Simple periprocedural precautions to reduce Doppler microembolic signals during AF ablation

Abstract Background Doppler microembolic signals (MES) occur during atrial fibrillation ablation despite of permanent flushed transseptal sheaths, frequent controls of periprocedural coagulation status and the use of irrigated ablation catheters Purpose To investigate the number and type of MES depending on the procedure time, prespecified procedure steps, the activated clotting time (ACT) during the ablation procedure and the catheter contact force. Methods In a prospective trial, 53 consecutive atrial fibrillation patients underwent pulmonary vein isolation by super-irrigated “point-by-point” ablation. All patients underwent a periinterventional, continuous transcranial Doppler examination (TCD) of the bilateral middle cerebral arteries during the complete ablation procedure. Results An average of 686±226 microembolic signals were detected by permanent transcranial Doppler. Thereby, 569±208 signals were differentiated as gaseous and 117±31 as solid MES. The number of MES with regard to defined procedure steps were as follows: gaseous: [transseptal puncture, 26 ± 28; sheath flushing, 24±12; catheter change, 21±11; angiography, 101±28; mapping, 9±9; ablation, 439±192; protamine administration, 0±0]; solid: [transseptal puncture, 8±8; sheath flushing, 9±5; catheter replacement, 6±6; angiography, not measurable; mapping, 2±5; ablation, 41±22; protamine administration, 0±0]. Significantly less MES occurred with shorter procedure time, higher ACT and the use of tissue contact force monitoring. Conclusion The current study demonstrates that during atrial fibrillation ablation using irrigated, “point-by-point” RF ablation, masses of microembolic signals are detected in transcranial ultrasound especially in the period of RF current application. The number of MES depends on the total procedure time and the reached ACT during ablation. The use of contact force monitoring might reduce MES during RF ablation.

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P371Impact of contact force sensing ablation catheter on atrial fibrillation ablation procedure

EP Europace ◽

10.1093/ehjci/eux141.097 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii70-iii70

Author(s):

C. Arantes ◽

N. Cortez-Dias ◽

J. Agostinho ◽

IS. Goncalves ◽

G. Lima Da Silva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Atrial Fibrillation Ablation ◽

Force Sensing ◽

Ablation Catheter ◽

Ablation Procedure

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Predictive Value of Thromboembolic Risk Scores Before an Atrial Fibrillation Ablation Procedure: Time for a Consensus?

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.12137 ◽

2013 ◽

Vol 24 (5) ◽

pp. E8-E8 ◽

Cited By ~ 1

Author(s):

MOISÉS RODRÍGUEZ-MAÑERO ◽

LUIS MARTÍNEZ-SANDE ◽

JOSÉ RAMÓN GONZÁLEZ-JUANATEY

Keyword(s):

Atrial Fibrillation ◽

Predictive Value ◽

Atrial Fibrillation Ablation ◽

Risk Scores ◽

Procedure Time ◽

Ablation Procedure ◽

Thromboembolic Risk

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Second-generation cryoballoon versus contact force radiofrequency ablation for atrial fibrillation: an updated meta-analysis of evidence from randomized controlled trials

Scientific Reports ◽

10.1038/s41598-021-96820-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chenxia Wu ◽

Xinyi Li ◽

Zhengtian Lv ◽

Qian Chen ◽

Yang Lou ◽

...

Keyword(s):

Atrial Fibrillation ◽

Randomized Controlled Trials ◽

Contact Force ◽

Second Generation ◽

Meta Analysis ◽

Fluoroscopy Time ◽

Controlled Trials ◽

Rf Ablation ◽

Procedure Time ◽

Randomized Controlled

AbstractCatheter ablation has been recommended for patients with symptomatic atrial fibrillation (AF), with pulmonary vein isolation being the cornerstone of the ablation procedure. Newly developed technologies, such as cryoballoon ablation with a second-generation cryoballoon (CB2) and the contact force radiofrequency (CF-RF) ablation, have been introduced in recent years to overcome the shortcomings of the widely used RF ablation approach. However, high-quality results comparing CB2 and CF-RF remain controversial. Thus, we conducted this meta-analysis to assess the efficacy and safety between CB2 and CF-RF using evidence from randomized controlled trials (RCTs). Databases including Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov were systematically searched from their date of inception to January 2021. Only RCTs that met the inclusion criteria were included for analysis. The primary outcome of interest was freedom from atrial tachyarrhythmia (AT) during follow-up. Secondary outcomes included procedure-related complications, procedure time and fluoroscopy time. Six RCTs with a total of 987 patients were finally enrolled. No significant differences were found between CB2 and CF-RF in terms of freedom from AT (relative risk [RR] = 1.03, 95% confidence interval [CI] 0.92–1.14, p = 0.616) or total procedural-related complications (RR = 1.25, 95% CI 0.69–2.27, p = 0.457). CB2 treatment was associated with a significantly higher risk of phrenic nerve palsy (PNP) than CF-RF (RR = 4.93, 95% CI 1.12–21.73, p = 0.035). The occurrences of pericardial effusion/tamponade and vascular complications were comparable between the CB2 and CF-RF treatments (RR = 0.41, p = 0.398; RR = 0.82, p = 0.632). In addition, CB2 treatment had a significantly shorter procedure time than CF-RF (weighted mean difference [WMD] = − 20.75 min, 95% CI − 25.44 ~ − 16.05 min, P < 0.001), whereas no difference was found in terms of fluoroscopy time (WMD = 4.63 min, p = 0.179). CB2 and CF-RF treatment are comparable for AF patients regarding freedom from AT and procedure-related complications. Compared to CF-RF, CB2 treatment was associated with a shorter procedure time but a higher incidence of PNP. Further large-scale studies are warranted to compare these two techniques and provide an up-to-date recommendation.

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Comparison of Contact-force Monitoring Irrigated Tip Catheter and Mesh-like Irrigated Tip Catheter in Atrial Fibrillation Ablation: Prospective Randomized Trial (COMMIC Trial)

Case Medical Research ◽

10.31525/ct1-nct04264117 ◽

2020 ◽

Author(s):

Keyword(s):

Atrial Fibrillation ◽

Randomized Trial ◽

Contact Force ◽

Atrial Fibrillation Ablation ◽

Prospective Randomized Trial ◽

Force Monitoring

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Catheter-related complications and mortality of atrial fibrillation ablation following introduction of contact force-sensing technology

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2020-000058 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000058

Author(s):

Joseph G Akar ◽

James P Hummel ◽

Xiaoxi Yao ◽

Lindsey Sangaralingham ◽

Sanket Dhruva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Care ◽

Contact Force ◽

Emergency Department Visits ◽

Atrial Fibrillation Ablation ◽

Esophageal Injury ◽

Force Sensing ◽

Complication Rates ◽

Af Ablation ◽

Complications And Mortality

ObjectivesContact force-sensing catheters allow real-time catheter-tissue contact force monitoring during atrial fibrillation. These catheters were rapidly adopted into clinical practice following market introduction in 2014, but concerns have been raised regarding collateral damage such as esophageal injury. We sought to examine whether the introduction of force-sensing catheters was associated with a change in short-term and intermediate-term acute care use, complications and mortality following atrial fibrillation ablation.DesignRetrospective cohort analysis. We used inverse probability treatment weight matching to account for the differences in baseline characteristics between groups.SettingWe examined patients included in the OptumLabs Data Warehouse who underwent ablation for atrial fibrillation before (2011–2013) and after (2015–2017) the market introduction of contact force-sensing catheters.Main outcome measuresWe examined 30-day and 90-day rates of all-cause acute care use, including hospitalizations and emergency department visits, as well as death and hospitalization for catheter-related complications, including atrioesophageal fistula, pericarditis, cardiac tamponade/perforation and stroke/transient ischemic attack.ResultsOur sample included 3470 and 5772 patients who underwent atrial fibrillation (AF) ablation before and after market introduction of contact force-sensing catheters, respectively. Complication rates were low and did not differ between the two periods (p>0.10 for each outcome). The 30-day and 90-day mortality was 0.1% and 0.3%, respectively after market introduction and unchanged from prior to 2014. The 90-day rates of all-cause acute care use decreased, from 27.0% in 2011–2013 to 23.9% in 2015–2017 (p<0.001).ConclusionsAF ablation-related catheter complications and mortality are low and there has been no significant change following the introduction of force-sensing catheters.

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