Impact of irrigated energy application on the right coronary artery hemodynamics: FFR measurement in patients who underwent ablation of common type atrial flutter

Meißner, Axel; Borchard, Rolf; Maagh, Petra; Christ, Martin; Bracht, M. van; Wickenbrock, Ingo; Trappe, Hans‐Joachim; Plehn, Gunnar

doi:10.1007/s10840-007-9188-8

Cited by 7 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17 Whether there really was subclinical spasm in these cases is unknown, although it was certainly plausible given the data regarding RFA at the CTI or mitral isthmus. 39,40 The other important related question is whether nitroglycerin should be administered before PFA near a coronary artery, or whether parenteral nitroglycerin should simply be ready for use if ECG changes are observed. Although either approach is probably reasonable, we do believe that administration before treatment will prove more effective than after-the-fact administration.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation

et al. 2022

View full text Add to dashboard Cite

BACKGROUND: Pulsed field ablation (PFA) has a unique safety profile when used to treat atrial fibrillation, largely related to its preferentiality for myocardial tissue ablation, in particular, esophageal sparing. A pentaspline catheter was the first such PFA system studied clinically for atrial fibrillation ablation; in these initial regulatory trials, the catheter was used for pulmonary vein isolation and left atrial posterior wall ablation. Since its regulatory approval in Europe, in clinical practice, physicians have ablated pulmonary vein isolation and left atrial posterior wall ablation to expanded lesion sets in closer proximity to coronary arteries. This is an unstudied important issue because preclinical and clinical data have raised the potential for coronary arterial spasm. Herein, we studied the vasospastic potential of PFA lesion sets, both remote from and adjacent to coronary arteries. METHODS: During routine atrial fibrillation ablation using the pentaspline PFA catheter, coronary angiography was performed before, during, and after pulsed field applications. The lesion sets studied included: (1) those remote from the coronary arteries such as pulmonary vein isolation (n=25 patients) and left atrial posterior wall ablation (n=5), and (2) ablation of the cavotricuspid isthmus (n=20) that is situated adjacent to the right coronary artery. RESULTS: During pulmonary vein isolation and left atrial posterior wall ablation, coronary spasm did not occur, but cavotricuspid isthmus ablation provoked severe subtotal vasospasm in 5 of 5 (100%) consecutive patients, and this was relieved by intracoronary nitroglycerin in 5.5±3.5 minutes. ST-segment elevation was not observed. However, no patient (0%, P =0.004) had severe spasm if first administered parenteral nitroglycerin, either intracoronary (n=5) or intravenous (n=10), before treatment. CONCLUSIONS: Coronary vasospasm was not provoked during PFA at locations remote from coronary arteries, but when the energy is delivered adjacent to a coronary artery, PFA routinely provokes subclinical vasospasm. This phenomenon is attenuated by nitroglycerin, administered either post hoc to treat spasm or as prophylaxis.

show abstract

Section: Discussionmentioning

confidence: 99%

“…17 Whether there really was subclinical spasm in these cases is unknown, although it was certainly plausible given the data regarding RFA at the CTI or mitral isthmus. 39,40…”

Section: Discussionmentioning

confidence: 99%

Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In complex AF procedures, ablation of substrate is not limited to the LA [25]. It has been shown that RF ablation of cavo-tricuspid isthmus could be accompanied by temporary but significant reduction of fractional flow reserve (FFR) in 21.2% of patients, or rarely by acute occlusion of distal segment of right coronary artery with inferior myocardial infarction [188,189]. A coronary artery injury induced with RF ablation usually is treated by emergency percutaneous coronary procedure with artery recanalization and stenting [3,187].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

View full text Add to dashboard Cite

Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

show abstract

“…Interestingly, in a small study of patients undergoing isthmus ablation using irrigated tip catheters (≤50 • C/≤50 W), Meissner et al did not show significant angiographic changes but did demonstrate significant depression of functional flow reserve of the RCA during ablation in ∼20% of patients. 11 The flow reserve returned to normal in all cases. One possible explanation for the differential rates of RCA involvement between these studies is that the younger pigs have much smaller hearts with thinner walled atria and thus are possibly more comparable to children rather than adults.…”

Section: Discussionmentioning

confidence: 81%

“…Using 4‐mm nonirrigated tip ablation catheters with clinically applicable RF delivery settings (75°C for 30 seconds), Paul et al demonstrated that at 6 months postisthmus ablation 80% of the animals had lymphocytic infiltration extending into the RCA, and that in 40% of these there was associated narrowing of the RCA. Interestingly, in a small study of patients undergoing isthmus ablation using irrigated tip catheters (≤50°C/≤50 W), Meissner et al did not show significant angiographic changes but did demonstrate significant depression of functional flow reserve of the RCA during ablation in ∼20% of patients 11 . The flow reserve returned to normal in all cases.…”

Section: Discussionmentioning

confidence: 95%

Right Coronary Artery Damage during Cavotricuspid Isthmus Ablation

Caldwell

Fath-Odoubadi

Garratt

2010

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Radiofrequency ablation of the cavotricuspid isthmus is the first-line treatment for typical atrial flutter. Despite the close proximity of the right coronary artery (RCA) to the cavotricuspid isthmus, only four cases of arterial injury have been reported during radiofrequency ablation, all detected postablation by inferior ST elevation. Here, we report atrioventricular (AV) conduction delay during coronary sinus pacing as a possible early sign of RCA involvement and review the previous literature on RCA damage and variations of AV nodal circulation.

show abstract

Impact of irrigated energy application on the right coronary artery hemodynamics: FFR measurement in patients who underwent ablation of common type atrial flutter

Abstract: Ablation of AFlu did not alter RCA morphology; simultaneous FFR measurement showed severe depression of the FFR in a few patients, consistent with impairment in myocardial perfusion.

Cited by 7 publications

References 28 publications

Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation

Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation

Catheter Ablation of Lone Atrial Fibrillation

Right Coronary Artery Damage during Cavotricuspid Isthmus Ablation

Contact Info

Product

Resources

About