.
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Affiliation(s)
- Larry A Chinitz
- NYU Langone Medical Center, New York University, 550 First Avenue, New York, NY, USA
| | | | | | | | | | - George Monir
- Florida Hospital Cardiovascular Institute, Orlando, FL, USA
| | | | | | | | - Lee Ming Boo
- Biosense Webster Inc., Diamond Bar, California, CA, USA
| | - Robert Stagg
- Biosense Webster Inc., Diamond Bar, California, CA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Research Foundation, Austin, TX, USA
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14
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Macle L, Frame D, Gache LM, Monir G, Pollak SJ, Boo LM. Atrial fibrillation ablation with a spring sensor-irrigated contact force-sensing catheter compared with other ablation catheters: systematic literature review and meta-analysis. BMJ Open 2019; 9:e023775. [PMID: 31189669 PMCID: PMC6575819 DOI: 10.1136/bmjopen-2018-023775] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The objective of our review was to systematically assess available evidence on the effectiveness, safety and efficiency of a spring sensor-irrigated contact force (CF) catheter (THERMOCOOL SMARTTOUCH Catheter (ST)) for percutaneous ablation of paroxysmal or persistent atrial fibrillation (AF), compared with other ablation catheters, or with the ST with the operator blinded to CF data. DESIGN Systematic literature review and meta-analysis. BACKGROUND Emerging evidence suggests improved clinical outcomes of AF ablation using CF-sensing catheters; however, reviews to date have included data from multiple, distinct CF technologies. METHODS We conducted a systematic review and meta-analysis of published studies comparing the use of ST versus other ablation catheters for the treatment of AF. A comprehensive search of electronic and manual sources was conducted. The primary endpoint was freedom from recurrent atrial tachyarrhythmia (AT) at 12 months. Procedural and safety data were also analysed. RESULTS Thirty-four studies enrolling 5004 patients were eligible. The use of ST was associated with increased odds of freedom from AT at 12 months (71.0%vs60.8%; OR 1.454, 95% CI 1.12 to 1.88, p=0.004) over the comparator group, and the effect size was most evident in paroxysmal AF patients (75.6%vs64.7%; OR 1.560, 95% CI 1.09 to 2.24, p=0.015). Procedure and fluoroscopy times were shorter with ST (p=0.05 and p<0.01, respectively, vs comparator groups). The reduction in procedure time is estimated at 15.5 min (9.0%), and fluoroscopy time 4.8 min (18.7%). Complication rates, including cardiac tamponade, did not differ between groups. CONCLUSIONS Compared with the use of other catheters, AF ablation using the CF-sensing ST catheter for AF is associated with improved success rates, shorter procedure and fluoroscopy times and similar safety profile.
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Affiliation(s)
- Laurent Macle
- Department of Medicine, Institut De Cardiologie de Montreal, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Diana Frame
- Real World Evidence (RWE), CTI Clinical Trial and Consulting Services Inc., Covington, Kentucky, USA
| | - Larry M Gache
- Real World Evidence (RWE), CTI Clinical Trial and Consulting Services Inc., Covington, Kentucky, USA
| | - George Monir
- Cardiology, Arrhythmia and Ablation Center, Florida Hospital, Orlando, Florida, USA
| | - Scott J Pollak
- Cardiology, Arrhythmia and Ablation Center, Florida Hospital, Orlando, Florida, USA
| | - Lee Ming Boo
- Clinical Research, Biosense Webster, Inc., Irvine, California, USA
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15
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Pedrote A, Acosta J, Frutos-López M, Jáuregui-Garrido B, Alarcón F, Arana-Rueda E. Analysis of late reconnections after pulmonary vein isolation: Impact of interlesion contiguity and ablation index. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:678-685. [PMID: 30912154 DOI: 10.1111/pace.13673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/21/2019] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interlesion distance and ablation index (AI) have been proposed as parameters of radiofrequency (RF) lesion durability. This study analyzes the relationship between RF parameters of automatically acquired lesion tags and late reconnections in repeat pulmonary vein isolation (PVI) procedures. METHODS One hundred fifty-seven patients underwent contact force (CF)-guided PVI with automatic acquisition of RF lesions. During follow-up, 21 patients underwent a repeat PVI procedure. The relationship between RF parameters (power, CF, impedance drop, and AI) of the initial PVI procedure and reconnections observed at repeat PVI was analyzed. Visual gap was defined as the existence of a discontinuity between two RF lesions automatically acquired in the initial PVI procedure. Regional values of AI associated with lesion durability were identified. RESULTS Twenty-one patients were included. Three hundred thirty-six segments and 2507 RF lesions were analyzed. The median interval between the initial and repeat PVI procedures was 17 (11-24) months. All patients showed ≥1 reconnected segment. Sixty-three segments (18.7%) were reconnected. Reconnected segments showed visual gaps more frequently than non-reconnected segments (66.6% vs 17.6%; P < .001; negative predictive value 91.4%). The mean distance of visual gaps was 8 ± 2.8 mm. No differences were observed in power (31.4 ± 4.7 W vs 31 ± 4.1 W; P = .573), CF (14.4 ± 5.3 g vs 15.4 ± 5.4 g; P = .315), and impedance drop (6.9 ± 5.2 ohms vs 6.5 ± 3.8 ohms; P = .576) between reconnected and non-reconnected segments. Among segments without visual gap, the minimum AI value was significantly higher in the non-reconnected segments (325 ± 96.1 vs 204.7 ± 78.5; P < .001). No reconnections were observed in segments without visual gap and minimum AI ≥ 330/220 in anterior/posterior wall, respectively. CONCLUSIONS Contiguity between automatically acquired RF lesions and minimum AI value are the main determinants of long-term PVI durability.
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Affiliation(s)
- Alonso Pedrote
- Arrhythmia Section, Cardiology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Juan Acosta
- Arrhythmia Section, Cardiology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Manuel Frutos-López
- Arrhythmia Section, Cardiology Department, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Francisco Alarcón
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Eduardo Arana-Rueda
- Arrhythmia Section, Cardiology Department, Virgen del Rocío University Hospital, Seville, Spain
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Paneque I, Calvo-Calvo MÁ, Rubio-Guerrero C, Frutos-López M, Arana-Rueda E, Pedrote A. Sedación profunda basada en propofol y administrada por electrofisiólogos en la ablación de la fibrilación auricular. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Steinberg JS, Altman RK. Should the force be with us? Heart Rhythm 2018; 15:209-210. [DOI: 10.1016/j.hrthm.2017.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 11/26/2022]
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Abstract
The prevalence of atrial fibrillation (AF) has risen significantly over the past two decades. Catheter ablation is an increasingly utilized treatment strategy and has evolved significantly over the same time period. Successful ablation improves patient symptoms, reduces stroke risk, and can preserve or improve cardiac function. Recurrences following ablation can occur, particularly in patients with persistent AF. Procedural efficacy can best be improved through continued advancements in ablation technology and strategy, better understanding of the mechanisms of AF initiation and perpetuation, and rigorous integration of ablation into a multidisciplinary AF management approach.
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Affiliation(s)
| | - Fred Morady
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109; ,
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19
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Deep Sedation With Propofol Administered by Electrophysiologists in Atrial Fibrillation Ablation. ACTA ACUST UNITED AC 2017; 71:683-685. [PMID: 28757116 DOI: 10.1016/j.rec.2017.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022]
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Hussein A, Das M, Chaturvedi V, Asfour IK, Daryanani N, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D. Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2017. [PMID: 28639728 DOI: 10.1111/jce.13281] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Late recovery of ablated tissue leading to reconnection of pulmonary veins remains common following radiofrequency catheter ablation for AF. Ablation Index (AI), a novel ablation quality marker, incorporates contact force (CF), time, and power in a weighted formula. We hypothesized that prospective use of our previously published derived AI targets would result in better outcomes when compared to CF-guided ablation. METHODS Eighty-nine consecutive drug-refractory AF patients (49% paroxysmal) underwent AI-guided ablation (AI-group). AI targets were 550 for anterior/roof and 400 for posterior/inferior left atrial segments. Procedural and clinical outcomes of these patients were compared to 89 propensity-matched controls who underwent CF-guided ablation (CF-group). All 178 procedures were otherwise similar, and both groups were followed-up for 12 months. The last 25 patients from each group underwent analysis of all VisiTags™ for ablation duration, CF, Force-Time Integral, and impedance drop. RESULTS First-pass pulmonary vein isolation (PVI) was more frequent in AI-group than in CF-group (173 [97%] vs. 149 [84%] circles, P < 0.001), and acute PV reconnection was lower (11 [6%] vs. 24 [13%] circles, P = 0.02). Mean PVI ablation time was similar (AI-group: 42 ± 9 vs. CF-group: 45 ± 14 minutes, P = 0.14). Median impedance drop for AI-group was significantly higher than in CF-group (13.7 [9-19] Ω vs. 8.8 [5.2-13] Ω, P < 0.001). Two major complications occurred in CF-group and none in AI-group. Atrial tachyarrhythmia recurrence was significantly lower in AI-group (15 of 89 [17%]) than in CF-group (33 of 89 [37%], P = 0.002). CONCLUSION AI-guided ablation is associated with significant improvements in the incidence of acute PV reconnection and atrial tachyarrhythmia recurrence rate compared to CF-guided ablation, potentially due to creation of better quality lesions as suggested by greater impedance drop.
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Affiliation(s)
- Ahmed Hussein
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Moloy Das
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vivek Chaturvedi
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Issa Khalil Asfour
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Niji Daryanani
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Maureen Morgan
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Christina Ronayne
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Richard Snowdon
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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Lin H, Chen YH, Hou JW, Lu ZY, Xiang Y, Li YG. Role of contact force-guided radiofrequency catheter ablation for treatment of atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2017; 28:994-1005. [PMID: 28569422 DOI: 10.1111/jce.13264] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Hui Lin
- Department of Respiratory; The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University; Wenzhou China
| | - Yi-He Chen
- Department of Cardiology; Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University; Shanghai China
| | - Jian-Wen Hou
- Department of Cardiology; Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University; Shanghai China
| | - Zhao-Yang Lu
- Department of Cardiology; Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University; Shanghai China
| | - Yin Xiang
- Department of Cardiology; Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University; Shanghai China
| | - Yi-Gang Li
- Department of Cardiology; Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University; Shanghai China
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22
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Pedrote A, Acosta J, Jáuregui-Garrido B, Frutos-López M, Arana-Rueda E. Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions. World J Cardiol 2017; 9:230-240. [PMID: 28400919 PMCID: PMC5368672 DOI: 10.4330/wjc.v9.i3.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.
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Duytschaever M, O'Neill M, Martinek M. Increasing the Single-Procedure Success Rate of Pulmonary Vein Isolation. Arrhythm Electrophysiol Rev 2017; 6:217-221. [PMID: 29326838 DOI: 10.15420/aer.2017.38/1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To improve the single-procedural success and long-term outcomes of catheter ablation techniques for AF, there is a need for durable, contiguous and transmural lesions encircling the pulmonary veins (PV). Measurement of contact force (CF) between the catheter tip and the target tissue can optimise ablation procedures. A new approach to obtain single-procedure durable PV isolation (PVI) using the latest CF technology combined with the CARTO VISITAG™ Module with Ablation Index (Biosense Webster) has been shown in small studies to almost eliminate recurrence of paroxysmal AF at 1-year follow up and to make PVI procedures more reproducible. The use of a standardised workflow is expected to increase the reproducibility of results and to increase the efficiency of PVI procedures.
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Affiliation(s)
| | - Mark O'Neill
- St. Thomas' Hospital,London, UK.,King's College London,London, UK
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