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 Using adenosine triphosphate in catheter radiofrequency pulmonary vein isolation: does elimination of “dormant” atriovenous conduction really allow to refine long-term results?

2017 ◽  
Vol 21 (4) ◽  
pp. 23
Author(s):  
Y. S. Krivosheev ◽  
D. I. Bashta ◽  
A. A. Simonyan ◽  
T. A. Myznikova ◽  
Z. A. Mishodzheva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Adenosine Triphosphate ◽  
Conflict Of Interest ◽  
Pulmonary Veins ◽  
Prognostic Significance ◽  
Long Term Results ◽  
Data Collection And Analysis ◽  
Critical Revision

<p>This literature review looks at the efficacy of removing “dormant” atriovenous conduction, which can be identified by means of intravenous ejection of adenosine triphosphate following catheter isolation of pulmonary vein ostia in patients with atrial fibrillation. The incidence of detecting conduction “breakthroughs” in the ablation lines when carrying out drug tests after isolation of pulmonary veins, as well as the prognostic significance of this phenomenon for atrial fibrillation recurrence are evaluated. Also assessed are drawbacks and limitations of the studies looking at the possibility of improving the efficiency of catheter ablation of atrial fibrillation by combining the removal of “dormant” atriovenous conduction zones identified by adenosine triphosphate testing and the ablation of ganglionated plexi.</p><p>Received 10 April 2017. Accepted 23 October 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: Y.S. Krivosheev, V.N. Kolesnikov.<br />Data collection and analysis: Y.S. Krivosheev, D.I. Bashta.<br />Drafting the article: Y.S. Krivosheev, A.A. Simonyan.<br />Critical revision of the article: V.N. Kolesnikov.<br />Final approval of the version to be published: Y.S. Krivosheev, D.I. Bashta, A.A. Simonyan, T.A. Myznikova, Z.A. Mishodzheva, V.N. Kolesnikov.</p><p> </p>

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

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.

Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?

2021 ◽  
Author(s):  
Igor Belluschi ◽  
Elisabetta Lapenna ◽  
Davide Carino ◽  
Cinzia Trumello ◽  
Manuela Cireddu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Ventricular ◽  
Class I ◽  
Long Term Results ◽  
Left Ventricular Ejection ◽  
Af Recurrence

Abstract OBJECTIVES Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years. METHODS Fifty consecutive patients {mean age 55 [standard deviation (SD): 11.2] years, previous catheter ablation in 56%, left ventricular ejection fraction 60% (SD: 4.6), left atrium volume 65 ml (SD: 17)} with stand-alone symptomatic paroxysmal AF underwent PVI through bilateral thoracoscopy ablation between 2005 and 2014. The CHA2DS2-VASc score was ≥2 in 12 patients (24%). RESULTS No hospital deaths occurred. At hospital discharge all patients but 1 (2%) were in sinus rhythm (SR). Follow-up was 100% complete [mean 8.4 years (SD: 2.3), max 15]. The 8-year cumulative incidence function of AF recurrence, with death as a competing risk, on or off class I/III antiarrhythmic drugs (AADs)/electrocardioversion/re-transcatheter ablation (TCA) was 20% (SD: 5; 95% confidence interval: 10, 32); and off class I/III AADs/electrocardioversion/re-TCA was 52% (SD: 7; 95% confidence interval: 0.83, 8.02). At 8 years, the predicted prevalence of patients in SR was 87% and 53% were off class I/III AADs/electrocardioversion/re-TCA. The recurrent arrhythmia was AF in all patients except 2, who had atypical atrial flutter (4%). No predictors of AF recurrence were identified. At the last follow-up, 76% of the patients showed European Heart Rhythm Association class I. No strokes or thromboembolic events were documented and 76% of the subjects were off anticoagulation therapy. CONCLUSIONS Despite a considerable AF recurrence rate, our single-centre, long-term outcome of surgical PVI showed encouraging data, with the majority of patients remaining in SR, although many of them were on antiarrhythmic therapy.

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