scholarly journals B-AB06-02 PULSED FIELD ABLATION TRAINS REDUCE TISSUE IMPEDANCE IN PATIENTS UNDERGOING PULMONARY VEIN ISOLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S10
Author(s):  
Kuldeep Bharat Shah ◽  
Nishaki Mehta ◽  
Ilana B. Kutinsky ◽  
Mark T. Stewart ◽  
Atul Verma ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Tissue Impedance ◽  
Pulsed Field

Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Di Cori ◽  
L Segreti ◽  
G Zucchelli ◽  
S Viani ◽  
F Tarasco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Vascular Complications ◽  
Lesion Formation ◽  
Tissue Impedance ◽  
Af Ablation ◽  
Group 2 ◽  
Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

Validation of a Multipolar Pulsed-Field Ablation Catheter for Endpoint Assessment in Pulmonary Vein Isolation Procedures

2021 ◽  
Author(s):  
Thomas Kueffer ◽  
Samuel Baldinger ◽  
Helge Servatius ◽  
Antonio Madaffari ◽  
Jens Seiler ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Ablation Catheter ◽  
Pulsed Field

scholarly journals Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Jacob S. Koruth ◽  
Kenji Kuroki ◽  
Iwanari Kawamura ◽  
William C. Stoffregen ◽  
Srinivas R. Dukkipati ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Pulsed Field

scholarly journals B-PO05-088 SINGLE-SHOT LATTICE TIP CATHETER FOR PULMONARY VEIN ISOLATION WITH PULSED FIELD ABLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S407
Author(s):  
Elad Anter ◽  
Hagai Yavin ◽  
Koji Higuchi ◽  
David Biton ◽  
Jakub Sroubek ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Single Shot ◽  
Pulsed Field

scholarly journals First-in-Human Experience and Acute Procedural Outcomes Using a Novel Pulsed Field Ablation System: The PULSED AF Pilot Trial

2021 ◽  
Author(s):  
Atul Verma ◽  
Lucas Boersma ◽  
David E. Haines ◽  
Andrea Natale ◽  
Francis E. Marchlinski ◽  
...  
Keyword(s):  
Clinical Study ◽  
Adverse Events ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Pulmonary Veins ◽  
The United States ◽  
Esophageal Injury ◽  
Serious Adverse Events ◽  
Electrical Fields ◽  
Pulsed Field

Background: Pulsed field ablation (PFA) is a novel form of ablation using electrical fields to ablate cardiac tissue. There are only limited data assessing the feasibility and safety of this type of ablation in humans. Methods: PULSED AF (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF; https://www.clinicaltrials.gov ; unique identifier: NCT04198701) is a nonrandomized, prospective, multicenter, global, premarket clinical study. The first-in-human pilot phase evaluated the feasibility and efficacy of pulmonary vein isolation using a novel PFA system delivering bipolar, biphasic electrical fields through a circular multielectrode array catheter (PulseSelect; Medtronic, Inc). Thirty-eight patients with paroxysmal or persistent atrial fibrillation were treated in 6 centers in Australia, Canada, the United States, and the Netherlands. The primary outcomes were ability to achieve acute pulmonary vein isolation intraprocedurally and safety at 30 days. Results: Acute electrical isolation was achieved in 100% of pulmonary veins (n=152) in the 38 patients. Skin-to-skin procedure time was 160±91 minutes, left atrial dwell time was 82±35 minutes, and fluoroscopy time was 28±9 minutes. No serious adverse events related to the PFA system occurred in the 30-day follow-up including phrenic nerve injury, esophageal injury, stroke, or death. Conclusions: In this first-in-human clinical study, 100% pulmonary vein isolation was achieved using only PFA with no PFA system–related serious adverse events.

scholarly journals Does pulsed field ablation regress over time? A quantitative temporal analysis of pulmonary vein isolation

Heart Rhythm ◽  
2021 ◽  
Author(s):  
Iwanari Kawamura ◽  
Petr Neuzil ◽  
Poojita Shrivamurthy ◽  
Jan Petru ◽  
Moritoshi Funasako ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Temporal Analysis ◽  
Pulsed Field ◽  
Over Time

scholarly journals Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation

2019 ◽  
Vol 74 (3) ◽  
pp. 315-326 ◽  
Author(s):  
Vivek Y. Reddy ◽  
Petr Neuzil ◽  
Jacob S. Koruth ◽  
Jan Petru ◽  
Moritoshi Funosako ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Pulsed Field

scholarly journals Lattice-Tip Focal Ablation Catheter That Toggles Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Vivek Y. Reddy ◽  
Elad Anter ◽  
Gediminas Rackauskas ◽  
Petr Peichl ◽  
Jacob S. Koruth ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Diffusion Weighted Imaging ◽  
Persistent Atrial Fibrillation ◽  
Ablation Catheter ◽  
Pulsed Field ◽  
Linear Lesions ◽  
Fluid Attenuated Inversion Recovery

Background: The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters have been shown capable of performing pulmonary vein isolation, but not flexible lesion sets such as linear lesions. A novel lattice-tip ablation catheter with a compressible 9-mm nitinol tip is able to deliver either focal radiofrequency ablation or PFA lesions, each in 2 to 5 s. Methods: In a 3-center, single-arm, first-in-human trial, the 7.5F lattice catheter was used with a custom mapping system to treat paroxysmal or persistent atrial fibrillation. Toggling between energy sources, point-by-point pulmonary vein encirclement was performed using biphasic PFA posteriorly and either temperature-controlled irrigated radiofrequency ablation or PFA anteriorly (RF/PF or PF/PF, respectively). Linear lesions were created using either PFA or radiofrequency ablation. Results: The 76-patient cohort included 55 paroxysmal and 21 persistent atrial fibrillation patients undergoing either RF/PF (40 patients) or PF/PF (36 patients) ablation. The pulmonary vein isolation therapy duration time (transpiring from first to last lesion) was 22.6±8.3 min/patient, with a mean of 50.1 RF/PF lesions/patient. Linear lesions included 14 mitral (4 RF/2 RF+PF/8 PF), 34 left atrium roof (12 RF/22 PF), and 44 cavotricuspid isthmus (36 RF/8 PF) lines, with therapy duration times of 5.1±3.5, 1.8±2.3, and 2.4±2.1 min/patient, respectively. All lesion sets were acutely successful, using 4.7±3.5 minutes of fluoroscopy. There were no device-related complications, including no strokes. Postprocedure esophagogastroduodenoscopy revealed minor mucosal thermal injury in 2 of 36 RF/PF and 0 of 24 PF/PF patients. Postprocedure brain magnetic resonance imaging revealed diffusion-weighted imaging+/fluid-attenuated inversion recovery- and diffusion-weighted imaging+/fluid-attenuated inversion recovery+ asymptomatic lesions in 5 and 3 of 51 patients, respectively. Conclusions: A novel lattice-tip catheter could safely and rapidly ablate atrial fibrillation using either a combined RF/PF approach (capitalizing on the safety of PFA and the years of experience with radiofrequency energy) or an entirely PF approach. Registration: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT04141007 and NCT04194307.

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