Pulmonary Vein Antral Isolation Using an Open Irrigation Ablation Catheter for the Treatment of Atrial Fibrillation

Kanj, Mohamed; Wazni, Oussama; Fahmy, Tamer S.; Thal, Sergio; Patel, Dimpi; Elay, Claude; Biase, Luigi Di; Arruda, Mauricio; Saliba, Walid; Schweikert, Robert A.; Cummings, Jennifer E.; Burkhardt, J. David; Martin, David O.; Pelargonio, Gemma; Russo, Antonio Dello; Casella, Michela; Santarelli, P; Potenza, Domenico; Fanelli, Raffaele; Massaro, Rosalba; Forleo, Giovanni B.; Natale, Andrea

doi:10.1016/j.jacc.2006.12.041

Cited by 106 publications

(98 citation statements)

References 16 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] Despite a high rate of acute isolation, the incidence of (1 through 4). C, The compliant balloon catheter was placed in the RIPV and conformed well to the size and shape of the PV ostium.…”

Section: Discussionmentioning

confidence: 99%

Visual Balloon-Guided Point-by-Point Ablation

Dukkipati

Neužil

Škoda

et al. 2010

Circ: Arrhythmia and Electrophysiology

105

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Background-While conceptually straightforward, placing point-to-point contiguous radiofrequency lesions to achieve pulmonary vein isolation (PVI) is technically challenging in patients with paroxysmal atrial fibrillation. Furthermore, chronic efficacy is limited by late PV reconnections. A novel compliant balloon ablation catheter able to deliver visually guided short arcs/spots of laser energy was tested in initial preclinical and clinical cases to determine if visual guidance could predict reliable and persistent PVI. Methods and Results-This study consisted of (1) an experimental porcine phase with both acute (nϭ15 pigs) and 4-week chronic (nϭ10) data and (2) a single-center clinical feasibility phase (nϭ27 patients with paroxysmal atrial fibrillation), again with acute and 3-month chronic data. Under endoscopic guidance, point-by-point perivenous ablation was performed in a contiguous and overlapping manner. Each porcine PV was longitudinally sectioned for detailed histological analysis. At 3 months after ablation, patients underwent a prespecified remapping procedure regardless of symptomotology. In the acute and chronic animals, 29 of 30 (97%) PVs were electrically isolated after placing the initial circumferential lesion set. For the 4-week chronic animals, 80% of PVs remained isolated; lesions were histologically circumferential in 120 of 120 (100%) PV sections and transmural in 116 of 120 (96.7%) PV sections (average transmuralityϭ99.0Ϯ5.5%). In patients, 100% of the PVs were isolated after 1.3 attempts per PV-84% of them (85 of 101) isolated after the initial visually guided lesion set. At 3 months, 61 of 68 (90%) PVs continued to be electrically isolated. Conclusions-Using a visually guided, compliant balloon ablation catheter with point-by-point ablative capability, PV isolation can be achieved in a reliable, reproducible, and persistent manner. (Circ Arrhythm Electrophysiol. 2010;3:266-273.)

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Section: Discussionmentioning

confidence: 99%

Visual Balloon-Guided Point-by-Point Ablation

Dukkipati

Neužil

Škoda

et al. 2010

Circ: Arrhythmia and Electrophysiology

105

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“…Radiofrequency energy was delivered using the power control mode with a target power output of 20-35 W and maximum temperature of 42°C. 18 The endpoint of the extensive PVI was the creation of extensive ipsilateral bidirectional conduction block between the atrium and PVs, which was confirmed at least 60 min after successful PVI. 16, 17 If AF was sustained after the PVI, additional ablation, consisting of a linear ablation of the left atrial roof, superior vena cava isolation, and/or ablation of complex fractionated atrial electrograms, was performed.…”

Section: Rfcamentioning

confidence: 94%

Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation Decreases a Sleep-Disordered Breathing Parameter During a Short Follow-up Period

Naruse

Tada

Satoh

et al. 2012

Circ J

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“…24 However, after observation of high incidence of steam pops and pericardial effusion at higher power in a randomized trial, the maximum temperature and power were changed to 42°C and 45 W, respectively. 25,26 The superior vena cava (SVC) was also mapped and isolated circumferentially in all patients. Briefly, the circular mapping catheter, guided by ICE, was positioned at the SVC-right atrial junction, which is marked by the lower border of the pulmonary artery.…”

Section: Ablation Proceduresmentioning

confidence: 99%

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

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Pulmonary Vein Antral Isolation Using an Open Irrigation Ablation Catheter for the Treatment of Atrial Fibrillation

Abstract: Although there was a decrease in fluoroscopy and left atrium instrumentation time with the use of OIC at higher power, this setting was associated with increased cardiovascular and gastrointestinal complications.

Cited by 106 publications

References 16 publications

Visual Balloon-Guided Point-by-Point Ablation

Visual Balloon-Guided Point-by-Point Ablation

Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation Decreases a Sleep-Disordered Breathing Parameter During a Short Follow-up Period

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

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