المؤلفون: Jonathan C. Hsu, MD, MAS, FHRS, Rajesh S. Banker, MD, Douglas N. Gibson, MD, Tara Gomez, PhD, Dror Berman, BSc, Keshava Datta, PhD, Qi Chen, PhD, Shephal K. Doshi, MD

المصدر: Heart Rhythm O2, Vol 4, Iss 10, Pp 662-667 (2023)

مصطلحات موضوعية: Catheter ablation, Pulmonary vein isolation, Pulsed field ablation, Irreversible electroporation, Preclinical model, Diseases of the circulatory (Cardiovascular) system, RC666-701

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666501823002246; https://doaj.org/toc/2666-5018

URL الوصول: https://doaj.org/article/916ca4322477487a832ea8a8fd80ea5b

المؤلفون: Leon M. Ptaszek, MD, PhD, FHRS, Jacob Koruth, MD, Pasquale Santangeli, MD, Jonathan P. Piccini, MD, MHS, FHRS, Ravi Ranjan, MD, PhD, FHRS, Srijoy Mahapatra, MD, FHRS, Catherine Pipenhagen, BS, Jeffrey M. Fish, DVM, L. Boyce Moon, BS, Nicholas M. Ambrosius, BS, Hana Boudlali, MS, James A. Jensen, PhD

المصدر: Heart Rhythm O2, Vol 4, Iss 1, Pp 42-50 (2023)

مصطلحات موضوعية: Atrial fibrillation, High-power, short-duration ablation, Pulmonary vein isolation, Pulmonary vein stenosis, Radiofrequency ablation, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: High-power, short-duration (HPSD) radiofrequency ablation (RFA) may reduce ablation time. Concerns that catheter-mounted thermocouples (TCs) can underestimate tissue temperature, resulting in elevated risk of steam pop formation, potentially limit widespread adoption of HPSD ablation. Objective: The purpose of this study was to compare the safety and efficacy of HPSD and low-power, long-duration (LPLD) RFA in the context of pulmonary vein isolation (PVI). Methods: An open-irrigated ablation catheter with a contact force sensor and a flexible-tip electrode containing a TC at its distal end (TactiFlexTM Ablation Catheter, Sensor EnabledTM, Abbott) was used to isolate the left pulmonary veins (PVs) in 12 canines with HPSD RFA (50 W for 10 seconds) and LPLD RFA (30 W for a maximum of 60 seconds). PVI was assessed at 30 minutes and 28 ± 3 days postablation. Computed tomographic scans were performed to assess PV stenosis after RFA. Lesions were evaluated with histopathology. Results: A total of 545 ablations were delivered: 252 with LPLD (0 steam pops) and 293 with HPSD RFA (2 steam pops) (P = .501). Ablation time required to achieve PVI was >3-fold shorter for HPSD than for LPLD RFA (P = .001). All 24 PVs were isolated 30 minutes after ablation, with 12/12 LPLD-ablated and 11/12 HPSD-ablated PVs still isolated at follow-up. Histopathology revealed transmural ablations for HPSD and LPLD RFA. No major adverse events occurred. Conclusion: An investigational ablation catheter effectively delivered RFA lesions. Ablation time required to achieve PVI with HPSD with this catheter was >3-fold shorter than with LPLD RFA.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666501822002811; https://doaj.org/toc/2666-5018

URL الوصول: https://doaj.org/article/9ce80865fb514d1ead158fe8fc40ab44

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

المؤلفون: Takahiko Nagase, MD, Ruiko Seki, MD, So Asano, MD, Hiroshi Fukunaga, MD, Kazuhiro Terashima, MD, Kei Mabuchi, MD, Kanki Inoue, MD, Kohei Tanizaki, MD, Nobuo Iguchi, MD, Junichi Nitta, MD, Mitsuaki Isobe, MD

المصدر: Heart Rhythm O2, Vol 2, Iss 4, Pp 347-354 (2021)

مصطلحات موضوعية: Atrial fibrillation, Optimal energy, Optimal overlap ratio, Point-by-point laser balloon ablation, Pulmonary vein isolation, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: Optimal overlap ratio remains unclear in point-by-point laser balloon (LB) ablation. Objective: This study sought to determine the optimal overlap strategy with target energies on the acute and chronic outcomes in LB pulmonary vein (PV) isolation (PVI). Methods: Consecutive 38 patients (148 PVs) with atrial fibrillation underwent the first-generation LB PVI with the following protocols based on the overlap ratios for each PV anterior/posterior wall: 50%/50% (13 patients [49 PVs], group A), 50%/25% (15 patients [60 PVs], group B), and 25%/25% (10 patients [39 PVs], group C). High energies (240–255 J: 12 W / 20 seconds, 8.5 W / 30 seconds), moderate energies (200–210 J: 10 W / 20 seconds, 7 W / 30 seconds), and low-to-moderate energies (low, 165–170 J: 5.5 W / 30 seconds, 8.5 W / 20 seconds) were targeted for left PV anterior walls, right PV anterior walls, and bilateral PV posterior walls, respectively. First-pass PVI, the other procedure-related data, and atrial tachyarrhythmia recurrences were analyzed. Results: First-pass PVI rate per PV was higher in group A (94%) than in group B (88%) and group C (62%) (P < .001). All PVs were finally isolated. First-pass time, total LB PVI time, complications, and atrial tachyarrhythmia recurrences during a mean follow-up of 11 ± 5 months did not differ between the groups. A few residual gaps after first-pass LB ablations were found for PV anterior walls even in group A and group B. Conclusion: Sufficiently overlapped LB ablation promises a high rate of first-pass PVI without adverse outcomes. High energy could be required for PV anterior walls.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666501821001161; https://doaj.org/toc/2666-5018

URL الوصول: https://doaj.org/article/2d8023cb50824552b2b81f7c45f51938

المؤلفون: Fehmi Keçe, MD, PhD, Marta de Riva, MD, Reza Alizadeh Dehnavi, MD, PhD, Adrianus P. Wijnmaalen, MD, PhD, Bart J. Mertens, PhD, Martin J. Schalij, MD, PhD, Katja Zeppenfeld, MD, PhD, Serge A. Trines, MD, PhD

المصدر: Heart Rhythm O2, Vol 2, Iss 3, Pp 290-297 (2021)

مصطلحات موضوعية: Atrial fibrillation, Cryoballoon ablation, Dormant conduction, Pulmonary vein isolation, Time-to-isolation, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. Objective: To identify procedural and biophysical parameters predicting ERC. Methods: Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. Results: A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09–1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15–2.49], P = .008) and a longer TTI (HR 1.02 [1.01–1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. Conclusion: Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666501821000489; https://doaj.org/toc/2666-5018

URL الوصول: https://doaj.org/article/75c35fd5405b4ac8b02daa740a5b2a17

المؤلفون: Jason G. Andrade, MD, FHRS

المصدر: Heart Rhythm O2, Vol 1, Iss 1, Pp 44-58 (2020)

مصطلحات موضوعية: Ablation, Atrial fibrillation, Cryoablation, Pulmonary vein isolation, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Cryoballoon ablation for the treatment of atrial fibrillation has established itself as an effective and efficient modality for achieving pulmonary vein isolation. Over the past 13 years more than 100,000 Cryoballoon ablation procedures have been performed with the first to fourth generation cryoballoons. Over that time there have been significant advances in our understanding regarding the optimal procedural techniques. The purpose of this ''topic in review'' is to focus on the practical aspects of performing a Cryoballoon ablation procedure, within the context of the contemporary literature. Specifically there is a focus on how contemporary studies can inform clinical decision making and ensure operators are able to perform a safe and effective procedure.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666501820300064; https://doaj.org/toc/2666-5018

URL الوصول: https://doaj.org/article/393962a6a8634ed39c54143aa2c4e156

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.