scholarly journals Efficiency, Safety, and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Atrial Fibrillation

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Xuerong Sun ◽  
Jiang Lu ◽  
Jinxuan Lin ◽  
Tianjie Feng ◽  
Ni Suo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Short Duration ◽  
High Power ◽  
Dwell Time ◽  
Radiofrequency Catheter Ablation ◽  
Experimental Studies ◽  
Research Findings ◽  
Rf Energy

Pulmonary vein isolation (PVI) is the cornerstone therapy of atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) is performed using a point-by-point method to achieve durable PVI. However, this procedure remains complex and time-consuming, and the long-term clinical outcomes are still not satisfactory. Recently, there has been increasing interest in the clinical application of high-power short-duration (HPSD) approaches in the field of RFCA. HPSD ablation, distinguishing it from the conventional ablation strategy, delivers RF energy at a high power and saves the dwell time at each site. It is unknown whether the HPSD approach can bring some gratifying changes in the field of RF energy ablation. A number of experimental studies and clinical studies have been conducted regarding this topic. The review aimed to summarize the research findings and evaluate the procedural efficiency, safety, and clinical outcomes of the HPSD approach based on the evidence available to date.

scholarly journals High-Power, Short-Duration Ablation in the Treatment of Atrial Fibrillation Patients

2021 ◽  
Author(s):  
Nándor Szegedi ◽  
László Gellér
Keyword(s):  
Atrial Fibrillation ◽  
Short Duration ◽  
High Power ◽  
Pulmonary Veins ◽  
Long Term Results ◽  
Control Treatment ◽  
Technical Developments ◽  
Radiofrequency Lesions ◽  
Two Phases

Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI.

scholarly journals 10-year clinical outcomes after radiofrequency catheter ablation for atrial fibrillation. A single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.F Alderete Martinez ◽  
S Shizuta ◽  
F Yoneda ◽  
S Nishiwaki ◽  
M Tanaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Adverse Events ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Radiofrequency Catheter Ablation ◽  
Rank Test ◽  
Log Rank Test

Abstract Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is becoming a routine procedure to treat patients with drug-refractory symptomatic AF. However, data regarding very long-term clinical outcomes is limited. The aim of the present study was to evaluate the 10-year clinical outcomes of patients who underwent RFCA for paroxysmal and persistent AF. Methods We retrospectively enrolled 503 consecutive patients (mean age 66,9±9,51 years; 71,6% male) who underwent RFCA for drug-refractory symptomatic AF between February 2004 and June 2011. Follow-up information was obtained using medical records and/or telephonic interviews with the patient, relatives and/or referring physicians. Results Among 503 patients enrolled in this study, 362 had paroxysmal atrial fibrillation (PAF) and 141 had persistent atrial fibrillation (PeAF) (72% and 28%, respectively). Mean follow-up was 8,84±3,05 years. The 10-year event-free rate for recurrent atrial tachyarrhythmia (AT) after the first procedure was 44,5% (49,4% for PAF vs 31,9% for PeAF; p=0,002 by log-rank test) and 81,9% after the last procedure (87,3% for PAF and 67,9% for PeAF; p≤0,001 by log-rank test). AT recurrence was observed most commonly during the first 12 months of the initial procedure (56%), with only 18% of them occurring after 60 months. Multivariate analysis revealed that persistent AF (hazard ratio=1,366; 95% confidence interval 1,058–1,76; p=0,017) and duration of AF >5 years (hazard ratio=1,357; 95% confidence interval 1,064–1,732; p=0,005) were independent risk factors for AT recurrence. Regarding adverse events, there were 24 (4,8%) hospitalizations for acute decompensated heart failure, 20 (4%) ischemic strokes and 14 (2,8%) bleeding complications requiring hospital admissions. Patients taking oral anticoagulation and antiarrhythmic drugs at the end of the study accounted for 32,8% and 16,7% respectively. Conclusions RFCA for AF provided favorable results in terms of arrhythmia event-free survival in long-term follow-up with better results in patients with paroxysmal AF. Persistent AF and long-standing AF (beyond 5 years) were associated with AT recurrence. Despite the large number of patients who discontinued oral anticoagulation, thromboembolic adverse events were rare. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Very long-term clinical outcomes after radiofrequency catheter ablation for atrial fibrillation: A large single-center experience

2017 ◽  
Vol 249 ◽  
pp. 204-213 ◽  
Author(s):  
Tetsuma Kawaji ◽  
Satoshi Shizuta ◽  
Takeshi Morimoto ◽  
Takanori Aizawa ◽  
Shintaro Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Radiofrequency Catheter Ablation ◽  
Single Center ◽  
Single Center Experience

scholarly journals Impact of High-Power Short-Duration Radiofrequency Ablation on Long-Term Lesion Durability for Atrial Fibrillation Ablation

2020 ◽  
Vol 6 (8) ◽  
pp. 973-985 ◽  
Author(s):  
Hagai D. Yavin ◽  
Eran Leshem ◽  
Ayelet Shapira-Daniels ◽  
Jakub Sroubek ◽  
Michael Barkagan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Short Duration ◽  
High Power ◽  
Atrial Fibrillation Ablation

Is higher power shorter duration radiofrequency energy is better than lower power longer duration strategy in catheter ablation of atrial fibrillation A meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Khanra ◽  
P Aggarwal ◽  
H Kumar ◽  
V Mishra ◽  
B Jain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
High Power ◽  
Meta Analysis ◽  
Experimental Studies ◽  
P Value ◽  
Radiofrequency Energy ◽  
Safe Procedure ◽  
Lower Power

Abstract Background An ideal strategy for radiofrequency ablation (RFA) of atrial fibrillation (AF) in the left atrium should be efficient enough to achieve transmural lesions in left atrium with no or minimal collateral tissue damage. Resistive heating of high power short duration (HPSD) RFA has been found to result in lesions larger in width but lesser in depth compared to lower power longer duration (LPLD) RFA in some experimental studies. Purpose This meta-analysis was performed to compare procedural, short-term and long-term outcomes of HPSD versus LPLD RFA of AF. Methods PubMed, Embase and Cochrane databases were systematically reviewed. Five observational studies meeting criteria were included in the meta-analysis. All the studies scored six or more points in the New-castle Ottawa scale. There were considerable variations in the ablation strategies across the studies. However, radiofrequency power more than 40W was considered as high power. Hypergeometric model with exact likelihood function was utilized for statistical analysis. Results Baseline parameters and ablation details have been depicted in Table 1. 740 patients with HPSD and 287 patients with LPLD ablation strategies, were followed up from 6 to 30 months. Total procedural time (P value <0.0001) and ablation time (P value <0.0001) were significantly lower in the HPSD group than LPLD group. However, the fluoroscopy time was similar (P value = 0.09) in both the groups (Table 2). There were no occurrences of atrio-esophageal fistula or pulmonary venous stenosis in any of the studies. Cardiac tamponade (P value = 0.56), stroke (P value = 0.70) and AF recurrences (P value = 0.81), were similar in both groups (Table 2). Conclusion Newer HPSD and conventional LPLD RFA, both the strategies are very safe procedure for treatment of RFA with low to no procedural complications. AF recurrence rates were reasonably high irrespective of ablation strategies, however, no strategy scored statistically better over the other one. Large randomized multi-centric studies with long-term follow up are needed to test the theoretical advantage of HPSD ablation over the traditional ablation strategy of AF. Funding Acknowledgement Type of funding source: None

Abstract 16072: Clinical Outcomes of Catheter Ablation for Left Ventricular Summit/intramural Premature Ventricular Contractions Comparing Conventional vs. Fluoroless Techniques

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jorge Romero ◽  
Juan C Diaz ◽  
Isabella Alviz ◽  
David Briceno ◽  
Chintan Trivedi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Side Effects ◽  
Catheter Ablation ◽  
Ionizing Radiation ◽  
Clinical Outcomes ◽  
Radiofrequency Catheter Ablation ◽  
Left Ventricular ◽  
Premature Ventricular Contractions ◽  
Acute Success

Introduction: Radiofrequency catheter ablation (CA) is the preferred treatment for premature ventricular contractions (PVCs). Ionizing radiation has major side effects for both patients and personnel in the electrophysiology laboratory. Fluoroless procedures are routinely performed for atrial fibrillation and simple PVC cases. Nonetheless, left ventricular (LV) summit/intramural PVCs cases are more challenging and clinical outcomes and complications have been poorly studied in this category with the use of fluoroless ablation. Hypothesis: We aimed to compare acute, long-term success rate and complications between fluoroless procedures versus standard approach for left ventricular (LV) summit/intramural PVCs. Methods: We conducted a retrospective analysis of patients who underwent PVC ablation under fluoroscopy and non-fluoroscopy at two institutions. Results: A total of 41 cases were enrolled (male: 61%; mean age: 55 ). Twenty-five cases underwent ablation under fluoroscopy whereas 16 underwent non-fluoroscopy ablation. Acute success was seen in 88% of non-fluoroscopy cases compared to 87.5% in the fluoroscopy group ( p = 0.9). The PVC recurrence at 12 months was similar between both groups (non-fluoroscopy: 15% vs Fluoroscopy: 18%) ( p = 0.9). No complications occurred in any group. Conclusions: Fluoroless CA is an emerging technique in the treatment of LV summit/intramural PVCs that appears to have similar clinical outcomes and complications compared to conventional fluoroscopic procedures.

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