The incidence and location of epicardial connections in the era of contact force guided ablation for pulmonary vein isolation

Sun, Xuerong; Niu, Guodong; Lin, Jinxuan; Suo, Ni; Guo, Tao; Jiang, Lu; Feng, Tianjie; Zheng, Lihui; Yao, Yan; Zhang, Shu

doi:10.1111/jce.15174

Cited by 11 publications

(28 citation statements)

References 22 publications

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“…Fifth , recently, the effects of epicardial connections involving PVs in catheter ablation of AF have been revealed during high‐density mapping after radiofrequency‐guided PVI 13 . Epicardial connections were most frequently found at the carina region but were also located at the roof of the right pulmonary veins 13 . Ablation of such epicardial connections could also challenge PFA‐guided ablation.…”

Section: Discussionmentioning

confidence: 99%

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Pulsed‐field ablation combined with ultrahigh‐density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations

Gunawardene

Schaeffer

Jularic

et al. 2022

Cardiovasc electrophysiol

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Background: Pulsed-field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited.Objective: This study sought to investigate PFA lesion creation with ultrahighdensity (UHDx) mapping.Methods: Consecutive AF patients underwent PFA-based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA-lesions and decrease of LA-voltage were assessed with pre-and post PFA UHDx-mapping (Orion™ catheter and Rhythmia™ 3D-mapping system, Boston Scientific).Results: In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx-mapping subsequent to PVI revealed early PV-reconnection in five case (5/80, 6.25%). Gaps were located at the anterior-superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p < .0001) with almost no complex electrogram-fractionation at the lesion border zones. PFA-catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites. Conclusion:For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.

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Section: Discussionmentioning

confidence: 99%

“…13 Epicardial connections were most frequently found at the carina region but were also located at the roof of the right pulmonary veins. 13 Ablation of such epicardial connections could also challenge PFA-guided ablation.…”

Section: Pulmonary Vein Reconnection and Practical Considerationsmentioning

confidence: 99%

Pulsed‐field ablation combined with ultrahigh‐density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations

Gunawardene

Schaeffer

Jularic

et al. 2022

Cardiovasc electrophysiol

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“…The RFCA procedures were performed under conscious sedation. The details of the procedure have been described previously ( 21 ). After access to the left atrium (LA) via the transseptal puncture needle (Synaptic Medical), two 8.5—French sheaths (NaviEase, Synaptic Medical) were advanced into LA.…”

Section: Methodsmentioning

confidence: 99%

Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance

Qiao

Zhao

Cai

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe long-term outcomes of ablation index (AI)-guided radiofrequency catheter ablation (RFCA) on atrial fibrillation (AF) and different subtypes of heart failure (HF) remain unknown. The aim of the study was to evaluate the long-term prognosis of AI-guided RFCA procedures in patients with AF and concomitant HF.MethodsWe retrospectively included consecutive patients with AF and HF who underwent the initial RFCA procedure with AI guidance from March 2018 to June 2021 in our institution. The patients were categorized into two groups: HF with preserved ejection fraction (HFpEF) group and HF with mid-range ejection fraction (HFmrEF) +HF with reduced ejection fraction (HFrEF) group.ResultsA total of 101 patients were included. HFpEF and HFmrEF + HFrEF groups consisted of 71 (70.3%) and 30 patients (29.7%), respectively. During a median follow-up of 32.0 (18.2, 37.6) months, no significant difference was detected in AF recurrence between groups (21.1 vs. 33.3%) after multiple procedures, whereas the incidence of the composite endpoint of all-cause death, thromboembolic events, and HF hospitalization was significantly lower in HFpEF group (9.9 vs. 25.0%, Log-rank p = 0.018). In multivariable analysis, a history of hypertension [hazard ratio (HR) 4.667, 95% confidence interval (CI) 1.433–15.203, p = 0.011], left ventricular ejection fraction (LVEF) < 50% (HR 5.390, 95% CI 1.911–15.203, p = 0.001) and recurrent AF after multiple procedures (HR 7.542, 95% CI 2.355–24.148, p = 0.001) were independently associated with the incidence of the composite endpoint.ConclusionLong-term success could be achieved in 75% of patients with AF and concomitant HF after AI-guided RFCA procedures, irrespective of different HF subtypes. Preserved LVEF was associated with a reduction in the composite endpoint compared with impaired LVEF. Patients with recurrent AF tend to have a poorer prognosis.

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“…The radiofrequency catheter ablation (RFCA) procedures were performed under conscious sedation. The detail of the procedure has been described previously 13 . After access to the left atrium (LA) via the transseptal puncture needle (Synaptic Medical), two 8.5 -French sheaths (NaviEase, Synaptic Medical) were advanced into LA.…”

Section: Cather Ablation Proceduresmentioning

confidence: 99%

The long-term outcomes of catheter ablation for atrial fibrillation in heart failure with preserved ejection fraction

Niu

Qiao

Zhao

et al. 2022

Preprint

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Background We aimed to compare the long-term outcomes of catheter ablation and medical treatment in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Methods We retrospectively screened consecutive patients with AF and HFpEF who received catheter ablation or medical treatment from December 2017 to June 2021 in our institution. The primary endpoint was defined as a composite of all-cause death, thromboembolic events and heart failure (HF) hospitalization. Multivariate analysis, 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to adjust for potential confounders. Results A total of 131 patients were included, among whom 71 patients (54.2%) underwent 1.15 + 0.36 catheter ablation procedures. During a median follow-up of 31.8 months, the incidence of the primary endpoint was significantly lower in catheter ablation group (9.9% vs 25.0%, log rank p = 0.018) compared with medical treatment group. In the multivariate model, catheter ablation was independently associated with a lower incidence of the primary endpoint (hazard ratio 0.281, 95% confidence interval 0.110 – 0.721, p = 0.008), which was consistent both in PSM and IPTW cohorts. The New York Heart Association class [2 (1, 2) vs 2 (2, 2), paired p < 0.001], N-terminal pro-B type natriuretic peptide level [334.3 (187.1, 821.8) vs 859.2 (308.4, 1903.0), paired p < 0.001] and left atrial diameter (39.4 + 6.4 vs 41.1 + 6.2, paired p = 0.001) were significantly improved at the end of follow-up in catheter ablation group. Conclusion Catheter ablation was significantly associated with a lower incidence of the composite endpoint, improved HF symptoms and reverse atrial remodeling in AF and concomitant HFpEF.

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The incidence and location of epicardial connections in the era of contact force guided ablation for pulmonary vein isolation

Cited by 11 publications

References 22 publications

Pulsed‐field ablation combined with ultrahigh‐density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations

Pulsed‐field ablation combined with ultrahigh‐density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations

Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance

The long-term outcomes of catheter ablation for atrial fibrillation in heart failure with preserved ejection fraction

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