Segmental pulmonary vein isolation in atrial fibrillation: new insights from the high density mesh mapper technique in an electrophysiologically guided approach

Meißner, Axel; Bracht, M. van; Schrage, Max-Olav; Christ, Martin; Trappe, Hans‐Joachim; Maagh, Petra; Perings, Ch.; Butz, Thomas; Plehn, Gunnar

doi:10.1007/s10840-009-9365-z

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…Our group described, that the majority of the PVs could be examined despite the relatively stiff mapping tool 4. The mesh offers beside excellent electrophysiological control a very good 3d orientation because of the basket configuration, which allows an easy anatomical understanding, even at the complex LA-PV junction.…”

Section: Discussionmentioning

confidence: 99%

“…The HDMM electrode (Figure 1) and the ablation procedure had been described by our group 4 and Neumann et al 9. Under fluoroscopy, the transseptal puncture (TSP) was done twice, first for the HDMM, the high-density mapping catheter, and second for the RF ablation catheter.…”

Section: Methodsmentioning

confidence: 99%

“…Studies reporting in comparative manner learning curves, PD, FT and associated complications using different ablation techniques are lacking. In our single center study, we aim to compare three approaches (in the following I-III) to perform PVI:The High density Mesh Mapper (HDMM, BARD Electrophysiology, Lowell, MA, USA) as already described by our group 4: segmental ostial ablation was performed by irrigated radiofrequency (RF) application around the HDMM requiring transseptal puncture (TSP) twice, one for the HDMM itself as the mapping catheter, the second one for the ablation. Entry- and exit conduction block, as well as decreased local electrode amplitude, were endpoints for short-term successful ablation.…”

Section: Introductionmentioning

confidence: 99%

“…The High density Mesh Mapper (HDMM, BARD Electrophysiology, Lowell, MA, USA) as already described by our group 4: segmental ostial ablation was performed by irrigated radiofrequency (RF) application around the HDMM requiring transseptal puncture (TSP) twice, one for the HDMM itself as the mapping catheter, the second one for the ablation. Entry- and exit conduction block, as well as decreased local electrode amplitude, were endpoints for short-term successful ablation.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Vein Isolation in 2012: Is It Necessary to Perform a Time Consuming Electrophysical Mapping or Should We Focus on Rapid and Safe Therapies? A Retrospective Analysis of Different Ablation Tools

Maagh¹,

Butz²,

Plehn³

et al. 2013

Int. J. Med. Sci.

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Background: Pulmonary Vein Isolation (PVI) is evolving as an established treatment option in atrial fibrillation (AF). Different fluoroscopy-guided ablation devices exist either on the basis of expandable circumferential and mesh designs with mapping and ablation of pulmonary vein potentials, or of a balloon technology, a “single shot” device with a purely anatomical approach. Systematic comparisons between procedure duration (PD), fluoroscopy time (FT) and clinical outcome in using different ablation tools are lacking in the literature.Methods: In a single center retrospective analysis, 119 PVI procedures were performed between August 2008 and March 2011 in paroxysmal AF (PAF, 59.7%) and persistent AF (persAF, 40.3%) patients with mean age of 59.4±10.3 years and history of AF since 8.1±9.7 months. The PVI procedures were evaluated by comparing PD and FT using I) the High Density Mesh Mapper (HDMM), II) the High Density Mesh Ablator (HDMA), and III) the Arctic Front® Cryoballoon. The primary endpoints were FT and PD, the secondary endpoint was procedural safety and efficacy in short- and longterm follow-up.Results: The procedures performed for 119 patients (63.0 % male) included 42 PVIs with the HDMM (35.3 %), 47 with the HDMA (39.5 %) and 30 with the cryoballoon (25.2 %). Comparing the 30 first procedures in groups of 10 in the HDMM and HDMA group, PD and FT fell in the HDMM group (PD from 257.5 to 220.9 min and FT from 80.5 to 67.3 min, both p < 0.05) as well as in the HDMA group (PD from 182.9 to 147.2 min and FT from 41.02 to 29.1 min, both p < 0.05). In the cryoballoon group, there was a steep learning curve with a steady state after the first 10 procedures (PD and FT decreased significantly from 189.5 to 138.1 min and 36.9 to 27.3 min, p values 0.005 and 0.05 respectively). With respect to recurrence of AF in a 24 months follow up, the HDMM and cryoballoon group showed comparable results with ~72% of patients free of arrhythmias. None of the patients died due to severe complications, or suffered a hemodynamic relevant pericardial effusion and/or stroke. Impairment of the phrenic nerve was observed in three patients.Conclusion: Use of the cryoballoon technology was associated with a steep learning curve and a reduced PD and FT; the long-term outcome was similar compared with the HDMM group. The efficacy and safety of the devices but also PD and FT should be respected as the strongest indicators of the quality of ablation. Further studies with long time follow-ups will show if the time for correct mapping of the PV potentials is a price we should be willing to pay or if we should adopt a “wait-and-see” attitude referring the AF recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary Vein Isolation in 2012: Is It Necessary to Perform a Time Consuming Electrophysical Mapping or Should We Focus on Rapid and Safe Therapies? A Retrospective Analysis of Different Ablation Tools

Maagh¹,

Butz²,

Plehn³

et al. 2013

Int. J. Med. Sci.

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“…Some previous studies reported that the rate of exit conduction after the entrance block of the PV‐LA junction in patients undergoing segmental PV isolation can be as high as 42% 9–11 . However, some pitfalls should be noted in those studies.…”

Section: Introductionmentioning

confidence: 99%

Blocking the Pulmonary Vein to Left Atrium Conduction in Addition to the Entrance Block Enhances Clinical Efficacy in Atrial Fibrillation Ablation

Chen

Meng

et al. 2012

Pacing Clinical Electrophis

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New-onset versus chronic atrial fibrillation in acute myocardial infarction: differences in short- and long-term follow-up

et al. 2010

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Our results indicate that patients with chronic AF had a higher incidence of in-hospital death than those with new-onset AF or without. Chronic AF includes a group of older and sicker patients than their counterparts with new-onset AF. Understanding these findings may ultimately lead to better care of patients with this arrhythmia to prevent the development of the underlying atrial substrate in chronic AF patients and to improve their otherwise worse prognosis.

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Segmental pulmonary vein isolation in atrial fibrillation: new insights from the high density mesh mapper technique in an electrophysiologically guided approach

Cited by 10 publications

References 19 publications

Pulmonary Vein Isolation in 2012: Is It Necessary to Perform a Time Consuming Electrophysical Mapping or Should We Focus on Rapid and Safe Therapies? A Retrospective Analysis of Different Ablation Tools

Pulmonary Vein Isolation in 2012: Is It Necessary to Perform a Time Consuming Electrophysical Mapping or Should We Focus on Rapid and Safe Therapies? A Retrospective Analysis of Different Ablation Tools

Blocking the Pulmonary Vein to Left Atrium Conduction in Addition to the Entrance Block Enhances Clinical Efficacy in Atrial Fibrillation Ablation

New-onset versus chronic atrial fibrillation in acute myocardial infarction: differences in short- and long-term follow-up

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