Duty-cycled bipolar/unipolar radiofrequency ablation for symptomatic atrial fibrillation induces significant pulmonary vein narrowing at long-term follow-up

Compier, Marieke; Leong, Darryl P.; Marsan, Nina Ajmone; Delgado, Victoria; Zeppenfeld, Katja; Schalij, Martin J.; Trines, Serge A.

doi:10.1093/europace/eus420

Cited by 12 publications

(4 citation statements)

References 20 publications

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“…A potentially lethal complication, atrio-oesophageal fistula can develop with the nMARQ ® catheter [26] , [28] . In addition, the scientific evidence for pulmonary vein narrowing related with the PVAC ® ablation is controversial although it has been found to be higher with the PVAC ® ablation [43] . In the current meta-analysis, there was no significant difference between the multi-electrode and conventional ablation groups in regard to major procedure-related complications including cerebrovascular events although no data for asymptomatic cerebral micro-embolization were presented.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Aras

Topaloğlu

Çay

et al. 2017

Indian Pacing and Electrophysiology Journal

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AimsPulmonary vein isolation is effective in reducing atrial fibrillation (AF) episodes. Previous studies suggest single-shot techniques are effective and safe for this purpose. Procedural and clinical outcomes were compared between multi-electrode and point-by-point radiofrequency ablations by performing a meta-analysis of all randomized and non-randomized studies.Methods and resultsSystematic reviews of MEDLINE and Cochrane Library databases were performed. Studies comparing procedural (procedure and fluoroscopy times) and clinical (AF recurrence) outcomes were included in the meta-analysis. A total of 13 clinical studies (5 randomized and 8 non-randomized) including 2152 patients met the inclusion criteria. In patients underwent multi-electrode ablation, there were significant reductions in both total procedure and fluoroscopy times, compared with point-by-point ablation (mean difference = −34.3 min [95% CI (−50.1 to −18.5)], p < 0.001 and mean difference = −7.1 min [95% CI (−12.0 to −2.2)], p < 0.01, respectively). These significances also continued in patients with paroxysmal AF. No such difference was observed in regard to AF recurrence between the 2 ablation strategies (RR = 0.90 [95% CI (0.80–1.01)], p = 0.066). This insignificance was also observed in patients with paroxysmal AF.ConclusionsIn a heterogeneous AF population, multi-electrode ablation is as effective as point-by-point ablation, with better procedural and fluoroscopy durations.

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Section: Discussionmentioning

confidence: 99%

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Aras

Topaloğlu

Çay

et al. 2017

Indian Pacing and Electrophysiology Journal

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“…28 This study did not search systematically for PV stenosis and only imaged the PV's in patients undergoing repeat ablation or symptomatic PV stenosis causing exertional breathlessness or haemoptysis. Therefore, we may have underestimated its incidence.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

et al. 2014

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AimsThe current challenge in atrial fibrillation (AF) treatment is to develop effective, efficient, and safe ablation strategies. This randomized controlled trial assesses the medium-term efficacy of duty-cycled radiofrequency ablation via the circular pulmonary vein ablation catheter (PVAC) vs. conventional electro-anatomically guided wide-area circumferential ablation (WACA).Methods and resultsOne hundred and eighty-eight patients (mean age 62 ± 12 years, 116 M : 72 F) with paroxysmal AF were prospectively randomized to PVAC or WACA strategies and sequentially followed for 12 months. The primary endpoint was freedom from symptomatic or documented >30 s AF off medications for 7 days at 12 months post-procedure. One hundred and eighty-three patients completed 12 m follow-up. Ninety-four patients underwent PVAC PV isolation with 372 of 376 pulmonary veins (PVs) successfully isolated and all PVs isolated in 92 WACA patients. Three WACA and no PVAC patients developed tamponade. Fifty-six percent of WACA and 60% of PVAC patients were free of AF at 12 months post-procedure (P = ns) with a significant attrition rate from 77 to 78%, respectively, at 6 months. The mean procedure (140 ± 43 vs. 167 ± 42 min, P<0.0001), fluoroscopy (35 ± 16 vs. 42 ± 20 min, P<0.05) times were significantly shorter for PVAC than for WACA. Two patients developed strokes within 72 h of the procedure in the PVAC group, one possibly related directly to PVAC ablation in a high-risk patient and none in the WACA group (P = ns). Two of the 47 patients in the PVAC group who underwent repeat ablation had sub-clinical mild PV stenoses of 25–50% and 1 WACA patient developed delayed severe PV stenosis requiring venoplasty.ConclusionThe pulmonary vein ablation catheter is equivalent in efficacy to WACA with reduced procedural and fluoroscopy times. However, there is a risk of thrombo-embolic and pulmonary stenosis complications which needs to be addressed and prospectively monitored.ClinicalTrials.gov IdentifierNCT00678340.

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“…PVAC is a modified form of RFA using a multielectrode, circular, bidirectional catheter; it may offer lower procedural times compared to conventional RFA but is no longer widely used due to concerns over the considerable levels of pulmonary stenosis after treatment. 58 LBA was significantly favoured over AAD in the RMST-based analyses but not the HR-based analysis, which may be attributed to the presence of only 2 LBA studies and its short follow-up. The visually guided LBA used was similar to RFA in requiring point-by-point ablations, as the aiming beam produces an arc covering only ~30 o of a circle.…”

Section: A 2bmentioning

confidence: 79%

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

Fong

Zhao

Chan

et al. 2023

Ann Acad Med Singap

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Introduction: Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AAD. Method: Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores. Results: Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25–0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25–0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07–0.30) for combined CBA and RFA, 0.20 (95% CI=0.10–0.41) for hot-balloon ablation, 0.43 (95% CI=0.15–1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18–0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy. Conclusion: The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis. Keywords: Atrial fibrillation, catheter ablation, network meta-analysis

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Duty-cycled bipolar/unipolar radiofrequency ablation for symptomatic atrial fibrillation induces significant pulmonary vein narrowing at long-term follow-up

Abstract: Ablation with PVAC results in a significant decrease in PV dimensions after long-term follow-up. In line with previous literature, PV narrowing was mild and patients did not develop any clinical symptoms.

Cited by 12 publications

References 20 publications

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

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