scholarly journals High-power short-duration versus standard-power standard-duration settings for repeat atrial fibrillation ablation

2021 ◽  
Author(s):  
Joey Junarta ◽  
Sean J. Dikdan ◽  
Naman Upadhyay ◽  
Sairamya Bodempudi ◽  
Michael Y. Shvili ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Contact Force ◽  
High Power ◽  
Force Sensing ◽  
Standard Duration ◽  
Sinus Rhythm Maintenance ◽  
Power Standard

Abstract Introduction High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation. Methods We studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 and 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure. Results A total of 61 patients underwent repeat ablation (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p = 0.01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA2DS2-VASc score, or left ventricular ejection fraction. Conclusion We demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.

Abstract 15977: Comparison of Clinical and Procedural Outcomes Between High-power Short-duration, Standard-power Standard-duration, and Temperature-controlled Non-contact Force Guided Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sean J Dikdan ◽  
Joey Junarta ◽  
Sairamya Bodempudi ◽  
Naman Upadhyay ◽  
Zachary Pang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Clinical Outcomes ◽  
Contact Force ◽  
High Power ◽  
Pulmonary Veins ◽  
Standard Duration ◽  
Temperature Controlled ◽  
Sinus Rhythm Maintenance ◽  
Power Standard

Introduction: High-power short-duration (HPSD) ablation via the St. Jude EnSite™ Velocity™ system (St. Paul, MN) utilizes 50W delivered for up to 15s, guided by a Lesion Size Index of 5-6 specific to the Velocity™ system. HPSD is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Procedural and clinical outcomes of HPSD compared to standard-power standard-duration (SPSD; 20-25W until 400-500 gram seconds, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W up to 60s of ablation) settings would inform this strategy. Methods: We studied consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) with TCNC, SPSD, and HPSD between 7/1/13 to 11/1/19. Procedural data collected include total radiofrequency time (RFT), time to isolate the left pulmonary veins (LPVT), time to isolate the right pulmonary veins (RPVT), and safety outcomes. Clinical data collected include sinus rhythm maintenance 3 and 12-months post-procedure. Results: A total of 171 patients were studied (44 TCNC, 51 SPSD, 76 HPSD). There was no difference in age, sex, or AF type between groups. RFT was shorter when comparing HPSD to SPSD (71 vs 101 min; p<0.01), HPSD to TCNC (71 vs 146 min; p<0.01), and SPSD to TCNC groups (101 vs 146 min; p<0.01). This was driven by decreases in LPVT between the HPSD vs SPSD (34 vs 46 min; p=0.04), HPSD vs TCNC (34 vs 72 min; p<0.01), and SPSD vs TCNC groups (46 vs 72 min; p<0.01), as well as decreases in RPVT between the HPSD vs SPSD (42 vs 54 min; p=0.03), HPSD vs TCNC (42 vs 75 min; p<0.01), and SPSD vs TCNC groups (54 vs 75 min; p<0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA 2 DS 2 -VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06). Conclusion: AF ablation with contact force utilizing an HPSD ablation strategy reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC approaches. Further research is needed to determine whether clinical outcomes differ with a larger population and longer follow-up.

scholarly journals A novel local impedance algorithm and contact force sensing to guide high power short duration radiofrequency ablation is efficient and safe for circumferential pulmonary vein isolation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Schreieck ◽  
D Heinzmann ◽  
C Scheckenbach ◽  
M Gawaz ◽  
M Duckheim
Keyword(s):  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Contact Force ◽  
High Power ◽  
Force Sensing ◽  
The Novel ◽  
Rf Ablation ◽  
Af Ablation ◽  
Circumferential Pulmonary Vein Isolation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Local impedance (LI) drop can predict sufficient lesion formation during radiofrequency ablation (RF). Recently, a novel ablation catheter technology able to measure LI and contact force has been made available for clinical use. High power short duration (HPSD) RF ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure time. We used LI drop and plateau formation to guide duration of 50 Watt RF power applications for circumferential pulmonary vein isolation (PVI). Methods Consecutive patients with indication for de novo AF ablation (n = 32, age 65 ± 10 years) with paroxysmal (n = 16) or persistent (n = 16) AF underwent ultra high density 3D mapping of the left atrium and catheter ablation. Thereafter, ipsilateral PV encircling with 50 Watt RF-applications targeting an interlesion distance of ≤ 6mm and a contact force of 10-30g was performed. Duration of HPSD RF application between 7-15s was guided by impedance drop &gt;20 Ohm and plateau formation of LI. Further ablation strategy was left to the investigator’s discretion. Esophageal temperature measurement was performed using a three thermistor catheter with temperature cut off 39.0°C. In case of temperature rise or very near esophageal contact to the circumferential line, RF application time was shortened to 7s. Patients underwent adenosine testing after PVI. Previously we performed all types of AF ablation using an LI guided HPSD ablation without contact force measurement capability in 80 patients. Results Complete PVI was achieved in all pts with only 13.5 ± 4.3 min cumulative RF application duration and an ablation procedure duration of 46.5 ± 10.4 min with the novel LI measuring catheter. First-pass isolation of ipsilateral veins was achieved in 75% of circles. Recurrence of PV conduction during waiting period (20min) and adenosine testing occured in 25% of circles, and was reablated in most patients with a single spot of HPSD application. Using 94 ± 36 RF application per patient, mean maximum LI drop was 23.6 ± 4.0 Ohm. Reconnected fibers were associated with low LI drop due to instability of contact in most cases due to breathing in case of difficult sedation of the patients. No serious complications occurred in all 32 pts using HPSD with the novel contact force catheter design. Conclusion Guiding of HPSD RF ablation by LI is highly efficient and safe. A novel local impedance algorithm in combination with contact force sensing enable short PVI times with low early recurrence of PV conduction. Prediction of permanent lesions seems possible and the only limitation seems to be unstable RF catheter contact due patients breathing. Follow up have to be waited.

Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: A systematic review and meta-analysis

Heart Rhythm ◽  
2015 ◽  
Vol 12 (9) ◽  
pp. 1990-1996 ◽  
Author(s):  
Muhammad R. Afzal ◽  
Jawaria Chatta ◽  
Anweshan Samanta ◽  
Salman Waheed ◽  
Morteza Mahmoudi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Radiofrequency Ablation ◽  
Contact Force ◽  
Meta Analysis ◽  
Force Sensing ◽  
Sensing Technology

scholarly journals Procedural Patterns and Safety of Atrial Fibrillation Ablation

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Zak Loring ◽  
DaJuanicia N. Holmes ◽  
Roland A. Matsouaka ◽  
Anne B. Curtis ◽  
John D. Day ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
De Novo ◽  
Class I ◽  
Cryoballoon Ablation ◽  
Af Ablation ◽  
Life Threatening

Background: Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. Methods: A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ 2 and Wilcoxon rank-sum tests. Results: Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. Conclusions: More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.

High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation

Heart Rhythm ◽  
2020 ◽  
Vol 17 (8) ◽  
pp. 1223-1231 ◽  
Author(s):  
Roger A. Winkle ◽  
R. Hardwin Mead ◽  
Gregory Engel ◽  
Melissa H. Kong ◽  
Jonathan Salcedo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Short Duration ◽  
Contact Force ◽  
High Power ◽  
Posterior Wall ◽  
Force Sensing ◽  
Predictors Of Success

scholarly journals High-power short-duration radiofrequency ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Kassa ◽  
Z Nagy ◽  
B Kesoi ◽  
Z Som ◽  
C Foldesi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Short Duration ◽  
Contact Force ◽  
High Power ◽  
Posterior Wall ◽  
Pericardial Tamponade ◽  
Fluoroscopy Time ◽  
Control Group

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In recent times, high-power short-duration (HPSD) radiofrequency ablation (RFA) has emerged as an alternative strategy for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Purpose We aimed to compare HPSD approach and conventional, ablation-index (AI) guided PVI using contact force sensing ablation catheters in respect of efficacy, safety, procedural characteristics, and outcome. Methods A total of 184 consecutive AF patients with first PVI were enrolled (age: 60 ± 11 years, paroxysmal: 56.5%, persistent: 43.5%) between November 2016 and December 2019. An ablation protocol of 50W energy with 15-20 g contact force was used for a duration of 8-12 sec based on the loss of capture concept in the HPSD group (n = 91) meanwhile, PVI was achieved according to the conventional power settings (posterior wall 25W, AI: 400, anterior wall 35W, AI: 550 ) in the control group (n = 93). During 1-year follow-up, documented AF for more than 30 seconds was considered as recurrence. Results Radiofrequency time and procedural time were significantly shorter using HPSD ablation (26.0 ± 12.7 min vs. 42.9 ± 12.6 min, p &lt; 0.001, and 91 ± 30.1 min vs. 105.3 ± 28 min, p &lt; 0.001). The HPSD strategy significantly lowered fluoroscopy time and radiation dose (5.47 ± 4.07 min vs. 8.15 ± 10.04 min, p = 0.019, and 430.2 ± 534.06 cGycm2 vs. 604.2 ± 633.9 cGycm2, p = 0.046). The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 76.9% of patients free from AF compared to 66.7% in the control group (p = 0.037). No pericardial tamponade, periprocedural thromboembolic complication, or atrio-oesophageal fistula occurred in the HPSD group. We observed 2 pericardial tamponade and 1 periprocedural stroke in the control group. Conclusions HPSD RFA for AF was demonstrated to be safe, and lead to significantly improved 1-year outcome in our mixed patient population. HPSD protocol significantly shortened procedural and radiofrequency time with decreased fluoroscopy time and radiation exposure.

Sign in / Sign up

Export Citation Format

Share Document