Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters

Rubín, José M.; Calvo, David; Pérez, Diego; Fidalgo, Ana; Hera, Jesús M. de la; Martínez, Lidia; Capín, Esmeralda; Arrizabalaga, Haritz; Carballeira, Lidia; García, Daniel; Morı́s, César

doi:10.1111/pace.13170

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…For both cryoablation and RF ablation, a larger ablation tip is associated with reduced time to achieve conduction block and shorter overall procedure times. 14,20 Consequently, the small number of freezes needed to acquire conduction block further decreased the use of fluoroscopy. (1.44%) as the most frequent, followed by respiratory (0.88%), vascular (0.78%), and neurologic (0.05%) complications.…”

Section: Acute Success and Procedural Outcomesmentioning

confidence: 99%

Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

Klaver

Potter

Iliodromitis

et al. 2021

Cardiovasc electrophysiol

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Introduction: Cryoablation has evolved as a safe alternative to radiofrequency ablation in the treatment of several supraventricular arrhythmias and has potential advantages, yet is limited by the properties of the cryogen used. We investigated a novel ultralow temperature cryoablation (ULTC) system using nitrogen near its liquid-vapor critical point as a freezing source, achieving temperatures as low as -196 degrees Celsius in a long linear catheter with a continuous energy release. Initial safety, procedural and efficacy outcomes of ULTC are described in patients undergoing cavotricuspid isthmus (CTI) ablation. Methods and Results:The Cryocure studies (NCT02355106, NCT02839304) are prospective, single-arm, multi-center, first-in-human clinical studies in 17 patients with atrial flutter (AFL) and 13 patients with atrial fibrillation (AF). A total of 30 patients, mean age 65 ± 8 years old and 67% male, were enrolled and underwent ablation of the CTI. Acute success, defined as the confirmation of stable bidirectional conduction block across the CTI, was achieved in all 30 patients. After 12 months of follow-up, 14 out of 17 AFL patients remained free from any AFL. One (3.3%) procedure-related but not devicerelated serious adverse event was reported, involving transient inferolateral ST-elevation associated with temporary AV conduction block. Conclusion:In this first-in-human clinical study the safety and performance results demonstrate the capabilities of ultralow temperature near-critical nitrogen as an effective energy source for CTI ablation. Ongoing, larger, studies should confirm our findings and evaluate the capabilities to create linear and focal transmural lesions in other arrhythmias.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Acute Success and Procedural Outcomesmentioning

confidence: 99%

Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

Klaver

Potter

Iliodromitis

et al. 2021

Cardiovasc electrophysiol

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“…The assessment of sudden death risk in patients with arrhythmogenic cardiomyopathyand of the arrhythmia burden in AF patients undergoing a rhythm-control strategy (yield of 14.6% and 16.6% in our series, respectively)is generally accepted, and we thus do not recommend revisiting such indication. Periodical 24H monitoring may indeed increase the ability of the technique to pick up AF relapses to up to 40% of cases [22] .…”

Section: Discussionmentioning

confidence: 99%

Contemporary Yield of 24-hour Holter Monitoring: Role of Inter-Atrial Block Recognition

Bazán

Cediel

Llibre

et al. 2019

Journal of Atrial Fibrillation

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BackgroundThe diagnostic yield of 24-hour ECG Holter monitoring (24H) is currently overcome by alternative ECG monitoring techniques and it needs to be optimized. The recognition of inter-atrial block (IAB) has emerged as a reliable indicator of patients at risk of atrial fibrillation relapses, and its role enhancing the yield of 24H is yet to be determined. We hypothesized that a presumably low yield of 24H may be ameliorated by means of incorporating the assessment for IAB. MethodsWe retrospectively analyzed 1017 consecutive 24H registers performed in a Multidisciplinary Integrated Health Care Institution, in which a restrictive definition of diagnostic 24H findings was used. A univariate and multivariate regression analysis served to determine the variables associated with a higher 24H's yield, including the requesting medical specialty, type of indication and a number of clinical, echocardiographic and ECG variables, including IAB. ResultsThe mean age of our population was 62 ± 17 years (55% males). The majority of 24H were indicated from the Cardiology department (48%). The overall yield was 12.8%, higher for the assessment of the integrity of the electrical conduction system (26.1%) and poorer for the assessment of syncope (3.2%) and cryptogenic stroke (4.6%). The variables associated with higher diagnostic performance were indication from Cardiology (p < 0.001), IAB (p = 0.004), structural heart disease (p = 0.008) and chronic renal failure (p = 0.009). Patients ≤ 50 years old only retrieved a 7% yield. In the multivariate analysis, indication from Cardiology and IAB remained significant predictors of higher 24H's yield. In a secondary analysis including echocardiographic data, only identification of IAB remained statistically significant. ConclusionsThe recognition of IAB and the type of indication are major determinants of a higher 24H's diagnostic yield and may help to optimize the selection of candidates.

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“…Although the aforementioned study demonstrated no statistical difference in ablation efficacy or complications between the catheters, there was a significant difference in speed to achieve a bidirectional block between catheters . The 8‐mm ablation catheter was significantly quicker to achieve bidirectional block than both irrigated‐tip catheters after 10 minutes of radiofrequency (RF) delivery (success 68% vs 40% and 28%, P = 0.001) and 20 minutes (96% vs 70% and 70%, P = 0.002).…”

mentioning

confidence: 95%

“…A study conducted by Rubín et al., compared the outcomes of linear CTI flutter ablation between three ablation catheters: a solid large‐tip iridium‐made 8‐mm catheter, a classic 6‐hole irrigated‐tip catheter (ThermoCool®), and a new 64‐hole irrigated‐tip catheter (ThermoCool® SF). All catheters were manufactured by Biosense Webster Inc., Diamond Bar, CA, USA.…”

mentioning

confidence: 99%

“…On the other hand, an advantage of irrigated‐tip catheters over solid large‐tip catheters is a more efficient RF delivery in areas of low blood flow such as pouches or concave portions of the CTI, as the irrigation at the tip of the catheter reduces overheating in these areas. Rubín et al . may have avoided areas of low flow in the 8‐mm ablation group by performing lines of block more septally or laterally.…”

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confidence: 99%

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Reduce procedure time for cavotricuspid flutter ablation: What is the optimal catheter?

Elayi

2017

Pacing Clinical Electrophis

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Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters

Cited by 5 publications

References 22 publications

Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

Contemporary Yield of 24-hour Holter Monitoring: Role of Inter-Atrial Block Recognition

Reduce procedure time for cavotricuspid flutter ablation: What is the optimal catheter?

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