Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients After a Single Pulmonary Vein Isolation Procedure

Pooter, Jan De; Strisciuglio, Teresa; Haddad, Milad El; Wolf, Michael; Phlips, Thomas; Vandekerckhove, Yves; Tavernier, René; Knecht, Sébastien; Duytschaever, Mattias

doi:10.1016/j.jacep.2018.11.020

Cited by 87 publications

(96 citation statements)

References 29 publications

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“…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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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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“…The recently published CLOSE protocol made extreme efforts regarding delivery of constant energy and force with sufficient duration in contiguous lesions, and their excellent efficacy has already been proven in both animal and clinical studies [8][9][10]. The VISITAG ™ is a fundamental component of such point-by-point approaches, as it objectively demonstrates the gaps in the line that are inadequately ablated regions associated with future reconnections [11]. Therefore, the analysis of the gaps in our study is clinically important, as it could reveal the missing points in our practice and ultimately enhance outcomes after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Cho

Kim

et al. 2020

Int J Arrhythm

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Background An automated tagging module (VISITAG™; Biosense Webster, Irvine, CA) allows objective demonstration of energy delivery. However, the effect of VISITAG™ on clinical outcomes remains unclear. This study evaluated (1) clinical outcome after AF ablation using VISITAG™ and (2) the prevalence of gaps in the ablation line. Methods This retrospective analysis included 157 consecutive patients (mean age, 56.7 years; 73.2% men) with paroxysmal atrial fibrillation who underwent successful PVI between 2013 and 2016. Outcomes after the index procedure were compared between those using the VISITAG™ module (VISITAG group, n = 62) and those not using it (control group, n = 95). The primary outcome was recurrence of AF or atrial tachycardia after a blanking period of 3 months. Results The VISITAG group showed significantly shorter overall procedure time (172.2 ± 37.6 min vs. 286.9 ± 66.7 min, P < 0.001), ablation time (49.8 ± 9.7 min vs. 82.8 ± 28.2 min, P < 0.001), and fluoroscopy time (11.8 ± 5.3 min vs. 34.2 ± 30.1 min, P < 0.001) compared with controls. The 1-year recurrence-free survival rate was not statistically different between the groups (70.8% in the VISITAG group vs. 79.2% in the control group, P = 0.189). Gaps in the VISITAG line were common in the both carina and left side pulmonary veins. Patients without gaps (≥ 5 mm) by the criteria emphasizing catheter stability (> 15 s, < 4 mm range, > 60% force over time, > 6 g contact force) showed higher recurrence-free survival rate compared with those with gaps (borderline statistical significance, 91.7% vs. 66.0%, P = 0.094). Conclusion Use of the VISITAG™ module significantly reduced procedure, ablation, and fluoroscopic times with a similar AF/AT recurrence rate compared with the conventional ablation. Clinical implications of minimizing gaps along the ablation line should be evaluated further in the future prospective studies.

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“…Use of contemporary RF catheter ablation technologies has significantly decreased both re-ablation following first PVI and PV reconnection rates at second PVI procedure, as demonstrated in two large, single-center studies [28,29]. A recent study confirmed that PV reconnection did not occur in the majority of patients after a single PVI procedure using STAI and the ''CLOSE'' protocol [30]. These findings may help to explain the results of our analysis which show a significantly lower 12-month recurrence rate after ablation for PAF than has previously been reported [21,22].…”

Section: Impact Of New Rf Lesion-quality Markersmentioning

confidence: 96%

Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation

et al. 2019

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Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients After a Single Pulmonary Vein Isolation Procedure

Cited by 87 publications

References 29 publications

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

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

Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation

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