Relationship Between Catheter Stability and 12-Month Success After Pulmonary Vein Isolation

Reddy, Vivek Y.; Pollak, Scott J.; Lindsay, Bruce D.; McElderry, H. Thomas; Natale, Andrea; Kantipudi, Charan; Mansour, Moussa; Melby, Daniel P.; Lakkireddy, Dhanunjaya; Levy, Tzachi; Izraeli, D.; Sangli, Chithra; Wilber, David J.

doi:10.1016/j.jacep.2016.07.014

Cited by 44 publications

(43 citation statements)

References 19 publications

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“…Therefore, we believe contiguous atrial scar formation, which reflected in absence of gaps by Criterion 2 emphasizing longer ablation time, might lead to better clinical outcomes. Our results are in line with aforementioned study by Reddy et al [13].…”

Section: Discussionsupporting

confidence: 94%

“…It also demonstrates that the stability of catheter is important as gaps by Criterion 2 are associated with a lower arrhythmia-free survival rate. Recently published data from Reddy et al stressed that catheter stability is more important than force itself and that it is associated with better long-term outcomes [13]. In their study, which is in line with ours, difficulties in maintaining stability in both carina and left PVs were noted.…”

Section: Discussionsupporting

confidence: 88%

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Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Cho

Kim

et al. 2020

Int J Arrhythm

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Background An automated tagging module (VISITAG™; Biosense Webster, Irvine, CA) allows objective demonstration of energy delivery. However, the effect of VISITAG™ on clinical outcomes remains unclear. This study evaluated (1) clinical outcome after AF ablation using VISITAG™ and (2) the prevalence of gaps in the ablation line. Methods This retrospective analysis included 157 consecutive patients (mean age, 56.7 years; 73.2% men) with paroxysmal atrial fibrillation who underwent successful PVI between 2013 and 2016. Outcomes after the index procedure were compared between those using the VISITAG™ module (VISITAG group, n = 62) and those not using it (control group, n = 95). The primary outcome was recurrence of AF or atrial tachycardia after a blanking period of 3 months. Results The VISITAG group showed significantly shorter overall procedure time (172.2 ± 37.6 min vs. 286.9 ± 66.7 min, P < 0.001), ablation time (49.8 ± 9.7 min vs. 82.8 ± 28.2 min, P < 0.001), and fluoroscopy time (11.8 ± 5.3 min vs. 34.2 ± 30.1 min, P < 0.001) compared with controls. The 1-year recurrence-free survival rate was not statistically different between the groups (70.8% in the VISITAG group vs. 79.2% in the control group, P = 0.189). Gaps in the VISITAG line were common in the both carina and left side pulmonary veins. Patients without gaps (≥ 5 mm) by the criteria emphasizing catheter stability (> 15 s, < 4 mm range, > 60% force over time, > 6 g contact force) showed higher recurrence-free survival rate compared with those with gaps (borderline statistical significance, 91.7% vs. 66.0%, P = 0.094). Conclusion Use of the VISITAG™ module significantly reduced procedure, ablation, and fluoroscopic times with a similar AF/AT recurrence rate compared with the conventional ablation. Clinical implications of minimizing gaps along the ablation line should be evaluated further in the future prospective studies.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 88%

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Cho

Kim

et al. 2020

Int J Arrhythm

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“…In spite of the use of force‐sensing catheters, ablation outcomes remained suboptimal 17,18 . This may be accountable by the lack of contiguity of ablation lesions within the RF encirclement even in the context of adequate CF 19,20 . Indeed, the marriage of regimental AI applications (AI ≥ 550 at anterior wall, AI ≥ 400 at posterior wall) and strict ITD criteria (≤6 mm), that is, the CLOSE protocol, has yielded excellent first‐pass PVI rates and high single‐procedure freedom from atrial arrhythmia at 1 year 8 …”

Section: Discussionmentioning

confidence: 99%

The feasibility and effectiveness of a streamlined single‐catheter approach for radiofrequency atrial fibrillation ablation

Chin

O'Brien

Epicoco

et al. 2020

Journal of Arrhythmia

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Background Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC‐free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol. Methods A CLOSE‐guided and CMC‐free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre‐ and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block. Results The CMC‐free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148 ± 32 minutes, ablation time of 27.5 ± 5.7 minutes, and fluoroscopy time of 7.8 ± 1.0 minutes. First‐pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12 months follow‐up, 60 (89.6%) patients remained free from AF. The CMC‐free approach resulted in a cost saving of £47,190. Conclusion A CMC‐free CLOSE‐guided PVI approach is feasible, safe, and cost‐saving, and is associated with excellent clinical outcomes at 1 year.

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“…The fact that CF stability with sufficient CF (both measures of VisiTag and AI) was found to be the most predictive of optimal 12-month success is in line with this hypothesis. 25 Whether ALCI-guided PVI will be associated with higher reproducibility in outcome and safety is currently being evaluated in a multicenter study. .…”

Section: Discussionmentioning

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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Relationship Between Catheter Stability and 12-Month Success After Pulmonary Vein Isolation

Abstract: In the SMART-AF trial, CF stability with sufficient CF was most predictive of optimal 12-month success. (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation [SMART-AF]; NCT01385202).

Cited by 44 publications

References 19 publications

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

The feasibility and effectiveness of a streamlined single‐catheter approach for radiofrequency atrial fibrillation ablation

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

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