AimsAlthough contact force (CF)-guided circumferential pulmonary vein isolation (CPVI) for paroxysmal atrial fibrillation (PAF) is useful, AF recurrence at long-term follow-up still remains to be resolved. The purpose of this study was to assess safety and efficacy of CF-guided CPVI and to compare residual conduction gaps during CPVI and long-term outcome between the conventional (non-CF-guided) and the CF-guided CPVI.Methods and resultsWe studied the 50 consecutive PAF patients undergoing CPVI by a ThermoCool EZ Steer catheter (conventional group, mean age 61 ± 10 years) and the other 50 consecutive PAF patients by a ThermoCool SmartTouch catheter (CF group, 65 ± 11 years). The procedure parameters and residual conduction gaps during CPVI, and long-term outcome for 12 months were compared between the two groups. Circumferential pulmonary vein isolation was successfully accomplished without any major complications in both groups. Total procedure and total fluoroscopy times were both significantly shorter in the CF group than in the conventional group (160 ± 30 vs. 245 ± 61 min, P < 0.001, and 17 ± 8 vs. 54 ± 27 min, P < 0.001, respectively). Total number of residual conduction gaps was significantly less in the CF group than in the conventional group (2.7 ± 1.7 vs. 6.3 ± 2.7, P < 0.05). The AF recurrence-free rates after CPVI during 12-month follow-up were 96% (48/50) in the CF group and 82% (41/50) in the conventional group (P = 0.02 by log rank test). Multivariate Cox regression analysis further supported this finding.ConclusionContact force-guided CPVI is safe and more effective in reducing not only the procedure time but also the AF recurrence than the conventional CPVI, possibly due to reduced residual conduction gaps during CPVI procedure.
>10% in men and >7% in women aged ≥80 years. 4 Consistent with these findings, a recent review found that Australia, Europe, and the US have the highest reported prevalence of AF. These findings indicate a lower prevalence of AF in Asian populations. However, limited data are available regarding recent AF prevalence and its trend in the Japanese population. For many decades, warfarin was the only oral anticoagulant (OAC) that reduced the risk of cardioembolic stroke in patients with AF; however, from 2011, direct OACs (DOACs) became available in Japan. Several large randomized controlled trials have shown that DOACs produce A trial fibrillation (AF) is a common arrhythmia in elderly people and is a common cause of cardioembolic stroke. According to the results of a 2006 Japanese community-based study, AF is observed in 0.5% of men and 0.2% of women aged 40-59 years, in 2.3% of men and 1.0% of women aged 60-79 years, and in 3.5% of men and 2.5% of women aged ≥80 years. 1 A similar prevalence of AF was reported using the data from Japanese periodic health examinations in 2003. 2 In Korean general health screening tests, the prevalence of AF was 1.2% in men and 0.4% in women aged ≥40 years, and 3.3% in men and 1.1% in women aged ≥65 years, 3 which is similar to the prevalence of AF in the Japanese population. In contrast, the prevalence of AF in the US population was 0.9% in men and 0.4% in women aged 55-59 years, increasing to Editorial p ????
BackgroundBy using a noncontact mapping system, adenosine triphosphate (ATP)-sensitive atrial tachycardia (ATP-AT) originating from the atrioventricular (AV) node vicinity was successfully ablated at the entrance to the slow conduction zone indicated by the manifest entrainment technique. We aimed to prospectively validate the efficacy of the combination of CARTO electroanatomical mapping and manifest entrainment in ablating this ATP-AT.MethodsOf the 27 AT patients from January 2013 to March 2014, 6 patients with sustained ATP-AT were studied (age, 67±13 years; tachycardia cycle length, 350±95 ms). We first created the CARTO map during AT, and performed rapid pacing from the anterior right atrial wall (ARAW) and cavotricuspid isthmus (CTI) approximately 30 mm remote from the earliest activation site (EAS). We identified the site where manifest entrainment, defined as the orthodromic capture of the EAS with a long conduction time, was observed, and ablated the site approximately 20 mm remote from the EAS, between the pacing site and the EAS.ResultsManifest entrainment was demonstrated in all patients paced from the ARAW (four patients) and from the CTI (two patients). Ablation at the prespecified site terminated AT in 6±3 s, and AT became no longer inducible in all patients. At the successful ablation sites, discrete atrial electrograms were recorded; however, low-amplitude, fractionated electrograms suggestive of slow conduction were not observed in all patients. The atrio-His interval during sinus rhythm remained unchanged (from 96±12 to 89±7 ms, p=NS). During 11±6 months, no patients showed AT recurrence and AV conduction abnormality.ConclusionCARTO mapping- and manifest entrainment-guided ablation strategy is effective and safe in the treatment of ATP-AT.
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