Backgrounds
Ablation index (AI) is useful to complete circumferential pulmonary vein isolation (CPVI) for atrial fibrillation (AF), but the role of radiofrequency power in AI‐guided CPVI remains to be elucidated.
Methods
We investigated 60 patients with AF undergoing AI‐guided CPVI (mean age, 66 ± 9 years; nonparoxysmal AF in 16). The first 40 patients were randomly assigned to low‐power (LP; n = 20) and medium‐power (MP; n = 20) groups and the following 20 patients to high‐power (HP). In LP, radiofrequency (RF) application was done at 30 W at the anterior and 20 W at the posterior left atrial (LA) wall, while in MP, it was at 40 W at the anterior and 30 W at the posterior LA wall. In HP, 50 W was applied at the anterior, 40 W at posterior LA wall and 30 W on the esophagus. At each ablation point, target AI was 400 at the anterior, 360 at the posterior LA wall, and 260 on the esophagus.
Results
The time to complete both‐side CPVI was shortest in HP (median, 40 minutes, interquartile range [IQR], 28‐63) followed by MP (58 [49‐83] minutes, P = .008 vs HP) and LP (84 [72‐93] minutes, P = .002 vs MP). Higher RF power application significantly increased first‐pass isolation rate (55% in LP, 80% in MP and 85% in HP, P = .002) and decreased LA‐PV reconnection rate (10% in LP, 8% in MP, and 0% in HP, P = .03).
Conclusion
In AI‐guided PVI, the HP RF application can shorten the time to complete PVI with a high rate of first‐pass isolation and a low rate of LA‐PV reconnection.
Modern cardiac implantable devices (CIDs. such as pacemakers (PMs), implantable cardioverter defibrillators (ICDs), and defibrillators for cardiac resynchronization therapy (CRT‐Ds. are engineered to be resistant to electromagnetic interference (EMI). However, such interference is still a concern when patients are exposed to household and occupational appliances in daily life. The aim of this study was to evaluate the risk of EMI caused by several types of household and industrial appliances. EMI with 20 CIDs (12 PMs, 7 ICDs, 1 CRT‐D. was tested for 16 household and 19 industrial appliances using three methods of measurement: Irnich's human body model, an alternating electric field device, and an alternate‐current and static‐current magnetic field device. The thresholds for the risk of EMI were defined as an alternating electric field of 5000 V/m, an alternate‐current magnetic field of 20 mT, and a static‐current magnetic field of 10 G. In 35 tests, 15 of the 16 household appliances showed no EMI with any CIDs, but an induction oven showed a potential risk of EMI with 2 PMs. None of the 19 industrial appliances showed EMI with any CIDs, provided that an appropriate distance from the appliances was maintained. These findings should allow physicians to evaluate whether patients with a CID can safely return to their homes and workplaces.
Backgrounds. Fusion of the left and right inferior pulmonary
veins (PV) (confluent inferior PV, CIPV) is a rare variation. Using
intracardiac echocardiography (ICE) from the left atrium (LA), we
measured the posterior wall thickness (PWT) of CIPV adjacent to the
esophagus and compared it with LA posterior wall thickness (LAPWT) in
non-CIPV cases. Methods. Of the consecutive 986 patients
undergoing atrial fibrillation (AF) ablation from July 2020 to June
2022, seven (0.7%) had CIPV with a common trunk connecting to the LA
diagnosed by 3-dimentinal contrast-enhanced computed tomography.
Twenty-five AF patients without CIPV served as control. ICE was done
from LA to measure PWT of CIPV and LAPWT of non-CIPV cases at the level
of the left inferior PV. For ablation in CIPV patients, each superior PV
was individually isolated, and BOX isolation of CIPV without ablating
CIPV posterior wall was added. Results. CIPV PWT was 0.7±0.1
mm, while LAPWT of non-CIPV was 2.0±0.4 mm (P<0.001). In CIPV
group, the upper and lower portions of CIPV were both apart from the
esophagus (mean distances, 6.7±3.4 mm and 7.9±2.7 mm, respectively).
Individual superior PV isolation and BOX CIPV isolation resulted in
complete isolation of all PVs. There were no complications. All CIPV
patients but one remained free from AF recurrence for 376±52 days.
Conclusions. Although CIPV frequency is low (0.7%), CIPV PWT
is very thin and a special care is needed in ablation. The present
ablation strategy is effective for complete PV isolation with a less
risk of the esophageal injury.
Modern cardiac implantable devices (CIDs) such as pacemakers (PMs), implantable cardioverter defibrillators (ICDs), and defibrillators for cardiac resynchronization therapy (CRT-Ds) are engineered to be resistant to electromagnetic interference (EMI). However, such interference is still a concern when patients are exposed to household and occupational appliances in daily life. The aim of this study was to evaluate the risk of EMI caused by several types of household and industrial appliances. EMI with 20 CIDs (12 PMs, 7 ICDs, 1 CRT-D) was tested for 16 household and 19 industrial appliances using three methods of measurement: Irnich's human body model, an alternating electric field device, and an alternate-current and static-current magnetic field device. The thresholds for the risk of EMI were defined as an alternating electric field of 5000 V/m, an alternate-current magnetic field of 20 mT, and a static-current magnetic field of 10 G. In 35 tests, 15 of the 16 household appliances showed no EMI with any CIDs, but an induction oven showed a potential risk of EMI with 2 PMs. None of the 19 industrial appliances showed EMI with any CIDs, provided that an appropriate distance from the appliances was maintained. These findings should allow physicians to evaluate whether patients with a CID can safely return to their homes and workplaces. (J Arrhythmia 2011; 27: 49-56)
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