First Experiences for Pulmonary Vein Isolation with the High‐Density Mesh Ablator (HDMA): A Novel Mesh Electrode Catheter for Both Mapping and Radiofrequency Delivery in a Single Unit

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

doi:10.1111/j.1540-8167.2008.01335.x

Cited by 41 publications

(8 citation statements)

References 29 publications

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“…The HDMA (Figure 2) and the ablation procedure had been described in detail by our group and Steinwender et al 5,10,11. Under fluoroscopy, a single TSP and introduction of a long sheath in the LA with selective venography of all PVs was performed.…”

Section: Methodsmentioning

confidence: 99%

“…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.

The High Density Mesh Ablator (HDMA, BARD Electrophysiology, Lowell, MA, USA) as already described by our group 5: complete elimination or disconnection of PV signals was performed with a catheter combining direct RF energy delivery and high-density circumferential mapping in a single unit.Arctic Front® (Medtronic Cryocath®, Chemin Stemarie Kirkland, QC, Canada), an anatomically based approach without mapping capacities using a cryoballoon ablation system that allows cooling the temperature for circumferential ablation 6,7,8. The endpoint was the PVI checked by a circular mapping catheter.…”

Section: Introductionmentioning

confidence: 99%

“…The High Density Mesh Ablator (HDMA, BARD Electrophysiology, Lowell, MA, USA) as already described by our group 5: complete elimination or disconnection of PV signals was performed with a catheter combining direct RF energy delivery and high-density circumferential mapping in a single unit.…”

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: Methodsmentioning

confidence: 99%

“…In our single center study, we aim to compare three approaches (in the following I-III) to perform PVI:

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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“…An einem kleinen Patientenkollektiv von 26 Patienten stellten wir die spezifischen technologischen Aspekte dieser neuen Kathetertechnologie vor, an einem deutlich größeren Patientenkollektiv werden hier die wesentlichen klinischen Aspekte dieses Verfahrens berücksichtigt [24].…”

Section: Parameter Anzahl (Prozent)unclassified

Paroxysmales und persistierendes Vorhofflimmern: Neue Therapiekonzepte der Pulmonalvenen-Isolation

Meißner¹,

Hj²,

Butz³

et al. 2009

Dtsch med Wochenschr

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“…1. An advanced balloon catheter design with multiple sensors on the outside surface was reported for enabling the catheter to obtain temperature, flow characteristics, tactile, optical, and electrophysiological data from the tissue-balloon interface [17][18][19][20][21][22][23][24][25][26][27][28]. While the CA is considered as one of the best methods for diagnosing and treating AF, there is a higher risk of procedural complications due to the complexity of technique and the location of ablation sites [5].…”

Section: Introductionmentioning

confidence: 99%

A review: flexible, stretchable multifunctional sensors and actuators for heart arrhythmia therapy

Kang¹,

Pak

2017

Micro and Nano Syst Lett

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Cardiovascular disease is a very serious disease which results in about 30% of all global mortality. Atrial fibrillation (AF) causes rapid and irregular contractions resulting in stroke and cardiac arrest. AF is caused by abnormality of the heartbeat controlling electrical signal. Catheter ablation (CA) is often used to treat and remove the abnormal electrical source from the heart but it has limitations in sensing capability and spatial coverage. To overcome the limitations of the CA, new devices for improving the spatial capability have been reported. One of the most impressive methods is wrapping the heart surface with a flexible/stretchable film with an array of high-density multifunctional micro-sensors and actuators. With this technique, the overall heart surface may be diagnosed in real time and the AF may be treated much more effectively. The data acquisition from the array of multifunctional sensors is also very important for making the new devices useful. To operate the implanted device system, a battery is mostly used and it should be avoided to replace the battery by surgery. Therefore, various energy harvesting techniques or wireless energy transfer techniques to continuously feed the power to the system are under investigation. The development of these technologies was reviewed, and the current level of technology was reviewed and summarized.

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First Experiences for Pulmonary Vein Isolation with the High‐Density Mesh Ablator (HDMA): A Novel Mesh Electrode Catheter for Both Mapping and Radiofrequency Delivery in a Single Unit

Abstract: In this first study of PV isolation using the HDMA, our findings suggest that this method is safe and yields good primary success rates. The HDMA simplifies AF ablation, favorably impacting procedure and fluoroscopy times.

Cited by 41 publications

References 29 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

Paroxysmales und persistierendes Vorhofflimmern: Neue Therapiekonzepte der Pulmonalvenen-Isolation

A review: flexible, stretchable multifunctional sensors and actuators for heart arrhythmia therapy

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