Randomized Comparison of the Continuous vs Point-by-Point Radiofrequency Ablation of the Cavotricuspid Isthmus for Atrial Flutter

Miyazaki, Shinsuke; Takahashi, Atsushi; Kuwahara, Taishi; Kobori, Atsushi; Yokoyama, Yasuhiro; Nozato, Toshihiro; Sato, Akira; Aonuma, Kazutaka; Hirao, Kazuyuki; Isobe, Mitsuaki

doi:10.1253/circj.71.1922

Cited by 34 publications

(25 citation statements)

References 15 publications

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“…Contiguous ablations, where the catheter is dragged along the tissue, have been suggested to create uninterrupted lesions [15,16]. Linear ablation paths are constructed by positioning the sheath and the catheter in a correct orientation and position, and inserting/retracting the catheter.…”

Section: Clinical Motivationmentioning

confidence: 99%

Autonomous Control of Continuum Robot Manipulators for Complex Cardiac Ablation Tasks

Yip

Sganga

Camarillo

2017

J. Med. Robot. Res.

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Continuum manipulators enable minimally-invasive surgery on the beating heart, but the challenges involved in manually controlling the manipulator's tip position and contact force with the tissue result in failed procedures and complications. The objective of this work is to achieve autonomous robotic control of a continuum manipulator's position and force in a beating heart model. We present a model-less hybrid control approach that regulates the tip position/force of manipulators with unknown kinematics/ mechanics, under unknown constraints along the manipulator's body. The algorithms estimate the Jacobian in the presence of heartbeat disturbances and sensor noise in real time, enabling closed-loop control. Using this model-less control approach, a robotic catheter autonomously traced clinically relevant paths on a simulated beating heart environment while regulating contact force. A gating procedure is used to tighten the treatment margins and improve precision. Experimental results demonstrate the capabilities of the robot (1:4 AE 1:1 mm-1:9 AE 1:4 mm tracking error) while user demonstrations show the difficulty of manually performing the same task (2:6 AE 2:0 mm-4:3 AE 3:9 mm tracking error). This new, robotically-enabled contiguous ablation method could reduce ablation path discontinuities, improve consistency of treatment, and therefore improve clinical outcomes.

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Section: Clinical Motivationmentioning

confidence: 99%

Autonomous Control of Continuum Robot Manipulators for Complex Cardiac Ablation Tasks

Yip

Sganga

Camarillo

2017

J. Med. Robot. Res.

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“…6 Thereafter, a cavotricuspid isthmus line was created with an end point of bidirectional conduction block. 7 Isoproterenol (5-20 μg/min) was intravenously injected before completing the procedure. If sustained or nonsustained AFs were reproducibly initiated from non-PV foci, they were focally ablated.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

“…In the present study, the number of ineffective AADs was a significant predictor of AF recurrence; few other reports have examined this parameter as a predictor of AF outcome. 21,22 Most patients were referred to our institution after the failure of intensive treatment involving a variety of AADs (median, 2; range, [1][2][3][4][5][6][7][8], suggesting that the number of ineffective AADs may have been an indicator of the disease severity. The significant association between LA size and AF recurrence after CA is described in the literature 2,15 and is in accordance with our findings.…”

Section: Clinical Predictors Of Af Recurrence After the Initial Camentioning

confidence: 99%

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Takigawa

Takahashi

Kuwahara

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— Although catheter ablation (CA) is a standard treatment for atrial fibrillation (AF), its long-term efficacy remains unclear. This study aimed to elucidate the incidences of AF recurrence and of progression from paroxysmal to persistent AF, after CA, in patients with paroxysmal AF. Methods and Results— We examined the incidence of AF recurrence and AF progression in 1220 consecutive patients (mean age, 61 years), with symptomatic paroxysmal AF, undergoing CA, based on extensive pulmonary vein isolation and focal ablation for nonpulmonary vein foci. AF recurrence–free survival probabilities at 5 years were 59.4% after the initial CA and 81.1% after the final CA (average, 1.3 procedures). During a median follow-up period of 47.9 (range, 5.3–123.3) months after the initial CA, AF progressed from paroxysmal to persistent in 15 (1.2%) patients (0.3%/y). The duration of AF history (hazard ratio [HR], 1.03; P <0.0001), number of ineffective antiarrhythmics (HR, 1.09; P =0.005), and left atrial diameter indexed by the body surface area (HR, 1.05; P =0.001) were significant predictors of AF recurrence. Patient age (HR, 1.12; P =0.0001) and left atrial diameter indexed by the body surface area (HR, 1.26; P =0.0006) were significantly associated with AF progression. Patients aged ≤65 years and with a left atrial diameter indexed by the body surface area of ≤24.0 mm/m 2 did not develop AF progression for ≤10 years after the initial CA. Conclusions— Although the long-term follow-up revealed the effect of CA on preventing AF recurrence, repeated CA sessions might be required. The rate of progression from paroxysmal to persistent AF was 0.3%/y.

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“…After completing the extensive PV isolation (EPVI), the cavo-tricuspid isthmus (CTI) was also ablated to create bi-directional conduction block. 11 In patients with chronic AF, we restored sinus rhythm by internal cardioversion before ablation and performed the EPVI and CTI ablation as described above. If the cardioversion failed to restore sinus rhythm, we started the ablation during ongoing AF and after completing the EPVI, we performed a repeated cardioversion to achieve sinus rhythm.…”

Section: Extensive Pulmonary Vein (Pv) Isolationmentioning

confidence: 99%

Effect of Left Atrial Ablation on the Quality of Life in Patients With Atrial Fibrillation

Miyazaki

Kuwahara

Takahashi

et al. 2007

Circ J

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BackgroundThe current study aimed to investigate the effect of ablation therapy on the quality of life (QOL) in patients with atrial fibrillation (AF) by using a questionnaire specific for AF. Methods and Results A total of 86 patients (paroxysmal/chronic, 61/25) with drug-resistant AF undergoing extensive pulmonary vein isolation were recruited for the study. The QOL was quantitatively assessed by the Atrial Fibrillation Quality of Life Questionnaire at baseline, and 1, 3 and 6 months after the ablation. Sinus rhythm was maintained in 48/61 (79%) of the paroxysmal AF group, and 15/25 (60%) of those in the chronic AF group during 6 months after the initial ablation procedure. Among the patients without any AF recurrences, patients with chronic AF exhibited a substantial improvement in the QOL at 1 month after the procedure, and it remained unchanged until the end of the follow-up period. However, in the patients with paroxysmal AF, the QOL level gradually increased over a 6-month period. The patients with recurrent AF exhibited no improvement in the QOL. Conclusion Although the clinical course of the QOL improvement was different, both paroxysmal and chronic AF patients gained better QOL to maintain sinus rhythm by means of catheter ablation. (Circ J 2008; 72: 582 -587)

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Randomized Comparison of the Continuous vs Point-by-Point Radiofrequency Ablation of the Cavotricuspid Isthmus for Atrial Flutter

Cited by 34 publications

References 15 publications

Autonomous Control of Continuum Robot Manipulators for Complex Cardiac Ablation Tasks

Autonomous Control of Continuum Robot Manipulators for Complex Cardiac Ablation Tasks

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Effect of Left Atrial Ablation on the Quality of Life in Patients With Atrial Fibrillation

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