Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: The CLOSE to CURE study

Duytschaever, Mattias; Pooter, Jan De; Demolder, Anthony; Haddad, Milad El; Phlips, Thomas; Strisciuglio, Teresa; Debonnaire, Philippe; Wolf, Michael; Vandekerckhove, Yves; Knecht, Sébastien; Tavernier, René

doi:10.1016/j.hrthm.2019.11.004

Cited by 99 publications

(80 citation statements)

References 39 publications

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“…The use of force‐sensing catheters, which allows better control during catheter manipulation, seemed to improve the clinical outcome; however, acute and late PV gap reconnections still occurred, and outcome data from related studies appeared inconsistent 16–18 . In the absence of real‐time RF lesion assessment, the AI, integrating contact force, power, and ablation duration in a weighted formula, has been validated to predict lesion formation and to further improve clinical outcome after the AF ablation 11,12 …”

Section: Discussionmentioning

confidence: 99%

“…The use of force‐sensing catheter enables visual contact/proximity information between the catheter and the myocardium to optimize the catheter manipulation during the point‐by‐point radiofrequency (RF) ablation. Moreover, the ablation index (AI), incorporating contact force, power, and ablation duration in a weighted formula, has been validated to predict lesion formation and to improve clinical outcome after AF ablation 10–12 …”

Section: Introductionmentioning

confidence: 99%

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Catheter ablation of atrial fibrillation using ablation index‐guided high‐power technique: Frankfurt AI high‐power 15‐month follow‐up

Chen

Schmidt

Bordignon

et al. 2021

Cardiovasc electrophysiol

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Background Radiofrequency (RF) high‐power ablation appears to be a novel concept in treating atrial fibrillation (AF). The ablation‐index (AI) has been linked with the durability of pulmonary vein isolation (PVI). To report the midterm clinical results of a new ablation strategy using AI‐guided high‐power (50 W) ablation (AI‐HP). Methods and Results Symptomatic AF patients were included and underwent wide‐area circumferential PVI. Contact‐force catheters were used, RF power was set to 50 W targeting AI values (550/400 for anterior/posterior) and interlesion distance 6 mm. Luminal esophageal temperature (LET) was monitored during the procedure; patients with LET ≥39°C underwent post‐ablation esophageal‐endoscopy. Seventy‐two‐hour‐Holter ECGs were scheduled during follow‐up. Procedural PVI was achieved in all (N = 122; mean age, 68.2 years; male, 71.3%) patients, rate of first‐pass PVI was 96.7% per patient. Procedural mean RF time was 11.5 min, and mean RF time during posterior wall segment was 3.1 min. Per RF‐lesion, the mean contact force, RF duration, AI, and impedance‐drop at anterior/posterior wall were 26 ± 14 g/23 ± 12 g, 16.2 ± 7.5 s/8.8 ± 3.6 s, 552 ± 53/438 ± 47, and 13 ± 6 Ω/9 ± 5 Ω, respectively. Mean PVI procedural‐time, 55.8 min; mean procedural fluoroscopic time, 5.6 min. Three (2.5%) patients had asymptomatic endoscopic small erosion/erythema esophageal lesions, no serious adverse events were observed. During a 15‐month follow‐up, overall single‐procedure freedom from clinical recurrence of AF/atrial tachycardia (AT) off antiarrhythmic drug after blanking period was 85.2% (89.4% for paroxysmal AF, 80.4% for persistent AF). Conclusion The AI‐HP (50 W) appears as an efficient ablation technique in treating AF and leads to a high single‐procedure arrhythmia‐free survival at 15 months.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation using ablation index‐guided high‐power technique: Frankfurt AI high‐power 15‐month follow‐up

Chen

Schmidt

Bordignon

et al. 2021

Cardiovasc electrophysiol

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“…Such an indicator would be a lowerbound or underestimate of the eventual 12-month success rate, for example in the recent CLOSE to CURE study, freedom from recurrent arrhythmia was 69% during the 3-month blanking period versus 87% at 12 months, both measured by continuous loop monitoring. 30…”

Section: Discussionmentioning

confidence: 99%

Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period

et al. 2021

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“…Over the last decade, continuous monitoring with ICMs has emerged as the gold standard for AF detection with significantly higher rates of arrhythmia detection over longer periods of monitoring. Three recent studies have evaluated the role of ICM for rhythm monitoring following AF ablation: Continuous Monitoring after AF Ablation: the LINQ AF study; Cryoballoon or Radiofrequency Ablation for AF Assessed by Continuous Monitoring (CIRCA DOSE); and the CLOSE‐Guided PV Isolation as Cure for Paroxysmal AF (CLOSE to CURE) 22–24 . In addition to good arrhythmia‐free survival, these studies demonstrated even greater reductions in AF burden, which may be a more meaningful measure of the benefit of ablation.…”

Section: Discussionmentioning

confidence: 99%

Continuous rhythm monitoring‐guided anticoagulation after atrial fibrillation ablation

Pothineni

Amankwah

Schaller

et al. 2021

Cardiovasc electrophysiol

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Introduction Oral anticoagulation (OAC) based on estimated stroke risk is recommended following catheter ablation (CA) of atrial fibrillation (AF), regardless of the extent of arrhythmia control. However, discontinuing OAC in selected patients may be safe. We sought to evaluate a strategy of OAC discontinuation following AF ablation guided by continuous rhythm monitoring. Methods and Results We prospectively studied AF ablations performed at our institution from June 2015 to December 2019. Patients that had pre‐existing cardiac implantable electronic devices (CIEDs) or underwent insertable cardiac monitor (ICM) implantation immediately following AF ablation were included. OAC was continued for 6 weeks following CA in all patients, following which OAC management was guided by CHA2DS2‐VASc score and continuous rhythm monitoring results, according to a prespecified protocol. AF recurrence was defined as ≥30 s (CIEDs) or ≥2 min (ICM). We studied 196 patients (mean age 64.7 ± 11.3 years, 66.8% male, 85.7% ICM, 14.3% CIEDs). Mean CHA2DS2‐VASc score was 2.2 ± 1.5. One‐year AF‐free survival following CA was 83% for paroxysmal AF and 63% for persistent AF patients. Over 3 year follow‐up, OAC was discontinued in 57 (33.7%) patients, mean 7.4 ± 7.1 months following ablation. Following discontinuation, OAC was restarted for AF recurrence in 9 (15.8%) patients, mean 11.7 ± 6.8 months after stopping. This discontinuation protocol led to a 21.9% reduction in overall time exposed to OAC. There were no thromboembolic or major bleeding events. Conclusion OAC can be discontinued in a significant percentage of patients following CA of AF. When guided by continuous rhythm monitoring, this practice does not unacceptably increase the risk of thromboembolic events

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Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: The CLOSE to CURE study

Cited by 99 publications

References 39 publications

Catheter ablation of atrial fibrillation using ablation index‐guided high‐power technique: Frankfurt AI high‐power 15‐month follow‐up

Catheter ablation of atrial fibrillation using ablation index‐guided high‐power technique: Frankfurt AI high‐power 15‐month follow‐up

Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period

Continuous rhythm monitoring‐guided anticoagulation after atrial fibrillation ablation

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