High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation

Winkle, Roger A.; Mead, R. Hardwin; Engel, Gregory; Kong, Melissa H.; Salcedo, Jonathan; Brodt, Chad; Patrawala, Rob A.

doi:10.1016/j.hrthm.2020.03.022

Cited by 43 publications

(52 citation statements)

References 13 publications

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“…6 Calzolari et al 15 When ablating near the esophagus, the RF times were shortened by a few seconds. 18 In their study, no esophagus-related complications were reported. Although the lesion durability was unclear, an HPSD on the posterior wall near the esophagus might be acceptable for assuring the safety.…”

Section: Ablation Lesion Width Assessed By Lge-mrimentioning

confidence: 88%

Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force‐sensing catheter: Late‐gadolinium enhancement magnetic resonance imaging assessment

Kurose

Kiuchi

Fukuzawa

et al. 2020

Cardiovasc electrophysiol

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Background: Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are characterized as a wider and more continuous than that after conventional radiofrequency catheter ablation (RFCA) without the contact force (CF)-sensing technology. However, the impact on the lesion characteristics of ablation with a CFsensing catheter has not been well discussed. We sought to assess the lesions using late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) and to compare the differences between the two groups (CB group vs. RF group). Methods: A total of 30 consecutive patients who underwent PVI were enrolled (CB group, 18; RF group, 12). The RF applications were delivered with a target lesion size index (LSI) of 5. The PVI lesions were assessed by LGE-MRI 3 months after the PVI. The region around the PV was divided into eight segments: roof, anteriorsuperior, anterior carina, anterior inferior, bottom, posterior inferior, posterior carina, and posterior superior segment. The lesion width and visual gap of each segment were compared between the two groups. The visual gaps were defined as no-enhancement site of >4 mm. Results: The mean LSI was 4.7 ± 0.7. The lesion width was significantly wider but the visual gaps were more frequently documented at the bottom segment of right PV in the CBA group (lesion width: 8.1 ± 2.2 vs. 6.3 ± 2.2 mm; p = .032; visual gap at the bottom segment or right PV: 39% vs. 0%; p = .016). Conclusions: The PVI lesion was wider after CBA, while the visual gaps were fewer after RFCA with a CF-sensing catheter.

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Section: Ablation Lesion Width Assessed By Lge-mrimentioning

confidence: 88%

Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force‐sensing catheter: Late‐gadolinium enhancement magnetic resonance imaging assessment

Kurose

Kiuchi

Fukuzawa

et al. 2020

Cardiovasc electrophysiol

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“…In our opinion, the lack of an effective indicator of transmural lesion formation may be another reason: in the HPSD approach, catheter movement on the posterior wall was guided by dwell time, while it was based upon meeting a local attenuation of electrograms in low power group. A recently published study examined 4‐year outcomes after HPSD ablations with a target CF of 10–40 g (conducted using Biosense Webster or St. Jude CF‐sensing catheters), and the RF times were shortened by a few seconds when ablating the posterior wall 23 . The 4‐year freedom from AF after HPSD ablations were paroxysmal AF: 87.0%, persistent AF: 71.9%, and longstanding AF: 64.9%.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Most studies 21,26,27,30 tended to lower the RF power on the posterior wall by 5–10 W than that of the anterior wall, while other studies 22,32 reported reduced ablation duration times. Some studies 23,25,28 suggested using a fixed power setting with the guidance of LSI or AI. Thus, managing HPSD ablation on the posterior wall is worthy of further research.…”

Section: Current Existing Problems and Future Perspectivesmentioning

confidence: 99%

Update on high‐power short‐duration ablation for pulmonary vein isolation

Qiu

Wang

et al. 2020

Cardiovasc electrophysiol

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Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. However, this procedure remains complex and time‐consuming, and the recurrence of AF after PVI is still unsatisfactory. Current technologies have improved our knowledge of the association between radiofrequency lesion creation and ablation parameters (power and duration), which triggered the development of high‐power short‐duration (HPSD). During the past decade, several preclinical and clinical studies have been conducted to confirm the feasibility, safety, and outcome of PVI ablation with HPSD or very high‐power short‐duration (vHPSD) settings, which increased electrophysiologists' interests in the utility of HPSD strategies. This paper describes the theoretical basis and recent research findings of HPSD or vHPSD ablation and summarizes the state‐of‐the‐art evidence behind the role of this strategy in PVI.

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“…Wesentlicher Vorteil dieser sog. HPSD-Protokolle sind die kürzere Eingriffsdauer sowie eine mutmaßlich dauerhaftere Ablationsläsion [12,24,25]. Anders als bei Standard-Radiofrequenz(RF)-Protokollen führte im vorliegenden Fall die gesteigerte Energieabgabe zu einer sehr schnellen Läsionsbildung, sodass auf den schlagartigen Impedanzanstieg und der damit drohenden Gewebeexplosion nicht mehr präventiv reagiert werden konnte.…”

Section: Komplikationsmanagement Bei Vorhofperforation -Ist Der Weg Zunclassified

Jetzt ist alles aus!

Duncker

Dahme

Deisenhofer

et al. 2020

Herzschr Elektrophys

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Jetzt ist alles aus! Komplikationen im EPU-Labor und ihre Lösungen Zuallererst keinen Schaden anrichten-für Ärztinnen und Ärzte stellt die Patientensicherheit die oberste Priorität dar. In der Rhythmologie stehen zunehmend komplexe Prozeduren den immer stärker prozessoptimierten Abläufen gegenüber. Dies stellt gerade in der rhythmologischen Ausbildung eine Herausforderung dar. Wer beginnt, invasive Prozeduren durchzuführen, wird immer auch Komplikationen erleben und Sorge vor weiteren unerwünschten Ereignissen haben. Ein vorbereitetes und standardisiertes Komplikationsmanagement kann helfen, das Auftreten von Komplikationen zu vermeiden oder diese zumindest optimal kontrollieren zu können [18]. Ziel des vorliegenden Artikels soll sein, anhand von Fallbeispielen gemeinsam zu lernen. Zu jedem Fall werden Maßnahmen zur Vermeidung aufgezeigt sowie Handlungsempfehlungen zum Management der jeweiligen Komplikation gegeben. 4 Kontinuierliches 12-Kanal-EKG-Monitoring zur frühzeitigen Erkennung von ST-Streckenveränderungen 4 Stimulationsbereitschaft im Fall höhergradiger AV-Blockierungen 4 Bereitschaft zur umgehenden Koronarangiographie und ggf. Intervention 4 Oberkörpertieflagerung zur Vermeidung weiterer zerebraler Embolien Herzschrittmachertherapie + Elektrophysiologie 4 • 2020 401

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High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation

Cited by 43 publications

References 13 publications

Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force‐sensing catheter: Late‐gadolinium enhancement magnetic resonance imaging assessment

Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force‐sensing catheter: Late‐gadolinium enhancement magnetic resonance imaging assessment

Update on high‐power short‐duration ablation for pulmonary vein isolation

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