Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

Pedrote, Alonso; Acosta, Juan; Jáuregui, Beatriz; Frutos‐López, Manuel; Arana‐Rueda, Eduardo

doi:10.4330/wjc.v9.i3.230

Cited by 8 publications

(7 citation statements)

References 66 publications

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“…Permanent PVI and freedom from AF recurrence are contingent upon efficient and durable RF lesion formation 22,23 . The amount of RF energy delivered to the tissue during ablation plays a central role in lesion durability 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Use of steerable sheaths has improved procedural outcomes in comparison to conventional sheaths due to the ease of manipulation, access and contact with target sites 14,19 . The rigid make up of steerable sheaths, also, reduces the effects of cardiac and respiratory excursions and provide better catheter control 23 . Several steerable sheaths are commercially available but their relative influence on CF and catheter stability remains unknown.…”

Section: Discussionmentioning

confidence: 99%

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Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

Hiner¹,

Shah²

2020

Preprint

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Purpose: A stable contact force (CF) is correlated with more effective radiofrequency ablation (RFA) lesions and long-term procedural outcomes. Efforts to improve catheter stability include jet ventilation, pacing, steerable sheaths, and CF sensing ablation catheters. This study compares CF stability and effective RF lesions between two commercially available steerable sheaths. Methods: Thirty patients underwent first time RFA at a single center using the Agilis NxT or SureFlex Steerable Sheath. High power short duration RFA was utilized targeting a 10Ω drop. Sheath performance was assessed for the entire procedure and around each pulmonary vein (PV) in terms of mean CF, CF variability, RF time per lesion, and inefficient contact lesions (defined as lesions with CF < 5g for at least 10% of the RF delivery time). Results: Operator-targeted mean CF was achieved using both sheaths; however, overall CF variability was 12.8% lower using the SureFlex sheath (p = 0.08). CF variability was generally 16% greater in the right PVs than the left PVs (p = 0.001), but trended lower with the SureFlex sheath. There were 8% more inefficient contact lesions using Agilis as compared to SureFlex (p = 0.035), especially in the right inferior PV (p = 0.009). RF time per lesion was on average 12% (1.4s) shorter using SureFlex than Agilis (p < 0.05). Conclusion: Choice of steerable sheath may affect catheter stability and potential lesion quality, especially in the right PVs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

Hiner¹,

Shah²

2020

Preprint

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“…This suggests that these two methods may have different mechanisms for the recovery of latent conduction between PV and LA. Pedrote et al 15 suggested that adenosine provocation test + pacing capture + supplemental ablation may help reduce the recurrence of AF.…”

Section: Dovepressmentioning

confidence: 99%

The Effect of the Enhanced Endpoint of Pulmonary Vein Isolation on the Long-Term Success Rate of Radiofrequency Ablation for Atrial Fibrillation

Chen

Zhang

et al. 2021

IJGM

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“…Wakili et al [14] show that contact force > 10 g can create more effective lesions. Pedrote et al [15] suggest that excessive contact force (> 50 g) can provoke steam pop. Thiagalingam et al [16] indicate that a "moderate" catheter contact force (20 g) can increase the possibility of more effective lesions, and a "high" contact force of 60 g can cause steam pop.…”

Section: Related Workmentioning

confidence: 99%

Analysis of Contact Stability and Contact Safety of a Robotic Intravascular Cardiac Catheter under Blood Flow Disturbances

Hao

Poirot

Çavuşoğlu

2020

2020 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS)

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This paper studies the contact stability and contact safety of a robotic intravascular cardiac catheter under blood flow disturbances while in contact with tissue surface. A probabilistic blood flow disturbance model, where the blood flow drag forces on the catheter body are approximated using a quasi-static model, is introduced. Using this blood flow disturbance model, probabilistic contact stability and contact safety metrics, employing a sample based representation of the blood flow velocity distribution, are proposed. Finally, the contact stability and contact safety of a MRIactuated robotic catheter are analyzed using these models in a specific example scenario under left pulmonary inferior vein (LIV) blood flow disturbances. This paper investigates the contact stability and contact safety of a robotic catheter under blood flow disturbances given tip position constraint on the tissue surface. The MRIactuated robotic catheter [8], [9] designed for performing intra-vascular cardiac interventions, including circumferential pulmonary vein ablation for treatment of atrial

show abstract

Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

Cited by 8 publications

References 66 publications

Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

The Effect of the Enhanced Endpoint of Pulmonary Vein Isolation on the Long-Term Success Rate of Radiofrequency Ablation for Atrial Fibrillation

Analysis of Contact Stability and Contact Safety of a Robotic Intravascular Cardiac Catheter under Blood Flow Disturbances

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