P1428The outcome of atrial fibrillation ablation in patients undergoing radiofrequency ablation, guided by novel indices incorporating force, time and power

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Rattanakosit ◽  
K Franke ◽  
H Marshall ◽  
T Agbaedeng ◽  
P Sanders ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Contact Force ◽  
Lesion Size ◽  
Fluoroscopy Time ◽  
Procedure Time ◽  
Time Integral ◽  
Ablation Index ◽  
Force Time ◽  
Af Recurrence

Abstract Background Ablation index (AI) and Lesion Size Index (LSI) are novel parameters that incorporates contact force, time, and power in a weighted formula. Recent studies have shown that such indices predict lesion size and durability of pulmonary vein isolation (PVI). However, the outcomes of ablation guided by indices of force-time-power, such as PV reconnections and atrial fibrillation recurrence, have not been well characterised. Objectives To determine the association between indices of force-time-power and acute PV reconnections, procedure and fluoroscopy time and AF recurrence in patients undergoing radiofrequency PVI. Methods PUBMED and EMBASE were searched using the terms "catheter ablation" AND "Ablation index" OR "Contact force" OR "Force time integral" OR "lesion size" from inception through 22 May 2019. Studies reporting the procedure time, ablation time, fluoroscopy time, and incidence of AI acute and late reconnection and AF recurrence were included. Result  Six studies were included in this study with 530 patients, which n = 416 were paroxysmal AF and 114 non-paroxysmal AF. All procedural characteristics (procedure, radiofrequency, and fluoroscopy times) were similar between AI guided and non-AI guided ablation (p > 0.05). Two studies comparing mean PV reconnections in AI guided vs. AI Blinded. Two studies compared minimum AI in reconnected vs. non-reconnected PV segments. Acute PV segment reconnection was associated with a lower minimum AI vs. non-reconnection. In 3 studies reporting AI guided vs. AI blinded ablations, AI was associated with an increased freedom from AF after average follow-up of 12 months. Conclusions Radiofrequency ablation guided by AI/LSI was associated with lower acute PV reconnection rates and improved AF freedom after PVI. There was no difference in fluoroscopy, ablation or procedure time with the use of these novel parameters. Abstract Figure.

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

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.

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.

scholarly journals Ablation Index for Catheter Ablation of Atrial Fibrillation　― Clinical Applicability and Comparison With Force-Time Integral ―

2018 ◽  
Vol 82 (11) ◽  
pp. 2722-2727 ◽  
Author(s):  
Paula Münkler ◽  
Stefan Kröger ◽  
Spyridon Liosis ◽  
Amr Abdin ◽  
Evgeny Lyan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Integral ◽  
Clinical Applicability ◽  
Ablation Index ◽  
Force Time ◽  
Force Time Integral

Area Under the Real-Time Contact Force Curve (Force-Time Integral) Predicts Radiofrequency Lesion Size in an In Vitro Contractile Model

2010 ◽  
Vol 21 (9) ◽  
pp. 1038-1043 ◽  
Author(s):  
DIPEN C. SHAH ◽  
HENDRIK LAMBERT ◽  
HIROSHI NAKAGAWA ◽  
ARNE LANGENKAMP ◽  
NICOLAS AEBY ◽  
...  
Keyword(s):  
Real Time ◽  
Contact Force ◽  
Lesion Size ◽  
Force Curve ◽  
The Real ◽  
Time Integral ◽  
Radiofrequency Lesion ◽  
Force Time ◽  
Force Time Integral

scholarly journals Derivation and validation of a VISITAG™-guided contact force ablation protocol for pulmonary vein isolation

2017 ◽  
Author(s):  
David R. Tomlinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Stability Range ◽  
Time Integral ◽  
Long Term Follow Up ◽  
Force Time ◽  
Af Recurrence

AbstractAims Following radiofrequency (RF) pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence mediated by recovery of pulmonary vein (PV) conduction is common. I examined whether comparative VISITAG™ (Biosense Webster Inc.) data analysis at sites showing intra-procedural recovery of PV conduction versus acutely durable ablation could inform the derivation of a more effective VISITAG™-guided contact force (CF) PVI protocol.Methods and results Retrospective analysis of VISITAG™ Module annotated ablation site data in 10 consecutive patients undergoing CF-guided PVI without active VISITAG™ guidance. Employing 2mm positional stability range and lenient CF filter (force-over-time 10%, minimum 2g), inter-ablation site distance >10-12mm, adjacent 0g-minimum CF and short RF duration (3-5s) were associated with intra-procedural recovery of PV conduction. A VISITAG™-guided CF PVI protocol was derived employing ≤6mm inter-ablation site distances, minimum target ablation site duration ≥9s / force time integral (FTI) 100gs and 100% 1g-minimum CF filter. Seventy-two consecutive VISITAG™-guided CF PVI procedures were then undertaken using this protocol, with PVI achieved in all utilising 23.8[8.4] minutes total RF (30W, 48°C, 17ml/min, continuous RF application). Following protocol completion, acute intra-procedural spontaneous / dormant recovery of PV conduction requiring touch-up RF occurred in 1.4% / 1.8% of PVs, respectively. At 14[5] months’ follow-up in all 34 patients with paroxysmal AF ≥6 months’ post-ablation, 30 (88%) were free from atrial arrhythmia, off class I/III anti-arrhythmic medication.Conclusion VISITAG™ provides means to identify and then avoid factors associated with intra-procedural recovery of PV conduction. This VISITAG™ Module-guided CF PVI protocol demonstrated excellent intra-procedural and long-term efficacy.Condensed abstract Following CF-guided PVI, retrospective VISITAG™ Module analyses permitted the identification of ablation parameters associated with intra-procedural recovery of PV conduction. The derived VISITAG™ Module-guided CF PVI protocol employed short over RF duration yet proved efficient at achieving PVI acutely, with long-term follow-up demonstrating high clinical efficacy.

scholarly journals Contact force and force-time integral in atrial radiofrequency ablation predict transmurality of lesions

EP Europace ◽  
2014 ◽  
Vol 16 (5) ◽  
pp. 660-667 ◽  
Author(s):  
F. Squara ◽  
D. G. Latcu ◽  
Y. Massaad ◽  
M. Mahjoub ◽  
S.-S. Bun ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Contact Force ◽  
Time Integral ◽  
Force Time ◽  
Force Time Integral
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