scholarly journals Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Min Soo Cho ◽  
Jun Kim ◽  
Ungjeong Do ◽  
Minsoo Kim ◽  
Gi-Byoung Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Clinical Outcomes ◽  
Paroxysmal Atrial Fibrillation ◽  
Statistical Significance ◽  
Pulmonary Veins ◽  
Control Group ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Ablation Line

Abstract Background An automated tagging module (VISITAG™; Biosense Webster, Irvine, CA) allows objective demonstration of energy delivery. However, the effect of VISITAG™ on clinical outcomes remains unclear. This study evaluated (1) clinical outcome after AF ablation using VISITAG™ and (2) the prevalence of gaps in the ablation line. Methods This retrospective analysis included 157 consecutive patients (mean age, 56.7 years; 73.2% men) with paroxysmal atrial fibrillation who underwent successful PVI between 2013 and 2016. Outcomes after the index procedure were compared between those using the VISITAG™ module (VISITAG group, n = 62) and those not using it (control group, n = 95). The primary outcome was recurrence of AF or atrial tachycardia after a blanking period of 3 months. Results The VISITAG group showed significantly shorter overall procedure time (172.2 ± 37.6 min vs. 286.9 ± 66.7 min, P < 0.001), ablation time (49.8 ± 9.7 min vs. 82.8 ± 28.2 min, P < 0.001), and fluoroscopy time (11.8 ± 5.3 min vs. 34.2 ± 30.1 min, P < 0.001) compared with controls. The 1-year recurrence-free survival rate was not statistically different between the groups (70.8% in the VISITAG group vs. 79.2% in the control group, P = 0.189). Gaps in the VISITAG line were common in the both carina and left side pulmonary veins. Patients without gaps (≥ 5 mm) by the criteria emphasizing catheter stability (> 15 s, < 4 mm range, > 60% force over time, > 6 g contact force) showed higher recurrence-free survival rate compared with those with gaps (borderline statistical significance, 91.7% vs. 66.0%, P = 0.094). Conclusion Use of the VISITAG™ module significantly reduced procedure, ablation, and fluoroscopic times with a similar AF/AT recurrence rate compared with the conventional ablation. Clinical implications of minimizing gaps along the ablation line should be evaluated further in the future prospective studies.

scholarly journals Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Masaharu Masuda ◽  
Mitsutoshi Asai ◽  
Osamu Iida ◽  
Shin Okamoto ◽  
Takayuki Ishihara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Low Voltage ◽  
Strong Predictor ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Group B

Background The efficacy of low‐voltage‐area ( LVA ) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation ( AF ). Methods and Results VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVA s were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF ‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P =0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P =0.034) were longer in group B than group C. Patients with LVA s demonstrated lower AF ‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P <0.0001; C, 53%, P <0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF ‐recurrence‐free survival rate (group B versus C, P =0.67). Conclusions The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF . However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. Registration URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000023403.

Abstract 15927: Successful Pharmacological Cardioversion by Oral Amiodarone Therapy is Correlated With Favorable Post-Ablation Clinical Outcomes in Non-Paroxysmal Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kiyoshi Otomo ◽  
Kaname Takizawa ◽  
Naoto Inoue ◽  
Taiichiro Meguro
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Clinical Outcomes ◽  
Paroxysmal Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Amiodarone Therapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Pharmacological Cardioversion

Backgrounds: Catheter ablation (CA) for non-paroxysmal atrial fibrillation (AF)(non-PAF) is less successful in patients (pts) with highly remodeled atria. It is still controversial that how far CA should be indicated in non-PAF pts with highly remodeled atria. Impacts of successful pharmacological cardioversion of non-PAF by oral amiodarone (AMD) on post-CA clinical outcomes remain to be evaluated. Purposes: To assess efficacy of oral AMD and implications of successful cardioversion by AMD in advance to CA on post-CA clinical outcomes in non-PAF pts. Methods: In consecutive 418 non-PAF pts (age: 63±9 years, AF duration: 28±37 months, LA diameter: 44±5mm), oral AMD (300 mg/day for 2 weeks and 100 mg/day thereafter) was initiated at outpatient clinic one month prior to the initial CA procedure. Recurrence-free survival after last CA procedure was compared between those with successful pharmacological conversion to sinus rhythm, atrial flutter or atrial tachycardia by the time of the initial CA procedure (Group non-AF) and those without (Group AF) . Results: At the beginning of initial CA procedure, 79 pts were in sinus rhythm, 8 in typical atrial flutter, 3 in atrial tachycardia (Group non-AF: 90 pts (22%)) and the remaining 328 still in AF (Group AF: 78%) . During follow-up period of 287±204 days after last CA procedure (procedure number:1.6±0.7/pt, range: 1-4), 45 pts (11%) were followed up while taking AMD, whereas the other 373 pts (89%) without any antiarrhythmic drugs. Kaplan-Meier analysis revealed that recurrence-free survival after last CA procedure was significantly higher in Group non-AF than in Group AF (88 (98%) vs. 291 (89%) pts; p=0.02) . Group non-AF pts exhibited significantly shorter AF duration (9±9 (range: 1-46) vs. 33±41 months (range: 1-240): p<0.0001) and smaller LA diameter (42±5 (range: 28-54) vs. 44±5 mm (range: 31-61): p<0.0001) as compared with those in Group AF pts. Conclusions: Successful cardioversion by AMD in advance to CA was correlated with higher recurrence-free survival after last CA procedure. This simple criterion is helpful to find pts with less remodeled atria and good candidates for CA who will benefit from CA in non-PAF pts.

Expression profile of standard and variants forms of CD44 related to prostate cancer behavior

2015 ◽  
Vol 30 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Caio M. Moura ◽  
Jose Pontes ◽  
Sabrina T. Reis ◽  
Nayara I. Viana ◽  
Denis R. Morais ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Biochemical Recurrence ◽  
The Other ◽  
Control Group ◽  
Recurrence Free Survival ◽  
Cd44 Isoforms ◽  
Free Survival ◽  
Expression Levels

CD44 is a transmembrane glycoprotein and is regarded as a potential marker in various tumors. The aim of our study was to analyze the expression of the standard form of CD44 (CD44s) and its isoforms in localized prostate cancer (PCa), and to correlate these data with the classical prognostic factors and biochemical recurrence. Ninety-four surgical specimens were analyzed in this study. The expression levels of CD44s and all its 9 variants were analyzed by quantitative real time PCR (qRT-PCR). The control group consisted of 14 specimens from patients with benign prostatic hyperplasia. We correlated all the expression profiles with biochemical recurrence, as defined by a PSA >0.4 ng/mL in a mean follow-up period of 53.3 months. In PCa, CD44s was underexpressed and all the other isoforms were overexpressed. The mean expression level of most variants was higher in patients who had not recurred, and a higher expression of CD44v2 independently correlated with a better recurrence-free survival rate (p=0.045). This variant was also underexpressed in metastatic PCa cell lines. There was no correlation between the expression levels of any of the CD44 isoforms and the classical prognostic factors. We here demonstrated that PCa cases are characterized by a change in the expression of CD44, with a loss of CD44s and an overexpression of all the other CD44 variants. However, during cancer progression we found a loss of expression of all CD44 variants, and a correlation between higher expression of CD44v2 and a better recurrence-free survival rate. The understanding of the CD44 expression patterns in PCa could contribute to its use as a new prognostic marker.

Spontaneous Dissociated Firing from the Pulmonary Veins during Ablation of Paroxysmal Atrial Fibrillation: Implications and Impact on Arrhythmia-Free Survival

2013 ◽  
Vol 36 (8) ◽  
pp. 988-993 ◽  
Author(s):  
AYMAN A. HUSSEIN ◽  
ASUKA OZAKI ◽  
DAVID O. MARTIN ◽  
MANDEEP BHARGAVA ◽  
BRYAN BARANOWSKI ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Free Survival

scholarly journals Smart Touch Radiofrequency Catheter Ablation versus Cryoballoon Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

2020 ◽  
Vol 8 (B) ◽  
pp. 563-568
Author(s):  
Walid Shehata Hassan ◽  
Sherief Hamed Zaky ◽  
Khaled Hussein Mohamed ◽  
Moataz Mohammed Ibrahim
Keyword(s):  
Atrial Fibrillation ◽  
Complication Rate ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Medicine Department ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
Front Advance

AIM: Evaluation of the safety and efficacy of pulmonary veins isolation in patients with paroxysmal atrial fibrillation (AF) using two new different technologies, cryoballoon (CB) ablation and radiofrequency ablation with contact force (CF)-sensing catheters. METHODS: Prospective single-center evaluation, carried out from January 2016 to June 2018 in Critical Care Medicine Department – Cairo University, comparing CF radiofrequency (Thermocool® SmartTouch, Biosense Webster, Inc.) (CF group) with CB ablation (Arctic Front Advance 28 mm CB, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 50 consecutive patients were enrolled (25 in each group). RESULTS: The characteristics of patients of both the groups were similar (46.9 ± 11.2 years, the proportion of women 36%, mean documented AF duration 3 ± 2.3 years, mean CHA2DS2-VASc score 1.4 ± 1.3, and mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CB group (171.7 ± 15.24 vs. 199.3 ± 18.94 min, p = 0.002), with a longer duration of fluoroscopy and X-ray exposure in the CB group than the CF group but statistically non-significant difference (58.60 ± 11.57 vs. 48.7 ± 13.86 min and 6273 ± 4934 cGy cm² vs. 6853 ± 5069 cGy cm², p = 0.1 and p = 0.2, respectively). Overall complication rate was similar in both groups: 2 (8%) in each group. At 12 months, AF recurrence occurred in 7 patients (28%) in the CF group and in 9 patients (36%) in the CB group (log rank p = 0.682). CONCLUSION: Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 12 months with similar overall complication rate.

scholarly journals The impact of bronchial artery embolisation on the quality of life of patients with haemoptysis: a prospective observational study

2021 ◽  
Author(s):  
Naoki Omachi ◽  
Hideo Ishikawa ◽  
Masahiko Hara ◽  
Takashi Nishihara ◽  
Yu Yamaguchi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Survival Rate ◽  
Bronchial Artery ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Procedural Success ◽  
Bronchial Artery Embolisation ◽  
The Impact

Abstract Objectives Patients with haemoptysis often experience daily physical and mental impairment. Bronchial artery embolisation is among the first-line treatment options used worldwide; however, no evidence exists regarding the health-related quality of life (HRQoL) after bronchial artery embolisation. Therefore, this study aimed to evaluate the effects of bronchial artery embolisation on the HRQoL of patients with haemoptysis. Methods We prospectively enrolled 61 consecutive patients who visited our hospital from July 2017 to August 2018 and received bronchial artery embolisation for haemoptysis. The primary outcome was the HRQoL evaluated using the Short Form Health Survey, which contains physical and mental components, before and after bronchial artery embolisation. The secondary outcomes were procedural success, complications, and recurrence-free survival rate at 6 months. Results The mean age of the patients was 69 years (range, 31–87 years). The procedural success rate was 98%. No major complications occurred. The recurrence-free survival rate estimated using the Kaplan-Meier analysis at 6 months after bronchial artery embolisation was 91.8% (95% confidence interval, 91.1–92.5%). Compared with the pre-treatment scores, the physical and mental scores were significantly improved at 6 months after bronchial artery embolisation (p < 0.05). Conclusion Bronchial artery embolisation improved the HRQoL of patients with haemoptysis. Key Points • Bronchial artery embolisation improved the HRQoL of patients with haemoptysis. • Vessel dilation on computed tomography and systemic artery-pulmonary artery direct shunting on angiography were the most common abnormalities. • The recurrence-free survival rate estimated using the Kaplan-Meier analysis at 6 months after bronchial artery embolisation was 91.8%.

Clinical outcome of non-use of touch-up focal ablation catheters strategy during cryoballoon atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsunaga ◽  
Y Egami ◽  
M Yano ◽  
M Yamato ◽  
R Shutta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Pulmonary Veins ◽  
Conventional Group ◽  
Atrial Tachyarrhythmia ◽  
Free Survival ◽  
Af Ablation ◽  
Frequent Use ◽  
Class 1 ◽  
Focal Ablation

Abstract Background It has been reported that frequent use of touch-up focal ablation catheters was related to worse outcomes after cryoballoon (CB) atrial fibrillation (AF) ablation. It is unknown whether non-use of touch-up focal ablation catheters strategy affects the outcome of AF ablation. Therefore, this study aimed to assess whether non-use of touch-up focal ablation catheters strategy improve clinical outcome after AF ablation using CB. Methods A total of 151 consecutive patients who received CB ablation from February 2017 to August 2019 were enrolled. Non-use of a touch-up focal ablation catheters strategy was started from February 2018. Patients were divided into 2 groups according to the type of strategy. In the non-touch-up group, pulmonary veins were isolated without touch-up focal ablation catheters as much as possible and in conventional group, touch-up focal ablation catheters were used as required. The 1-year atrial tachyarrhythmia free survival without class 1 or 3 antiarrhythmic drugs after a 90-day blanking period was assessed between the 2 groups. Results The conventional group consisted of 76 patients and the non-touch-up group consisted of 75 patients. Baseline characteristics were comparable between 2 groups. Touch-up focal ablation catheters were used more in the conventional group (11 patients, 14%) than non-touch-up group (0 patients, 0%) (p&lt;0.001). Pulmonary isolation was achieved in all patients of both groups. Atrial tachyarrhythmia recurrence occurred more frequently in the non-touch-up group (15/75 patients, 20%) than conventional group (7/76 patients, 9%) (p=0.045). Conclusion Non-use of a touch-up focal ablation catheters strategy may be related to worse outcome after CB AF ablation. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document