Autonomic Changes Are More Durable After Radiofrequency Than Pulsed Electric Field Pulmonary Vein Ablation

Stojadinovic, P; Wichterle, Dan; Peichl, Petr; Nakagawa, Hiroshi; Čihák, Robert; Haskova, Jana; Kautzner, Josef

doi:10.1016/j.jacep.2022.04.017

Cited by 24 publications

(11 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Complications from the esophageal cooling device itself have been infrequent, with most occurring during long-term use for critical care patients (where durations of use extend well beyond 24 hours). [52][53][54] New technologies may arrive that further reduce the risk of AEF, such as irreversible electroporation, or pulsed field ablation (PFA); however concerns remain about both the longterm efficacy of procedures utilizing PFA, [55,56] as well as growing awareness of risks emerging with PFA, including stroke, acute coronary artery spasm, and delayed arterial injury via neointimal hyperplasia and medial fibrosis resulting in arterial stenosis. [57][58][59] Moreover, reports of fistula formation after irreversible electroporation are abundant in the oncology literature, which raises the question of whether PFA can actually eliminate the risk of AEF.…”

Section: Discussionmentioning

confidence: 99%

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Sánchez

Woods²,

Zagrodzky³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. No atrioesophageal fistula (AEF) has been reported to date with active esophageal cooling, and only one pericardio-esophageal fistula has been reported; however, a formal analysis of the AEF rate with active esophageal cooling has not previously been performed. Methods: Atrial fibrillation ablation procedure volumes before and after adoption of active cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were determined across 25 hospital systems with the highest total use of esophageal cooling during RF ablation. The number of AEFs occurring in equivalent time frames before and after adoption of cooling were then determined, and AEF rates were compared using generalized estimating equations robust to cluster correlation. Results: Throughout the 25 hospital systems, which included a total of 30 separate hospitals, 14,224 patients received active esophageal cooling during RF ablation, with the earliest adoption beginning in March 2019 and the most recent beginning in March 2022. In the time frames prior to adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In this pre-adoption cohort a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates of <0.1% to 0.25%. No AEFs were found in the cohort treated after adoption of active esophageal cooling, yielding an AEF rate of 0% (P<0.0001). Conclusion: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Sánchez

Woods²,

Zagrodzky³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…A similar temporary influence of PFA on the GP has been observed also with a different PFA technology. Stojadinovic et al 14 reported a reduced response of both the sinoatrial and the atrioventricular node to ECVS after PVI with PFA with the Affera system (Affera; Medtronic). However, the effects on the ANS induced by this PFA technology were still present 20 min after ablation in ∼30% of patients.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of transient autonomic modulation after single‐shot pulmonary vein isolation with pulsed‐field ablation

Del Monte,

Cespón Fernández,

Vetta

et al. 2023

Cardiovasc electrophysiol

View full text Add to dashboard Cite

IntroductionPulmonary vein isolation (PVI) with thermal energy is characterized by concomitant ablation of the surrounding ganglionated plexi (GP). Pulsed‐field ablation (PFA) selectively targets the myocardium and seems associated with only negligible effects on the autonomic nervous system (ANS). However, little is known about the dynamic effects of PFA on the GP immediately after PVI. This study sought to investigate the degree and acute vagal modulation induced by the FarapulseTM PFA system during PVI compared with single‐shot thermal ablation.MethodsA total of 76 patients underwent first‐time PVI with either FarapulseTM PFA (PFA group, n = 40) or cryoballoon ablation (thermal ablation group, n = 36) for paroxysmal atrial fibrillation (AF). The effect on the ANS in the two groups was assessed before and after PVI with extracardiac vagal stimulation (ECVS). To capture any transient effects of PFA on the ANS, in a subgroup of PFA patients ECVS was repeated at three predefined timepoints: (1) before PVI (T0); (2) immediately after PVI (T1); and (3) 10 min after the last energy application (T2).ResultsDespite similar baseline values, the vagal response induced by ECVS after PVI almost disappeared in the thermal ablation group but persisted in the PFA group (thermal group: 840 [706–1090] ms, p < .001 compared to baseline; PFA group: 11 466 [8720–12 293] ms, p = .70 compared to baseline). Intraprocedural vagal reactions (defined as RR increase >50%, transitory asystole, or atrioventricular block) occurred more frequently with PFA than thermal ablation (70% vs. 28%, p = .001). Moreover, heart rate 24 h post‐PVI increased more with thermal ablation than with PFA (16.5 ± 9.0 vs. 2.6 ± 6.1 beats/min, p < .001). In the subgroup of PFA patients undergoing repeated ANS modulation assessment (n = 11), ECVS demonstrated that PFA determined a significant acute suppression of the vagal response immediately after PVI (p < .001 compared to baseline), which recovered almost completely within 10 min.ConclusionPVI with the FarapulseTM PFA system is associated with only transitory and short‐lasting vagal effects on the ANS which recover almost completely within a few minutes after ablation. The impact of this phenomenon on AF outcome needs to be further investigated.

show abstract

“…31 One case of successful termination of an AT from the right atrial appendage by PFA after failed RFA has been published. 32…”

Section: Beyond Pulmonary Vein Isolationmentioning

confidence: 99%

Pulsed Field Ablation for Atrial Fibrillation

Schaack

Schmidt

Bordignon

et al. 2023

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

Catheter ablation is a widely used, effective and safe treatment for AF. Pulsed field ablation (PFA), as a novel energy source for cardiac ablation, has been shown to be tissue selective and is expected to decrease damage to non-cardiac tissue while providing high efficacy in pulmonary vein isolation. The FARAPULSE ablation system (Boston Scientific) follows the idea of single-shot ablation and is the first device approved for clinical use in Europe. Since its approval, multiple high-volume centres have performed increasing numbers of PFA procedures in patients with AF and have published their experiences. This review summarises the current clinical experience regarding the use of PFA for AF using the FARAPULSE system. It provides an overview of its efficacy and safety.

show abstract

Autonomic Changes Are More Durable After Radiofrequency Than Pulsed Electric Field Pulmonary Vein Ablation

Cited by 24 publications

References 28 publications

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Quantitative assessment of transient autonomic modulation after single‐shot pulmonary vein isolation with pulsed‐field ablation

Pulsed Field Ablation for Atrial Fibrillation

Contact Info

Product

Resources

About