Catheter Ablation for Atrial Fibrillation

O’Neill, Mark; Jaı̈s, Pierre; Hocini, Mélèze; Sacher, Frédéric; Klein, George J.; Clémenty, Jacques; Haı̈ssaguerre, Michel

doi:10.1161/circulationaha.106.655738

Cited by 99 publications

(56 citation statements)

References 122 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] Despite a high rate of acute isolation, the incidence of (1 through 4). C, The compliant balloon catheter was placed in the RIPV and conformed well to the size and shape of the PV ostium.…”

Section: Discussionmentioning

confidence: 99%

Visual Balloon-Guided Point-by-Point Ablation

Dukkipati

Neužil

Škoda

et al. 2010

Circ: Arrhythmia and Electrophysiology

105

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Background-While conceptually straightforward, placing point-to-point contiguous radiofrequency lesions to achieve pulmonary vein isolation (PVI) is technically challenging in patients with paroxysmal atrial fibrillation. Furthermore, chronic efficacy is limited by late PV reconnections. A novel compliant balloon ablation catheter able to deliver visually guided short arcs/spots of laser energy was tested in initial preclinical and clinical cases to determine if visual guidance could predict reliable and persistent PVI. Methods and Results-This study consisted of (1) an experimental porcine phase with both acute (nϭ15 pigs) and 4-week chronic (nϭ10) data and (2) a single-center clinical feasibility phase (nϭ27 patients with paroxysmal atrial fibrillation), again with acute and 3-month chronic data. Under endoscopic guidance, point-by-point perivenous ablation was performed in a contiguous and overlapping manner. Each porcine PV was longitudinally sectioned for detailed histological analysis. At 3 months after ablation, patients underwent a prespecified remapping procedure regardless of symptomotology. In the acute and chronic animals, 29 of 30 (97%) PVs were electrically isolated after placing the initial circumferential lesion set. For the 4-week chronic animals, 80% of PVs remained isolated; lesions were histologically circumferential in 120 of 120 (100%) PV sections and transmural in 116 of 120 (96.7%) PV sections (average transmuralityϭ99.0Ϯ5.5%). In patients, 100% of the PVs were isolated after 1.3 attempts per PV-84% of them (85 of 101) isolated after the initial visually guided lesion set. At 3 months, 61 of 68 (90%) PVs continued to be electrically isolated. Conclusions-Using a visually guided, compliant balloon ablation catheter with point-by-point ablative capability, PV isolation can be achieved in a reliable, reproducible, and persistent manner. (Circ Arrhythm Electrophysiol. 2010;3:266-273.)

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Section: Discussionmentioning

confidence: 99%

Visual Balloon-Guided Point-by-Point Ablation

Dukkipati

Neužil

Škoda

et al. 2010

Circ: Arrhythmia and Electrophysiology

105

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“…5,6 Irrespective of its electrophysiological causes, there often is a therapeutic imperative for catheter ablation of subsequent ATs because patients have more debilitating symptoms due to a fast ventricular response that is difficult to manage pharmacologically, and moreover, ATs often recur after cardioversion. 7 Thus, the aim of this study was first, to characterize electrophysiological mechanisms of ATs that occur after stepwise ablation of CAF and second, to evaluate the success rates of catheter ablation for late recurrent ATs guided exclusively by conventional mapping techniques.…”

mentioning

confidence: 99%

Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation

Rostock

Drewitz

Steven

et al. 2010

Circ: Arrhythmia and Electrophysiology

129

111

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Background-Atrial tachycardias (AT) often occur after ablation of long-lasting persistent AF (CAF) and are difficult to treat conservatively. This study evaluated mechanisms and success rates of conventional mapping and catheter ablation of recurrent ATs occurring late after stepwise ablation of CAF. Methods and Results-A total of 320 patients underwent de novo ablation of CAF using a stepwise ablation approach in 2006 to 2007 at our institution. This study comprised patients who presented with recurrent ATs at their first redo procedure after initial de novo CAF ablation. All procedures were guided by conventional mapping techniques exclusively. Sixty-one patients (63Ϯ10 years, 14 women) presented with their clinical AT at their redo procedure 7.7Ϯ4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2Ϯ0.9 per patient) were mapped. Forty-four (72%) were due to reentry; 17 (28%) were focal ATs. Reentry ATs were mainly characterized as roof and perimitral flutter (43% and 34%, respectively). Focal ATs mainly originated from the great thoracic veins (pulmonary veins: 41%, coronary sinus: 23%). Forty-five (74%) patients had conduction recovery of at least 1 pulmonary vein (mean, 1.2Ϯ0.8).Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181Ϯ59 minutes, with a mean fluoroscopy time of 45Ϯ21 minutes. After a mean follow-up of 21Ϯ4 months, 50 (82%) patients were free of any arrhythmia recurrences after a single redo procedure. Conclusions-Although late recurrent ATs may have complex mechanisms, catheter ablation guided exclusively by conventional techniques is highly effective with excellent acute and long-term success rates. (Circ Arrhythm Electrophysiol. 2010;3:160-169.)

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“…1,2 Although conceptually straightforward, its clinical application has been hindered by important technical hurdles related to the complexity and patient-to-patient variability of PV anatomy, as well as the difficulty in manipulating the ablation catheter to the peri-PV locations. This is compounded by the lack of a distinct separation between the left atrium (LA) and PVs; each of the ovoid veins is often observed to widen gradually and asymmetrically as they coalesce to join the body of the LA.…”

mentioning

confidence: 99%

Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation

et al. 2009

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Background-Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left atrial-PV junction with laser energy. Methods and Results-This study consisted of 2 phases: a short-term (nϭ9) and long-term (nϭ11) canine experimental validation phase and a multicenter clinical feasibility phase (nϭ30 paroxysmal atrial fibrillation patients). After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and arcs of laser energy (90°to 360°) were projected onto the target left atrial-PV junction. Electric PV isolation was defined with a circular multielectrode catheter. In the short-term preclinical experimental phase, 15 of 17 targeted PVs (88%) were successfully isolated. Pathological examination revealed well-demarcated circumferential lesions with minimal endothelial disruption. In the long-term experiments, 9 of 10 targeted veins (90%) remained persistently isolated (at 4 to 8 weeks). In the clinical phase, 105 of 116 PVs (91%) were successfully isolated. After a single procedure, the 12-month drug-free rate of freedom from atrial fibrillation was 60% (18 of 30 patients). There were no significant PV stenoses, but adverse events included 1 episode of cardiac tamponade, 1 stroke without residual defect, and 1 asymptomatic phrenic nerve palsy. Conclusion-This

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Catheter Ablation for Atrial Fibrillation

Cited by 99 publications

References 122 publications

Visual Balloon-Guided Point-by-Point Ablation

Visual Balloon-Guided Point-by-Point Ablation

Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation

Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation

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