scholarly journals 178 Catheter inversion during cavotricuspid isthmus catheter ablation: the new shaft visualization catheter reduces fluoroscopy use

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Nicolò Sisti ◽  
Amato Santoro ◽  
Claudia Baiocchi
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Linear Correlation ◽  
Procedure Time ◽  
Ablation Catheter ◽  
Anatomical Characteristics ◽  
Cavotricuspid Isthmus ◽  
Group 2 ◽  
Zero Fluoroscopy ◽  
Group 1

Abstract Aims Catheter ablation (CA) is the choice therapy of cavotricuspid isthmus (CTI) atrial flutter. The aim of this study was to describe our approach to improve the CTI ablation using a zero-fluoroscopy (ZF). The procedural difficulties could be related to anatomical characteristics of the CTI. Methods and results One hundred eighty-eight patients that performed CA of CTI were retrospectively and consecutively evaluated between 2017 and 2019. The studied population was divided into two groups. Eighty-eight patients who were undergone CA using ablation catheter without shaft visualization catheter (NSV) were Group 1. One hundred patients were undergone CA using ablation catheter with a shaft visualization (SV); they were Group 2. The catheter was looped at the Eustachian ridge after 200 s of radiofrequencies (RF) without elimination of local electrogram. A conduction line block of CTI was obtained in all patients of Group 2 using a ZF approach. In 16 patients of Group 1, the catheter inversion was obtained using fluoroscopy to avoid damages during its loop. In Group 2, a complete CTI block was obtained with a catheter inversion approach in 10 patients without fluoroscopy, visualizing the shaft and the tip of the ablation catheter on the electroanatomic (EAM) map. In the overall population studied the use of SV had a linear correlation with the ZF approach (r = 0.629; P < 0.001). The duration of RF was lower in Group 2 than in Group 1 (Group 1: 27.8 ± 6.3 vs. Group 2: 15.6 ± 7.2 min; P < 0.01). The procedure time between two groups was lower in Group 2 than in Group 1 (Group 1: 58.4 ± 22.4 vs. Group 2: 42.2 ± 15.7 min; P < 0.01). No differences between two groups were documented regarding success and complications. Conclusions The visualization of the shaft’s catheter on the EAM permitted the catheter inversion safely in order to overcome some complex CTI anatomy and obtain bidirectional block. The SV reduced procedure time, RF applications, and fluoroscopy exposition during CTI ablation.

P1446Cavo-tricuspid atrial flutter catheter ablation with a real zero fluoroscopic approach

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Santoro ◽  
C B Claudia Baiocchi ◽  
N S Nicolo Sisti ◽  
F F Francesca Falciani ◽  
S V Serafina Valente ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Real Zero ◽  
Line Length ◽  
P Value ◽  
Ablation Catheter ◽  
First Line Therapy ◽  
Group 2 ◽  
Zero Fluoroscopy ◽  
Group 1

Abstract Funding Acknowledgements none Background Catheter ablation(CA)is the first-line therapy of cavo-tricuspid isthmus(CTI)atrial flutter. Sometimes an inversion of ablation catheter is necessary to obtain a complete bidirectional line block. Purpose.The aim of this study was to describe this CA approach using electro-anatomical mapping(EAM)system with a zero-fluoroscopy(ZF)approach.Methods.Ninety-four patients that performed CA of CTI were retrospectively enrolled since 2017 to 2019.The studied population were divided in two groups.Group1(44patients) was composed of patients who underwent CA using ablation catheter without shaft visualization catheter(NSVC)on EAM.Group2(50patients)was composed of patients who underwent CA using ablation catheter with a shaft visualization(SVC). The catheter was looped at the Eustachian ridge after 200 seconds of RF without elimination of local electrogram. Results.ZF CTI ablation was obtained in all patients of group 2 without fluoroscopy use.In six patients of group 1, the catheter inversion was used to obtain a complete CTI block.In NSVC group, the catheter inversion was obtained using fluoroscopy to avoid damages during loop of catheter ablation.In overall population studied SVC had a linear correlation with ZF approach(β=0.629;p < 0.001). No differences were documented regarding acute and late success,complications.The procedural time between two groups was similar (Group1:83.4 ± 22.4 vs.Group2:80.2 ± 34.7minutes). The detailed results were summarize in table1. Conclusions.A real ZF catheter ablation of atrial flutter is safe and feasible.The use of SVC could improve the reproducibility of a successful zero-fluoroscopy CA.The visualization of the shaft’s catheter permit to invert the catheter safely to overcome anatomic complexity of some CTI without fluoroscopy use. detailed results Detailed results Group 1(44 CA) Group 2(50 CA) p value Procedure time (min) 83.4 ± 22.4 80.2 ± 34.7 NS AFL at begin CA (n.) 36 23 FT (min) 9.1 ± 9.8 0 ± 0 < 0.001 PWRF (W) 32 ±2.5 33.6 ±2.2 NS CA line length (mm) 28.1 ± 4.1 27.9 ± 5.5 NS Total RF (min) 27.8 ± 6.3 13.6 ± 7.2 < 0.01 SR during RF 35 23 Conductional block after 30 min 44 50 NS 6 months recurrences 1 1 NS AFL: atrial flutter; FT: fluoroscopy time; PWRF: power radiofrequencies; CA line length: length of line of radiofrequencies; RF: radiofrequencies; SR: sinus rhythm. Detailed results. Abstract Figure.

scholarly journals P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I A Minciuna ◽  
M Puiu ◽  
G Cismaru ◽  
S Istratoaie ◽  
G Simu ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Radiofrequency Catheter Ablation ◽  
Procedure Time ◽  
Total Procedure Time ◽  
The Mean ◽  
Group 2 ◽  
Total Procedure ◽  
Zero Fluoroscopy ◽  
Group 1

Abstract INTRODUCTION Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure. PURPOSE The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation. METHODS Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters. RESULTS Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded. CONCLUSIONS This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation. Abstract P338 Figure. ICE-guided transseptal puncture

Abstract 15328: Benefits of Prophylactic Pulmonary Vein Isolation in Reducing Future Risk of Atrial Fibrillation in Patients Undergoing Catheter Ablation for Typical Atrial Flutter: Results From a Randomized Trial (REDUCE AF)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
Prasant Mohanty ◽  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Randomized Study ◽  
Loop Recorder ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Group 2 ◽  
Group 1

Introduction: Catheter ablation of cavo-tricuspid isthmus (CTI) is considered to be the most effective therapy for eliminating target arrhythmia in lone atrial flutter (AFL). However, many patients subsequently develop AF after CTI ablation. Therefore, prophylactic pulmonary vein antrum isolation (PVAI) along with CTI ablation could be considered as an alternate option in these patients. We aimed to compare long-term incidence of post-ablation atrial fibrillation following CTI alone or CTI plus PVAI in patients presenting with isolated AFL and no history of atrial fibrillation. Methods: This multi-center prospective randomized study enrolled 216 patients undergoing catheter ablation for isolated typical atrial flutter. Patients were randomized to CTI alone (group 1, n=108, 61.2±9.7 year, 75% male, LVEF 59±10%) or combined ablation CTI+PVAI (group 2, n=108, 62.4±9.3 year, 73% male, LVEF 57±11%). Insertible Loop Recorder (ILR) was implanted in 21 and 19 patients from group 1 and 2 respectively, on the day of the ablation procedure. Remaining patients were monitored for recurrence with event recorders, ECG, 7-day Holter and cardiology evaluation. All patients were followed up for 18±6 months for recurrence. Results: Compared to group 1, group 2 had significantly longer average procedural duration (75.9±33 min vs. 161±48 min [p <0.001]) and fluoroscopy time (15.9±12.3 min vs 56.4+21 min [p<0.001]). At the end of 18±6 months follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank p=0.044). A subgroup analysis was performed with a 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI without undergoing the additional PVI (21 of 24 [83.3%] vs. 19 of 22 [86.4%] respectively, log-rank p=0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group compared to 58 of 86 (67.4%) with CTI+PVI (log-rank p= 0.029). Distribution of AF incidence was not different between patients with and without ILR. Conclusion: Prophylactic PVAI in lone atrial flutter caused marked reduction in new-onset AF in patients ≥ 55 years whereas younger patients (<55 years) did not incur any benefit from the additional procedure.

Clinical Experience with a Novel, Irrigated, Flexible Tip Ablation Catheter to Optimise Therapy Delivery

2010 ◽  
Vol 6 (3) ◽  
pp. 66 ◽  
Author(s):  
Carlo Pappone ◽  
Luigi Giannelli ◽  
Vincenzo Santinelli ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Experience ◽  
Accessory Pathway ◽  
Surrounding Tissue ◽  
Ablation Catheter ◽  
Innovative Design ◽  
Cavotricuspid Isthmus ◽  
Arrhythmogenic Substrate ◽  
Therapy Delivery

Innovative technologies are being developed to make current ablation procedures safer and easier. Sometimes conventional ablation catheters cannot easily adapt to anatomical targets, making radiofrequency applications challenging, time consuming or even ineffective. The Cool Flex is a novel, flexible and fully-irrigated tip catheter with an innovative design and various angular orientations to better adapt the ablation tip to the surrounding tissue. Here, peliminary experience with this new ablation catheter is reported in the treatment of different tachyarrhythmias, including slow and accessory pathway ablation, cavotricuspid isthmus-dependent atrial flutter and atrial fibrillation. One or two radiofreqency applications may be sufficient to eliminate the arrhythmogenic substrate in most patients without complications.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

Abstract 12571: Successful Catheter Ablation of Ventricular Tachycardia is Associated With Reduction of Mortality in Patients With Ventricular Tachycardia and Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Borislav Dinov ◽  
Arash Arya ◽  
Valentina Schirripa ◽  
Livio Bertagnolli ◽  
Lukas Fiedler ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Dilated Cardiomyopathy ◽  
Cardiac Mortality ◽  
Recurrence Rates ◽  
Success Group ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Group 2 ◽  
Reduction Of Mortality ◽  
Group 1

Introduction: Recent publications reported on higher recurrence rates and lack of survival benefit after catheter ablation (CA) of ventricular tachycardia (VT) in nonischemic dilated cardiomyopathy (NIDCM). Methods: We aimed to investigate the VT recurrence and cardiac mortality in patients with NIDCM ablated for VT. The studied cohort was divided in 2 groups depending on procedure success: complete success (group 1), and failure or incomplete success (group 2). Success definition was based on the VT inducibility after CA. The patients were prospectively followed for cardiac mortality and VT recurrence. Results: 104 patients with NIDCM (87 males, mean age 59.65 ± 14.69 years, mean ejection fraction 33.42 ± 11.42 %) underwent VT ablation. Ventricular stimulation after CA was not attempted in 13 (12.5%) patients. Out of the rest 91, complete success was achieved in 62 (68.1%) patients (group1), and incomplete success or failure in 29 (31.9%) patients (group 2). During 2-years follow-up, VT recurrence was observed in 56.5% in group 1 vs. 82.8% in group 2. Incomplete success was associated with higher VT recurrence (HR 1.91; 95% CI 1.13-3.22; p=0.015). The 2-years mortality was 14.5% in group 1 vs 34.5% in group 2. The probability for death was 3-times higher in group 2 (adjusted HR 3.18; 95% CI 1.18-8.56; p=0.022). The primary and secondary endpoints were comparable between patients with idiopathic, post-myocarditis and secondary NIDCM. Conclusion: Procedure success, defined as complete VT noninducibility after CA of VT, was associated with reduced VT recurrence and improved survival in patients with nonischemic dilated cardiomyopathy.

scholarly journals The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
YR Kim
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Volume Estimation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF). Methods We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein  anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration.  Results The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p &lt; 0.0001) but  LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1  (LA volume &lt; 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group  1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume &gt;160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045) Conclusion Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.

Abstract 15472: The Utility of Isoproterenol Testing in Pediatric Patients Following Atrioventricular Nodal Reentry Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tahmina Samad ◽  
Eric S Silver ◽  
Leonardo Liberman
Keyword(s):  
Catheter Ablation ◽  
Pediatric Patients ◽  
Common Mechanism ◽  
Slow Pathway ◽  
Significant Cost ◽  
Prior Use ◽  
Acute Success ◽  
Group 2 ◽  
Procedural Success ◽  
Group 1

Intro: AVNRT is a common mechanism of SVT in pediatric patients. Catecholamines such as isoproterenol (ISO) are routinely given during post ablation (ABL) testing to confirm acute success. In light of its recent significant cost increase, the aim of our study was to determine if ISO is necessary in all pediatric patients after AVNRT ablation to ensure acute procedural success. Method: Retrospective study of patients <21 years with AVNRT from 1/06-12/18 who had undergone catheter ablation. We excluded patients with congenital heart disease (CHD), prior ABL, without inducible tachycardia (presumed AVNRT), unsuccessful ABL and those who required ISO to induce tachycardia (TACHY) prior to ABL lesions. All patients were tested after ABL without ISO and if AVNRT was not induced they were retested while on ISO. Result: We identified 232 patients with AVNRT of whom 65 (28%) met the study criteria; 123 (53%) were excluded for requiring ISO to induce AVNRT prior to ABL, 23 (10%) for CHD, 12 (5%) with presumed AVNRT and 9 (4%) with an unsuccessful ABL. The average age was 14.4 yrs (±3.5) and 54% were female. All patients received anesthesia, 40/65 were intubated (62%). Evidence of slow pathway conduction (Spath) (AH jump with atrial extrastimulus testing, presence of AV nodal echo beats or PR>RR) was seen in 35/65 patients (54%). Patients were divided into 2 groups: group 1 (n= 57, 88%) consisted of patients without inducible TACHY post ABL while receiving ISO, group 2 (n = 8, 12%) of patients in whom TACHY was inducible with ISO thus required further ABL. There was no difference between the groups with regards to sex, age, intubation status, prior use of antiarrhythmic meds, or in the incidence of Spath (31/57, 54% vs. 4/8, 50%, p=1). Four of the 8 patients in group 2 with no evidence of Spath had inducible TACHY with ISO. Conclusion: We found that 12% of pediatric patients who did not require ISO to induce AVNRT prior to ABL had inducible TACHY only with ISO after AVNRT ABL. Presence of dual AV nodal physiology after ABL lesions did not predict inducibility of AVNRT on ISO, and 50% of the patients with no evidence of slow pathway conduction by conventional testing had inducible AVNRT with ISO. ISO testing is useful in all pediatric patients to test for inducibility following catheter ablation of AVNRT.

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