scholarly journals Silent cerebral lesions and cognitive function after pulmonary vein isolation with an irrigated gold‐tip catheter: REDUCE‐TE Pilot study

2019 ◽  
Vol 30 (6) ◽  
pp. 877-885 ◽  
Author(s):  
Boris Schmidt ◽  
Gábor Széplaki ◽  
Bela Merkely ◽  
Josef Kautzner ◽  
Vincent Driel ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cerebral Lesions ◽  
Gold Tip

scholarly journals Gold tip ablation facilitates acute pulmonary vein isolation. A prospective randomized pilot study

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4121-P4121
Author(s):  
B. Schmidt ◽  
S. Bordignon ◽  
A. Fuernkranz ◽  
K. R. J. Chun
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Gold Tip

Pulmonary vein isolation by irreversible electroporation: an efficacy and safety study in 20 patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Loh ◽  
MHA Groen ◽  
K Taha ◽  
FHM Wittkampf ◽  
PA Doevendans ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Conscious Sedation ◽  
Brain Mri ◽  
Irreversible Electroporation ◽  
Cerebral Lesions ◽  
Private Company ◽  
Funding Sources ◽  
Before And After

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Abbott Background Irreversible electroporation (IRE) is a promising new non-thermal ablation technology for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). First in human studies demonstrated the feasibility and safety of IRE PVI. Objective Further investigate the safety of IRE PVI. Methods Twenty patients with symptomatic AF underwent IRE PVI under conscious sedation. Oral anticoagulation was uninterrupted and heparin was administered to maintain activated clotting time at 300-350 seconds. Non-arcing, non-barotraumatic 6 ms, 200 J IRE applications were delivered via a custom non-steerable 8 F, 14-polar circular IRE ablation catheter with a variable hoop diameter (16-27 mm). Voltage mapping  of the left atrium and the PVs was performed before and after ablation with a conventional circular mapping catheter. For both catheters a single transseptal access (8 F introducer, Agilis NxTTM) was used. Adenosine testing was performed after a 30-minute waiting period. On day 1 after ablation, patients underwent esophagoscopy and brain MRI (DWI/FLAIR). If abnormalities were detected, examinations were repeated in due time. Results In 20 patients, all 80 PVs could be successfully isolated with a mean of 11,8 ± 1,4 IRE applications per patient. Average time from first to last IRE application was 22 ± 5 minutes, total procedure duration was 107 ± 13 minutes and total fluoroscopy time was 23 ± 5 minutes. One PV reconnection occurred during adenosine testing, re-isolation was achieved with 2 additional IRE pulses. No periprocedural complications were observed. Brain MRI on day 1 after ablation showed punctate asymptomatic lesions in 3/20 patients (15%). At follow-up MRI the lesion disappeared in 1 patient while in the other 2 patients 1 lesion persisted. Esophagoscopy on day 1 showed an asymptomatic esophageal lesion in 1/20 patients (5%), at repeat esophagoscopy on day 22 the lesion had resolved completely. Conclusion Acute electrical PV isolation could be achieved safely and rapidly by IRE ablation under conscious sedation in 20 patients with symptomatic AF. Acute silent cerebral lesions were detected in 3/20 patients (15%) and may be due to ablation or to changes of therapeutic and diagnostic catheters over a single transseptal access.

scholarly journals The role of local impedance drop in the acute lesion efficacy during pulmonary vein isolation performed with a new contact force sensing catheter—A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257050
Author(s):  
Nándor Szegedi ◽  
Zoltán Salló ◽  
Péter Perge ◽  
Katalin Piros ◽  
Vivien Klaudia Nagy ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Force Sensing ◽  
Lesion Formation ◽  
Force Time

Introduction Our pilot study aimed to evaluate the role of local impedance drop in lesion formation during pulmonary vein isolation with a novel contact force sensing ablation catheter that records local impedance as well and to find a local impedance cut-off value that predicts successful lesion formation. Materials and methods After completing point-by-point radiofrequency pulmonary vein isolation, the success of the applications was evaluated by pacing along the ablation line at 10 mA, 2 ms pulse width. Lesions were considered successful if loss of local capture was achieved. Results Out of 645 applications, 561 were successful and 84 were unsuccessful. Compared to the unsuccessful ablation points, the successful applications were shorter (p = 0.0429) and had a larger local impedance drop (p<0.0001). There was no difference between successful and unsuccessful applications in terms of mean contact force (p = 0.8571), force-time integral (p = 0.0699) and contact force range (p = 0.0519). The optimal cut-point for the local impedance drop indicating successful lesion formation was 21.80 Ohms on the anterior wall [AUC = 0.80 (0.75–0.86), p<0.0001], and 18.30 Ohms on the posterior wall [AUC = 0.77 (0.72–0.83), p<0.0001]. A local impedance drop larger than 21.80 Ohms on the anterior wall and 18.30 Ohms on the posterior wall was associated with an increased probability of effective lesion creation [OR = 11.21, 95%CI 4.22–29.81, p<0.0001; and OR = 7.91, 95%CI 3.77–16.57, p<0.0001, respectively]. Conclusion The measurement of the local impedance may predict optimal lesion formation. A local impedance drop > 21.80 Ohms on the anterior wall and > 18.30 Ohms on the posterior wall significantly increases the probability of creating a successful lesion.

Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study

2019 ◽  
Vol 57 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Sergio Castrejón-Castrejón ◽  
Marcel Martínez Cossiani ◽  
Marta Ortega Molina ◽  
Carlos Escobar ◽  
Consuelo Froilán Torres ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Short Term

Two Versus One Repeat Freeze-Thaw Cycle(s) After Cryoballoon Pulmonary Vein Isolation: The ALSTER EXTRA Pilot Study

2012 ◽  
Vol 23 (8) ◽  
pp. 814-819 ◽  
Author(s):  
KYOUNG RYUL JULIAN CHUN ◽  
ALEXANDER FÜRNKRANZ ◽  
ILKA KÖSTER ◽  
ANDREAS METZNER ◽  
TOBIAS TÖNNIS ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Freeze Thaw ◽  
Thaw Cycle ◽  
Freeze Thaw Cycle

scholarly journals Asymptomatic cerebral lesions during pulmonary vein isolation under uninterrupted oral anticoagulation

EP Europace ◽  
2012 ◽  
Vol 15 (3) ◽  
pp. 325-331 ◽  
Author(s):  
Martin Martinek ◽  
Elisabeth Sigmund ◽  
Christine Lemes ◽  
Michael Derndorfer ◽  
Josef Aichinger ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Oral Anticoagulation ◽  
Cerebral Lesions

scholarly journals Temperature controlled high power short duration ablation with 90 watts for 4 seconds: Outcome, safety, biophysical characteristics and cranial MRI findings in patients undergoing pulmonary vein isolation

2021 ◽  
Author(s):  
Marc Kottmaier ◽  
Leonie Förschner ◽  
Nada Harfoush ◽  
Felix Bourier ◽  
Sarah Mayr ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Tissue Temperature ◽  
Neurological Deficits ◽  
Cerebral Lesions ◽  
Number Of Patients ◽  
Cerebral Mri ◽  
Temperature Controlled

Background High power short duration (HPSD) radiofrequency-ablation (RFA) is highly efficient and safe while reducing procedure and RF time in pulmonary vein isolation (PVI). The QDot-catheter is a novel contact-force ablation catheter that allows automated flow and power adjustments depending on the local tissue temperature to maintain a target temperature during 90watts/4seconds lesions. We analysed intraprocedural data and periprocedural safety using the QDot-catheter in patients undergoing PVI for paroxysmal atrial fibrillation (PAF). Methods We included n=48 patients undergoing PVI with the QDot-catheter with a temperature controlled HPSD ablation mode with 90watts/4seconds (TC-HPSD). If focal reconnection occurred besides repeat ablation the ablation mode was changed to 50watts/15seconds (QMode). N=23 patients underwent cerebral MRI to detect silent cerebral lesions. Results Mean RF-time was 8.1+/-2.8min, procedure-duration was 84.5+/-30min. The overall maximal measured catheter-tip temperature was 52.0°C +/- 4.6°C, mean overall applied current was 871mA +/-44mA and over all applied energy was 316J +/-47J. The mean local impedance-drop was 12.1 +/- 2.4 Ohms. During Adenosine challenge n=14 (29%) patients showed dormant conduction. A total of n=24 steam pops were detected in n=18 patients (39.1%), while no pericardial tamponade occurred. No periprocedural thromboembolic complications occurred, while n=4 patients (17.4%) showed silent cerebral lesion. Conclusion TC-HPSD ablation with 90watts/4seconds using the QDot-catheter led to a reduction of procedure and RF time, while no major complications occurred. Despite optimized temperature control and power adjustment steam pops occurred in a rather high number of patients, while none of them lead to tamponade or to clinical or neurological deficits.

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