Cryoablation vs. radiofrequency ablation of the atrioventricular node in patients with His-bundle pacing

EP Europace ◽  
2020 ◽  
Author(s):  
Alwin Zweerink ◽  
Elise Bakelants ◽  
Carine Stettler ◽  
Haran Burri
Keyword(s):  
Radiofrequency Ablation ◽  
Atrioventricular Node ◽  
Complete Loss ◽  
Success Rates ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Acute Success ◽  
Redo Procedure ◽  
Biplane Fluoroscopy

Abstract Aims Radiofrequency ablation (RFA) of the atrioventricular node (AVN) with His-bundle pacing (HBP) can cause rise in capture thresholds. Cryoablation (CRYO) may offer reversibility in case of threshold rise but has never been tested for AVN ablation in this setting. Our aim was to compare procedural characteristics and outcome of CRYO compared with RFA for AVN ablation in patients with HBP. Methods and results Forty-four patients with HBP underwent AVN ablation for an ‘ablate and pace’ indication. Cryoablation was performed in the first 22 patients and RFA in the following 22 patients. Procedural characteristics, success rates, and change in His capture thresholds were compared between groups. Distance from the ablation site to the His lead was measured using biplane fluoroscopy. Acute success was 100% with both strategies. Median procedural duration was significantly longer for CRYO {50 [interquartile range (IQR) 38–63] min} compared with RFA [36 (IQR, 30–41) min; P = 0.027]. An acute threshold rise of ≥1 V was observed in four CRYO (one complete loss of capture) and three RFA patients (P = 0.38), with all of the applications being within 6 mm of the His lead tip. During follow-up, nine patients had AVN re-conduction (six CRYO vs. three RFA; P = 0.58), but only four patients required a redo procedure (all CRYO; P = 0.09). Conclusion Cryoablation does not offer any advantage over RFA for AVN ablation in patients with HBP and tended to require more redo procedures. If possible, a distance of ≥6 mm should be maintained from the His lead tip to avoid a rise in capture thresholds.

304Cryoablation versus Radiofrequency Ablation of the Atrioventricular Node in Patients with His-bundle Pacing

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Zweerink ◽  
E Bakelants ◽  
C Stettler ◽  
H Burri
Keyword(s):  
Radiofrequency Ablation ◽  
Atrioventricular Node ◽  
P Value ◽  
Success Rates ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Total Procedure Time ◽  
Redo Procedure ◽  
Procedural Success ◽  
Transient Elevation

Abstract Background Atrioventricular node (AVN) ablation in the setting of His bundle pacing (HBP) may be challenging due to risk of compromising the function of the His lead. Cryoablation (CRYO) may offer theoretical advantages over conventional radiofrequency ablation (RFA), due to absence of shunting of current to the His lead, more discrete lesions, and potential reversibility in case of transient elevation of capture thresholds. However, CRYO has never been tested for AVN ablation in this setting. Purpose To compare procedural characteristics and outcome of CRYO compared to RFA for AVN ablation in patients with HBP. Methods Thirty-five patients (age 76 ± 8 yrs, 23% male) with HBP underwent AVN ablation for an "ablate and pace" indication. CRYO was performed in the first 22 pts and RFA in the following 13 pts. Procedure and fluoroscopy times, change in His threshold and success rates were compared between groups. Results The acute procedural success rate was 100% for both strategies without any major complications. There were no significant differences in procedure characteristics and outcome between CRYO and RFA, except for significantly shorter application times with RFA and a trend to more frequent reconduction and requirement for a redo procedure with CRYO (see table). All recurrences occurred within one month after ablation. Conclusion CRYO does not seem to offer any advantage over RFA for AVN ablation in patients with HBP, and does not avoid rise of His capture thresholds. Moreover, the recurrence rate may be higher with CRYO leading to more redo procedures. Table Parameter CRYO (22 pts) RFA (13 pts) P-value Total procedure time (min) 50 [38 - 63] 40 [33 - 53] 0.257 Fluoroscopy time (min) 5.0 [2.2 - 5.4] 3.5 [1.9 - 9.0] 0.578 Expo Rx (mcGy.cm2) 237 [110 - 525] 139 [65 - 721] 0.468 Number of applications (n) 6 [3 - 11] 4 [1 - 15] 0.371 Total application time (min) 17 [9 - 29] 3 [1 - 9] 0.001 His threshold pre-ablation (V) 1.63 [0.75 - 3.44] 0.75 [0.53 - 1.63] 0.180 His threshold post-ablation (V) 1.88 [0.75 - 3.81]* 1.25 [0.63 - 3.50] 0.389 His threshold change (V) 0.00 [0.00 - 0.31]* 0.00 [0.00 - 0.75] 0.933 His threshold rise ≥1 volt (n) 4 (18%)* 3 (23%) 0.726 Acute procedural success (n) 22 (100%) 13 (100%) 1.000 AV reconduction during follow-up (n) 5 (23%) 1 (8%) 0.254 AV reconduction needing redo procedure (n) 3 (14%) 0 0.146 Interquartile range is shown in square brackets. *one loss of capture.

scholarly journals Can atrioventricular node ablation be safely performed in patients with permanent His bundle pacing? Data from a multicentric registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Chaumont ◽  
N Auquier ◽  
A Mirolo ◽  
E Popescu ◽  
A Milhem ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Rate Control ◽  
Atrioventricular Node ◽  
Atrial Arrhythmia ◽  
Av Node ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Ventricular Lead ◽  
Qrs Duration

Abstract Introduction Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of HBP but there is still very limited data about the feasibility of AVNA after HBP. Purpose To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia. Methods We included in three hospitals between september 2017 and december 2019 all patients who underwent AVNA for non-controlled atrial arrhythmia after permanent His bundle pacing. No back-up right ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheter. Acute HBP threshold increase during AVNA was defined as a threshold elevation >1V. His bundle capture (HBC) thresholds were recorded at 3 months follow-up. Results AVNA after HBP lead implantation was performed in 45 patients. HBP and AVNA were performed simultaneously during the same procedure in 10. AVNA was successful in 32 of 45 patients (71%). Modulation of the AV node conduction was obtained in 7 patients (16%). The mean procedure duration was 42±24min, and mean fluoroscopy duration was 6.4±8min. A mean number of 7.7±9.9 RF applications (347±483 sec) were delivered to obtain complete / incomplete AV block. Acute HBC threshold increase occurred in 8 patients (18%) with return to baseline value at day 1 in 5 patients. There was no lead dislodgment during the AVNA procedures. Mean HBC threshold at implant was 1.26±[email protected] and slightly increased at 3 months follow-up (1.34±[email protected]). AV node re-conduction was observed in 5 patients (16% of the successful procedures) with a second successful ablation procedure in 4 patients. No ventricular lead revision was required during the follow-up period. The baseline native QRS duration was 102±21 ms and the paced QRS duration was 107±18 ms. Conclusion AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBC but seems technically difficult with significant AV nodal re-conduction rate. The presence of a back-up right ventricular lead could have changed our results and therefore would require further evaluation. Unipolar HBP after AV node ablation Funding Acknowledgement Type of funding source: None

Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii19-ii26
Author(s):  
Lan Su ◽  
Mengxing Cai ◽  
Shengjie Wu ◽  
Songjie Wang ◽  
Tiancheng Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrioventricular Node ◽  
Composite Endpoint ◽  
His Bundle ◽  
His Bundle Pacing ◽  
All Cause Mortality ◽  
Long Term Performance ◽  
Term Performance

Abstract Aims His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation has been demonstrated to be effective in patients with atrial fibrillation (AF) and heart failure (HF) during medium-term follow-up and there are limited data on the risk analysis of adverse prognosis in this population. In this study, we aimed to evaluate the long-term performance of HBP following AVN ablation in AF and HF. Methods and results From August 2012 to December 2017, consecutive AF patients with HF and narrow QRS who underwent AVN ablation and HBP were enrolled. The clinical and echocardiographic data, pacing parameters, all-cause mortality, and heart failure hospitalization (HFH) were tracked. A total of 94 patients were enrolled (age 70.1 ± 10.5 years; male 57.4%). Acute HBP were achieved in 89 (94.7%) patients with successful permanent HBP combined with AVN ablation in 81 (86.2%) patients. Left ventricular ejection fraction (LVEF) improved from 44.9 ± 14.9% at baseline to 57.6 ± 12.5% during a median follow-up of 3.0 (IQR: 2.0–4.4) years (P < 0.001). Heart failure hospitalization or all-cause mortality occurred in 21 (25.9%) patients. The LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥40 mmHg, or serum creatinine (Scr) ≥97 μmol/L at baseline was significantly associated with higher composite endpoint of HFH or death (P < 0.05). The His capture threshold was 1.0 ± 0.7 V/0.5 ms at implant and remained stable during follow-up. Conclusion His-bundle pacing combined with AVN ablation was effective in patients with AF and drug-refectory HF. High PASP, high Scr, or low LVEF at baseline was independent predictors of composite endpoint of all-cause mortality or HFH.

His-bundle pacing in CHF-patients with narrow QRS and chronic AF – an upgrade from single-chamber to dual-chamber ICD

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
A Zabek ◽  
K Boczar ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Short Period

Abstract   A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it does not contribute to the regularization of heart rate, which is crucial for proper treatment. Moreover, to avoid the deleterious effect of right ventricular pacing only minority of the patients with single chamber ICD get the appropriate, recommended dose of beta-blockers. The aim of our study was to assess the efficacy of direct His-bundle pacing in a population of patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD and atrial channel to perform the His-bundle pacing Methods The study population included 39 patients (37 men, 2 women) aged 67.2±9.3 years, with CHF and chronic AF implanted primarily with single chamber ICD with established pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during follow-up were presented in the table: During short period (3–6 months) of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The physiological pacing contributes to better pharmacotherapy. Funding Acknowledgement Type of funding source: None

Electrical characteristics of pacing different portions of the His bundle in bradycardia patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii27-ii35
Author(s):  
Yiran Hu ◽  
Min Gu ◽  
Wei Hua ◽  
Hongxia Niu ◽  
Hui Li ◽  
...  
Keyword(s):  
Wave Amplitude ◽  
Electrical Characteristics ◽  
Normal Range ◽  
Tricuspid Valve Regurgitation ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Pacing Mode ◽  
Echocardiographic Assessment ◽  
R Wave Amplitude

Abstract Aims His-bundle pacing (HBP) can be achieved in either atrial-side HBP (aHBP) or ventricular-side HBP (vHBP). The study compared the pacing parameters and electrophysiological characteristics between aHBP and vHBP in bradycardia patients. Methods and results Fifty patients undergoing HBP implantation assisted by visualization of the tricuspid valvular annulus (TVA) were enrolled. The HBP lead position was identified by TVA angiography. Twenty-five patients were assigned to undergo aHBP and compared with 25 patients who underwent vHBP primarily in a prospective and randomized fashion. Pacing parameters and echocardiography were routinely assessed at implant and 3-month follow-up. His-bundle pacing was successfully performed in 45 patients (90% success rate with 44.4% aHBP and 55.6% vHBP). The capture threshold was lower in vHBP than aHBP at implant (vHBP: 1.1 ± 0.5 vs. aHBP: 1.4 ± 0.4 V/1.0 ms, P = 0.014) and 3-month follow-up (vHBP: 0.8 ± 0.4 vs. aHBP: 1.7 ± 0.8 V/0.4 ms, P < 0.001). The R-wave amplitude was higher in vHBP than in aHBP at implant (vHBP: 4.5 ± 1.4 vs. aHBP: 2.0 ± 0.8 mV, P < 0.001) and at 3-month follow-up (vHBP: 4.4 ± 1.5 vs. aHBP: 1.8 ± 0.7 mV, P < 0.001). No procedure-related complications and aggravation of tricuspid valve regurgitation were observed in most patients and echocardiographic assessment of cardiac function remained in the normal range in all patients during the follow-up. Conclusion This study demonstrates that vHBP features a low and stable pacing capture threshold and high R-wave amplitude, suggesting better pacing mode management and battery longevity can be achieved by HBP in the ventricular side.

Abstract 16017: Mid-term Outcomes in Persistent and Long-standing Persistent Atrial Fibrillation Patients Undergoing Rotor Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Tamara Metz ◽  
Luigi Di Biase ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Statistical Difference ◽  
Antiarrhythmic Drugs ◽  
Prospective Observational Study ◽  
Persistent Atrial Fibrillation ◽  
Success Rates ◽  
Single Procedure ◽  
Acute Success ◽  
Multicenter Prospective Observational Study

Introduction: Focal impulse and rotor modulation (FIRM)-guided ablation targets localized sources that are thought to sustain AF. We sought to evaluate if acute success of FIRM-guided ablation in patients with non-paroxysmal AF influenced the mid-term ablation outcomes. Methods: This was a multicenter prospective observational study of persistent and LSP AF patients undergoing FIRM ablation in 3 centers. Patients with at least 2 months follow-up were included in the analysis. FIRM was performed alone or in addition to conventional ablation and rotors were ablated as confirmed by their absence during remapping. Acute success was defined as AF termination, organization or slowing 10%. Mid-term success was defined as freedom from AT/AF off antiarrhythmic drugs (AADs) and after a single procedure during the initial follow-up (excluding the 2-month blanking period). Results: A total of 43 patients were enrolled (mean age 62 ± 10; 91% persistent, 9% LSP). Rotors-only ablation was performed in 65% of patients, and in addition to conventional ablation in the remaining 35%. Overall, acute success was achieved in 33% of patients. During a mean follow-up of 5.5 ± 2.4 months, 35% of patients were free of AT/AF off AADs after a single procedure. When comparing patients who underwent rotors-only ablation with those who received additional conventional ablation, mid-term success rates were respectively 25% vs. 53% (P = NS). There was no statistical difference in SR maintenance between patients with and without acute success during FIRM ablation (29% vs. 38%, P = NS). Conclusion: FIRM-guided ablation in persistent and LSP AF was not effective in obtaining AF slowing/organization/termination during the procedure and in preventing mid-term AT/AF recurrences. Acute success did not impact the mid-term success rate.

Programming and follow-up of patients with His bundle pacing

2020 ◽  
Vol 31 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Elise Bakelants ◽  
Alwin Zweerink ◽  
Haran Burri
Keyword(s):  
His Bundle ◽  
His Bundle Pacing

Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins

2018 ◽  
Vol 34 (4) ◽  
pp. 278-283 ◽  
Author(s):  
Gary K Yang ◽  
Marina Parapini ◽  
Joel Gagnon ◽  
Jerry C Chen
Keyword(s):  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Treatment Success ◽  
Vancouver General Hospital ◽  
Wound Complications ◽  
Complication Rates ◽  
Success Rates

Objective To review clinical outcomes of varicose vein patients treated with cyanoacrylate embolization and radiofrequency ablation at our institution. Methods A retrospective review of patients who underwent cyanoacrylate embolization and radiofrequency ablation during a three-year period. Patient records were reviewed to assess demographics, location and severity of disease, treatment details and outcome at short- and mid-term follow-ups. Outcome parameters included treatment success and complications. Results Between January 2014 and December 2016, 335 patients with 476 veins were treated with either cyanoacrylate embolization (n = 148) or radiofrequency ablation (n = 328) at the Vancouver General Hospital Vascular Surgery Vein Clinic. The average age of patients were 57 ± 1 years with the majority being female (78%) and an average BMI of 24.8 ± 0.5. CEAP classes were 2 (49%), 3 (26%), 4a (22%) and >4b (3%). Of the veins treated with cyanoacrylate embolization, the vein types were as follows: 76% were great saphenous vein, 16% were small saphenous vein, 5% were anterior accessory great saphenous vein and 1.4% were perforator veins. The vein types for radiofrequency ablation were 88%, 9%, 3% and 0%, respectively. The average amount of cyanoacrylate embolization delivered for great saphenous vein treatment was 1.8 ± 0.1 ml with a treatment length of 43 ± 1 cm. Subgroup comparison was done for great saphenous vein segments. Treatment success was 100% in cyanoacrylate embolization and 99% in radiofrequency ablation. Superficial phlebitis was the most common complication noted at mid-term follow-up in 5% of cyanoacrylate embolization and 16% of radiofrequency ablation treatments (P < 0.05). One patient in each group had asymptomatic proximal thrombus extension treated with anticoagulation for 2–3 weeks. Three superficial infections from glue clumps were noted in the cyanoacrylate embolization group requiring excision and drainage. Five patients in the radiofrequency ablation group had persistent numbness and one wound complications at the access site. Conclusion Cyanoacrylate embolization offers equivalent success rates with lower mid-term complication rates as radiofrequency ablation.

scholarly journals Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow-Up

2020 ◽  
Vol 6 (7) ◽  
pp. 883-900 ◽  
Author(s):  
Haran Burri ◽  
Marek Jastrzebski ◽  
Pugazhendhi Vijayaraman
Keyword(s):  
His Bundle ◽  
His Bundle Pacing
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