Persistent Atrial Fibrillation Ablation With Contact Force–Sensing Catheter

Mansour, Moussa; Calkins, Hugh; Osorio, José; Pollak, Scott J.; Melby, Daniel P.; Marchlinski, Francis E.; Athill, Charles A.; Delaughter, Craig; Patel, Ankit; Gentlesk, Philip J.; DeVille, Brian; Macle, Laurent; Ellenbogen, Kenneth A.; Dukkipati, Srinivas R.; Reddy, Vivek Y.; Natale, Andrea

doi:10.1016/j.jacep.2020.04.024

Cited by 63 publications

(66 citation statements)

References 17 publications

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“…The primary endpoint was FFAF, defined as freedom from documented AF/atrial tachycardia/atrial flutter greater than 30 s, from the end of a 90-day blanking period through 15 months postprocedure (12 months post-blanking period). 1,14 This study was approved by the Institutional Review Board (IRB) at Northwestern University and adhered to guidelines set forth in the Helsinki Declaration.…”

Section: Patientsmentioning

confidence: 99%

Impact of pre‐ablation weight loss on the success of catheter ablation for atrial fibrillation

Peigh

Wasserlauf

Vogel

et al. 2021

Cardiovasc electrophysiol

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Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) after ablation in obese and nonobese patients is unknown.Methods: A single-center retrospective cohort study of patients undergoing pulmonary vein isolation was performed. Before ablation, all candidates were encouraged to adopt healthy lifestyle habits according to American Heart Association guidelines, including weight loss, by their physician. The primary endpoint was FFAF through 1-year after completion of the 3-month blanking period.Results: Of the 601 patients (68% male; average age 62.1 ± 10.3 years) included in analysis, 234 patients (38.9%) were obese (body mass index ≥ 30) and 315 (52.4%) had paroxysmal AF. FFAF was observed in 420 patients (69.9%) at 15 months. Percent change in weight that occurred during the year before ablation independently predicted FFAF through 15-months in all patients (adjusted odds ratio = 1.17, 95% confidence interval: 1.11-1.23). Subgroup analyses based on paroxysmal vs persistent AF, presence of obesity, and history of prior ablation were performed. Percent change in weight over the year before ablation was independently associated with FFAF in all subgroups except nonobese patients with persistent AF. Conclusion:Pre-ablation weight loss was associated with FFAF in both obese and nonobese patients. Further studies are needed to define the optimal approach to weight loss before AF ablation.

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Section: Patientsmentioning

confidence: 99%

Impact of pre‐ablation weight loss on the success of catheter ablation for atrial fibrillation

Peigh

Wasserlauf

Vogel

et al. 2021

Cardiovasc electrophysiol

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“…A meta-analysis in 2015 of nine nonrandomized studies involving 1,148 patients examined CF-guided PVI versus non-CF-guided PVI, demonstrating a 37% relative risk reduction (p = 0.01) in AF recurrence post-PVI at a median of 12 months. 29 The recent Prospective Review of the Safety and Effectiveness of the Thermocool ® SmartTouch™ Surround Flow Catheter Evaluated for Treating Symptomatic Persistent AF (PRECEPT) trial by Mansour et al 30 used CF-sensing irrigated catheters; over half of study participants received a lesion set beyond PVI. In 348 patients with PeAF, the rate of freedom from documented recurrence of AF/AFL/AT of 30 seconds or longer was 61.7% and that of freedom from symptomatic recurrences was 80.4% at 15 months.…”

Section: Contact Forcementioning

confidence: 99%

Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation

Sharif

Heist

2021

J Innov Cardiac Rhythm Manage.

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Radiofrequency ablation (RFA) remains a highly effective therapy in the management of paroxysmal atrial fibrillation (PAF) and is an important therapeutic option in the management of persistent atrial fibrillation (PeAF) when clinically indicated. Lesion size is influenced by many parameters, which include those related to energy application (RFA power, temperature, and time), delivery mechanism (electrode size, orientation, and contact force), and the environment (blood flow and local tissue contact, stability, and local impedance). Successful durable RFA is dependent on achieving lesions that are reliably transmural and contiguous, whilst also avoiding injury to the surrounding structures. This review focuses on the variables that can be adjusted in connection with RFA to achieve long-lasting lesions that enable patients to derive the maximum sustained benefit from pulmonary vein isolation and additional lesion sets if utilized.

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“…101,102 So, antiarrrhythmics are the first line management with amiodarone as the preferred option for patients with HF-rEF; however, its effectiveness in maintaining the sinus rhythm in the medium and long term is debatable. The CASTLE-AF 103 study demonstrated the superiority of transcatheter ablation versus pharmacological treatment in terms of decreased risk of the primary outcome composed of death from all causes/hospitalizations due to heart failure worsening (HR 0.62, 95% CI 0.43-0.87, p = 0.007) in a patients cohort with HF-rEF and paroxystic or persistent atrial fibrillation, recently, the PRECEPT (Prospective Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH SF Catheter Evaluated for Treating Symptomatic PsAF and nonresponse or intolerance to > 1 antiarrhythmic drug (class I or III)) endorsed the usefulness and safety of transcatheter ablation in persistent atrial fibrillation, 104 although it is true that these patients were not HF carriers, the usefulness of electrophysiological procedures in the contemporary handling of atrial fibrillation was evident. It is therefore suggested that whenever possible, transcatheter ablation should be considered as treatment for rhythm control in patients with HF-rEF and paroxysmal or persistent atrial fibrillation.…”

Section: It Is Necessary To Intentionally Explore the Presence Of Atrial Fibrillation In Every Hf Patient During Their Comprehensive Evalmentioning

confidence: 99%