Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

Samuel, Michelle; Abrahamowicz, Michal; Joza, Jacqueline; Pilote, Louise; Essebag, Vidal

doi:10.1111/jce.14202

Cited by 4 publications

(1 citation statement)

References 42 publications

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“…While these modalities are relatively non-invasive and are considered safe and effective, they have significant limitations. These include high AF recurrence rates ( Balk et al, 2010 ; Sultan et al, 2017 ), prolonged procedure times, and rare but serious complications related to the damage of off-target neighboring structures, such as pulmonary vein (PV) stenosis, phrenic nerve paralysis, and fatal esophageal fistula ( Bertaglia et al, 2007 ; Spragg et al, 2008 ; Kearney et al, 2014 ; Calkins et al, 2017 ; Steinbeck et al, 2018 ; Samuel et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Human in vitro assay for irreversible electroporation cardiac ablation

et al. 2023

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Introduction: Pulsed electric field (PEF) cardiac ablation has been recently proposed as a technique to treat drug resistant atrial fibrillation by inducing cell death through irreversible electroporation (IRE). Improper PEF dosing can result in thermal damage or reversible electroporation. The lack of comprehensive and systematic studies to select PEF parameters for safe and effective IRE cardiac treatments hinders device development and regulatory decision-making. Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) have been proposed as an alternative to animal models in the evaluation of cardiac electrophysiology safety.Methods: We developed a novel high-throughput in vitro assay to quantify the electric field threshold (EFT) for electroporation (acute effect) and cell death (long-term effect) in hiPSC-CMs. Monolayers of hiPSC-CMs were cultured in high-throughput format and exposed to clinically relevant biphasic PEF treatments. Electroporation and cell death areas were identified using fluorescent probes and confocal microscopy; electroporation and cell death EFTs were quantified by comparison of fluorescent images with electric field numerical simulations.Results: Study results confirmed that PEF induces electroporation and cell death in hiPSC-CMs, dependent on the number of pulses and the amplitude, duration, and repetition frequency. In addition, PEF-induced temperature increase, absorbed dose, and total treatment time for each PEF parameter combination are reported.Discussion: Upon verification of the translatability of the in vitro results presented here to in vivo models, this novel hiPSC-CM-based assay could be used as an alternative to animal or human studies and can assist in early nonclinical device development, as well as inform regulatory decision-making for cardiac ablation medical devices.

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Section: Introductionmentioning

confidence: 99%

Human in vitro assay for irreversible electroporation cardiac ablation

et al. 2023

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A randomized ablation-based atrial fibrillation rhythm control versus rate control trial in patients with heart failure and high burden atrial fibrillation: The RAFT-AF trial rationale and design

Parkash

Wells

Rouleau

et al. 2021

American Heart Journal

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Long-term effectiveness of catheter ablation in patients with atrial fibrillation and heart failure

et al. 2020

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Aims Randomized trials suggest reductions in all-cause mortality and heart failure (HF) rehospitalizations with catheter ablation (CA) in patients with atrial fibrillation (AF) and HF. Whether these results can be replicated in a real-world population with long-term follow-up or varies over time is unknown. We sought to evaluate the long-term effectiveness of CA in reducing the incidence of all-cause mortality, HF hospitalizations, stroke, and major bleeding in AF–HF patients. Methods and results In a cohort of patients newly diagnosed with AF–HF in Quebec, Canada (2000–2017), CA patients were matched 1:2 to controls on time and frequency of hospitalizations. Confounders were controlled for using inverse probability of treatment weighting. Multivariable Cox models adjusted for the presence of cardiac electronic implantable devices and medication use during follow-up, and the effect of time since CA was modelled with B-splines. For non-fatal outcomes, the Lunn–McNeil approach was used to account for the competing risk of death. Among 101 933 AF–HF patients, 451 underwent CA and were matched to 899 controls. Over a median follow-up of 3.8 years, CA was associated with a statistically significant reduction in all-cause mortality [hazard ratio 0.4 (95% confidence interval 0.2–0.7)], but no difference in stroke or major bleeding. The hazard of HF rehospitalization for CA patients, relative to non-CA patients, varied with time since CA (P = 0.01), with a reduction in HF rehospitalizations until approximately 3 years post-CA. Conclusion Compared with matched non-CA patients, CA was associated with a long-term reduction in all-cause mortality and a reduction in HF rehospitalizations until 3 years post-CA.

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Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

Cited by 4 publications

References 42 publications

Human in vitro assay for irreversible electroporation cardiac ablation

Human in vitro assay for irreversible electroporation cardiac ablation

A randomized ablation-based atrial fibrillation rhythm control versus rate control trial in patients with heart failure and high burden atrial fibrillation: The RAFT-AF trial rationale and design

Long-term effectiveness of catheter ablation in patients with atrial fibrillation and heart failure

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