scholarly journals The First-Pass Isolation Effect in High-Power Short-Duration Compared to Low-Power Long-Duration Atrial Fibrillation Ablation: a Predictor of Success

2020 ◽  
Vol 33 (3) ◽  
pp. 161-169
Author(s):  
Fabricio Vassallo ◽  
Lucas Luis Meigre ◽  
Eduardo Serpa ◽  
Carlos Lovatto ◽  
Christiano Cunha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Low Power ◽  
Short Duration ◽  
High Power ◽  
Arterial Disease ◽  
Obstructive Apnea ◽  
Long Duration ◽  
First Pass

Introduction: Different results are described after atrial fibrillation ablation and multiples predictors of recurrence are well established. Objective: Evaluate and analyze if first-pass isolation effect (FPI) during first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) can impact on late outcome. Methods: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD: 71 patients, 50 (70.42%) males, mean age 59.73 years, 52 (73.24%) hypertension, 44 (61.97%) obstructive apnea, 23 (32.39%) arterial disease, 20 (28.17%) diabetes, and 10(14.08%) stroke. CHADS2VASC2 2.57. CT: 73 patients, 50 (68.49%) males, mean age 60.7 years, 53 (72.60%) hypertension, 41 (56.16%) obstructive apnea, 28 (38.36%) arterial disease, 14 (19.17%) diabetes and 8 (10.96%) stroke. CHAD2SVASC2 2.22. Results: Recurrence occurred in 33 patients (22.92%) at 12 months follow-up, HPSD with 9 patients and LPLD with 24 patients. Higher rate of bilateral FPI were observed in HPSD patients with 62 of 71 patients comparing to 17 of 73 patients in LPLD (P < 0.00001). At the end of study 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD (P 0.0039). Conclusion: HPSD ablation produced higher rates of FPI comparing to LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months. At patients submitted to HPSD protocol ablation, FPI could predict higher rate of sinus rhythm at 12 months follow-up.

scholarly journals High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

2020 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chol Techorueangwiwat ◽  
Chanavuth Kanitsoraphan ◽  
Thiratest Leesutipornchai ◽  
Nazem Akoum ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Power ◽  
Short Duration ◽  
High Power ◽  
Meta Analysis ◽  
Atrial Fibrillation Ablation ◽  
Long Duration

scholarly journals High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis

2020 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chol Techorueangwiwat ◽  
Chanavuth Kanitsoraphan ◽  
Thiratest Leesutipornchai ◽  
Nazem Akoum ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Power ◽  
Short Duration ◽  
High Power ◽  
Meta Analysis ◽  
Atrial Fibrillation Ablation ◽  
Long Duration

scholarly journals High-power short-duration radiofrequency ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Kassa ◽  
Z Nagy ◽  
B Kesoi ◽  
Z Som ◽  
C Foldesi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Short Duration ◽  
Contact Force ◽  
High Power ◽  
Posterior Wall ◽  
Pericardial Tamponade ◽  
Fluoroscopy Time ◽  
Control Group

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In recent times, high-power short-duration (HPSD) radiofrequency ablation (RFA) has emerged as an alternative strategy for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Purpose We aimed to compare HPSD approach and conventional, ablation-index (AI) guided PVI using contact force sensing ablation catheters in respect of efficacy, safety, procedural characteristics, and outcome. Methods A total of 184 consecutive AF patients with first PVI were enrolled (age: 60 ± 11 years, paroxysmal: 56.5%, persistent: 43.5%) between November 2016 and December 2019. An ablation protocol of 50W energy with 15-20 g contact force was used for a duration of 8-12 sec based on the loss of capture concept in the HPSD group (n = 91) meanwhile, PVI was achieved according to the conventional power settings (posterior wall 25W, AI: 400, anterior wall 35W, AI: 550 ) in the control group (n = 93). During 1-year follow-up, documented AF for more than 30 seconds was considered as recurrence. Results Radiofrequency time and procedural time were significantly shorter using HPSD ablation (26.0 ± 12.7 min vs. 42.9 ± 12.6 min, p &lt; 0.001, and 91 ± 30.1 min vs. 105.3 ± 28 min, p &lt; 0.001). The HPSD strategy significantly lowered fluoroscopy time and radiation dose (5.47 ± 4.07 min vs. 8.15 ± 10.04 min, p = 0.019, and 430.2 ± 534.06 cGycm2 vs. 604.2 ± 633.9 cGycm2, p = 0.046). The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 76.9% of patients free from AF compared to 66.7% in the control group (p = 0.037). No pericardial tamponade, periprocedural thromboembolic complication, or atrio-oesophageal fistula occurred in the HPSD group. We observed 2 pericardial tamponade and 1 periprocedural stroke in the control group. Conclusions HPSD RFA for AF was demonstrated to be safe, and lead to significantly improved 1-year outcome in our mixed patient population. HPSD protocol significantly shortened procedural and radiofrequency time with decreased fluoroscopy time and radiation exposure.

6122Pulmonary vein isolation by different setting of high-power short-duration radiofrequency application: feasibility, short term efficacy and safety in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Castrejon Castrejon ◽  
M Martinez Cossiani ◽  
M Ortega Molina ◽  
C Escobar Cervantes ◽  
C Froilan Torres ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Short Duration ◽  
High Power ◽  
Cryoballoon Ablation ◽  
Power Group ◽  
First Pass ◽  
Group 2 ◽  
Low Incidence ◽  
Index Value ◽  
Group 1

Abstract Aims Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoballoon ablation. In addition, it is associated with more esophageal lesions. The aim of this study was to evaluate the feasibility and safety of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation. Methods PPRF around the PVs was done in 125 consecutive patients distributed in two chronologically successive groups. Conventional PPRF with 30W for ≤30 s under luminal esophageal temperature monitoring was performed in the first 47 patients (Group 1). 68 patients were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI ≥5 or Abl-I ≥350) in the first 18 patients (Group 2A). 30 patients underwent PPRF with 60W for 7–10 s (Group 2B) and the last 30 patients underwent PPRF with 70W for 9 s (Group 2C). Esophageal endoscopy was performed after ablation in all patients. Results PVI of all targeted veins was achieved in 96% and 100% of patients of groups 1 and 2 respectively (p=0.6). Total RF time was 30 [27–43], 25 [20–29], 16 [14–20] and 14 [11–16] min in groups 1, 2A and 2B and 2C respectively (p<0.001). RF was delivered for 12 [9–17] s vs 9 [8–9]s vs 9 [8–9] per application in groups 2 A, 2B and 2C respectively (p<0.001). Total number of RFa to completely isolate all PV was 105 [90–126] in group 2A, 113 [90–135] in group 2B and 94 [79–112] in group 2C (p=0.12). First-pass PVI was achieved in 56%, 57% and 85% of left PV (p=0.038) and in 56%, 60% and 82% of right PV (p=0.13) in groups 50W, 60W and 70W respectively. The carina was the most frequent location of persistent conduction when first-pass failed. Reconnections occurred in 6%, 3% and 11% of left PV (p=0.6) and in 6%, 7% and 4% (p=0.63) of right PV in groups 50W, 60W and 70W respectively. Adenosine test was systematically used in groups 60W and 70W: the incidence of dormant conduction was 23% and 22% (p=0.9) in left PV and 20% and 22% (p=0.8) in right PV respectively. The incidence of esophageal lesions was 28% in Group 1, 2% in Group 2A, and 0% in groups 2B and 2C (p<0.001). No other intraprocedural complications occurred in the high-power group. Total RF time Conclusions PVI is feasible with HPSD PPRF in most patients using shorter total RF times. This approach appears associated with very low incidence esophageal damage than the conventional one, especially when 60W/70W and shorter application time are used. Acknowledgement/Funding Grant of the Spanish Society of Cardiology

scholarly journals Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure

2021 ◽  
pp. 69-78
Author(s):  
Fabricio Vassallo ◽  
Eduardo Serpa ◽  
Betina Reseck Walker ◽  
Lucas Luis Meigre ◽  
Hermes Carloni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Observational Study ◽  
Sinus Rhythm ◽  
Short Duration ◽  
High Power ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Combined Treatment ◽  
Left Atrial Appendage Closure

Introduction: Long-term freedom from atrial fibrillation (AF) after catheter ablation and, consequently, the potential for stroke reduction remain unpredictable. Recently, left atrial appendage closure (LAAC) became an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. Objective: This study aims to evaluate the feasibility and safety of combined treatment for AF with catheter ablation (CA) with the high-power short duration technique associated with LAAC in one single procedure. Methods: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective observational study. Between April 2018 and October 2020, 13 patients with AF were included, eight (61,54%) males, eight (61.54%) with persistent AF (PersAF), mean age 68.54 (65–84) years old, mean time from AF diagnosis to treatment 13.08 (3–33) months, mean CHA2VASC2 5.08 (3–7), all patients with coronary or vascular disease, 12 (92.31%) with hypertension, five (38.46%) with left ventricular dysfunction, four (30.77%) prior strokes using OAC and four (30.77%) patients with diabetes. Indications for LAAC included history of contraindication to OAC because of severe bleeding in eight (61.54%), previous stroke in four (30.77%) and two (13.08%) patients with LAA thrombus, despite the use of two different OAC (one associated with bleeding). One patient had a pseudoaneurysm in femoral artery, and two patients died of non-procedure complications after 30 days. At six months, angiotomography showed successful complete sealing of the LAA in seven (77.72%) of nine patients evaluated, and the two patients without it had a leak of less than 2 mm. After mean follow-up of 14 months (five to 33), 10 (90.91%) of the 11 patients were in sinus rhythm. Three (27.27%) patients, one in blanking period, recovered sinus rhythm after amiodarone. No cardioembolic or bleeding events occurred. Conclusion: In this small observational study, we showed the feasibility and safety of the combined therapy with AF catheter ablation with LAAC with a high rate of sinus rhythm and no cardioembolic event.

Sign in / Sign up

Export Citation Format

Share Document