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Topalović M, Jan M, Kalinšek TP, Žižek D, Štublar J, Rus R, Kuhelj D. Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1513. [PMID: 37761474 PMCID: PMC10527735 DOI: 10.3390/children10091513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.
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Affiliation(s)
- Mirko Topalović
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Matevž Jan
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - David Žižek
- Cardiology Department, Internal Medicine Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
| | - Jernej Štublar
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Rina Rus
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
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Abuelazm M, Mohamed I, Seri AR, Almaadawy O, Abdelazeem B, Brašić JR. Contact Force-Guided versus Contact Force-Blinded Cavo-Tricuspid Isthmus Ablation for Atrial Flutter: A Systematic Review and Meta-Analysis. Diseases 2023; 11:98. [PMID: 37489450 PMCID: PMC10366732 DOI: 10.3390/diseases11030098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023] Open
Abstract
Contact force (CF) is a novel approach developed to increase the safety and efficacy of catheter ablation. However, the value of CF-sensing technology for atrial flutter (AFL) cavo-tricuspid isthmus ablation (CTIA) is inconclusive. To generate a comprehensive assessment of optimal extant data on CF for AFL, we synthesized randomized controlled trials (RCTs) and observational studies from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 29 November 2022, using the odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with a corresponding 95% confidence interval (CI). Two RCTs and three observational studies with a total of 376 patients were included in our analysis. CF-guided ablation was associated with (A) a higher rate of AFL recurrence (OR: 2.26 with 95% CI [1.05, 4.87]) and total CF (MD: 2.71 with 95% CI [1.28, 4.13]); (B) no effect on total procedure duration (MD: -2.88 with 95% CI [-7.48, 1.72]), fluoroscopy duration (MD: -0.96 with 95% CI [-2.24, 0.31]), and bidirectional isthmus block (BDIB) (OR: 1.50 with 95% CI [0.72, 3.11]); and (C) decreased radiofrequency (RF) duration (MD: -1.40 with 95% CI [-2.39, -0.41]). We conclude that although CF-guided CTIA was associated with increased AFL recurrence and total CF and reduced RF duration, it did not affect total procedure duration, fluoroscopy duration, or BDIB. Thus, CF-guided CTIA may not be the optimal intervention for AFL. These findings indicate the need for (A) providers to balance the benefits and risks of CF when utilizing precision medicine to develop treatment plans for individuals with AFL and (B) clinical trials investigating CF-guided catheter ablation for AFL to provide definitive evidence of optimal CF-sensing technology.
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Affiliation(s)
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Amith Reddy Seri
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - Omar Almaadawy
- Department of Internal Medicine, MedStar Health, Baltimore Internal Medicine Residency Program, Baltimore, MD 21218, USA
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - James Robert Brašić
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
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Cui X, Li R, Zhou W, Zhang X, Wang X, Zhang J. Safety and efficacy of zero-fluoroscopy catheter ablation for paroxysmal supraventricular tachycardia in Chinese children. Front Cardiovasc Med 2022; 9:979577. [PMID: 36158836 PMCID: PMC9500196 DOI: 10.3389/fcvm.2022.979577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the safety and efficacy of completely zero-fluoroscopy radiofrequency ablation (RFA) with that of conventional RFA guided by three-dimensional mapping in Chinese children with paroxysmal supraventricular tachycardia (PSVT). Methods The study had a single-center observational design and included 46 children aged 6–14 years who underwent RFA for PSVT at the Second Hospital of Hebei Medical University between March 2019 and September 2021. The children were divided according to whether they underwent zero-fluoroscopy RFA (zero-fluoroscopy group, n = 26) or routine RFA under X-ray guidance (conventional group, n = 20). Three-dimensional mapping was used in both groups. Baseline characteristics, total procedure time, RFA time, volume and duration of X-ray exposure, target mapping time, the immediate RFA success rate, incidence of complications, and recurrence rate were compared between the two groups. Results The children had a median age of 12 years (interquartile range 10, 13), 47.8% (22/46) were boys, and 52.2% (24/46) were girls. The mean body weight was 48.75 ± 15.26 kg. There was no significant between-group difference in the baseline data (P > 0.05). All children were followed up as outpatients at 1, 3, and 6 months postoperatively. The target mapping time was significantly longer in the zero-fluoroscopy group than in the conventional group (12.96 ± 2.24 min vs. 6.65 ± 2.56 min, P < 0.05); however, there was no significant between-group difference in the immediate success rate (100% vs. 100%), success rate at 6 months postoperatively (92.30% vs. 95.00%), complication rate (0% vs. 0.05%), recurrence rate (7.70% vs. 5.00%), RFA time (212.50 s vs. 214.00 s), or total procedure time (78.50 min vs. 74.00 min) (P > 0.05). Conclusion Zero-fluoroscopy catheter ablation can completely avoid fluoroscopy exposure in children without affecting the safety and efficacy of RFA.
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Affiliation(s)
- Xiaoran Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruibin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenli Zhou
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohui Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoning Wang
- Department of Pediatric Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jidong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Jidong Zhang,
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Backhoff D, Müller MJ, Betz T, Arnold A, Schneider H, Paul T, Krause U. Contact Force Guided Radiofrequency Current Application at Developing Myocardium: Summary and Conclusions. J Cardiovasc Electrophysiol 2022; 33:1757-1766. [PMID: 35578015 DOI: 10.1111/jce.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter contact is one key determinant for lesion size in radiofrequency catheter ablation (RFA). Monitoring of contact force (CF) during RFA has been shown to improve efficacy of RFA in experimental settings as well as in adult patients. Coronary artery narrowing after RFA has been described in experimental settings as well as in children and adults and may be dependent from catheter contact. Value of CF monitoring concerning these issues has not been systematically yet. OBJECTIVE Value of high versus low CF during RFA in piglets was studied to assess lesion size and potential coronary artery involvement mimicking RFA in small children. ANIMALS AND METHODS RFA with continuous CF monitoring was performed in 24 piglets (median weight 18.5 kg) using a 7F TactiCath Quartz RF ablation catheter (Abbott, Illinois, USA). A total of 7 lesions were induced in each animal applying low (10-20 g) or high (40-60 g) CF. RF energy was delivered with a target temperature of 65 °C at 30 W for 30 seconds. Coronary angiography was performed prior and immediately after RF application. Animals were assigned to repeat coronary angiography followed by heart removal after 48 h (n=12) or 6 months (n=12). Lesions with surrounding myocardium were excised, fixated and stained. Lesion volumes were measured by microscopic planimetry. RESULTS A total of 148 RF lesions were identified in the explanted hearts. Only in the subset of lesions at the AV annulus 6 month after ablation, lesion size and number of lesions exhibiting transmural extension were higher in the high CF group compared to low CF. In all other locations CF had no impact on lesion size and mural extension after 48 h as well as after 6 months. Additional parameters as Lesion Size Index and Force Time Integral were also not related to lesion size. Coronary artery damage was present in 2 animals after 48 h and in 1 after 6 months and was not related to CF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Teresa Betz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Andreas Arnold
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
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Fluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire. J Interv Card Electrophysiol 2022; 64:183-190. [PMID: 35194727 PMCID: PMC9236982 DOI: 10.1007/s10840-022-01157-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
Purpose Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Methods A retrospective analysis was conducted on ablation procedures for various cardiac arrhythmias performed non-fluoroscopically at two centers using the VersaCross RF wire transseptal system under EAM and ICE guidance. Results A total of 72 and 54 patients underwent RFA and CBA, respectively, successfully without any procedural complications. Transseptal access time for RFA was 14.5 ± 6.6 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 2.8 ± 1.0 min from RF wire insertion into the femoral introducer. Transseptal access time for CBA was 19.2 ± 11.7 min from procedure start (including sheath and catheter placements ± right-sided ablation) or 3.5 ± 1.6 min from RF wire insertion into the femoral introducer. Average procedure time was 104.4 ± 38.0 min for RFA and 91.1 ± 22.1 min for CBA. Conclusions A RF wire can be used to achieve completely fluoroless transseptal puncture safely and effectively while improving procedural efficiency in both RFA and CBA.
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H, the Japanese Circulation Society / the Japanese Heart Rhythm Society Joint Working Group. JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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Capulzini L, de Terwangne C, Chierchia G, de Asmundis C, Paparella G, Sorgente A. Real world data on non-complex catheter ablations performed on zero fluoroscopy in a secondary centre in the south of Belgium. Acta Cardiol 2021; 76:1073-1077. [PMID: 32914688 DOI: 10.1080/00015385.2020.1817647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We have designed a study, whose aim was to confirm the feasibility and safety of the zero fluoroscopy approach in the treatment of supraventricular tachycardias (SVT) and premature ventricular contractions (PVCs) originating in the right ventricle in a secondary centre located in the south of Belgium. METHODS We included in our retrospective analysis patients with a clinical history and/or electrocardiographic documentation of SVT or frequent symptomatic monomorphic PVCs referred to our centre from November 2019 to March 2020 for catheter ablation. RESULTS A total of 49 patients were considered eligible for potential enrolment in the study, 3 were excluded because of presence of a manifest left sided atrio-ventricular accessory pathway, 5 because of left ventricular PVCs and 4 because of left atrial tachycardia. 4 patients were instead excluded because of need of utilisation of fluoroscopy during the procedure. A total of 33 patients were therefore included in the analysis. Right atrial flutters and typical AVNRT were the most common arrhythmia treated, corresponding together to the 81% of the total. Right femoral access was obtained in 86% of cases with left femoral access used in the remaining when right femoral access was not successful after the third attempt. Coronary sinus cannulation was efficacious within 10 min in 76% of cases. There were four minor complications overall. CONCLUSION The main finding of our study is that non-complex ablations can be performed on zero-fluoroscopy safely and with a good clinical outcome also in a secondary centre.
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Affiliation(s)
- Lucio Capulzini
- Arrhythmia and Electrophysiology Center, Department of Cardiology, Epicura Center Hospitalier, Hornu, Belgium
- Heart Rhythm Management Centre, Postgraduate in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe de Terwangne
- Arrhythmia and Electrophysiology Center, Department of Cardiology, Epicura Center Hospitalier, Hornu, Belgium
| | - Gianbattista Chierchia
- Heart Rhythm Management Centre, Postgraduate in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Antonio Sorgente
- Arrhythmia and Electrophysiology Center, Department of Cardiology, Epicura Center Hospitalier, Hornu, Belgium
- CEO Brain and Heart SRL, Bruxelles, Belgium
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Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review. Heart Rhythm O2 2021; 2:187-200. [PMID: 34113921 PMCID: PMC8183875 DOI: 10.1016/j.hroo.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Since 1996, it has been recognized that catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) may require an approach through the left atrium. Objective The purposes are to present a case report and to provide a comprehensive narrative review on this topic. Methods A literature review of all articles that provided detailed information on patients who underwent catheter ablation via the left atrium for AVNRT was performed. The primary search queried PubMed using Medical Subject Headings (MeSH) terms "atrioventricular nodal reentrant tachycardia" and "left." The secondary search was performed by manual review of reference lists and Google Scholar citations of manuscripts retrieved by the primary search. The review was limited to the English language. Results The searches yielded 30 articles that described 79 patients. A case report was added. Therefore, the final review consisted of 80 patients. The prevalence of left atrial ablation for patients with AVNRT undergoing catheter ablation at tertiary care centers was approximately 1%. Failed right atrial ablation, with or without coronary sinus ablation, was the most common indication for left atrial ablation. Pooled data from 3 cohort studies estimated the acute success rate for radiofrequency ablation of the slow pathway at the septal or inferoparaseptal segments of the mitral valve annulus after failed right-sided ablation to be 90%. There were no reports of atrioventricular block requiring permanent pacemaker implantation. Conclusion Catheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.
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Salam T, Wilson L, Bohannan S, Morin M. Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. J Innov Card Rhythm Manag 2020; 11:4079-4085. [PMID: 32368383 PMCID: PMC7192152 DOI: 10.19102/icrm.2020.110405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/07/2023] Open
Abstract
Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment.
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Affiliation(s)
- Tariq Salam
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Lane Wilson
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Sara Bohannan
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Michael Morin
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
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Bertini M, Brieda A, Balla C, Pollastrelli A, Smarrazzo V, Francesco V, Malagù M, Ferrari R. Efficacy and safety of catheter ablation of atrioventricular nodal re-entrant tachycardia by means of flexible-tip irrigated catheters. J Interv Card Electrophysiol 2019; 58:61-67. [PMID: 31236760 DOI: 10.1007/s10840-019-00578-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Irrigated-tip ablation catheters increase safety and efficacy of ablation procedures, but their use in atrioventricular nodal re-entrant tachycardia (AVNRT) ablation has not been systematically evaluated. The aim of this study is to evaluate the safety and efficacy of radiofrequency (RF) catheter ablation of AVNRT by means of the novel flexible-tip open-irrigated catheter FlexAbility™ and a 3D electroanatomic mapping (EAM) system. METHODS This is a single-center and single-operator study on 80 patients referred for AVNRT catheter ablation. Outcome included acute and long-term procedural success as well as complications reported over a median follow-up of 19 months (interquartile range 6-24 months). RESULTS Acute success was achieved in all 80 patients. One procedure-related major complication, involving the vascular access, occurred. Mean fluoroscopy time was 106 ± 71 s. One patient (1.2%) suffered long-term AVNRT recurrence. Five patients (6.2%) underwent ablation for AVNRT combined with ablation for other clinical arrhythmias. CONCLUSIONS Irrigated RF ablation of AVNRT by means of the novel flexible-tip open-irrigated catheter associated to 3D EAM system is effective and safe. Success rates are comparable to those of other techniques. Complication rate is very low.
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Affiliation(s)
- Matteo Bertini
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy.
| | - Alessandro Brieda
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Cristina Balla
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Annalisa Pollastrelli
- Abbott Medical Italy, Clinical Department, Viale Thomas Alva Edison, 110, 20099, Sesto San Giovanni, MI, Italy
| | - Vittorio Smarrazzo
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Vitali Francesco
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Michele Malagù
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Roberto Ferrari
- From Maria Cecilia Hospital, GVM Care & Research, Via Madonna di Genova, 1, 48033, Cotignola, RA, Italy
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Patel H, Hiner E, Naqvi A, Wrobel J, Machado C. The safety and efficacy of electroanatomical mapping (EAM)-guided device implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:897-903. [PMID: 31106434 DOI: 10.1111/pace.13724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The conventional method of device implantation requires fluoroscopic guidance. With the guidance of three-dimensional (3-D) navigation systems, devices can be implanted with minimal use of fluoroscopy. To date, this technique has been reported in several case reports in young, pregnant patients. However, this technique has not been widely utilized by electrophysiologists, despite offering several benefits, including reduced radiation exposure for the patient and the operator. METHODS In this study, we evaluated 18 patients who successfully underwent device implantation with limited use of fluoroscopy under the guidance of the EnSite Precision 3-D mapping navigation system (Abbott, St. Paul, MN, USA). In most of the patients, the total fluoroscopy time was 1 s, accounted by a single postprocedural frame to insure appropriate lead placement. RESULTS A total of 19 leads were implanted in 18 patients (14 male, four female) using the electroanatomical mapping (EAM)-guided technique. A total of 19 leads were implanted in 15 patients (10 male, five female) using the conventional method. The average length of stay was 1.20 days in the EAM group compared to 1.47 days in the conventional group (P = .10). Majority of the devices implanted in both groups were single-chamber implantable cardiac defibrillators (VVI ICD, Abbott) implanted for cardiomyopathy with left ventricular ejection fraction persistently below 35%, including 88% (16/18) in the EAM group compared to 73% (11/15) in the conventional group. No periprocedural or immediate postprocedure complications were reported in either group. Device parameters, including impedance, capture time, and capture voltage, showed no significant difference in either group. Total radiation time and radiation dose were markedly lower in the EAM-guided implantation group. CONCLUSIONS In patients who meet appropriate criteria for device implantation, the use of EAM system offers a safe, practical, efficacious alternative method to device implantation, with significant reduction in radiation time and dose.
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Affiliation(s)
- Hardik Patel
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | - Evan Hiner
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | - Amir Naqvi
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | | | - Christian Machado
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
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Sadek MM, Ramirez FD, Nery PB, Golian M, Redpath CJ, Nair GM, Birnie DH. Completely nonfluoroscopic catheter ablation of left atrial arrhythmias and ventricular tachycardia. J Cardiovasc Electrophysiol 2018; 30:78-88. [DOI: 10.1111/jce.13735] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Mouhannad M. Sadek
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - F. Daniel Ramirez
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Pablo B. Nery
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Mehrdad Golian
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Calum J. Redpath
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - Girish M. Nair
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
| | - David H. Birnie
- Arrhythmia Service, Division of Cardiology; University of Ottawa Heart Institute; Ottawa Canada
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Huang X, Chen Y, Huang Z, He L, Liu S, Deng X, Wang Y, Li R, Xu D, Peng J. Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography. Medicine (Baltimore) 2018; 97:e11044. [PMID: 29923993 PMCID: PMC6023703 DOI: 10.1097/md.0000000000011044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ± 17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ± 21.0 (99-177) minutes, the reconstruction time was 6.5 ± 2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ± 3.4 (6-20) minutes, and the mapping time was 11.7 ± 8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.
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Affiliation(s)
| | - Yanjia Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou
| | | | | | | | | | - Yongsheng Wang
- The Second People's Hospital of Jiedong District, Jieyang
| | - Rucheng Li
- Guangning County People's Hospital, Zhaoqing, Guangdong Province, China
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Blockhaus C, Schmidt J, Kurt M, Clasen L, Müller P, Brinkmeyer C, Kelm M, Shin DI, Makimoto H. Fluoroscopy integrating technology in a 3D mapping system during ablation of atrial arrhythmias: first experiences. Arch Med Sci 2018; 14:794-800. [PMID: 30002696 PMCID: PMC6040117 DOI: 10.5114/aoms.2016.61944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/15/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Ablation of the cavotricuspid isthmus (CTI) in patients with atrial flutter (AFL) and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are both common therapies. As the demand for ablative treatments rises, total radiation exposure times of staff increase concomitantly. Here, we report on our first experiences with a new fluoroscopy integrating system (FIS) integrated into a current 3D mapping system (3DMS). MATERIAL AND METHODS The study population consisted of 59 consecutive patients who underwent PVI or CTI ablation (26 and 33 patients with and without FIS respectively). Total procedure time (PT), fluoroscopy exposure time (FT) and dose-area product (DAP) were monitored. RESULTS All procedures were successfully completed without major complications. Employing FIS in the PVI group, FT and DAP were both significantly reduced after completing a short learning curve of 6 cases (respectively 361.6 ±181 s vs. 530.3 ±156.7 s, p = 0.039; 801.9 ±439.15 cGycm² vs. 1495 ±435.2 cGycm², p = 0.002). Mean PT was not significantly affected (121 ±26.7 min vs. 135.6 ±23.2 min, p = 0.21). The same holds true for CTI ablation: FT (99.29 ±51.4 s vs. 153.9 ±76.6 s, p = 0.022) and DAP (269 ±128.7 cGycm² vs. 524.3 ±288.4 cGycm², p = 0.002) were significantly reduced, leaving PT not significantly affected (29.5 ±10 min vs. 35.2 ±16.3 min, p = 0.23). CONCLUSIONS The introduction of the new FIS with a current 3DMS results in a significant reduction of both the total FT and DAP without affecting PT. The initial learning curve for adopting this method is considerably short.
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Affiliation(s)
- Christian Blockhaus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dong-In Shin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany
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Nishimori M, Kiuchi K, Mori S, Kurose J, Izawa Y, Kouno S, Nakagawa H, Shimoyama S, Fukuzawa K, Hirata KI. Atypical inferoseptal accessory pathway connection associated with an aneurysm of the coronary sinus: Insight from a three-dimensional combined image of electroanatomic mapping and computed tomography. HeartRhythm Case Rep 2018; 4:389-392. [PMID: 30228961 PMCID: PMC6140418 DOI: 10.1016/j.hrcr.2018.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Kurose
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kouno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinsuke Shimoyama
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Haegeli LM, Stutz L, Mohsen M, Wolber T, Brunckhorst C, On CJ, Duru F. Feasibility of zero or near zero fluoroscopy during catheter ablation procedures. Cardiol J 2018; 26:226-232. [PMID: 29611170 DOI: 10.5603/cj.a2018.0029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. METHODS This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). RESULTS Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. CONCLUSIONS This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.
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Affiliation(s)
- Laurent M Haegeli
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland. .,Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland.
| | - Linda Stutz
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Mohammed Mohsen
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas Wolber
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Corinna Brunckhorst
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Chol-Jun On
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Firat Duru
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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Kerst G, Vázquez-Jiménez J, Gonzalez y Gonzalez MB, Maizza A, Ostermayer S. Tachykardien bei Kindern ohne und mit angeborenem Herzfehler. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhang JQ, Yu RH, Liang JB, Long DY, Sang CH, Ma CS, Dong JZ. Reconstruction left atrium and isolation pulmonary veins of paroxysmal atrial fibrillation using single contact force catheter with zero x-ray exposure: A CONSORT Study. Medicine (Baltimore) 2017; 96:e7726. [PMID: 29019873 PMCID: PMC5662296 DOI: 10.1097/md.0000000000007726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Conventional ablation of paroxysmal atrial fibrillation (PAF) is associated with radiation risks for patients and laboratory staff. Three-dimensional (3D) mapping system capable of showing contact force (CF) and direction of catheter tip may compensate for nonfluoroscopic safety issues. OBJECTIVE The aim of this study was to investigate the feasibility of zero x-ray exposure during reconstruction left atrium (LA) and ablation. METHODS Single, CF catheter, and 3D mapping system were used to reconstruct LA and isolate pulmonary veins (PV) in all patients. The patients were randomly divided into 2 groups after LA angiography. In group 1, reconstruction LA and isolation PV was performed with the help of 3D system (without x-ray), whereas in group 2, x-ray and 3D system were utilized to reconstruct LA and ablate PV antrum. After ablation, Lasso catheter was used to confirm the PV isolation. All patients were followed up to 12 months. RESULTS A total of 342 PAF patients were continuously enrolled. The basic clinical characteristics between the 2 groups had no significant difference. Parameters related to the procedure, average procedure time, ablation procedure time, average contact force (CF) applied, the percentage of time within CF settings, and average power applied during radiofrequency application showed no significant difference between the 2 groups. In group 1, the average fluoroscopy time before LA reconstruction was similar to that in group 2 (2.8 ± 0.4 vs. 2.4 ± 0.6 minutes, P = .75). The average fluoroscopy time during ablation was significantly lower than that in group 2 (0 vs. 7.6 ± 1.3 minutes, P < .001). The total x-ray exposure dose of the procedure in group 1 was significantly lower than that in group 2 (19.6 ± 9.4 vs. 128.7 ± 62.5 mGy, respectively, P < .001). Kaplan-Meier analysis indicated that there were no statistical differences in the probability of freedom from atrial arrhythmia (AF/AFL/AT) recurrence at 12 months between group 1 and group 2 (P = .152). The success rate after a single ablation procedure and without drugs (Class I/III AAD) at 12 months was not significantly different between the 2 groups (67.6%, 95% confidence interval [CI]: 62%-79.5% in group 1 and 68.9%, 95% CI: 63%-80.7% in group 2, P = .207). Procedural-related adverse events showed no significant different incidence between group 1 and group 2. A multivariate logistic regression analysis of risk factors was performed to evaluate the effectiveness outcome, which demonstrated that the percentage of CF (within the investigator-selected work ranges) during therapy was significantly associated with positive outcomes (odds ratio: 3.68; 95% CI: 1.65-10.6, P = .008), whereas the LA dimension was negatively associated with effectiveness outcomes (odds ratio: 0.72; 95% CI: 0.52-0.84, P = .016). CONCLUSIONS Reconstruction LA and isolation PV ablation using single CF-assisted catheter without x-ray exposure was both safe and effective. CF was positively associated with effective outcomes and LA dimensions negatively with effective ones.
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Affiliation(s)
- Jian Qiang Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai Beijing Anzhen Hospital, Capital Medical University, Beijing Juxian People Hospital, Shandong Province 276500,China
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Radiofrequency Catheter Ablation For Atrial Fibrillation: Approaches And Outcomes. Heart Lung Circ 2017; 26:941-949. [DOI: 10.1016/j.hlc.2017.05.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/27/2023]
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Deutsch K, Śledź J, Mazij M, Ludwik B, Labus M, Karbarz D, Pasicka B, Chrabąszcz M, Śledź A, Klank-Szafran M, Vitali-Sendoz L, Kameczura T, Śpikowski J, Stec P, Ujda M, Stec S. Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach. Medicine (Baltimore) 2017; 96:e6939. [PMID: 28640075 PMCID: PMC5484183 DOI: 10.1097/md.0000000000006939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n = 164; age: 63.7 ± 9.5; 30% women), NXR + PBT (n = 55; age: 63.9 ± 10.7; 39% women); ALARA + MVG (n = 36; age: 64.2 ± 9.6; 39% women); and ALARA + PBT (n = 205; age: 64.7 ± 9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P = NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ± 17.6 and 47.2 ± 15.7 min vs. 52.6 ± 23.7 and 59.8 ± 24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ± 1.1 [NXR + PBT] and 0.3 ± 1.6 [NXR + MVG] to 7.7 ± 6.0 min [ALARA + MVG] and 9.1 ± 7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.
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Affiliation(s)
| | | | | | | | | | - Dariusz Karbarz
- Department of Cardiology, Masovia Specialist Hospital, Radom, Poland
| | | | | | | | | | | | - Tomasz Kameczura
- Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok
- Faculty of Medicine, University of Rzeszow, Rzeszow
| | | | - Piotr Stec
- District Socialistic Hospital in Stalowa Wola, Stalowa Wola, Poland
| | - Marek Ujda
- District Socialistic Hospital in Stalowa Wola, Stalowa Wola, Poland
| | - Sebastian Stec
- ELMedica EP-Network, Kielce
- Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok
- Faculty of Medicine, University of Rzeszow, Rzeszow
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RAZMINIA MANSOUR, WILLOUGHBY MICHAELCAMERON, DEMO HANY, KESHMIRI HESAM, WANG THEODORE, D'SILVA OLIVERJ, ZHEUTLIN TERRYA, JIBAWI HAKEEM, OKHUMALE PAUL, KEHOE RICHARDF. Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:425-433. [DOI: 10.1111/pace.13038] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
- MANSOUR RAZMINIA
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - MICHAEL CAMERON WILLOUGHBY
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HANY DEMO
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HESAM KESHMIRI
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - THEODORE WANG
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - OLIVER J. D'SILVA
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - TERRY A. ZHEUTLIN
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - HAKEEM JIBAWI
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - PAUL OKHUMALE
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
| | - RICHARD F. KEHOE
- Section of Cardiology and Clinical Cardiac Electrophysiology; Advocate Illinois Masonic Medical Center; Chicago Illinois
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A Three-Dimensional Shape-Based Force and Stiffness-Sensing Platform for Tendon-Driven Catheters. SENSORS 2016; 16:s16070990. [PMID: 27367685 PMCID: PMC4970041 DOI: 10.3390/s16070990] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
This paper presents an efficient shape-based three-axial force and stiffness estimator for active catheters commonly implemented in cardiac ablation. The force-sensing capability provides important feedback for catheterization procedures including real-time control and catheter steering in autonomous navigation systems. The proposed platform is based on the introduced accurate and computationally efficient Cosserat rod model for tendon-driven catheters. The proposed nonlinear Kalman filter formulation for contact force estimation along with the developed catheter model provides a real-time force observer robust to nonlinearities and noise covariance uncertainties. Furthermore, the proposed platform enables stiffness estimation in addition to tip contact force sensing in different operational circumstances. The approach incorporates pose measurements which can be achieved using currently developed pose-sensing systems or imaging techniques. The method makes the approach compatible with the range of forces applied in clinical applications. The simulation and experimental results verify the viability of the introduced force and stiffness-sensing technique.
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Gaita F, Guerra PG, Battaglia A, Anselmino M. The dream of near-zero X-rays ablation comes true. Eur Heart J 2016; 37:2749-2755. [DOI: 10.1093/eurheartj/ehw223] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/12/2016] [Indexed: 11/15/2022] Open
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Blockhaus C, Schmidt J, Kurt M, Clasen L, Brinkmeyer C, Katsianos E, Müller P, Gerguri S, Kelm M, Shin DI, Makimoto H. Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter. Int Heart J 2016; 57:299-303. [PMID: 27181037 DOI: 10.1536/ihj.15-399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with atrial fibrillation (AF). With increasing numbers of PVI procedures, demand arises to reduce the cumulative fluoroscopic radiation exposure for both the physician and the patient. New technologies are emerging to address this issue. Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed. All PVI procedures were performed by one experienced physician using a commercially available circular multipolar irrigated ablation catheter. All PVI procedures were successfully undertaken without major complications. Baseline characteristics of the two groups showed no significant differences. In the group using the FIS, the fluoroscopic time and DAP were significantly reduced from 571 ± 187 seconds versus 1011 ± 527 seconds (P = 0.0029) and 4342 ± 2073 cGycm(2) versus 6208 ± 3314 cGycm(2) (P = 0.049), respectively. Mean procedure time was not significantly affected and was 114 ± 31 minutes versus 104 ± 24 minutes (P = 0.23) by the FIS.The use of the new FIS with the current 3D-mapping system enables a significant reduction of the total fluoroscopy time and DAP compared to the previous combination of 3D-mapping system plus normal fluoroscopy during PVI utilizing a circular multipolar irrigated ablation catheter. However, the concomitant total procedure time is not affected. Thus, the new system reduces the radiation exposure for both the physicians and patients.
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Affiliation(s)
- Christian Blockhaus
- Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Medical Faculty
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Naniwadekar A, Joshi K, Greenspan A, Mainigi S. Use of the new contact force sensing ablation catheter dramatically reduces fluoroscopy time during atrial fibrillation ablation procedures. Indian Pacing Electrophysiol J 2016; 16:83-87. [PMID: 27788997 PMCID: PMC5067844 DOI: 10.1016/j.ipej.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/29/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the impact of contact force (CF) sensing on fluoroscopy, procedure, left atrial (LA) and ablation times and number of ablations during atrial fibrillation (AF) ablation. BACKGROUND Catheter ablation is an effective treatment for symptomatic AF. Recently a new ablation catheter providing real-time CF has been approved for use. METHODS A nested case-control study was performed comparing radiofrequency ablation of AF using the irrigated CF-sensing ThermoCool SmartTouch catheter versus open-irrigated ThermoCool SF catheter (Biosense Webster, Inc., Diamond Bar, California). Demographic and procedure data were obtained and student t-test was used to compare data between groups. RESULTS Thirty consecutive adult patients were included with 15 patients in each group. Mean fluoroscopy time was significantly lower in CF group (19.4 ± 8 vs 40.7 ± 8 min, p < 0.0001). LA time was significantly lower in CF group (151.7 ± 44 vs 185.7 ± 35 min, p = 0.01). There were no significant differences in procedure time between CF and SF groups (204 ± 37 vs 207 ± 36 min) and ablation time (121 ± 32 vs 122 ± 37 min). When patients who only underwent pulmonary vein isolation (PVI) were compared, fluoroscopy time was significantly lower in CF group (18 ± 9 vs 37.8 ± 5 min, p < 0.0001) as was LA time (141.4 ± 39 vs 171.8 ± 30 min, p = 0.04). Fluoroscopy time was also significantly lower in CF subgroup with additional ablation (20.9 ± 7 vs 44.9 ± 10 min, p < 0.001). CONCLUSION Use of CF-sensing catheter significantly reduced fluoroscopy and LA times during AF ablation with similar acute efficacy.
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Affiliation(s)
- Aditi Naniwadekar
- Division of Cardiovascular Medicine, Einstein Medical Center, Philadelphia, PA, USA.
| | - Kamal Joshi
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Allan Greenspan
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Sumeet Mainigi
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
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Raju H, Whitaker J, Taylor C, Wright M. Electroanatomic Mapping and Transoesophageal Echocardiography for near Zero Fluoroscopy during Complex Left Atrial Ablation. Heart Lung Circ 2016; 25:652-60. [PMID: 26979468 DOI: 10.1016/j.hlc.2016.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND We evaluated Carto 3, transoesophageal echocardiography (TOE) and contact force (CF) sensing catheter in atrial fibrillation (AF) ablation. METHODS Unselected consecutive ablations performed under general anaesthesia (GA) were studied with modified protocol (cases, n=11) and compared to retrospective consecutive controls (n=10). Patent foramen ovale (PFO) or single transseptal puncture enabled left atrial (LA) access; ablation strategy was stepwise approach. Modified protocol utilised right atrial (RA) electrograms, CF and TOE to localise SmartTouch and create RA and CS electroanatomic map (EAM) without fluoroscopy. Transseptal puncture was performed with fluoroscopy in absence of PFO. Fluoroless pulmonary vein and LA EAM was created using TOE to locate circular-mapping catheter. RESULTS Mean age of cases was 57±11 years with 64% male compared with 60±11 (70% male) for controls. Patent foramen ovale was identified in four cases (36%) and two controls (20%). No early complications occurred. Shorter fluoroscopy time (median 36 vs 390seconds; p=0.038) and trend to lower radiation dose (median 17 vs 165 cGym2; p=0.053) was seen in cases, with no increase in total procedure time (p=0.438). CONCLUSIONS General anaesthesia, TOE and CF mapping catheters facilitate minimised fluoroscopy for catheter ablation of LA arrhythmias. Zero fluoroscopy is possible in a majority of cases with PFO.
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Affiliation(s)
| | - John Whitaker
- Cardiology Department, St Thomas' Hospital, London, UK
| | - Carly Taylor
- Cardiology Department, St Thomas' Hospital, London, UK
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Krause U, Backhoff D, Klehs S, Schneider HE, Paul T. Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. J Interv Card Electrophysiol 2016; 46:191-8. [DOI: 10.1007/s10840-015-0096-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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McCauley MD, Patel N, Greenberg SJ, Molina-Razavi JE, Safavi-Naeini P, Razavi M. Fluoroscopy-free Atrial Transseptal Puncture. ACTA ACUST UNITED AC 2016; 2:57-61. [PMID: 29862050 DOI: 10.17925/ejae.2016.02.02.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Fluoroscopy is traditionally used in atrial transseptal puncture (TSP); however fluoroscopy exposes patient and physician to excess radiation. Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation. Methods Seven patients received ZFTSP. An Acunav™ ICE catheter (Biosense Webster Inc., California, US) was placed in the right atrium, then an Agilis™ sheath (St. Jude Medical, Saint Paul, Minnesota, US) was established into the inferior vena cava. A ThermoCool® SmartTouch™ catheter (Biosense Webster Inc., California, US) was inserted through the Agilis to map the fossa ovalis. Mapping catheter exchange for dilator and needle allowed for facile ZFTSP. AF outcome, fluoroscopy times, and procedure times were compared with eight age-matched control patients. Results There were no significant differences in age, body mass index (BMI) or AF duration between the two groups and no immediate complications. ZFTSP procedure time was 183.9±33.7 minutes versus 293.13±129.9 minutes for TSP-only controls (p=0.05). Fluoroscopy time was 17.5±14.1 minutes in ZFTSP patients versus 73.4±50.3 minutes in controls (p=0.01). AF recurrence in ZFTSP patients was 14% versus 25% in controls. Conclusion ZFTSP utilising ICE and EAM is safe, effective, and time-efficient. There is a small but significant reduction in radiation exposure to patient and physician by the use of this technique.
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Affiliation(s)
- Mark D McCauley
- Department of Medicine, Section of Cardiology, The University of Illinois at Chicago and the Jesse Brown VA Medical Center, Chicago, Illinois, US
| | - Nisarg Patel
- The Wright Center, Wilkes-Barre, Pennsylvania, US
| | - Scott J Greenberg
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
| | | | - Payam Safavi-Naeini
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
| | - Mehdi Razavi
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
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Bourier F, Reents T, Ammar-Busch S, Buiatti A, Kottmaier M, Semmler V, Telishevska M, Brkic A, Grebmer C, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures. Europace 2015; 18:1406-10. [PMID: 26589627 PMCID: PMC5400031 DOI: 10.1093/europace/euv364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022] Open
Abstract
Aims This study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels. Methods and results From October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0). Conclusion The new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Sonia Ammar-Busch
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Alessandra Buiatti
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christof Kolb
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
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Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias. Herz 2015; 41:241-5. [DOI: 10.1007/s00059-015-4358-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 07/29/2015] [Accepted: 09/11/2015] [Indexed: 11/27/2022]
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Ponti RD. Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned. World J Cardiol 2015; 7:442-448. [PMID: 26322183 PMCID: PMC4549777 DOI: 10.4330/wjc.v7.i8.442] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/23/2015] [Accepted: 05/08/2015] [Indexed: 02/06/2023] Open
Abstract
Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable (ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 mSv and in some cases > 50 mSv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, non-fluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zero-fluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulation of catheters; however, the learning curve is shorter for more experienced operators compared to less experienced operators.
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Makimoto H, Heeger CH, Lin T, Rillig A, Metzner A, Wissner E, Mathew S, Deiss S, Rausch P, Lemeš C, Kuck KH, Ouyang F, Tilz RR. Comparison of contact force-guided procedure with non-contact force-guided procedure during left atrial mapping and pulmonary vein isolation: impact of contact force on recurrence of atrial fibrillation. Clin Res Cardiol 2015; 104:861-70. [PMID: 25893569 DOI: 10.1007/s00392-015-0855-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/01/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of contact force (CF) visualization on the incidence of low and high CF during left atrial (LA) mapping and pulmonary vein isolation (PVI). METHODS CF was assessed in 70 patients who underwent PVI. Three highly experienced operators performed all procedures. The operators were blinded to CF in group A (35 patients), and CF was displayed in group B (35 patients). In group B, optimal CF was defined as mean CF between 10 and 39g, and operators attempted to acquire points and ablate within this range. RESULTS A total of 8401 mapping points were analyzed during LA mapping (group A: 4104, group B: 4297). Low CF <10g and high CF ≥40g were noted in a significantly larger number of points in group A (37.7 vs. 12.0 %, P < 0.001; 11.5 vs. 1.5 %, P < 0.001). At the mitral isthmus and ridge areas, CF was significantly lower (7.7 vs. 12.2g, P < 0.001; 5.3 vs. 11.7g, P < 0.001) in group A than in group B. PVI was successfully achieved in all patients. There were significant site-dependent CF differences between the two groups. Optimal CF was achieved in significantly more applications in group B (P < 0.001). There was no significant difference in atrial fibrillation (AF) recurrence rates after a minimum follow-up of 1 year between the two groups in this cohort (P = 0.24). No significant peri-procedural complications occurred in either group. CONCLUSIONS CF visualization can assist in avoiding both low and high CF, which may have the potential to improve lesion formation and patient safety profile. In this study, CF-guided ablation did not affect AF recurrence.
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Affiliation(s)
- Hisaki Makimoto
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Christian-H Heeger
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Erik Wissner
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Sebastian Deiss
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Peter Rausch
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Christine Lemeš
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
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Jarman JWE, Panikker S, DAS M, Wynn GJ, Ullah W, Kontogeorgis A, Haldar SK, Patel PJ, Hussain W, Markides V, Gupta D, Schilling RJ, Wong T. Relationship between contact force sensing technology and medium-term outcome of atrial fibrillation ablation: a multicenter study of 600 patients. J Cardiovasc Electrophysiol 2015; 26:378-384. [PMID: 25546580 DOI: 10.1111/jce.12606] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 12/16/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Contact force sensing (CFS) technology improves acute pulmonary vein isolation durability; however, its impact on the clinical outcome of ablating atrial fibrillation (AF) is unknown. METHODS AND RESULTS First time AF ablation procedures employing CFS from 4 centers were matched retrospectively to those without CFS in a 1:2 manner by type of AF. Freedom from atrial tachyarrhythmia was defined as the primary outcome measure, and fluoroscopy time the secondary outcome measure. Nineteen possible explanatory variables were tested in addition to CFS. A total of 600 AF ablation procedures (200 using CFS and 400 using non-CFS catheters) performed between 2010 and 2012 (46% paroxysmal, 36% persistent, 18% long-lasting persistent) were analyzed. The mean follow-up duration was 11.4 ± 4.7 months-paroxysmal AF 11.2 ± 4.1 CFS versus 11.3 ± 3.9 non-CFS (P = 0.745)-nonparoxysmal AF 10.4 ± 4.5 CFS versus 11.9 ± 5.4 non-CFS (P = 0.015). The use of a CFS catheter independently predicted clinical success in ablating paroxysmal AF (HR 2.24 [95% CIs 1.29-3.90]; P = 0.004), but not nonparoxysmal AF (HR 0.73 [0.41-1.30]; P = 0.289) in a multivariate analysis that included follow-up duration. Among all cases, the use of CFS catheters was associated with reduced fluoroscopy time in multivariate analysis (reduction by 7.7 [5.0-10.5] minutes; P < 0.001). Complication rates were similar in both groups. CONCLUSIONS At medium-term follow-up, CFS catheter technology is associated with significantly improved outcome of first time catheter ablation of paroxysmal AF, but not nonparoxysmal AF. Fluoroscopy time was lower when CFS technology was employed in all types of AF ablation procedures.
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Affiliation(s)
- Julian W E Jarman
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Sandeep Panikker
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Moloy DAS
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Imperial College London, UK
| | - Gareth J Wynn
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Imperial College London, UK
| | - Waqas Ullah
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, London, UK
| | - Andrianos Kontogeorgis
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Shouvik K Haldar
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Preya J Patel
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Wajid Hussain
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Vias Markides
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
| | - Dhiraj Gupta
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Imperial College London, UK
| | - Richard J Schilling
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, London, UK
| | - Tom Wong
- NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.,Imperial College London, UK
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SIGMUND ELISABETH, PUERERFELLNER HELMUT, DERNDORFER MICHAEL, KOLLIAS GEORGIOS, WINTER SIEGMUND, AICHINGER JOSEF, NESSER HANSJOACHIM, MARTINEK MARTIN. Optimizing Radiofrequency Ablation of Paroxysmal and Persistent Atrial Fibrillation by Direct Catheter Force Measurement-A Case-Matched Comparison in 198 Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:201-8. [DOI: 10.1111/pace.12549] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/26/2014] [Accepted: 10/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- ELISABETH SIGMUND
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - HELMUT PUERERFELLNER
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - MICHAEL DERNDORFER
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - GEORGIOS KOLLIAS
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - SIEGMUND WINTER
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - JOSEF AICHINGER
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - HANS-JOACHIM NESSER
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
| | - MARTIN MARTINEK
- Department of Cardiology; Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz; Linz Austria
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von Alvensleben JC, Dick M, Bradley DJ, LaPage MJ. Transseptal access in pediatric and congenital electrophysiology procedures: defining risk. J Interv Card Electrophysiol 2014; 41:273-7. [PMID: 25416565 DOI: 10.1007/s10840-014-9946-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/26/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Transseptal puncture (TSP) is commonly used to access the left heart for catheter ablation procedures. The specific complication risk of this procedure has not been determined. This study assesses the risk of TSP using a single standard technique during electrophysiology study (EPS) in pediatrics and congenital heart disease (CHD). METHODS Retrospective cohort study of patients undergoing TSP during EPS at the University of Michigan Congenital Heart Center between 1999 and 2011. RESULTS There were 373 left heart ablation procedures during the study period. Excluded were six adults without CHD, five procedures using an alternative imaging modality, five procedures using retrograde aortic access, one transhepatic access, and one where TSP was performed during a prior procedure. Included were 321 pediatric (≤18 years old without CHD) TSP procedures (median age 13 years) and 34 TSP procedures in patients with CHD (median age 28 years). There was one complication directly attributable to TSP: needle perforation of the left atrium without development of effusion in the pediatric group. Post-procedure echocardiograms were performed in 351 (99 %) cases, showing only trivial effusions in seven (1.9 %). CONCLUSIONS This single center experience over 12 years shows the risk of TSP in pediatric and CHD patients to be low, with a 0.3 % (95 % confidence interval (CI) 0, 0.9 %) risk for complications directly related to TSP using only single plane fluoroscopy for visualization.
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Akca F, Janse P, Theuns DAMJ, Szili-Torok T. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. Int J Cardiol 2014; 179:441-8. [PMID: 25465303 DOI: 10.1016/j.ijcard.2014.11.105] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/09/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contact force (CF) sensing catheters provide advantages with regard to safety and efficacy. This study aimed to evaluate if CF catheters reduce cardiac perforations and other major complications and offer equal safety compared to the magnetic navigation system (MNS). METHODS Data from 1.517 ablation procedures from our prospective registry was analyzed. Ablations were performed using either CF guided catheters (CF group, n=248), non-CF catheters (NCF group, n=813), or MNS (n=456). Four subgroups were analyzed: atrial fibrillation (AF, n=557), supraventricular tachycardia (SVT, n=715), ventricular tachycardia (VT, n=190) and patients with congenital heart defects (CHD, n=55). The primary endpoint of this study was incidence of cardiac perforation. Secondary endpoints were major and minor complications within 30 days of the procedure. RESULTS Complications occurred in 11.3% (n=172) of the procedures. In 2.8% (n=43) a major complication occurred, 0.9% (n=13) had a perforation, 8.5% (n=129) had a minor complication and 2 patients died (0.1%). No cardiac perforation occurred in the CF group, which was significantly different from NCF procedures (0.0% vs. 1.6%; relative risk 0.76, 95% CI 0.74-0.79, P=0.031) and equal to MNS (0.0%). This was also observed in the AF subgroup (0.0% vs. 3.3%; RR 0.67, 95% CI 0.63-0.72, P=0.021), and the occurrence of major complications was lower for CF versus NCF procedures (2.1% vs. 7.8%, P=0.010). CONCLUSIONS CF-guided catheter ablation is superior to NCF with regard to procedural safety and avoidance of cardiac perforation. This difference is due to a reduction of cardiac perforation and major complications in the AF subgroup.
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Affiliation(s)
- Ferdi Akca
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Petter Janse
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Lee SY, Kim J, Lee SH, Choi JH, Kim JS, Park YH, Kim JH, Chun KJ. Reduction of radiation exposure during catheter ablation for paroxysmal supraventricular tachycardia: the effect of a low frame rate of digital pulsed fluoroscopy. Int J Cardiol 2014; 177:573-4. [PMID: 25192785 DOI: 10.1016/j.ijcard.2014.08.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Soo-Yong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - Sang-Hyun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin-Hee Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeong-Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Hyun Park
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June-Hong Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Razminia M, Demo H, Arrieta-Garcia C, D'Silva OJ, Wang T, Kehoe RF. Nonfluoroscopic Ablation of Atrial Fibrillation Using Cryoballoon. J Atr Fibrillation 2014; 7:1093. [PMID: 27957089 DOI: 10.4022/jafib.1093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The conventional method of cryoballoon ablation of atrial fibrillation involves the use of fluoroscopy for visual guidance. The use of fluoroscopy is accompanied by significant radiation risks to the patient and the medical staff. Herein, we report our experience in performing successful nonfluoroscopic pulmonary vein isolation using cryoballoon ablation in 5 consecutive patients with paroxysmal atrial fibrillation. METHODS AND RESULTS Five consecutive patients with paroxysmal atrial fibrillation underwent cryoballoon ablation for pulmonary vein isolation using a nonfluoroscopic approach. Pre-procedural cardiac computed tomography or cardiac magnetic resonance imaging was not performed in any patient. A total of twenty pulmonary veins were identified and successfully isolated (100%) with the guidance of intracardiac echocardiography and 3-dimensional electroanatomic mapping. No fluoroscopy was used for the procedures. There were no major procedural adverse events. CONCLUSION In an unselected group of patients undergoing cryoballoon ablation, a nonfluoroscopic approach is feasible and can be performed safely and effectively while eliminating the risks associated with radiation to both the patient and the medical staff.
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Affiliation(s)
- Mansour Razminia
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
| | - Hany Demo
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
| | - Carlos Arrieta-Garcia
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
| | - Oliver J D'Silva
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
| | - Theodore Wang
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
| | - Richard F Kehoe
- Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL, USA
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Heidbuchel H, Wittkampf FHM, Vano E, Ernst S, Schilling R, Picano E, Mont L, Jais P, de Bono J, Piorkowski C, Saad E, Femenia F. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace 2014; 16:946-64. [PMID: 24792380 DOI: 10.1093/europace/eut409] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
| | - Fred H M Wittkampf
- Heart Lung Center, Department of Cardiology, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Eliseo Vano
- Radiology Department, Medicine School, Complutense University and San Carlos Hospital, IdISSC, Madrid 28040, Spain
| | - Sabine Ernst
- NIHR Biomedical Research Unit and Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK
| | - Richard Schilling
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
| | - Eugenio Picano
- CNR Biomedical Sciences Department, Institute of Clinical Physiology, 56124, Pisa, Italy
| | - Lluis Mont
- Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia 08036, Spain
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Joseph de Bono
- Queen Elizabeth Medical Centre, Department of Cardiology, Birmingham, United Kingdom
| | | | - Eduardo Saad
- Hospital Pró-Cardíaco, Setor de Arritmia Invasiva, Rio de Janeiro, Brazil
| | - Francisco Femenia
- Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK
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Stec S, Śledź J, Mazij M, Raś M, Ludwik B, Chrabąszcz M, Śledź A, Banasik M, Bzymek M, Młynarczyk K, Deutsch K, Labus M, Śpikowski J, Szydłowski L. Feasibility of implementation of a "simplified, No-X-Ray, no-lead apron, two-catheter approach" for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol 2014; 25:866-874. [PMID: 24654678 DOI: 10.1111/jce.12414] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although the "near-zero-X-Ray" or "No-X-Ray" catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used "No-X-Ray," simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients. METHODS Data were obtained from a prospective multicenter CA registry of patients with regular SVTs. After femoral access, 2 catheters were used to create simple, 3D electroanatomic maps and to perform electrophysiologic studies. Medical staff did not use lead aprons after the first 10 MINI CA cases. RESULTS A total of 188 patients (age, 45 ± 21 years; 17% <19 years; 55% women) referred for the No-X-Ray approach were included. They were compared to 714 consecutive patients referred for a simplified approach using X-rays (age, 52 ± 18 years; 7% <19 years; 55% women). There were 9 protocol exceptions that necessitated the use of X-rays. Ultimately, 179/188 patients underwent the procedure without fluoroscopy, with an acute success rate of 98%. The procedure times (63 ± 26 vs. 63 ± 29 minutes, P > 0.05), major complications (0% vs. 0%, P > 0.05) and acute (98% vs. 98%, P > 0.05) and long-term (93% vs. 94%, P > 0.05) success rates were similar in the "No-X-Ray" and control groups. CONCLUSIONS Implementation of a strict "No-X-Ray, simplified 2-catheter" CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
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Affiliation(s)
- Sebastian Stec
- Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw.,ELMedica EP-Network, Kielce.,Podkarpackie Center for Cardiovascular Interventions, Sanok
| | - Janusz Śledź
- ELMedica EP-Network, Kielce.,Carint Medica, Kraków.,Division of Interventional Cardiology, Center of Invasive Cardiology, Angiology and Electrotherapy in Ostrowiec, Poland
| | - Mariusz Mazij
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Małgorzata Raś
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Bartosz Ludwik
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Michał Chrabąszcz
- ELMedica EP-Network, Kielce.,Institute of Physics, Department of Atomic Physics, Jan Kochanowski University, Kielce
| | | | | | | | | | - Karol Deutsch
- Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw
| | - Michał Labus
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Jerzy Śpikowski
- Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Silesian Medical University, Katowice, Poland
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Sciarra L, Golia P, Natalizia A, De Ruvo E, Dottori S, Scarà A, Borrelli A, De Luca L, Rebecchi M, Fagagnini A, Bandini A, Guarracini F, Galvani M, Calò L. Which is the best catheter to perform atrial fibrillation ablation? A comparison between standard ThermoCool, SmartTouch, and Surround Flow catheters. J Interv Card Electrophysiol 2014; 39:193-200. [PMID: 24557861 DOI: 10.1007/s10840-014-9874-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/21/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). The SmartTouch catheter (STc) provides information about catheter tip to tissue contact force (CF). The Surround Flow catheter (SFc) provides a uniform cooling of the tip during ablation. We sought to analyze the impact of STc and SFc on CA of paroxysmal AF in terms of feasibility and acute efficacy. METHODS AND RESULTS Sixty-three patients (mean age 57.6 ± 9.8 years, 53 males) with paroxysmal AF underwent pulmonary veins (PVs) antral isolation, by using standard ThermoCool catheter (TCc) in 21, STc in 21, and SFc in 21. Total procedural, fluoroscopy, and radiofrequency (RF) delivery times; percentage of persistently deconnected PVs after 30 min; and percentage of isolated PVs at the end of the procedure were measured. The use of both STc and SFc obtained a reduction of fluoroscopy time (TCc 34 ± 18 min, STc 20 ± 10 min, p < 0.001; SFc 21 ± 13 min, p = 0.02 vs TCc) and RF time (TCc 41 ± 13 min, STc 30 ± 14 min, p = 0.013; SFc 30 ± 9 min, p < 0.01 vs TCc). The use of STc resulted in a reduction of procedural time (TCc 181 ± 53 min, STc 140 ± 53 min, p < 0.001; SFc 170 ± 51 min, p = NS vs TCc). The percentage of isolated PVs was comparable between groups (TCc 96 % vs STc 98 % vs SFc 96 %; p = NS). The percentage of deconnected PVs at 30 min was lower in TCc (89 %) than in STc (95 %) and in SFc (95 %) group (p < 0.05). CONCLUSIONS Both STc and SFc allowed a simplification of CA of paroxysmal AF. In addition, they reduced early PVs reconnection. Sixty-three patients with paroxysmal AF underwent ablation by standard ThermoCool, SmartTouch, or Surround Flow catheter. Both the SmartTouch and the Surround Flow significantly reduced radiofrequency and fluoroscopy times, as well as pulmonary veins reconnection rate at 30 min. Moreover, the SmartTouch reduced overall duration of the procedure.
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Affiliation(s)
- Luigi Sciarra
- Cardiology Department, Policlinico Casilino, Rome, Italy
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Tilz RR, Makimoto H, Lin T, Rillig A, Metzner A, Mathew S, Deiss S, Wissner E, Rausch P, Kamioka M, Heeger C, Kuck KH, Ouyang F. In vivo left-ventricular contact force analysis: comparison of antegrade transseptal with retrograde transaortic mapping strategies and correlation of impedance and electrical amplitude with contact force. Europace 2014; 16:1387-95. [PMID: 24493339 PMCID: PMC4149607 DOI: 10.1093/europace/eut430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Clinical outcomes following radiofrequency ablation of ventricular tachycardias (VTs) depend on catheter tip-to-tissue contact force (CF). Left-ventricular (LV) mapping is performed via antegrade-transseptal or retrograde-transaortic approaches, and the applied CF may depend on the approach used. This study evaluated (i) the impact of antegrade-transseptal vs. retrograde-transaortic LV-mapping approaches on CF and catheter stability and (ii) the clinical value of the commonly used surrogate markers of catheter-myocardial contact-impedance, unipolar, and bipolar electrogram amplitudes. METHODS AND RESULTS An antegrade-transseptal and a retrograde-transaortic LV-mapping approach was performed in 10 patients undergoing VT ablation by using CF-sensing catheters. Operators were blinded to CF data and data were analysed according to 11 predefined LV segments. Three thousand three hundred and twenty-four mapping points (1577 antegrade, 1747 retrograde) were analysed, including 80 (2.4%) points with maximum CF > 100 g. Median antegrade and retrograde CF were 16.0 g (q1-q3; 8.4-26.2) and 15.3 g (9.8-23.4), respectively. Contact force was significantly higher antegradely in mid-anteroseptum, mid-lateral, and apical segments, and significantly higher retrogradely in basal-anteroseptum, basal-inferoseptum, basal-inferior, and basal-lateral segments. Contact force did correlate with impedance, unipolar, and bipolar electrogram amplitudes; however, there were large overlaps. CONCLUSIONS Antegrade vs. retrograde LV-mapping approaches result in different CF. A combined approach to the LV mapping may improve the overall LV mapping, potentially resulting in better clinical outcomes for the left VT catheter ablation. The previous surrogate markers used to assess CF do correlate with in vivo CF; however, due to a larger overlap, their clinical value is limited.
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Affiliation(s)
- Roland Richard Tilz
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Sebastian Deiss
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Erik Wissner
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Peter Rausch
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Masashi Kamioka
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Christian Heeger
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099 Hamburg, Germany
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Marijon E, Fazaa S, Narayanan K, Guy-Moyat B, Bouzeman A, Providencia R, Treguer F, Combes N, Bortone A, Boveda S, Combes S, Albenque JP. Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: procedural and 1-year results. J Cardiovasc Electrophysiol 2013; 25:130-7. [PMID: 24433324 DOI: 10.1111/jce.12303] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/29/2013] [Accepted: 09/23/2013] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The additional benefit of contact force (CF) technology during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) to improve mid-term clinical outcome is unclear. METHODS AND RESULTS Eligible patients with symptomatic paroxysmal AF were enrolled in this prospective trial, comparing circular antral catheter ablation (guided by Carto 3 System, Biosense Webster) using either a new open-irrigated CF catheter (SmartTouch Thermocool, Biosense Webster) (CF group) or a non-CF open-irrigated catheter (EZ Steer Thermocool, Biosense Webster) (control group). Overall, 30 patients were enrolled in each group, with a standardized 12-month follow-up, free of antiarrhythmic therapy. Demographic, cardiovascular and anatomic characteristics were similar in both groups. Though complete PVI was eventually achieved in all cases in both groups, success using an exclusive anatomic approach was 80.0% in CF group versus 36.7% in control group (P < 0.0001). CF use was associated with significant reductions in fluoroscopy exposure (P < 0.01) and radiofrequency time (P = 0.01). The incidence rates of AF recurrence were 10.5% (95% CI, 1.38-22.4) in the CF group, and 35.9% (95% CI, 12.4-59.4) in the control group (log rank test, P = 0.04). After adjustment on potential confounders, the use of CF catheter was found to be associated with a lower AF recurrence (OR 0.18, 95% CI 0.04-0.94, P = 0.04). CONCLUSION Our findings suggest a potential benefit of real-time CF sensing technology, in reducing AF recurrence during the first year after PVI.
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Affiliation(s)
- Eloi Marijon
- Clinique Pasteur, Département de Rythmologie, Toulouse, France; Paris Cardiovascular Research Center, Paris, France
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Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation. Clin Res Cardiol 2013; 103:97-106. [DOI: 10.1007/s00392-013-0625-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
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Stec S, Krynski T, Baran J, Kulakowski P. "Rescue" ablation of electrical storm in arrhythmogenic right ventricular cardiomyopathy in pregnancy. BMC Cardiovasc Disord 2013; 13:58. [PMID: 23937302 PMCID: PMC3751358 DOI: 10.1186/1471-2261-13-58] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/10/2013] [Indexed: 09/14/2024] Open
Abstract
Background Radiofrequency ablation (RFCA) became a treatment of choice in patients with recurrent ventricular tachycardia, ventricular fibrillation, and appropriate interventions of implanted cardioverter-defibrillator (ICD), however, electrical storm (ES) ablation in a pregnant woman has not yet been reported. Case presentation We describe a case of a successful rescue ablation of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week). The arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) was diagnosed 3 years earlier and several drugs as well as 2 ablations failed to control recurrences of ventricular tachycardia. RFCA was performed on the day of the third electric storm. The use of electroanatomic mapping allowed very low X-ray exposure, and after applications in the right ventricular outflow tract, arrhythmia disappeared. Three months after ablation, a healthy girl was delivered without any complications. During twelve-month follow-up there was no recurrence of ventricular tachycardia or ICD interventions. Conclusions This case documents the first successful RFCA during ES due to recurrent unstable ventricular arrhythmias in a patient with ARVD/C in pregnancy. Current guidelines recommend metoprolol, sotalol and intravenous amiodarone for prevention of recurrent ventricular tachycardia in pregnancy, however, RFCA should be considered as a therapeutic option in selected cases. The use of 3D navigating system and near zero X-ray approach is associated with minimal radiation exposure for mother and fetus as well as low risk of procedural complication.
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Affiliation(s)
- Sebastian Stec
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
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48
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Filgueiras-Rama D, Merino JL. The Future of Pulmonary Vein Isolation - Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation? Arrhythm Electrophysiol Rev 2013; 2:59-64. [PMID: 26835042 DOI: 10.15420/aer.2013.2.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pulmonary vein isolation is the main goal of atrial fibrillation (AF) ablation to date. Lack of isolation is associated with an increased risk of AF recurrences. Precise navigation to specific target sites, catheter stability and appropriate contact force are requisites for effective radiofrequency applications. Conventional manual-guided point-by-point radiofrequency energy delivery shows limitations to reach them, especially when performed by non-experienced electrophysiologists. New technological alternatives are rapidly arising and becoming clinically available to overcome some of the manual-guided radiofrequency delivery shortcomings. Here, we review the most recent clinical data, potential advantages, shortcomings and future directions of the new ablation strategies for pulmonary vein isolation.
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Affiliation(s)
| | - Jose L Merino
- Head of the Robotic Cardiac Electrophysiology and Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
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Eickholt C, Boring YC, Kelm M, Shin DI, Meyer C. Nonfluoroscopic Catheter Ablation of a Double-Loop Re-entry Tachycardia Guided by Real-Time Contact Force Information. Can J Cardiol 2013; 29:254.e9-254.e11. [DOI: 10.1016/j.cjca.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/12/2012] [Accepted: 05/13/2012] [Indexed: 10/28/2022] Open
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