Less Pulmonary Vein Reconnection at Redo Procedures Following Radiofrequency Point-by-Point Antral Pulmonary Vein Isolation With the Use of Contemporary Catheter Ablation Technologies

Sándorfi, Gábor; Rodríguez‐Mañero, Moisés; Saenen, Johan; Baluja, Aurora; Bories, Wim; Huybrechts, Wim; Miljoen, Hielko; Vandaele, Lien; Heidbüchel, Hein; Sarkozy, Andrea

doi:10.1016/j.jacep.2018.09.020

Cited by 37 publications

(40 citation statements)

References 23 publications

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“…Our result showed high durability of PVI at repeat ablation with only 34% of the PVs reconnected in patients who underwent a repeat ablation procedure. This reconnection rate was lower than previous studies, in which reconnection was found in 79%–82% of the PVs during a repeat ablation procedure, 12,13 and is consistent with the findings from recent studies that reconnection rates have improved with contemporary CF sensing technologies such as with VS 14,15 . Despite the reduced PV reconnection observed in this study, arrhythmia‐free rate in patients with long‐standing persistent AF and %LVZ ≥ 3.24% remained low.…”

Section: Discussionsupporting

confidence: 88%

Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation

Yamaguchi

Takahashi

Yamamoto

et al. 2020

Cardiovasc electrophysiol

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Background: Recent studies have shown the improvement in long-term effectiveness with standardized pulmonary vein isolation (PVI) aimed at creating durable and contiguous lesions with VISITAG SURPOINT (VS) in paroxysmal atrial fibrillation (PAF). Objective: We aimed to assess efficacy of PVI alone strategy using VS in non-PAF patients and evaluate factors associated with corresponding clinical outcomes. Methods: Consecutive patients who underwent PVI for persistent/long-standing persistent AF between May 2017 to July 2019 were studied retrospectively. PVI was performed with 30-50 W guided by VS (posterior target: 400-500, anterior target: 500). Left atrial voltage maps were created during atrial pacing after PVI. Results: A total of 140 patients (119 males, age 62 ± 10 years, long-standing persistent AF: 35) were included and followed for median of 454 days. No adverse events were reported in any patients during periprocedural and followup period of up to 28 months.

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Section: Discussionsupporting

confidence: 88%

Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation

Yamaguchi

Takahashi

Yamamoto

et al. 2020

Cardiovasc electrophysiol

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“…In general, the aim is to achieve durable PVI . With contemporary technologies (contact force RF ablation and latest generation cryoballoons), this seems to be an attainable target [1,2,5,8,24] (Table 1). Identifying the weak links in this endeavor should help focus on these areas and thus further enhance the success rates of the index procedures and curtail the need for redo procedures [3,5].…”

Section: Durable Pvimentioning

confidence: 99%

“…Furthermore, these technologies have reduced PVR as a finding during second procedures. In the past, during repeat procedures, the reported PVR rate was very high reaching rates of 65–95% [7,8]. These PVR rates have now dropped to ∼22–38% [5,6,[8], [9], [10]], although exceptions have been reported where PVR rate remains high (62.5%) despite use of newer technology (contact-force RF ablation) [11].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary vein reconnection following cryo-ablation: Mind the “Gap” in the carinae and the left atrial appendage ridge

Manolis¹,

Manolis

2019

Indian Pacing and Electrophysiology Journal

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Pulmonary vein (PV) isolation (PVI) remains cornerstone to ablation of atrial fibrillation (AF). For effective and durable PVI and thus fewer AF recurrences, lesion gaps in transmurality and contiguity responsible for PV reconnection (PVR) could only be addressed when one is cognizant of the potential location and sites where these lesion characteristics may be more prevalent and responsible for PVR. In the case of RF ablation, newer technologies incorporating contact force, time and power with automated monitoring of lesion formation, paying attention to difficult areas (carinae, left superior PV-LAA ridge, right inferior PV) and measuring inter-lesion distance may provide the tools to reduce PVR. On the other hand, the improved thermodynamic characteristics of the latest generation of cryoballloons and operator dexterity to achieve better PV occlusion, may be crucial determinants towards the direction of reduced PVR. Whether newer visualization tools, more vigilant testing during the index ablation procedure in these particular regions, prolonging or adding cryothermic applications, waiting longer to test for entrance and exit block, and/or use of provocative drug testing (isoproterenol/adenosine challenge) might help prevent future PVRs awaits further studies.

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“…Recently, the use of a weighted formula (Ablation Index, AI), that incorporates power, contact force (CF), and time, has yielded superior rates of durable pulmonary vein isolation (PVI) and freedom from arrhythmia 4,5 . In addition, use of automated lesion tagging, and adherence to stringent intertag distance (ITD) targets as part of the contiguous lesion optimized (CLOSE) protocol has played an integral role in minimizing gaps along ablation lines 6‐8 …”

Section: Introductionmentioning

confidence: 99%

The feasibility and effectiveness of a streamlined single‐catheter approach for radiofrequency atrial fibrillation ablation

Chin

O'Brien

Epicoco

et al. 2020

Journal of Arrhythmia

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Background Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC‐free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol. Methods A CLOSE‐guided and CMC‐free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre‐ and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block. Results The CMC‐free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148 ± 32 minutes, ablation time of 27.5 ± 5.7 minutes, and fluoroscopy time of 7.8 ± 1.0 minutes. First‐pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12 months follow‐up, 60 (89.6%) patients remained free from AF. The CMC‐free approach resulted in a cost saving of £47,190. Conclusion A CMC‐free CLOSE‐guided PVI approach is feasible, safe, and cost‐saving, and is associated with excellent clinical outcomes at 1 year.

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Less Pulmonary Vein Reconnection at Redo Procedures Following Radiofrequency Point-by-Point Antral Pulmonary Vein Isolation With the Use of Contemporary Catheter Ablation Technologies

Cited by 37 publications

References 23 publications

Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation

Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation

Pulmonary vein reconnection following cryo-ablation: Mind the “Gap” in the carinae and the left atrial appendage ridge

The feasibility and effectiveness of a streamlined single‐catheter approach for radiofrequency atrial fibrillation ablation

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