Efficacy of the optimal ablation index–targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results

2019 ◽  
Vol 55 (2) ◽  
pp. 171-181 ◽  
Author(s):  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Eui-Jae Lee ◽  
Won-Seok Choe ◽  
Myung-Jin Cha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Ablation Index ◽  
Study Results

scholarly journals The role of ablation index-guided pulmonary vein isolation in high-sensitivity TrThe role of ablation index-guided pulmonary vein isolation in high-sensitivoponin I and atrial fibrillation recurrence

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D De Campos ◽  
L Puga ◽  
P Sousa ◽  
N Antonio ◽  
L Elvas
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
High Sensitivity ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ablation Index

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ablation Index (AI) software has been associated with better freedom from atrial arrhythmias after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). There is conflicting data regarding the relationship between high sensitivity cardiac Troponin I (Hs-cTnI) and arrhythmia recurrence. The objective was to evaluate the impact of AI on Hs-cTnI level and on ablation effectiveness quotient (AEQ) and to assess if these markers are predictors of arrhythmia recurrence.  Methods Prospective observational study of consecutive patients referred for PVI for paroxysmal AF ablation from October 2017 to June 2018 according to a pre-specified AI protocol. Procedural endpoints and 2-year follow-up outcomes were assessed and compared to a retrospective cohort of conventional PVI contact-force-guided group .  Results A total of 56 patients were included: 29 patients the AI group and 27 patients in the control group. The mean age was 60.5 ± 10.3 years, 48% males. Left ventricular ejection fraction (60 ± 6 % AI vs 61 ± 5 % control, P = 0.07) and left atrium diameter (43 ± 7 mm AI vs 44 ± 6 mm control, P = 0.58) were comparable between groups. First-pass isolation was shown to be higher in the AI group (79% AI vs 44%, p= 0.01). Mean number of radiofrequency applications was lower in the AI group (93 ± 24 vs 111 ± 30, P = 0.02). Average contact-force was similar between groups (17.6 ± 4.1 g vs 22.6 ± 10.7 g, P =0.166). Patients that performed PVI guided by the AI had lower Hs-cTnI (1815 ± 1146 ng/L vs 3274 ± 1696 ng/L, p < 0.001) and lower AEQ (1.01 ± 0.7 ng/L/s vs 1.51 ± 0.7 ng/L/s, P = 0.011) compared to patients in the control group. During a mean follow-up of 26 ± 11 months, AF recurrence was documented in 10.3% of patients in the AI group and 22.2% in the control group (P = 0.223). Neither Hs-cTnI nor AEQ levels were predictors of arrhythmia recurrence.  Conclusions These data suggest that AI-guided catheter ablation is associated with reduced levels of of Hs-cTnI and AEQ. Neither Hs-cTnI and AEQ should be used to predict arrhythmia recurrence. Abstract Figure.

scholarly journals Renal arteries denervation: from the treatment of resistant hypertension to the treatment of atrial fibrillation

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E177-E183
Author(s):  
Francesco Versaci ◽  
Sebastiano Sciarretta ◽  
Massimiliano Scappaticci ◽  
Riccardo Di Pietro ◽  
Simone Calcagno ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antihypertensive Drugs ◽  
Reduce Blood Pressure ◽  
Antiarrhythmic Effect ◽  
Uncontrolled Hypertension ◽  
Study Results ◽  
Opening Up

Abstract Renal denervation (RDN) is a therapeutic strategy for patients with uncontrolled arterial hypertension characterized by considerable fluctuations during its progression. After initial strong enthusiasm, the procedure came to an abrupt halt following the publication of the Symplicity HTN-3 study results. The results of recently published studies highlight the reduction in blood pressure values after RDN and justify the inclusion in the Guidelines of new recommendations for the use of RDN in clinical practice, in selected patients. Additionally, RDN findings are summarized in view of other potential indications such as atrial fibrillation. Six prospective, randomized studies are presented that evaluated RDN as an adjunct therapy to pulmonary vein isolation for the treatment of atrial fibrillation. In five studies, patients had uncontrolled hypertension despite therapy with three antihypertensive drugs. The analysis of these studies showed that RDN reduced the recurrence of atrial fibrillation (AF) by 57% compared to patients with pulmonary vein isolation (PVI) only. Modulation of the autonomic nervous system by RDN has been shown not only to reduce blood pressure but also to have an antiarrhythmic effect in symptomatic AF patients when the strategy is combined with PVI, thus opening up new therapeutic scenarios.

Pulmonary vein isolation using ablation index vs. CLOSE protocol with a surround flow ablation catheter

EP Europace ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Benjamin Berte ◽  
Gabriella Hilfiker ◽  
Federico Moccetti ◽  
Thomas Schefer ◽  
Vanessa Weberndörfer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Atrial Tachycardia ◽  
Ablation Catheter ◽  
Ablation Index ◽  
First Pass ◽  
Procedure Duration

Abstract Aims Pulmonary vein isolation (PVI) using ablation index (AI) incorporates stability, contact force (CF), time, and power. The CLOSE protocol combines AI and ≤6 mm interlesion distance. Safety concerns are raised about surround flow ablation catheters (STSF). To compare safety and effectiveness of an atrial fibrillation (AF) ablation strategy using AI vs. CLOSE protocol using STSF. Methods and results First cluster was treated using AI and second cluster using CLOSE. Procedural data, safety, and recurrence of any atrial tachycardia (AT) or AF >30 s were collected prospectively. All Classes 1c and III anti-arrhythmic drugs (AAD) were stopped after the blanking period. In total, all 215 consecutive patients [AI: 121 (paroxysmal: n = 97), CLOSE: n = 94 (paroxysmal: n = 74)] were included. Pulmonary vein isolation was reached in all in similar procedure duration (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) and similar radiofrequency time (CLOSE: 36 ± 11 vs. AI: 37 ± 8 min; P = 0.4) but first pass isolation was higher in CLOSE vs. AI [left veins: 90% vs. 80%; P < 0.05 and right veins: 84% vs. 73%; P < 0.05]. Twelve-month off-AAD freedom of AF/AT was higher in CLOSE vs. AI [79% (paroxysmal: 85%) vs. 64% (paroxysmal: 68%); P < 0.05]. Only four patients (2%) without recurrence were on AAD during follow-up. Major complications were similar (CLOSE: 2.1% vs. AI: 2.5%; P = 0.87). Conclusion The CLOSE protocol is more effective than a PVI approach solely using AI, especially in paroxysmal AF. In this off-AAD study, 79% of patients were free from AF/AT during 12-month follow-up. The STSF catheter appears to be safe using conventional CLOSE targets.

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