scholarly journals Review of interventional electrophysiology in Bulgaria in 2019 and 2020: data from the electronic ablation registry BG-EPHY 

2021 ◽  
Vol 27 (3) ◽  
pp. 31-42
Author(s):  
Tchavdar Shalganov ◽  
Milko Stoyanov ◽  
Vassil Traykov
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Age Distribution ◽  
National Registry ◽  
Reentrant Tachycardia ◽  
Common Procedure ◽  
Av Nodal Reentrant Tachycardia ◽  
Different Types ◽  
Acute Success ◽  
Very High

This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2019 and 2020. Material and methods. This is a retrospective study of a full two-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, electroanatomic mapping (EAM), irrigated ablations, distribution of different types of arrhythmia, intraprocedural success and complications are presented. Results. In 2019 four EP laboratories performed 1033 ablations in 652 men (63.1%) and 381 women, incl. 12 pediatric ablations (1.2%). EAM was used in 46.7% of the procedures, irrigation catheter was used in 52.2%, and cryocatheter – in 0.5%. The most common procedure was pulmonary vein isolation, followed by ablation for AV nodal reentrant tachycardia and typical atrial fl utter. In 2020 fi ve EP laboratories performed 835 ablations in 508 men (60.8%) and 327 women, incl. 8 pediatric ablations (1%). EAM was used in 50.9% of the ablations, irrigation catheter – in 54.5%, and cryocatheter – in 3.8%. The most common procedure was again pulmonary vein isolation. Ablation of typical atrial fl utter was the second most frequently performed procedure, ahead of AV nodal reentrant tachycardia. In 2020 the number of ablations of accessory pathways also distinctly dropped by 37%. In both years the acute success was over 98%, and the complications were less than 2%. Conclusion. The national registry of electrophysiology collects systematically and continuously basic data on all cardiac ablations performed in the country. The structure of the EP service is remarkably similar to other European countries. Acute success is very high, while intraprocedural complications are rare. In 2020 the number of the ablations dropped by 19% as a consequence of the COVID-19 pandemic.

scholarly journals Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions

2019 ◽  
Vol 5 (7) ◽  
pp. 778-786 ◽  
Author(s):  
Vivek Y. Reddy ◽  
Massimo Grimaldi ◽  
Tom De Potter ◽  
Johan M. Vijgen ◽  
Alan Bulava ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Temperature Controlled ◽  
Very High

Defining the blanking period duration after cryoballoon pulmonary vein isolation in patients taking an antiarrhythmic drug

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Musat ◽  
NS Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antiarrhythmic Drug ◽  
High Likelihood ◽  
Loop Recorder ◽  
Funding Sources ◽  
Very High ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, the actual BP duration in patients (pts) on an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To objectively define the BP duration in pts undergoing CB while taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 92 pts (66 ± 10 years; 62 [67%] male; 33 [36%] PAF; CHA2DS2-VASc 2.6 ± 1.7). AADs used included dofetilide (42), dronedarone (14), amiodarone (25), sotalol and propafenone (3 each), and flecainide (5). The AAD was stopped at a median of 80 [36, 105] days post-PVI.  We defined 4 distinct groups: (1) no AF in 90-day BP (n = 45 [49%]); (2) last AF within 30 days of PVI (n = 17 [18%]); (3) last AF within 60 days of PVI (n = 13 [15%]); and (4) last AF within 90 days of PVI (n = 17 [18%]). Following the 90-day BP, 47 (51%) pts had a recurrence of AF. Once recurrent AF was observed > 30 days post-ablation, patients had high likelihood of having a long term AF recurrence (p = 0.037, Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up. Abstract Figure.

Clinical significance of induced left atrial macro-reentrant tachycardia after pulmonary vein isolation

2015 ◽  
Vol 46 (2) ◽  
pp. 167-176 ◽  
Author(s):  
Hideyuki Hara ◽  
Masahiro Yoshinaga ◽  
Yumie Matsui ◽  
Satoshi Yamamoto ◽  
Takahiro Ishido ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Clinical Significance ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Reentrant Tachycardia

scholarly journals Spatial Thermodynamics of very High Power-Short Duration Catheter Ablation for Pulmonary Vein Isolation in an in-vivo model

2021 ◽  
Author(s):  
Atsushi Suzuki ◽  
H. Immo Lehmann ◽  
Songyun Wang ◽  
Kay Parker ◽  
Kristi Monahan ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
High Power ◽  
Tissue Temperature ◽  
In Vivo Model ◽  
Very High

Introduction: The spatial thermodynamics of very high power-short duration (vHPSD) radiofrequency (RF) application during pulmonary vein isolation (PVI) in in-vivo model has not been well characterized. This study was conducted to investigate the distance-temperature relationship during vHPSD-RF ablation. Methods: PVI was performed using the vHPSD catheter with the settings of 90W, RF time of 4 sec and 15mL/min irrigation in a canine model. Catheter contact force (CF) of 10-20g was defined as ‘normal’ and CF >20g as ‘firm’ CF. Tissue temperature was monitored using thermocouples implanted at the surface of the left atrial-pulmonary vein junction, left phrenic nerve, and the luminal esophagus. PVI using a standard contact-force sensing catheter (SCF) (settings of 35W, 30sec and 30mL/min irrigation) was performed for comparison. Results: A total of 334 TC profiles in 4 animals was investigated. Time to maximum tissue temperature (MTT) (6.0sec [vHPSD/normal CF] vs. 30.5 sec [SCF/normal CF], p<0.001; 8.0sec [vHPSD/firm CF] vs. 24.0sec [SCF/firm CF], p=0.022) was shorter with vHPSD than in SCF groups. MTT within 10mm from catheter-tip was lower in vHPSD ablation with normal CF than using SCF ablation (median 41.9°C [interquartile-range; 40.2-46.1] vs. 49.5°C [45.9-56.2], p=0.013). The distance margin to keep the MTT below 39ºC, 42ºC, and 50ºC were 4.9mm, 4.2mm, and 3.4mm, respectively in the vHPDS group. This margin was larger (8.0mm, 6.6mm, and 4.6mm) in the SCF group. Conclusion: Our study underscores that vHPSD creates greater resistive heating than conventional catheter ablation.

scholarly journals Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Musat ◽  
NS Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Loop Recorder ◽  
Funding Sources ◽  
Very High ◽  
Period Duration ◽  
Af Recurrence ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To compare the BP duration in pts undergoing CB while either taking or not taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.

Very high-power short-duration temperature-controlled ablation for pulmonary vein isolation: The Fast-and-Furious study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
CH Heeger ◽  
MS Sano ◽  
RMS Meyer-Saraei ◽  
CE Eitel ◽  
HL Phan ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
The Novel ◽  
Rf Ablation ◽  
Procedure Time ◽  
Ablation Catheter ◽  
Temperature Controlled ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable PVI associated with encouraging clinical outcome. The novel QDot ablation catheter with Qmode + ablation mode (90W/4sec, Figure 1) offers the ability to possibly improve safety and decrease ablation procedure times. Aims We aim to evaluate safety and efficacy of the very high-power short-duration (vHP-SD) temperature-controlled radiofrequency (RF) ablation Qmode + mode for pulmonary vein isolation (PVI) utilizing the novel QDot micro ablation catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI. Methods Twenty-five consecutive patients with paroxysmal or persistent AF were prospectively enrolled, underwent vHP-SD based PVI (vHP-SD group) and were compared to 25 consecutive patients treated with conventional CF-sensing catheters (control). Results All PVs were successfully isolated utilizing Qmode +. The total median RF ablation time was vHP-SD: 334 (282, 369) sec. vs control: 1567 (1250, 1756) sec. (p &lt; 0.0001), the median procedure time was vHP-SD: 56 (48-62) vs. control: 104 (92-122) min (p &lt; 0.0001). No differences in periprocedural complications were observed. Conclusions The novel Qmode + provides safe and effective PVI with impressive short RF time and short procedures times. Procedure time and RF time were substantial lower in the vHP-SD group. Abstract Figure 1

Visually Guided Sequential Pulmonary Vein Isolation: Insights into Techniques and Predictors of Acute Success

2012 ◽  
Vol 23 (6) ◽  
pp. 576-582 ◽  
Author(s):  
BORIS SCHMIDT ◽  
MELANIE GUNAWARDENE ◽  
VERENA URBAN ◽  
MEHMET KULIKOGLU ◽  
BRITTA SCHULTE-HAHN ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Visually Guided ◽  
Acute Success

scholarly journals Very high-power short-duration temperature-controlled ablation versus conventional ablation-index guided power-controlled ablation for pulmonary vein isolation

2021 ◽  
Author(s):  
Roland Tilz ◽  
Makoto Sano ◽  
Julia Vogler ◽  
Thomas Fink ◽  
Roza Meyer-Saraei ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Control Group ◽  
Rf Ablation ◽  
Ablation Index ◽  
Procedure Duration ◽  
Temperature Controlled ◽  
Very High

Background: Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable pulmonary vein isolation (PVI) and is associated with encouraging clinical outcome. A novel CF sensing temperature-controlled radiofrequency (RF) ablation catheter allows for very high-power short-duration (vHP-SD, 90W/4 seconds) ablation aiming a potentially safer, more effective and faster ablation. We thought to evaluate preliminary safety and efficacy of vHP-SD ablation for PVI utilizing a novel vHP-SD catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI utilizing conventional contact force (CF) sensing catheters. Methods and Results: Fifty-six patients with paroxysmal or persistent AF were prospectively enrolled in this study. Twenty-eight consecutive patients underwent vHP-SD based PVI (vHP-SD group) and were compared to 28 consecutive patients treated with conventional CF-sensing catheters utilizing the AI (control group). All PVs were successfully isolated using vHP-SD. The median RF ablation time for vHP-SD was 338 (IQR 286, 367) seconds vs control 1580 (IQR 1350, 1848) seconds (p<0.0001), the median procedure duration was vHP-SD 55 (IQR 48-60) minutes vs. control 105 (IQR 92-120) minutes (p<0.0001). No differences in periprocedural complications were observed. Conclusions: This preliminary data of the novel vHP-SD ablation mode provides safe and effective PVI. Procedure duration and RF ablation time were substantially shorter in the vHP-SD group in comparison to the control group.

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