Pulmonary vein isolation using “contact force” ablation: The effect on dormant conduction and long-term freedom from recurrent atrial fibrillation—A prospective study

Andrade, Jason G.; Monir, George; Pollak, Scott J.; Khairy, Paul; Dubuc, Marc; Roy, Denis; Talajic, Mario; Deyell, Marc W.; Rivard, Léna; Thibault, Bernard; Guerra, Peter G.; Nattel, Stanley; Macle, Laurent

doi:10.1016/j.hrthm.2014.07.033

Cited by 153 publications

(124 citation statements)

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“…Recent studies of CBA have also documented wide and antral ablation lesions. [10], [22]- [24] Nevertheless, the authors assessed only the border line between the ablated and non-ablated regions, and therefore, actual ablated regions within the PV have not been known. We identified the actual ablated regions where PV sleeve tissues were not captured by pacing within the low voltage areas.…”

Section: Cryoballoon-produced Pv Distentionmentioning

confidence: 99%

Mechanistic Insights Into Durable Pulmonary Vein Isolation Achieved by Second-Generation Cryoballoon Ablation

Okumura¹,

Watanabe²,

Iso³

et al. 2017

Journal of Atrial Fibrillation

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Key Wordsatrial fibrillation, cryoballoon ablation, pulmonary vein isolation, pulmonary vein distension. IntroductionCryothermal energy has emerged as an alternative ablation energy that does not issue in the clot formation and excessive tissue damage that occur with radiofrequency (RF) energy-based catheter ablation. [1] Although cryothermal energy is a milder and safer form of energy than RF energy, pulmonary vein isolation (PVI) performed with a second-generation cryoballoon has been highly successful in cases of paroxysmal atrial fibrillation (AF) and comparable to PVI performed by point by point-based RF ablation [2]-[6] or even contact force (CF)-based RF ablation.[7], [8] Despite the efficacy of cryoballoon ablation (CBA), however, some patients suffer recurrence of the AF, due mainly to PV reconnections or to non-PV triggers.[9], [10] Thus far, the mechanisms explaining durable and non-durable lesion formation around the PV ostium by means of second-generation CBA have not been fully investigated. Because establishing good balloon surface-totissue contact is essential for successful CBA of AF, we investigated, by means of 3-dimensional (3D) geometric imaging, how the inflated balloon surface contacts the 4 PVs. We then characterized lesions created around the PV ostia by CBA and those created by CF-based ablation to clarify the mechanism responsible for the efficacy of CBA. Material and Methods Study PatientsThe study involved 112 consecutive patients treated for AF (symptomatic paroxysmal AF [n=88] or persistent AF [n=24]) at Nihon University Itabashi Hospital between September 2014 and December 2015. The patient series comprised 72 men and 40 women with a mean±SD age of 63.8±7.7 years and median duration of AF of 18 months (interquartile range, 6-48 months). Patients were blindly (but not randomly) assigned to 1 of 2 ablation procedures: PVI performed by means of second-generation CBA (CBA group, n=56) and PVI performed by means of CF-based RF catheter ablation (CF group, n=56). Written informed consent was obtained from all patients. All antiarrhythmic drugs were withdrawn for at least 5 half-lives prior to the procedure. Transesophageal and transthoracic echocardiography were performed 1 day before the ablation procedure with an ACUSON Sequoia C256 echocardiography system (Siemens Medical Solutions USA, Inc., Malvern, PA). LA diameter (LAD) and maximum LA volume (by the prolate ellipsoid method) were determined, and the left ventricular ejection fraction (LVEF) was determined by means of M-mode echocardiography (Teichholz method). Multi-slice computed tomography was performed with a 320-detector row, dynamic volume scanner (Aquilion ONE; Toshiba Medical Systems, Tokyo, Japan) in all patients for 3D reconstruction of the left atrium (LA) and PVs before ablation. Electrophysiologic Study and AblationElectrophysiologic study was performed in all patients under conscious sedation achieved with dexmedetomidine and fentanyl.www.jafib.com Apr-May 2017| Volume 9| Issue 6Abstract Background: The mechanism ex...

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Section: Cryoballoon-produced Pv Distentionmentioning

confidence: 99%

Mechanistic Insights Into Durable Pulmonary Vein Isolation Achieved by Second-Generation Cryoballoon Ablation

Okumura¹,

Watanabe²,

Iso³

et al. 2017

Journal of Atrial Fibrillation

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“…[3][4][5] The use of contact force (CF)-sensing catheters, allowing to better control stability and lesion depth during point-by-point PV encircling, has improved freedom from AF now amounting to ≈80%. [6][7][8] Nevertheless, acute and late PVR still occur, and data on 1-year outcome are not consistent across studies. [6][7][8][9] We aimed to investigate whether acute and late PVR in CF-guided ablation are because of incomplete transmural or discontiguous radiofrequency lesions within the deployed PV circle and whether criteria can be set forward as targets to avoid weak links in the ablation chain.…”

mentioning

confidence: 99%

“…[6][7][8] Nevertheless, acute and late PVR still occur, and data on 1-year outcome are not consistent across studies. [6][7][8][9] We aimed to investigate whether acute and late PVR in CF-guided ablation are because of incomplete transmural or discontiguous radiofrequency lesions within the deployed PV circle and whether criteria can be set forward as targets to avoid weak links in the ablation chain. Criteria for lesion depth implied time of application, median delivered power, impedance drop, average CF, force-time integral (FTI), and ablation index (AI).…”

mentioning

confidence: 99%

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Haddad

Taghji

Phlips

et al. 2017

Circ: Arrhythmia and Electrophysiology

149

101

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From August 2013, all patients undergoing CF-guided ablation for AF were followed in a prospective database approved by the local © 2017 American Heart Association, Inc. , and higher ILD max (6.8 versus 5.5 mm). ALCI min was significantly lower in segments with PVR (74% versus 104%; P˂0.001) and was associated with the highest accuracy to predict durable segments (area under the curve=0.73). Conclusions-In CF-guided pulmonary vein isolation, PVR is explained by lack of both lesion depth and contiguity within the deployed radiofrequency circle. ALCI, a novel measure combining contiguity and depth, is the most accurate predictor for durable segments. By avoiding weak links in the ablation chain, ALCI-guided ablation is expected to improve success rate of point-by-point radiofrequency ablation. (Circ Arrhythm Electrophysiol. 2017;10:e004867.

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“…This technology improved the procedural parameters such as procedure duration, fluoroscopy time, time to PVI, and had better clinical outcomes than first-generation CB 13) . Both ablation technologies have a similar clinical success rate ranging from 73% to 88% 2,3,[13][14][15] , however, there are few reports on the incidence and characteristics of DC provoked by ATP or adenosine between the CFbased RFA and CBA. In the present study, the incidence of ATP-provoked DC was infrequent in both the CF-RFA group and CBA group, but the distribution of the DC was different.…”

Section: Impact Of Different Technique Of Cb Ablation Vsmentioning

confidence: 99%

Dormant Conduction after Second-Generation Cryoballoon-Mediated Pulmonary Vein Isolation for Atrial Fibrillation: Comparison with Contact Force-guided Irrigated-Tip Radiofrequency Ablation

Takahashi

Okumura

Watanabe

et al. 2017

Nichidai Igaku Zasshi

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Background: Both contact force (CF)-guided radiofrequency ablation (RFA) based pulmonary vein isolation (PVI) and second-generation cryoballoon ablation (CBA) based PVI may improve the procedural outcome. However, the clinical outcome after RFA-and CBA-based PVI remains unclear. Adenosine or adenosine triphosphate (ATP) administration after PVI is useful to detect dormant PV conduction (DC) after the ablation procedure, and the presence of DC has been shown to be related to AF recurrence.Methods: Out of 100 patients with paroxysmal AF (PAF), 50 underwent CF-guided PVI (25-30 W, 30 sec for each ablation: CF-RFA group), and the remaining 50 patients underwent cryoballoon ablation-based PVI (3 min cooling + 2 min bonus cooling for each PV: CBA group). Thirty minutes after PVI, a 30-mg bolus of ATP was administered. We compared the success rate of PVI, and incidence of DC after PVI between the CF-RFA and CBA groups.Results: The subsequent response was assessed for each vein using a ring catheter. In the CBA group, 180 (90%) of 200 PVs were isolated and 20 PVs (10%) (2 left superior PV (LSPV), 3 left inferior PV (LIPV), 4 right superior PV (RSPV), 11 right inferior PV (RIPV) from 14 of 50 patients (28%) required additional RFA because of residual potential at the PV or PV antra. After a waiting period of 30 min after the last energy application, acute PV reconduction was observed spontaneously in 13 PVs (6.5%) (6 LSPV, 3 LIPV, 4 RSPV) from 12 patients (24%) in the CF-RFA group. The DC sites provoked by ATP were 13 PVs (6.5%) (5 LSPV, 3 LIPV, 2 RSPV, 3 RIPV) from 8 patients (16%) in the CF-RFA group, compared with 9 PVs (4.5%) (2 LSPV, 4 LIPV, 1 RSPV, 2 RIPV) from 9 CBA patients (18%) (P = 1.000). AF recurred in 6/50 (12%) in both the CF-RFA and CBA groups at 1 year after the ablation (P = 1.000).Conclusions: There was no significant difference in the incidence of DC after PVI and the 12-month AF-free rate between the second-generation CBA-and CF-based RFA.

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Pulmonary vein isolation using “contact force” ablation: The effect on dormant conduction and long-term freedom from recurrent atrial fibrillation—A prospective study

Cited by 153 publications

References 30 publications

Mechanistic Insights Into Durable Pulmonary Vein Isolation Achieved by Second-Generation Cryoballoon Ablation

Mechanistic Insights Into Durable Pulmonary Vein Isolation Achieved by Second-Generation Cryoballoon Ablation

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Dormant Conduction after Second-Generation Cryoballoon-Mediated Pulmonary Vein Isolation for Atrial Fibrillation: Comparison with Contact Force-guided Irrigated-Tip Radiofrequency Ablation

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