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Sample records for catheter ablation predicts

  1. Catheter ablation.

    PubMed

    Fromer, M; Shenasa, M

    1991-02-01

    Catheter ablation is gaining increasing interest for the therapy of symptomatic, sustained arrhythmias of various origins. The scope of this review is to give an overview of the biophysical aspects and major characteristics of some of the most widely used energy sources in catheter ablation, e.g., the discharge of conventional defibrillators, modified defibrillators, laser light, and radiofrequency current application. Results from animal studies are considered to explain the basic mechanisms of catheter ablation. The recent achievements with the use of radiofrequency current to modify or ablate cardiac conduction properties are outlined in more detail.

  2. Catheter Ablation

    MedlinePlus

    ... you during the procedure. Machines will measure your heart’s activity. All types of ablation require cardiac catheterization to place flexible tubes, or catheters, inside your heart to make the scars. Your doctor will clean ...

  3. Atrial conduction delay predicts atrial fibrillation in paroxysmal supraventricular tachycardia patients after radiofrequency catheter ablation.

    PubMed

    Xu, Zhen-Xing; Zhong, Jing-Quan; Zhang, Wei; Yue, Xin; Rong, Bing; Zhu, Qing; Zheng, Zhaotong; Zhang, Yun

    2014-06-01

    This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469-48.914; OR = 2.569, 95% CI, 1.909-3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.

  4. Catheter Ablation for Ventricular Arrhythmias

    PubMed Central

    Nof, Eyal; Stevenson, William G; John, Roy M

    2013-01-01

    Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias. PMID:26835040

  5. The APPLE Score – A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Kornej, Jelena; Hindricks, Gerhard; Arya, Arash; Sommer, Philipp; Husser, Daniela; Bollmann, Andreas

    2017-01-01

    Background Arrhythmia recurrences after catheter ablation occur in up to 50% within one year but their prediction remains challenging. Recently, we developed a novel score for the prediction of rhythm outcomes after single AF ablation demonstrating superiority to other scores. The current study was performed to 1) prove the predictive value of the APPLE score in patients undergoing repeat AF ablation and 2) compare it with the CHADS2 and CHA2DS2-VASc scores. Methods Rhythm outcome between 3–12 months after AF ablation were documented. The APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR (<60 ml/min/1.73m2), LA diameter ≥43 mm, EF <50%) was calculated in every patient before procedure. Results 379 consecutive patients from The Leipzig Heart Center AF Ablation Registry (60±10 years, 65% male, 70% paroxysmal AF) undergoing repeat AF catheter ablation were included. Arrhythmia recurrences were observed in 133 patients (35%). While the CHADS2 (AUC 0.577, p = 0.037) and CHA2DS2-VASc scores (AUC 0.590, p = 0.015) demonstrated low predictive value, the APPLE score showed better prediction of arrhythmia recurrences (AUC 0.617, p = 0.002) than other scores (both p<0.001). Compared to patients with an APPLE score of 0, the risk (OR) for arrhythmia recurrences was 2.9, 3.0 and 6.0 (all p<0.01) for APPLE scores 1, 2, or ≥3, respectively. Conclusions The novel APPLE score is superior to the CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcomes after repeat AF catheter ablation. It may be helpful to identify patients with low, intermediate or high risk for recurrences after repeat procedure. PMID:28085921

  6. Low left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation of persistent atrial fibrillation.

    PubMed

    Kanda, Takashi; Masuda, Masaharu; Sunaga, Akihiro; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Watanabe, Tetsuya; Takahara, Mitsuyoshi; Sakata, Yasushi; Uematsu, Masaaki

    2015-11-01

    Recurrence after catheter ablation of persistent atrial fibrillation (AF) remains an unsolved issue. This study aimed to explore the association between the left atrial appendage peak flow velocity (LAAV) and AF recurrence after ablation in persistent AF patients. Fifty-three consecutive patients who underwent an initial catheter ablation of persistent AF were enrolled [age, 65±10 years; male, 42 (79%)]. The LAAV was obtained by transesophageal echocardiography before ablation. All the patients underwent pulmonary vein isolation and were followed up for 12 months. The LAAV and other clinical factors (AF duration, CHA2DS2VASc score, left atrial diameter, left atrial volume, and left ventricular ejection fraction) were tested using a Cox proportional hazards regression analysis as predictors of AF recurrence during the 1-year follow-up. AF recurrence occurred in 16 (30%) patients. The patients with AF recurrences had lower LAAVs (23.3±7.2cm/s vs. 33.3±15.1cm/s, p=0.002) than those without AF recurrence. In the multivariable analysis, a low LAAV independently predicted AF recurrence (hazard ratio, 3.04; 95% confidence interval, 1.05-8.79; p=0.040). A Kaplan-Meier analysis also demonstrated a lower survival rate free from AF recurrence in the low LAAV group than in the high LAAV group (p=0.030). A low LAAV was associated with AF recurrence after the initial catheter ablation of persistent AF. Copyright © 2015. Published by Elsevier Ltd.

  7. Repeat left atrial catheter ablation: cardiac magnetic resonance prediction of endocardial voltage and gaps in ablation lesion sets.

    PubMed

    Harrison, James L; Sohns, Christian; Linton, Nick W; Karim, Rashed; Williams, Steven E; Rhode, Kawal S; Gill, Jaswinder; Cooklin, Michael; Rinaldi, C Aldo; Wright, Matthew; Schaeffter, Tobias; Razavi, Reza S; O'Neill, Mark D

    2015-04-01

    Studies have reported an inverse relationship between late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) signal intensity and left atrial (LA) endocardial voltage after LA ablation. However, there is controversy regarding the reproducibility of atrial LGE CMR and its ability to identify gaps in ablation lesions. Using systematic and objective techniques, this study examines the correlation between atrial CMR and endocardial voltage. Twenty patients who had previous ablation for atrial fibrillation and represented with paroxysmal atrial fibrillation or atrial tachycardia underwent preablation LGE CMR. During the ablation procedure, high-density point-by-point Carto voltage maps were acquired. Three-dimensional CMR reconstructions were registered with the Carto anatomies to allow comparison of voltage and LGE signal intensity. Signal intensities around the left and right pulmonary vein antra and along the LA roof and mitral lines on the CMR-segmented LA shells were extracted to examine differences between electrically isolated and reconnected lesions. There were a total of 6767 data points across the 20 patients. Only 119 (1.8%) of the points were ≤ 0.05 mV. There was only a weak inverse correlation between either unipolar (r = -0.18) or bipolar (r = -0.17) voltage and LGE CMR signal intensities with low voltage occurring across a large range of signal intensities. Signal intensities were not statistically different for electrically isolated and reconnected lesions. This study demonstrates that there is only a weak point-by-point relationship between LGE CMR and endocardial voltage in patients undergoing repeat LA ablation. Using an objective method of assessing gaps in ablation lesions, LGE CMR is unable to reliably predict sites of electrical conduction. © 2015 American Heart Association, Inc.

  8. Catheter ablation - new developments in robotics.

    PubMed

    Chun, K R Julian; Schmidt, Boris; Köktürk, Bülent; Tilz, Roland; Fürnkranz, Alexander; Konstantinidou, Melanie; Wissner, Erik; Metzner, Andreas; Ouyang, Feifan; Kuck, Karl-Heinz

    2008-12-01

    Catheter ablation has become the curative treatment modality for various arrhythmias. Extending the indications for catheter ablation from simple supraventricular tachycardias to complex arrhythmias such as ventricular tachycardia or atrial fibrillation, the investigator faces prolonged procedure times, fluoroscopy exposure and the need for stable and reproducible catheter movement. Recently, remote-controlled robotic catheter ablation has emerged as a novel ablation concept to meet these requirements. This review describes the two available robotic ablation systems and summarizes their clinical applications and current human experience.

  9. [Catheter ablation in supraventricular tachycardia].

    PubMed

    Pitschner, H F; Neuzner, J

    1996-01-01

    The first report about successful radio frequency ablation of a right-posterior-septal accessory pathway appeared in 1986. Since then, the technology of both guidable ablation catheters and radio frequency generators has been considerably improved in an initially clinical-experimental phase. At the same time, electrophysiologists were equally able to enlarge their knowledge in the field of signal characteristics of arrhythmogenic substrates. This included the discovery of action potentials of accessory pathways (preexcitation syndromes), the location of fast and slow AV node conduction (AV nodal reentrant tachycardia, AVNRT), the functional importance of the anatomical isthmus between the os of the coronary sinus, the tricuspid valve and the inferior caval vein (atrial flutter). Mapping techniques such as transient and concealed entrainment became, among others, significant tools in finding the best localization for radio frequency catheter ablation. Thus, technical development and the increased knowledge of clinical electrophysiologists resulted in firmly establishing the procedure of catheter ablation as the method of first choice in the curative treatment of supraventricular tachycardias in a potential collective of about 5 per mill of the normal population (without atrial fibrillation). Supraventricular tachycardias with a reentry mechanism in the broadest sense (> 95% of all pts. with SVT) and those with focal automaticity (< 5%) occur as atrial fibrillation or atrial flutter in about 60% of all pts. (4-6 per mill of the normal population). Manifestation of the remaining reentrant tachycardias is mainly in the form of AVNRT (retrograde conduction via the fast pathway > 90% versus uncommon type < 10%). AV reentry via accessory pathways is found in about 15%, with orthodromic conduction via the AV node (> 90%). Atrial reentrant tachycardias are rather rare (with the exception of atrial fibrillation/flutter). The literature suggests medical therapy to be

  10. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus.

    PubMed

    Yokoyama, Katsuaki; Nakagawa, Hiroshi; Shah, Dipen C; Lambert, Hendrik; Leo, Giovanni; Aeby, Nicolas; Ikeda, Atsushi; Pitha, Jan V; Sharma, Tushar; Lazzara, Ralph; Jackman, Warren M

    2008-12-01

    An open-irrigated radiofrequency (RF) ablation catheter was developed to measure contact force (CF). Three optical fibers measure microdeformation of the catheter tip. The purpose of this study was to (1) validate the accuracy of CF sensor (CFS) (bench test); and (2) determine the relationship between CF and tissue temperatures, lesion size, steam pop, and thrombus during RF ablation using a canine thigh muscle preparation. CFS measurements (total 1409) from 2 catheters in 3 angles (perpendicular, parallel, and 45 degrees ) were compared with a certified balance (range, 0 to 50 g). CFS measurements correlated highly (R(2) > or =0.988; mean error, < or =1.0 g). In 10 anesthetized dogs, a skin cradle over the thigh muscle was superfused with heparinized blood at 37 degrees C. A 7F catheter with 3.5-mm saline-irrigated electrode and CFS (Endosense) was held perpendicular to the muscle at CF of 2, 10, 20, 30, and 40 g. RF was delivered (n=100) for 60 seconds at 30 or 50 W (irrigation 17 or 30 mL/min). Tissue temperature (3 and 7 mm depths), lesion size, thrombus, and steam pop increased significantly with increasing CF at each RF power. Lesion size was greater with applications of lower power (30 W) and greater CF (30 to 40 g) than at high power (50 W) with lower CF (2 to 10 g). This novel ablation catheter, which accurately measures CF, confirmed CF is a major determinant of RF lesion size. Steam pop and thrombus incidence also increases with CF. CFS in an open-irrigated ablation catheter that may optimize the selection of RF power and application time to maximize lesion formation and reduce the risk of steam pop and thrombus.

  11. [Indications for catheter ablation of ventricular tachycardia].

    PubMed

    Deneke, T; Israel, C W; Krug, J; Nentwich, K; Müller, P; Mügge, A; Schade, A

    2013-09-01

    Ventricular tachyarrhythmias (VT) can cause sudden cardiac death. This can be prevented by an implantable cardioverter-defibrillator (ICD) but approximately 25% of patients with an ICD develop electrical storm (≥ 3 VTs within 24 hours) during the course of 4-5 years. This is a life-threatening event even in the presence of an ICD, particularly if incessant VT is present, and may significantly deteriorate the patient's psychological state if multiple shocks are discharged. Catheter ablation of VT has developed into a standard procedure in many specialized electrophysiology centers. Patients with hemodynamically stable and unstable VT are amendable to substrate-based ablation strategies. Catheter ablation can be performed as emergency procedure in patients with electrical storm as well as electively in patients with monomorphic VT stored in ICD memory. In patients with ischemic or non-ischemic cardiomyopathy, VT ablation is complementary to ICD implantation and can reduce the number of ventricular arrhythmia episodes and shocks and should be performed early. In patients with electrical storm, catheter ablation can acutely achieve rhythm stabilization and may improve prognosis in the long term. Further indications for catheter ablation exist in patients with idiopathic VT where catheter ablation represents a curative therapy, and in patients with symptomatic or asymptomatic frequent premature ventricular beats which may improve prognosis in patients with heart failure and cardiac resynchronization therapy.

  12. Magnetic and robotic navigation for catheter ablation: "joystick ablation".

    PubMed

    Ernst, Sabine

    2008-10-01

    Catheter ablation has become the treatment of choice to cure various arrhythmias in the last decades. The newest advancement of this general concept is made on the navigation ability using remote-controlled ablation catheters. This review summarizes the concept of the two currently available systems, followed by a critical review of the published clinical reports for each system, respectively. Despite the limited amount of data, an attempt to compare the two systems is made.

  13. Incidence and Factors Predicting Skin Burns at the Site of Indifferent Electrode during Radiofrequency Catheter Ablation of Cardiac Arrhythmias

    PubMed Central

    Ibrahim, Hussain; Finta, Bohuslav; Rind, Jubran

    2016-01-01

    Radiofrequency catheter ablation (RFA) has become a mainstay for treatment of cardiac arrhythmias. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA. The purpose of this study was to determine the incidence of skin burns in cardiac RFA procedures performed at one institution. Also, we wanted to determine the factors predicting skin burns after cardiac RFA procedures at the indifferent electrode skin pad site. Methods. A retrospective case control study was performed to compare the characteristics in patients who developed skin burns in a 2-year period. Results. Incidence of significant skin burns after RFA was 0.28% (6/2167). Four of the six patients were female and all were Caucasians. Four controls for every case were age and sex matched. Burn patients had significantly higher BMI, procedure time, and postprocedure pain, relative to control subjects (p < 0.05, one-tailed testing). No one in either group had evidence of dispersive pad malattachment. Conclusions. Our results indicate that burn patients had higher BMI and longer procedure times compared to control subjects. These findings warrant further larger studies on this topic. PMID:27213077

  14. Magnetocardiographically-guided catheter ablation.

    PubMed

    Fenici, R R; Covino, M; Cellerino, C; Di Lillo, M; De Filippo, M C; Melillo, G

    1995-12-01

    After more than 30 years since the first magnetocardiographic (MCG) recording was carried out with induction coils, MCG is now approaching the threshold of clinical use. During the last 5 years, in fact, there has been a growing interest of clinicians in this new method which provides an unrivalled accuracy for noninvasive, three-dimensional localization of intracardiac source. An increasing number of laboratories are reporting data validating the use of MCG as an effective method for preoperative localization of arrhythmogenic substrates and for planning the best catheter ablation approach for different arrhythmogenic substrates. In this article, available data from literature have been reviewed. We consider the clinical use of MCG to localize arrhythmogenic substrates in patients with Wolff-Parkinson-White syndrome and in patients with ventricular tachycardia in order to assess the state-of-the-art of the method on a large number of patients. This article also addresses some suggestions for industrial development of more compact, medically oriented MCG equipments at reasonable cost.

  15. Catheter ablation of inappropriate sinus tachycardia.

    PubMed

    Gianni, Carola; Di Biase, Luigi; Mohanty, Sanghamitra; Gökoğlan, Yalçın; Güneş, Mahmut F; Horton, Rodney; Hranitzky, Patrick M; Burkhardt, J David; Natale, Andrea

    2016-06-01

    Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST.

  16. Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score.

    PubMed

    Mujović, Nebojša; Marinković, Milan; Marković, Nebojša; Shantsila, Alena; Lip, Gregory Y H; Potpara, Tatjana S

    2017-01-20

    Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), 20 patients expirienced a VLRAF during a 29.1 ± 10.1-month follow-up, with a 3-year cumulative VLRAF rate of 31.1%. The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47 mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AF = early recurrent AF), had better predictive ability for VLRAF (AUC 0.782) than the APPLE, ALARMc, BASE-AF2, CHADS2, CHA2DS2VASc or HATCH score (AUC 0.716, 0.671, 0.648, 0.552, 0.519 and 0.583, respectively), resulted in an improved net reclassification index (NRI) of 48.6-95.1% and better identified patients with subsequent VLRAF using decision-curve analysis (DCA). The MB-LATER score provides a readily available VLRAF risk assessment, and performs better than other scores. Validation of the MB-LATER score in other cohorts is underway.

  17. Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

    PubMed Central

    Mujović, Nebojša; Marinković, Milan; Marković, Nebojša; Shantsila, Alena; Lip, Gregory Y. H.; Potpara, Tatjana S.

    2017-01-01

    Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently “cured” patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month “blanking period”), 20 patients expirienced a VLRAF during a 29.1 ± 10.1-month follow-up, with a 3-year cumulative VLRAF rate of 31.1%. The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47 mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AF = early recurrent AF), had better predictive ability for VLRAF (AUC 0.782) than the APPLE, ALARMc, BASE-AF2, CHADS2, CHA2DS2VASc or HATCH score (AUC 0.716, 0.671, 0.648, 0.552, 0.519 and 0.583, respectively), resulted in an improved net reclassification index (NRI) of 48.6–95.1% and better identified patients with subsequent VLRAF using decision-curve analysis (DCA). The MB-LATER score provides a readily available VLRAF risk assessment, and performs better than other scores. Validation of the MB-LATER score in other cohorts is underway. PMID:28106147

  18. Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter.

    PubMed

    Golden, Keith; Mounsey, John Paul; Chung, Eugene; Roomiani, Pahresah; Morse, Michael Andew; Patel, Ankit; Gehi, Anil

    2012-05-01

    Catheter ablation is an effective therapy for symptomatic, medically refractory atrial fibrillation (AF). Open-irrigated radiofrequency (RF) ablation catheters produce transmural lesions at the cost of increased fluid delivery. In vivo models suggest closed-irrigated RF catheters create equivalent lesions, but clinical outcomes are limited. A cohort of 195 sequential patients with symptomatic AF underwent stepwise AF ablation (AFA) using a closed-irrigation ablation catheter. Recurrence of AF was monitored and outcomes were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models. Mean age was 59.0 years, 74.9% were male, 56.4% of patients were paroxysmal and mean duration of AF was 5.4 years. Patients had multiple comorbidities including hypertension (76.4%), tobacco abuse (42.1%), diabetes (17.4%), and obesity (mean body mass index 30.8). The median follow-up was 55.8 weeks. Overall event-free survival was 73.6% with one ablation and 77.4% after reablation (reablation rate was 8.7%). Median time to recurrence was 26.9 weeks. AF was more likely to recur in patients being treated with antiarrhythmic therapy at the time of last follow-up (recurrence rate 30.3% with antiarrhythmic drugs, 13.2% without antiarrhythmic drugs; hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.1-4.4, P = 0.024) and in those with a history of AF greater than 2 years duration (HR 2.7, 95% CI 1.1-6.9, P = 0.038). Our study represents the largest cohort of patients receiving AFA with closed-irrigation ablation catheters. We demonstrate comparable outcomes to those previously reported in studies of open-irrigation ablation catheters. Given the theoretical benefits of a closed-irrigation system, a large head-to-head comparison using this catheter is warranted. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  19. Diffuse ventricular fibrosis measured by T₁ mapping on cardiac MRI predicts success of catheter ablation for atrial fibrillation.

    PubMed

    McLellan, Alex J A; Ling, Liang-han; Azzopardi, Sonia; Ellims, Andris H; Iles, Leah M; Sellenger, Michael A; Morton, Joseph B; Kalman, Jonathan M; Taylor, Andrew J; Kistler, Peter M

    2014-10-01

    There is a complex interplay between the atria and ventricles in atrial fibrillation (AF). Cardiac magnetic resonance (CMR) imaging provides detailed tissue characterization, identifying focal ventricular fibrosis with late gadolinium enhancement (ventricular late gadolinium enhancement) and diffuse fibrosis with postcontrast-enhanced T1 mapping. The aim of the present study was to investigate the relationship between postcontrast ventricular T1 relaxation time on CMR and freedom from AF after pulmonary vein isolation. One hundred three patients undergoing catheter ablation for symptomatic AF (66% paroxysmal AF; age, 58±10 years; left atrial area, 27±7 cm(2)) underwent preprocedure CMR to determine postcontrast ventricular T1 time. Follow-up included clinical review and 7-day Holter monitors at 6 monthly intervals. All patients underwent successful pulmonary vein isolation. At a mean follow-up of 15±7 months, the single procedure success was 74%. Postcontrast ventricular T1 time was significantly shorter in patients with recurrent AF (366±73 ms) versus patients without AF recurrence (428±90 ms; P=0.002). Univariate predictors of AF recurrence included postcontrast ventricular T1 time, AF type (paroxysmal versus persistent), AF duration, and body mass index. After multivariate analysis, ventricular T1 time (P=0.03) and AF duration (P=0.03) were the only independent predictors. Freedom from AF was present in 84% of patients with a postcontrast ventricular T1 time >380 ms versus 56% in patients with a postcontrast ventricular T1 time <380 ms (P=0.002). A shorter postcontrast ventricular T1 relaxation time on CMR is associated with reduced freedom from AF after catheter ablation. Diffuse ventricular fibrosis as demonstrated by CMR may, in part, explain recurrent AF after AF ablation. © 2014 American Heart Association, Inc.

  20. Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy.

    PubMed

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen; Chen, Xu

    2017-08-17

    Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by remote magnetic navigation (RMN) in patients with ICM. A total of 54 ICM patients (87% male; mean age, 65 ± 7.1 years) presenting with VT storm undergoing acute ablation using RMN were enrolled. Acute complete ablation success was defined as noninducibility of any sustained monomorphic VT at the end of the procedure. Early VT recurrence was defined as the occurrence of sustained VT within 1 month after the first ablation. After a mean follow-up of 17.1 months, 27 patients (50%) had freedom from VT recurrence. Sustained VT recurred in 12 patients (22%) within 1 month following the first ablation. In univariate analysis, VT recurrence was associated with incomplete procedural success (hazard ratio [HR]: 6.25, 95% confidence interval [CI]: 1.20-32.47, P = 0.029), lack of amiodarone usage before ablation (HR: 4.71, 95% CI: 1.12-19.7, P = 0.034), and a longer procedural time (HR: 1.023, 95% CI: 1.00-1.05, P = 0.05). The mortality of patients with early VT recurrence was higher than that of patients without recurrence (P < 0.01). Inducibility of any VT at the end of procedure for VT storm guided by RMN is the strongest predictor of VT recurrence. ICM patients who have early recurrences after VT storm ablation are at high risk of all-cause death. © 2017 Wiley Periodicals, Inc.

  1. Basic aspects of radiofrequency catheter ablation.

    PubMed

    Nath, S; DiMarco, J P; Haines, D E

    1994-10-01

    Radiofrequency (RF) catheter ablation has become the treatment of choice for many symptomatic cardiac arrhythmias. It is presumed that the primary cause of tissue injury by RF ablation is thermally mediated, resulting in a relatively discrete homogeneous lesion. The mechanism by which RF current heats tissue is resistive heating of a narrow rim (< 1 mm) of tissue that is in direct contact with the ablation electrode. Deeper tissue heating occurs as a result of passive heat conduction from this small region of volume heating. Lesion size is proportional to the temperature at the electrode-tissue interface and the size of the ablation electrode. Temperatures above 50 degrees C are required for irreversible myocardial injury, but temperatures above 100 degrees C result in coagulum formation on the ablation electrode, a rapid rise in electrical impedance, and loss of effective tissue heating. Lesion formation is also dependent on optimal electrode-tissue contact and duration of RF delivery. Newer developments in RF ablation include temperature monitoring, longer ablation electrodes coupled to high-powered RF generators, and novel ablation electrode designs.

  2. Robotic navigation for catheter ablation: benefits and challenges.

    PubMed

    Aagaard, Philip; Natale, Andrea; Di Biase, Luigi

    2015-07-01

    Manual radio frequency (RF) ablation to restore a normal cardiac rhythm requires significant skill, manual dexterity and experience. In response to this, ablation methods and technologies have evolved rapidly in the past decade, including the development of remote navigation technologies. Today, two principal methods of remote navigation are available. One utilizes magnetic field vectors to navigate proprietary catheters, the other maneuvers standard catheters robotically. The main advantages of remote navigation include improved catheter stability, reduced fluoroscopy times and decreased total radiation exposure to both the patient and the operator. The main limitations include cost and longer procedure times. Remote magnetic navigation appears to have the best safety profile; however, its efficacy in creating lesions may be lower, which has been attributed to the soft-tip catheter used. Remote robotic navigation on the other hand, which uses regular catheter tips, is associated with a slightly higher overall complication rate, but higher efficacy. This article reviews the pros and cons of remote navigation for ablation of both atrial and ventricular substrates. Finally, it attempts to predict the direction of this field in the coming years.

  3. The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation.

    PubMed

    Canpolat, Uğur; Aytemir, Kudret; Yorgun, Hikmet; Şahiner, Levent; Kaya, Ergün Barış; Çay, Serkan; Topaloğlu, Serkan; Aras, Dursun; Oto, Ali

    2015-12-01

    Previous studies evidenced that increased monocyte count or activity and lower high-density lipoprotein (HDL) cholesterol levels were associated with more prevalent atrial fibrillation (AF) which attributed to pro-inflammatory and pro-oxidant effects. Monocyte-to-HDL ratio (M/H ratio) is a recently emerged indicator of inflammation and oxidative stress which have been only studied in patients with chronic kidney disease. We aimed to investigate the prognostic impact of M/H ratio on AF recurrence after cryoballoon-based catheter ablation. A total of 402 patients (43.5% female, age 53.5 ± 10.9 years, and 80.8% paroxysmal AF) with symptomatic AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural M/H ratio. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 20.6 ± 6.0 months, 95 patients (23.6%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest M/H ratio quartiles were 7.4, 7.4, 16.8, and 68.4%, respectively (P < 0.001). On multivariate Cox regression analysis, the preablation M/H ratio (HR: 1.20, 95% CI: 1.15-1.25, P < 0.001), left atrial diameter, duration of AF history, and early AF recurrence were independent predictors of AF recurrence. Using a cut-off level of 11.48, the pre-ablation M/H ratio predicted AF recurrence during follow-up with a sensitivity of 85% and a specificity of 74%. Elevated pre-ablation M/H ratio was associated with an increased recurrence of AF after cryoballoon-based catheter ablation. Our results support the role of pre-ablation pro-inflammatory and pro-oxidant environment in AF recurrence after ablation therapy but suggest that other factors are also important. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  4. Monopole antennas for microwave catheter ablation

    SciTech Connect

    Labonte, S.; Blais, A.; Legault, S.R.; Ali, H.O.; Roy, L.

    1996-10-01

    The authors study the characteristics of various monopole antennas for microwave catheter ablation of the endocardium. The investigation is done with a computer model based on the finite-element method in the frequency domain. Three monopole geometries are considered: open-tip, dielectric-tip, and metal-tip. Calculations are made for the magnetic field, the reflection coefficient and the power deposition pattern of the antennas immersed in normal saline. The theoretical results are compared with measurements performed on prototypes and good agreement is obtained. The antenna characteristics suggest that the metal-tip monopole best fulfills the requirements of catheter ablation. The computer model is then used to compare metal-tip monopoles of different dimensions and to determine design trade-offs.

  5. Catheter ablation of fascicular ventricular tachycardia.

    PubMed

    Ramprakash, B; Jaishankar, S; Rao, Hygriv B; Narasimhan, C

    2008-08-01

    Fascicular ventricular tachycardia (VT) is an idiopathic VT with right bundle branch block morphology and left-axis deviation occuring predominantly in young males. Fascicular tachycardia has been classified into three subtypes namely, left posterior fascicular VT, left anterior fascicular VT and upper septal fascicular VT. The mechanism of this tachycardia is believed to be localized reentry close to the fascicle of the left bundle branch. The reentrant circuit is composed of a verapamil sensitive zone, activated antegradely during tachycardia and the fast conduction Purkinje fibers activated retrogradely during tachycardia recorded as the pre Purkinje and the Purkinje potentials respectively. Catheter ablation is the preferred choice of therapy in patients with fascicular VT. Ablation is carried out during tachycardia, using conventional mapping techniques in majority of the patients, while three dimensional mapping and sinus rhythm ablation is reserved for patients with nonmappable tachycardia.

  6. Pharmacological therapy following catheter ablation of atrial fibrillation.

    PubMed

    Rordorf, Roberto; Savastano, Simone; Gandolfi, Edoardo; Vicentini, Alessandro; Petracci, Barbara; Landolina, Maurizio

    2012-01-01

    Catheter ablation has been proven to be an effective treatment for patients with drug-resistant atrial fibrillation. Nevertheless its efficacy is limited to 60-80% of patients in different studies. Whether the use of pharmacological therapy after catheter ablation of atrial fibrillation might increase the procedural success rate is still a matter of debate. There is general agreement that antiarrhythmic drugs (AADs) are useful in the management of arrhythmias occurring in the very early period after catheter ablation (blanking period). On the contrary, limited data are available on the efficacy of AADs over a longer period. Some patients remain free of arrhythmia recurrences by the use of AADs that were ineffective before catheter ablation: whether this latter situation is to be considered a partial success of catheter ablation or a treatment failure, thus demanding a redo procedure, is still an open question. Some studies have also investigated the role of non-AADs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, statins and corticosteroids] in preventing atrial fibrillation recurrences after catheter ablation, reporting conflicting results. Whereas there is a general consensus on the use of anticoagulation therapy in the first phase after catheter ablation, no definite data are available on the proper long-term management of anticoagulation therapy after catheter ablation. This review focuses on the still open issue of what is the optimal pharmacological treatment of patients after catheter ablation of atrial fibrillation.

  7. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study

    PubMed Central

    Mirza, Mahek; Caracciolo, Giuseppe; Khan, Uzma; Mori, Naoyo; Saha, Samir K.; Srivathsan, Komandoor; Altemose, Gregory; Scott, Luis; Sengupta, Partho

    2011-01-01

    Background Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. Methods and Results Sixty-three patients (63±10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18±12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55±17% vs. 64±14%, p=0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11±7% vs. 20±14%, p=0.007) and SR (0.9±0.4 vs. 1.3±0.6 s−1, p=0.01). Multivariate analysis revealed lateral wall LS (odds ratio=1.15, 95% CI=1.02–1.28, p=0.01) as an independent predictor of AFR. Conclusions Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA. PMID:21424845

  8. [Catheter ablation of atrial flutter and paroxysmal atrial fibrillation].

    PubMed

    Márquez, Manlio F

    2003-01-01

    Radiofrequency catheter ablation has emerged as a curative therapy for atrial flutter based on studies demonstrating the role of the cavotricuspid isthmus. With a high rate of success and minimal complications, catheter ablation is the therapy of choice for patients with the common type of atrial flutter. Left atrial flutter, non-cavotricuspid isthmus dependent, and those associated with heart disease have a worst outcome with catheter ablation. Radiofrequency catheter ablation has also emerged as a curative therapy for paroxysmal atrial fibrillation based on studies demonstrating the role of triggering foci in the pulmonary veins for the initiation of atrial fibrillation. Catheter ablation is performed by a transseptal approach using radiofrequency energy at the ostium of each pulmonary vein. Mapping is guided by special catheters. Sequential radiofrequency applications eliminates or dissociates pulmonary vein muscle activity. Although complications exists, this is the only curative method for these patients.

  9. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study.

    PubMed

    Mirza, Mahek; Caracciolo, Giuseppe; Khan, Uzma; Mori, Naoyo; Saha, Samir K; Srivathsan, Komandoor; Altemose, Gregory; Scott, Luis; Sengupta, Partho; Jahangir, Arshad

    2011-09-01

    Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. Sixty-three patients (63 ± 10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18 ± 12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55 ± 17% vs. 64 ± 14%, p = 0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11 ± 7% vs. 20 ± 14%, p = 0.007) and SR (0.9 ± 0.4 vs.1.3 ± 0.6 s(-1), p = 0.01). Multivariate analysis revealed lateral wall LS (odds ratio = 1.15, 95% CI = 1.02-1.28, p = 0.01) as an independent predictor of AFR. Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA.

  10. Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia.

    PubMed

    Deng, Yi; Naeini, Payam S; Razavi, Mehdi; Collard, Charles D; Tolpin, Daniel A; Anton, James M

    2016-12-01

    Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.

  11. Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation.

    PubMed

    den Uijl, Dennis W; Gawrysiak, Marcin; Tops, Laurens F; Trines, Serge A; Zeppenfeld, Katja; Schalij, Martin J; Bax, Jeroen J; Delgado, Victoria

    2011-11-01

    Total atrial activation time has been identified as an independent predictor of new-onset atrial fibrillation (AF). Echocardiographic assessment of PA-TDI duration provides an estimation of total atrial conduction time. The aim of this study was to investigate the prognostic value of total atrial conduction time to predict AF recurrence after radiofrequency catheter ablation (RFCA). In 213 patients undergoing RFCA for symptomatic drug-refractory paroxysmal AF, the total atrial conduction time was estimated by measuring the time delay between the onset of the P-wave in lead II of the surface electrocardiogram and the peak A'-wave on the tissue Doppler tracing of the left atrial (LA) lateral wall (PA-TDI duration). After RFCA, all patients were evaluated on a systematic basis at the outpatient clinic. After a mean follow-up of 13 ± 3 months, 74 patients (35%) had recurrent AF whereas 139 patients (65%) maintained sinus rhythm. Left atrial maximum volume index and PA-TDI duration were identified as independent predictors of AF recurrence after RFCA. However, receiver operator characteristics curve analyses demonstrated that PA-TDI duration had a superior accuracy to predict AF recurrence compared with LA maximum volume index (area under the curve 0.765 vs. 0.561, respectively). Assessment of total atrial conduction time using tissue Doppler imaging can be used to predict AF recurrence after RFCA.

  12. Temperature measurement within myocardium during in vitro RF catheter ablation.

    PubMed

    Cao, H; Vorperian, V R; Tsai, J Z; Tungjitkusolmun, S; Woo, E J; Webster, J G

    2000-11-01

    While most commercial ablation units and research systems can provide catheter tip temperature during ablation, they do not provide information about the temperature change inside the myocardium, which determines the lesion size. We present the details of a flow simulation and temperature measurement system, which allows the monitoring of the temperature change inside the myocardium during in vitro radio frequency (RF) cardiac catheter ablation at different blood flow rates to which the catheter site may be exposed. We set up a circulation system that simulated different blood flow rates of 0 to 5 L/min at 37 degrees C. We continuously measured the temperature at the catheter tip using the built-in thermistor and inside the myocardium using a three-thermocouple probe. The system provides a means for further study of the temperature inside myocardium during RF catheter ablation under different flow conditions and at different penetration depths.

  13. Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath

    PubMed Central

    Wallace, Daniel T.; Goldenberg, Alex S.; Peters, Nicholas S.; Davies, D. Wyn

    2008-01-01

    Background A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation. Objective To report our initial experience using this system for remotely performing catheter ablation in humans. Methods Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n = 1), atrial flutter (n = 2) and atrial fibrillation (n = 7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success. Results Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm2 for all ten ablation procedures. Conclusions Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator. Electronic supplementary material The online version of this article (doi:10.1007/s10840-007-9184-z) contains supplementary material, which is available to authorized users

  14. Catheter Ablation for Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy.

    PubMed

    Thompson, Nathaniel; Frontera, Antonio; Takigawa, Masateru; Cheniti, Ghassen; Massoullie, Gregoire; Cochet, Hubert; Denis, Arnaud; Chaumeil, Arnaud; Derval, Nicolas; Hocini, Meleze; Haissaguerre, Michel; Jais, Pierre; Sacher, Frederic

    2017-03-01

    Although catheter ablation has been successful in reducing the recurrence of ventricular tachycardia in patients with ischemic disease, outcomes in patients with nonischemic cardiomyopathy (NICM) have not met with the same results. Success is predicated on a methodical approach to diagnosis of disease type and identification of critical substrate, and the ablation strategies used. Cardiac MRI with delayed enhancement is able to identify areas of substrate involvement, particularly in situations when conventional catheter mapping is not able to do so. Radiofrequency needle, irrigated bipolar radiofrequency, and transcoronary alcohol ablation are effective and alternative techniques to endocardial and epicardial ablation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency.

    PubMed

    van Driel, Vincent J H M; Neven, Kars G E J; van Wessel, Harry; du Pré, Bastiaan C; Vink, Aryan; Doevendans, Pieter A F M; Wittkampf, Fred H M

    2014-08-01

    Radiofrequency ablation inside pulmonary vein (PV) ostia can cause PV stenosis. A novel alternative method of ablation is irreversible electroporation, but the long-term response of PVs to electroporation ablation is unknown. In ten 6-month-old pigs (60-75 kg), the response of PVs to circular electroporation and radiofrequency ablation was compared. Ten consecutive, nonarcing, electroporation applications of 200 J were delivered 5 to 10 mm inside 1 of the 2 main PVs, using a custom-deflectable, 18-mm circular decapolar catheter. Inside the other PV, circular radiofrequency ablation was performed using 30 W radiofrequency applications via an irrigated 4-mm ablation catheter. PV angiograms were made before ablation, immediately after ablation, and after 3-month survival. PV diameters and heart size were measured. With electroporation ablation, PV ostial diameter decreased 11±10% directly after ablation, but had increased 19±11% after 3 months. With radiofrequency ablation, PV ostial diameter decreased 23±15% directly after ablation and remained 7±17% smaller after 3 months compared with preablation diameter despite a 21±7% increase in heart size during aging from 6 to 9 months. In this porcine model, multiple circumferential 200-J electroporation applications inside the PV ostia do not affect PV diameter at 3-month follow-up. Radiofrequency ablation inside PV ostia causes considerable PV stenosis directly after ablation, which persists after 3 months. © 2014 American Heart Association, Inc.

  16. Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias.

    PubMed

    Yamada, Takumi; Kay, G Neal

    2016-01-01

    Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs.

  17. Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias

    PubMed Central

    Kay, G Neal

    2016-01-01

    Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs. PMID:28116086

  18. [Current treatment of Wolff-Parkinson-White syndrome and ventricular tachycardia: surgical ablation versus catheter ablation?].

    PubMed

    Misaki, T; Watanabe, G; Iwa, T; Watanabe, Y

    1992-09-01

    From November 1973, 454 patients with Wolff-Parkinson-White syndrome underwent surgical ablation of accessory pathways. Overall curative rate was 94% in our series including 65 cases of simultaneous surgical repair for combined heart diseases. In recent months, radiofrequency catheter ablation was applied in 7 cases. There has been 2 failures, which have taken more than 2 hours of radiation exposure and have required surgery. There has been 47 patients who underwent surgical ablation for non-ischemic ventricular tachycardia. Forty cases (85%) had a successful outcome of surgical ablation and another 2 cases required DC catheter ablation postoperatively to eliminate ventricular tachycardias. In conclusion, radiofrequency ablation of WPW syndrome in patients without combined heart disease or multiple accessory pathways is feasible. Surgical ablation is effective and safe technique compared with catheter ablation in patients with ventricular tachycardia.

  19. The effect of elastic modulus on ablation catheter contact area

    NASA Astrophysics Data System (ADS)

    Camp, Jon J.; Linte, Cristian A.; Rettmann, Maryam E.; Sun, Deyu; Packer, Douglas L.; Robb, Richard A.; Holmes, David R.

    2015-03-01

    Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrodetissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel[1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.

  20. Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience.

    PubMed

    Razminia, Mansour; Willoughby, Michael Cameron; Demo, Hany; Keshmiri, Hesam; Wang, Theodore; D'Silva, Oliver J; Zheutlin, Terry A; Jibawi, Hakeem; Okhumale, Paul; Kehoe, Richard F

    2017-04-01

    Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations on our patients for over 5 years. We present a retrospective analysis of the safety, efficacy, and feasibility data from 500 consecutive patients who underwent nonfluoroscopic catheter ablation, targeting a total of 639 arrhythmias, including atrioventricular reciprocating tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT), atrial fibrillation (AF), premature ventricular contractions (PVCs), and ventricular tachycardia (VT). We perform fluoroless ablations using intracardiac electrograms, electroanatomic mapping, and for most cases intracardiac echocardiography. Our experience includes exclusively endocardial cardiac ablations. The mean follow-up was 20.5 months. Recurrence rate for AVRT was 6.5%, for AVNRT 2.5%, for macro-reentrant AT 6.4%, for focal AT 5.4%, for AF 22.6%, for PVC 6.7%, and for VT 21.4%. Major complications occurred in five patients (1.0%); minor complications occurred in three patients (0.6%). No deaths occurred. Fluoroscopy was used in one instance, for 0.3 minutes, to confirm venous access. Completely fluoroless catheter ablations may be routinely performed for all endocardial ablations without compromising safety, efficacy, or procedural duration. © 2017 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  1. Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation.

    PubMed

    Fukushima, Keiko; Fukushima, Noritoshi; Ejima, Koichiro; Kato, Ken; Sato, Yasuto; Uematsu, Shoko; Arai, Kotaro; Manaka, Tetsuyuki; Takagi, Atsushi; Ashihara, Kyomi; Shoda, Morio; Hagiwara, Nobuhisa

    2015-07-01

    Atrial fibrillation (AF) is associated with atrial remodeling. We investigate the abilities of preprocedural echocardiographic parameters reflecting atrial remodeling to predict AF recurrence after radiofrequency catheter ablation (RFCA) for paroxysmal AF (PAF). Preprocedural echocardiographic parameters were measured during sinus rhythm in 105 patients with PAF undergoing RFCA. Electrical remodeling was assessed by the time from the onset of the P-wave to the peak A'-wave on the tissue Doppler imaging (PA-TDI), functional remodeling was assessed by the left atrial appendage flow velocity (LAAFV), and structural remodeling was assessed by the left atrial volume index (LAVI). PA-TDI, LAAFV, and LAVI values were divided into tertiles, and their abilities to predict AF recurrence were assessed using Cox regression analysis. AF recurrence occurred in 39/105 (37.1%) patients. After adjustment for confounders, the rate of AF recurrence was significantly higher in the highest tertile of PA-TDI compared with the lowest tertile (≥151.3 msec vs. <131.0 msec; hazard ratio [HR]: 2.477, 95% confidence interval [CI]: 1.031-5.950; P = 0.042), and in the lowest tertile of LAAFV compared with the highest tertile (<48.5 cm/sec vs. ≥64.9 cm/sec; HR: 2.680, 95% CI: 1.136-6.318; P = 0.024). The risk of AF recurrence was also higher in the highest tertile of LAVI (≥34.2 mL/m(2) ) compared with the lowest tertile, but this difference was not significant (HR: 2.146, 95% CI: 0.834-5.523; P = 0.113). LAAFV (reflecting functional remodeling) and PA-TDI (reflecting electrical remodeling) are independent predictors of AF recurrence after RFCA for PAF. © 2014, Wiley Periodicals, Inc.

  2. Coefficient of Variation of P-Wave Duration Is a Novel Atrial Heterogeneity Index to Predict Recurrence of Atrial Fibrillation After Catheter Ablation.

    PubMed

    Nakatani, Yosuke; Sakamoto, Tamotsu; Mizumaki, Koichi; Nishida, Kunihiro; Kataoka, Naoya; Tsujino, Yasushi; Yamaguchi, Yoshiaki; Inoue, Hiroshi

    2016-05-01

    Atrial conduction heterogeneity is associated with progression of atrial fibrillation (AF). However, the relationship between P-wave parameters representing atrial conduction heterogeneity and AF recurrence after catheter ablation (ABL) is still unclear. Subjects of the study were 126 consecutive patients with AF (78 paroxysmal and 48 persistent) who had received ABL. Coefficient of variation of P-wave duration (CV-PWD) was determined with all 12 surface electrocardiographic leads as an index of atrial conduction heterogeneity. Rates of freedom from AF recurrence were 78% and 77% in patients with paroxysmal and persistent AF, respectively, over a 12-month follow-up. CV-PWD measured before ABL was smaller in AF-free patients compared with AF-recurrent patients (0.089 ± 0.019 vs. 0.129 ± 0.042, P < 0.001). CV-PWD significantly decreased after ABL in AF-free patients, but did not change in AF-recurrent patients. CV-PWD after ABL was also smaller in AF-free patients compared with AF-recurrent patients (0.087 ± 0.025 vs. 0.133 ± 0.035, P < 0.001). In receiver operating curve analysis, CV-PWD before and after ABL achieved area under the curve of 0.829 and 0.854, respectively, for the ability to predict AF recurrence. CV-PWD correlated positively with left atrial (LA) diameter and negatively with LA appendage flow velocity. CV-PWD is a useful index to predict AF recurrence after ABL for both patients with paroxysmal and persistent AF. ABL may suppress AF by decreasing atrial conduction heterogeneity. © 2016 Wiley Periodicals, Inc.

  3. Accidental Entrapment of Electrical Mapping Catheter by Chiari's Network in Right Atrium during Catheter Ablation Procedure

    PubMed Central

    Sakamoto, Atsushi; Urushida, Tsuyoshi; Sakakibara, Tomoaki; Sano, Makoto; Suwa, Kenichiro; Saitoh, Takeji; Saotome, Masao; Katoh, Hideki; Satoh, Hiroshi; Hayashi, Hideharu

    2016-01-01

    A 78-year-old male was admitted to our hospital due to frequent palpitation. His electrocardiogram (ECG) presented regular narrow QRS tachycardia with 170 bpm, and catheter ablation was planned. During electroanatomical mapping of the right atrium (RA) with a multiloop mapping catheter, the catheter head was entrapped nearby the ostium of inferior vena cava. Rotation and traction of the catheter failed to detach the catheter head from the RA wall. Exfoliation of connective tissue twined around catheter tip by forceps, which were designed for endomyocardial biopsy, succeeded to retract and remove the catheter. Postprocedural echocardiography and pathologic examination proved the existence of Chiari's network. The handling of complex catheters in the RA has a potential risk of entrapment with Chiari's network. PMID:27366332

  4. Catheter ablation in patients with persistent atrial fibrillation

    PubMed Central

    Kirchhof, Paulus; Calkins, Hugh

    2017-01-01

    Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials. PMID:27389907

  5. A systematic review of surgical ablation versus catheter ablation for atrial fibrillation

    PubMed Central

    Kearney, Katherine; Stephenson, Rowan; Phan, Kevin; Chan, Wei Yen; Huang, Min Yin

    2014-01-01

    Background Atrial fibrillation (AF) is an increasingly prevalent condition in the ageing population, with significantly associated morbidity and mortality. Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF. This review consolidates all currently available comparative data to evaluate these two interventions. Methods A systematic search was conducted across MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from January 2000 until August 2013. All studies were critically appraised and only those directly comparing surgical and catheter ablation were included. Results Seven studies were deemed suitable for analysis according to the inclusion criteria. Freedom from AF was significantly higher in the surgical ablation group versus the catheter ablation group at 6-month, 12-month and study endpoint follow-up periods. Subgroup analysis demonstrated similar trends, with higher freedom from AF in the surgical ablation group for paroxysmal AF patients. The incidence of pacemaker implantation was higher, while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups. Conclusions Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF, higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment. Other complications and risks were poorly reported, which warrants further randomized controlled trials (RCTs) of adequate power and follow-up duration. PMID:24516794

  6. Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia

    PubMed Central

    Naeini, Payam S.; Razavi, Mehdi; Collard, Charles D.; Tolpin, Daniel A.; Anton, James M.

    2016-01-01

    Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia. PMID:28100967

  7. Radiofrequency catheter ablation for the management of cardiac tachyarrhythmias.

    PubMed

    Wood, M; Ellenbogen, K; Stambler, B

    1993-10-01

    Radiofrequency catheter ablation techniques allow for safe and highly effective curative therapy of a variety of cardiac dysrhythmias. The technique involves the delivery of a high-frequency, alternating electrical current through an intravascular catheter to sites of arrhythmogenic myocardium. This current induces resistive electrical heating of the tissue, resulting in discrete areas of myocardial destruction through coagulation and desiccation. Dysrhythmias most commonly treated with these techniques are atrioventricular nodal reentry and tachycardias related to accessory atrioventricular bypass tracts. For these dysrhythmias, success rates of 90% to 95% are achievable with a low (2% to 4%) risk of complications. Radiofrequency catheter ablation techniques also have been used to treat ventricular tachycardias, atrial flutter, ectopic atrial tachycardia, and sinus node reentry, albeit with lower success rates. These techniques are still evolving, alternate energy sources (such as microwave and laser) and improved catheter technology should enhance the technique's safety and efficacy for a wider range of dysrhythmias.

  8. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation.

    PubMed

    Mochizuki, Atsushi; Yuda, Satoshi; Fujito, Takefumi; Kawamukai, Mina; Muranaka, Atsuko; Nagahara, Daigo; Shimoshige, Shinya; Hashimoto, Akiyoshi; Miura, Tetsuji

    2017-06-01

    Several studies have shown the utility of left atrial (LA) function determined by two-dimensional or three-dimensional speckle tracking echocardiography (2D- or 3D-STE) for identifying patients with paroxysmal atrial fibrillation (AF). However, whether 3D-STE is applicable for prediction of the recurrence of AF after catheter ablation (CA) remains unknown. We examined whether any 3D-STE parameters are better than 2D-STE parameters for the prediction of AF recurrence. Forty-two patients with paroxysmal AF (58 ± 10 years old, 69% male) underwent 2D- and 3D-STE within 3 days before first-time CA. The global peak LA longitudinal, circumferential, and area strains during systole (3D-GLSs, -GCSs, and -GASs, respectively) and those just before atrial contraction (3D-GLSa, -GCSa, and -GASa, respectively) were determined by 3D-STE and standard deviations of times to peaks of regional LA strains were calculated as indices of LA dyssynchrony. In 2D-STE, global LA longitudinal strains during systole and just before atrial contraction (2D-GLSs and -GLSa) were determined. During follow-up of 441 ± 221 days, 12 patients (29%) had AF recurrence. In the univariate Cox proportional hazard analysis, age [hazard ratio (HR): 1.08, p = 0.04], 3D-GCSs (HR: 0.91, p = 0.03), and 3D-GASs (HR: 0.95, p = 0.01) were predictors of AF recurrence, though associations of recurrence with 2D-STE parameters, indices of LA synchrony, and LA volume were not significant. Multivariable analysis showed that 3D-GASs was an independent predictor of AF recurrence (HR: 0.96, p = 0.048). LA strain determined by 3D-STE is a novel and better predictor of AF recurrence after CA than that determined by 2D-STE or other known predictors.

  9. Task-Space Motion Planning of MRI-Actuated Catheters for Catheter Ablation of Atrial Fibrillation.

    PubMed

    Greigarn, Tipakorn; Cavuşoğlu, M Cenk

    2014-09-01

    This paper presents a motion planning algorithm for Magnetic Resonance Imaging (MRI) actuated catheters for catheter ablation of atrial fibrillation. The MRI-actuated catheters is a new robotic catheter concept which utilizes MRI for remote steering and guidance. Magnetic moments generated by a set of coils wound near the tip are used to steer the catheter under MRI scanner magnetic field. The catheter during an ablation procedure is modeled as a constrained robotic manipulator with flexible joints, and the proposed motion-planning algorithm calculates a sequence of magnetic moments based on the manipulator model to move the tip of the catheter along a predefined trajectory on the surface of the left atrium. The difficulties in motion planning of the catheter are due to kinematic redundancy and underactuation. The proposed motion planning algorithm overcomes the challenges by operating in the task space instead of the configuration space. The catheter is then regulated around this nominal trajectory using feedback control to reduce the effect of uncertainties.

  10. Task-Space Motion Planning of MRI-Actuated Catheters for Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Greigarn, Tipakorn; Çavuşoğlu, M. Cenk

    2014-01-01

    This paper presents a motion planning algorithm for Magnetic Resonance Imaging (MRI) actuated catheters for catheter ablation of atrial fibrillation. The MRI-actuated catheters is a new robotic catheter concept which utilizes MRI for remote steering and guidance. Magnetic moments generated by a set of coils wound near the tip are used to steer the catheter under MRI scanner magnetic field. The catheter during an ablation procedure is modeled as a constrained robotic manipulator with flexible joints, and the proposed motion-planning algorithm calculates a sequence of magnetic moments based on the manipulator model to move the tip of the catheter along a predefined trajectory on the surface of the left atrium. The difficulties in motion planning of the catheter are due to kinematic redundancy and underactuation. The proposed motion planning algorithm overcomes the challenges by operating in the task space instead of the configuration space. The catheter is then regulated around this nominal trajectory using feedback control to reduce the effect of uncertainties. PMID:25485168

  11. Factors influencing lesion formation during radiofrequency catheter ablation.

    PubMed

    Eick, Olaf J

    2003-07-01

    In radiofrequency (RF) ablation, the heating of cardiac tissue is mainly resistive. RF current heats cardiac tissue and in turn the catheter electrode is being heated. Consequently, the catheter tip temperature is always lower--or ideally equal--than the superficial tissue temperature. The lesion size is influenced by many parameters such as delivered RF power, electrode length, electrode orientation, blood flow and tissue contact. This review describes the influence of these different parameters on lesion formation and provides recommendations for different catheter types on selectable parameters such as target temperatures, power limits and RF durations.

  12. Factors Influencing Lesion Formation During Radiofrequency Catheter Ablation

    PubMed Central

    Eick, Olaf J

    2003-01-01

    In radiofrequency (RF) ablation, the heating of cardiac tissue is mainly resistive. RF current heats cardiac tissue and in turn the catheter electrode is being heated. Consequently, the catheter tip temperature is always lower - or ideally equal - than the superficial tissue temperature. The lesion size is influenced by many parameters such as delivered RF power, electrode length, electrode orientation, blood flow and tissue contact. This review describes the influence of these different parameters on lesion formation and provides recommendations for different catheter types on selectable parameters such as target temperatures, power limits and RF durations. PMID:16943910

  13. [Catheter ablation of tachyarrhythmias in children and adolescents].

    PubMed

    Ohm, Ole-Jørgen; Hoff, Per Ivar; Aasen, Lars Mikal; Solheim, Eivind; Schuster, Peter; Off, Morten Kristian; Chen, Jian

    2009-02-12

    Catheter ablation has been increasingly applied in children and adolescents with tachyarrhythmias. The aim of this article is to assess the results of ablation therapy of tachycardias in patients below 18 years of age at Haukeland University Hospital. 141 patients (70 boys and 71 girls, aged 5-17 (13.5 +/- 3.5 ) years with tachyarrhythmias underwent an electrophysiologic study and catheter ablation in the period 1992-2007. Ablation was successfully performed in 138/141 (98%) patients., The procedure was repeated (3 patients twice) until the arrhythmia substrate disappeared in 16 of 138 patients. 81/141 (57%) patients had accessory pathways; 52 (37%) had double atrioventricular nodal pathways, 48 had concealed and 33 patients had overt (classical Wolff-Parkinson-White-syndrome) atrioventricular pathways. 8 (6%) patients had other atrial or ventricular tachyarrhythmias and 4 (3%) had organic heart disease. Use of a 3D mapping system was decisive for success for ablation in patients with complex cardiac diseases. Procedure-related complications were observed in 2/141 (1.4%) patients of whom one had a temporary third degree and one had a permanent first-degree atrioventricular block which did not entail further treatment. Catheter ablation of tachycardia in children and adolescents is a safe treatment method with a high success rate and few complications and should be preferred before drug therapy.

  14. Catheter ablation of atrial fibrillation without the use of fluoroscopy.

    PubMed

    Reddy, Vivek Y; Morales, Gustavo; Ahmed, Humera; Neuzil, Petr; Dukkipati, Srinivas; Kim, Steve; Clemens, Janet; D'Avila, Andre

    2010-11-01

    In performing catheter ablation of paroxysmal atrial fibrillation (PAF), the advent of electroanatomical mapping (EAM) has significantly reduced fluoroscopy time. Recent advances in the ability of EAM systems to simultaneously visualize multiple catheters have allowed some operators to perform certain procedures, such as catheter ablation of supraventricular tachycardias, with zero fluoroscopy use. The purpose of this study was to evaluate the feasibility and safety of pulmonary vein (PV) isolation with zero fluoroscopy use, using a combination of three-dimensional EAM and intracardiac echocardiography (ICE). Using the NavX EAM system, the right atrial (RA) and coronary sinus (CS) geometries were created without fluoroscopy. Fluoroless transseptal puncture was performed under ICE guidance. Using a deflectable sheath and a multipolar catheter, the left atrial (LA) and PV anatomies were rendered and, in select cases, integrated with a three-dimensional computed tomography (CT) image. Irrigated radiofrequency ablation was performed to encircle each pair of ipsilateral PVs. This series included 20 consecutive PAF patients. RA/CS mapping required 5.5 ± 2.6 minutes. In all patients, single (n = 18) or dual (n = 2) transseptal access was successfully achieved. The LA-PV anatomy was rendered using either a circular (14 patients) or penta-array (six patients) catheter in 22 ± 10 minutes; CT image integration was used in 11 patients. Using 49 ± 18 ablation lesions/patient, electrical isolation was achieved in 38/39 ipsilateral PV isolating lesion sets (97%). The procedure time was 244 ± 75 minutes. There were no complications. Completely fluoroless catheter ablation of paroxysmal AF is safely feasible using a combination of ICE and EAM. Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. Contact Geometry Affects Lesion Formation in Radio-Frequency Cardiac Catheter Ablation

    PubMed Central

    Gallagher, Neal; Fear, Elise C.; Byrd, Israel A.; Vigmond, Edward J.

    2013-01-01

    One factor which may be important for determining proper lesion creation during atrial ablation is catheter-endocardial contact. Little information is available that relates geometric contact, depth and angle, to ablation lesion formation. We present an electrothermal computer model of ablation that calculated lesion volume and temperature development over time. The Pennes bioheat equation was coupled to a quasistatic electrical problem to investigate the effect of catheter penetration depth, as well as incident catheter angle as may occur in practice. Biological experiments were performed to verify the modelling of electrical phenomena. Results show that for deeply penetrating tips, acute catheter angles reduced the rate of temperature buildup, allowing larger lesions to form before temperatures elevated excessively. It was also found that greater penetration did not lead to greater transmurality of lesions. We conclude that catheter contact angle plays a significant role in lesion formation, and the time course must be considered. This is clinically relevant because proper identification and prediction of geometric contact variables could improve ablation efficacy. PMID:24086275

  16. [Thrombus visualisation during radiofrequency catheter ablation. A case report].

    PubMed

    Maciag, Aleksander; Szwed, Hanna; Pytkowski, Mariusz; Kraska, Alicja; Sterliński, Maciej

    2005-10-01

    We report two patients in whom thrombus formation during radiofrequency catheter ablation was detected by echocardiography. Resolution of thrombus after intravenous use of heparin was observed in both patients. Transesophageal and intracardiac echocardiography may be useful in management of this complication.

  17. Pacemaker implantation after catheter ablation for atrial fibrillation.

    PubMed

    Deshmukh, Abhishek J; Yao, Xiaoxi; Schilz, Stephanie; Van Houten, Holly; Sangaralingham, Lindsey R; Asirvatham, Samuel J; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A

    2016-01-01

    Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus <50 years), female gender, higher CHADS2 score (≥2 and 1 versus 0), higher Charlson index (≥2 versus 0-1), certain baseline comorbidities (conduction disorder, coronary atherosclerosis, and congestive heart failure), and the year of ablation. There was no significant difference in the risk of pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

  18. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

    PubMed Central

    Grothoff, Matthias; Dinov, Borislav; Kosiuk, Jedrzej; Richter, Sergio; Sommer, Philipp; Breithardt, Ole A.; Bollmann, Andreas; Arya, Arash; Hindricks, Gerhard

    2015-01-01

    Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy. PMID:25705659

  19. Thermal distribution of microwave antenna for atrial fibrillation catheter ablation.

    PubMed

    Zhang, Huijuan; Nan, Qun; Liu, Youjun

    2013-09-01

    The aim of this study is to investigate the effects of ablation parameters on thermal distribution during microwave atrial fibrillation catheter ablation, such as ablation time, ablation power, blood condition and antenna placement, and give proper ablative parameters to realise transmural ablation. In this paper, simplified 3D antenna-myocardium-blood finite element method models were built to simulate the endocardial ablation operation. Thermal distribution was obtained based on the coupled electromagnetic-thermal analysis. Under different antenna placement conditions and different microwave power inputs within 60 s, the lesion dimensions (maximum depth, maximum width) of the ablation zones were analysed. The ablation width and depth increased with the ablation time. The increase rate significantly slowed down after 10 s. The maximum temperature was located in 1 mm under the antenna tip when perpendicular to the endocardium, while 1.5 mm away from the antenna axis and 26 mm along the antenna (with antenna length about 30 mm) in the myocardium when parallel to the endocardium. The maximum temperature in the ablated area decreased and the effective ablation area (with the temperature raised to 50°C) shifted deeper into the myocardium due to the blood cooling. The research validated that the microwave antenna can provide continuous long and linear lesions for the treatment of atrial fibrillation. The dimensions of the created lesion widths were all larger than those of the depths. It is easy for the microwave antenna to produce transmural lesions for an atrial wall thickness of 2-6 mm by adjusting the applied power and ablation time.

  20. Catheter Ablation of Fascicular Ventricular Tachycardia

    PubMed Central

    Liu, Yaowu; Fang, Zhen; Yang, Bing; Kojodjojo, Pipin; Chen, Hongwu; Ju, Weizhu; Cao, Kejiang; Chen, Minglong

    2015-01-01

    Background— Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence. Methods and Results— Consecutive patients undergoing FVT ablation at a single tertiary center were enrolled. Activation mapping was performed to identify the earliest presystolic Purkinje potential during FVT that was targeted by radiofrequency ablation. Follow-up with clinic visits, ECG, and Holter monitoring was performed at least every 6 months. A total of 120 consecutive patients (mean age, 29.3±12.7 years; 82% men; all patients with normal ejection fraction) were enrolled. FVT involved left posterior fascicle and left anterior fascicle in 118 and 2 subjects, respectively. VT was noninducible in 3 patients, and ablation was acutely successful in 117 patients. With a median follow-up of 55.7 months, VT of a similar ECG morphology recurred in 17 patients, and repeat procedure confirmed FVT recurrence involving the same fascicle. Shorter VT cycle length was the only significant predictor of FVT recurrence (P=0.03). Six other patients developed new-onset upper septal FVT that was successfully ablated. Conclusions— Ablation of FVT guided by activation mapping is associated with a single procedural success rate without the use of antiarrhythmic drugs of 80.3%. Arrhythmia recurrences after an initially successful ablation were caused by recurrent FVT involving the same fascicle in two thirds of patients or new onset of upper septal FVT in the remainder. PMID:26386017

  1. Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies.

    PubMed

    Schmidt, Martin; Marschang, Harald; Clifford, Sarah; Harald, Rittger; Guido, Ritscher; Oliver, Turschner; Johannes, Brachmann; Daccarett, Marcos

    2012-06-28

    Chest pain after atrial fibrillation (AF) ablations is a common complaint with a wide differential diagnosis including coronary events. Elevation of troponins (Trop I) has been shown with radio-frequency (RF) ablation for atrial fibrillation. New devices including cryoballoon and multipolar ablation catheters have been introduced as alternative methods. We aim to compare cardiac injury following AF ablations according to different ablation technologies. In consecutive patients undergoing AF ablations with RF ablation, cryoballoon or multipolar ablation catheter (PVAC), Trop I, creatine kinase (CK) and CRP were analyzed immediately prior to and 24h following completion of ablation. Coronary events and symptoms and serial ECGs post procedure were evaluated. A total of 243 patients were included, 18.5% of them females. The mean age was 63 ± 11 years old. Baseline Trop I, CK and CRP levels were within normal range in all patients. After RF ablation Trop I, CK and CRP levels were elevated in 100%, 20% and 91% of patients respectively (Trop I 3.55 pg/ml [range: 0.60-24.01 pg/ml], CK 147 U/l [range: 56-380 U/l] and CRP 2.15 mg/dl [range: 0.28-20.98 mg/dl]). All post-procedure Trop I levels were above the range of myocardial infarction (>0.15 ng/ml). After cryoballoon ablation, Trop I and CK levels were significantly higher than after RF or PVAC ablation (p<0.001). No ischemic ECG changes were documented. Trop I elevations are not specific for ischemia in the setting of chest pain after AF ablation. Cryoballoon ablation resulted in a higher amount of cardiac injury. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  2. An Update on the Energy Sources and Catheter Technology for the Ablation of Atrial Fibrillation.

    PubMed

    Arora, Pawan K; Hansen, James C; Price, Adam D; Koblish, Josef; Avitall, Boaz

    2010-01-01

    The ablation of atrial fibrillation (AF) is an area of intense research in cardiac electrophysiology. In this review, we discuss the development of catheter-based interventions for AF ablation. We outline the pathophysiologic and anatomic bases for ablative lesion sets and the evolution of various catheter designs for the delivery of radiofrequency (RF), cryothermal, and other ablative energy sources. The strengths and weaknesses of various specialized RF catheters and alternative energy systems are delineated, with respect to efficacy and patient safety.

  3. Association of Single Nucleotide Polymorphisms with Atrial Fibrillation and the Outcome after Catheter Ablation

    PubMed Central

    Hu, Yu-Feng; Wang, Hsueh-Hsiao; Yeh, Hung-I; Lee, Kun-Tai; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Tuan, Ta-Chuan; Li, Cheng-Hung; Chao, Tze-Fan; Chung, Fa-Po; Liao, Jo-Nan; Tang, Paul Wei Hua; Tsai, Wei-Chung; Chiou, Chuen-Wang; Chen, Shih-Ann

    2016-01-01

    Background The association of gene variants with atrial fibrillation (AF) type and the recurrence of AF after catheter ablation in Taiwan is still unclear. In this study, we aimed to investigate the relationships between gene variants, AF type, and the recurrence of AF. Methods In our investigation, we examined 383 consecutive patients with AF (61.9 ± 14.0 years; 63% men); of these 383 patients, 189 underwent catheter ablation for drug-refractory AF. Thereafter, the single nucleotide polymorphisms rs2200733, and rs7193343 were genotyped using real-time polymerase chain reaction. Results The rs7193343 variant was independently associated with non-paroxysmal AF (non-PAF). In the PAF group, the rs7193343 variant was independently associated with AF recurrence after catheter ablation. However, the rs2200733 variant was not associated with AF recurrence in this group. The combination of the rs7193343 and rs2200733 risk alleles was associated with a better predictive power in the PAF patients. In contrast, in the non-PAF group, the SNPs were not associated with recurrence. The rs7193343 and rs2200733 variants were not associated with different atrial voltage and activation times. Conclusions The rs7193343 variants were associated with AF recurrence after catheter ablation in PAF patients but not in non-PAF patients. The rs7193343 CC variant was independently associated with non-PAF. PMID:27713600

  4. Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter.

    PubMed

    Knecht, Sven; Reichlin, Tobias; Pavlovic, Nikola; Schaer, Beat; Osswald, Stefan; Sticherling, Christian; Kühne, Michael

    2015-09-01

    Contact force (CF) sensing during radiofrequency (RF) ablation allows controlling lesion size. The aim of this study was to analyze the impact of catheter tip location and orientation on the association of CF and impedance decrease. We retrospectively analyzed RF applications from 32 patients undergoing catheter ablation for paroxysmal atrial fibrillation using a force-sensing catheter and 3D mapping system. CF, catheter location and orientation relative to the tissue during ablation as well as the absolute impedance decrease during the first 20 s of ablation as a surrogate for lesion effectiveness were analyzed for 791 RF applications. While a higher CF was achieved around the right pulmonary veins (12.5 vs. 11.4 g, p = 0.045), a lower median absolute impedance decrease within the first 20 s was seen around the right veins compared to the left veins (9.3 vs. 10.2 Ω, p = 0.02). With different catheter orientations relative to the tissue, higher CF and impedance decrease was seen when the catheter was orientated parallel or oblique to the tissue (30°-145°) as compared perpendicularly (0-30°) with a median CF of 13.2 vs. 8.0 g (p < 0.001) and a median impedance decrease during the first 20 s of 11 vs. 7 Ω (p < 0.001). Importantly, achieved CF, baseline impedance, catheter orientation and location all independently predicted the initial absolute and relative impedance decrease in a multivariable linear regression model (p < 0.05). The effectiveness of RF ablation lesions, as assessed by the initial impedance decrease, is not only dependent on the achieved catheter CF but also on catheter orientation and location.

  5. Use of a circular mapping and ablation catheter for ablation of atypical right ventricular outflow tract arrhythmia.

    PubMed

    Katritsis, Demosthenes G; Giazitzoglou, Eleftherios; Paxinos, George

    2010-02-01

    A new technique for ablation of persistent ectopic activity with atypical electrocardiographic characteristics at the vicinity of the right ventricular outflow tract is described. A new circular mapping and ablation catheter initially designed for pulmonary vein ablation was used. Abolition of ectopic activity was achieved with minimal fluoroscopy and ablation times.

  6. Development of a Novel Shock Wave Catheter Ablation System

    NASA Astrophysics Data System (ADS)

    Yamamoto, H.; Hasebe, Yuhi; Kondo, Masateru; Fukuda, Koji; Takayama, Kazuyoshi; Shimokawa, Hiroaki

    Although radio-frequency catheter ablation (RFCA) is quite effective for the treatment tachyarrhythmias, it possesses two fundamental limitations, including limited efficacy for the treatment of ventricular tachyarrhythmias of epicardial origin and the risk of thromboembolism. Consequently, new method is required, which can eradicate arrhythmia source in deep part of cardiac muscle without heating. On the other hand, for a medical application of shock waves, extracorporeal shock wave lithotripter (ESWL) has been established [1]. It was demonstrated that the underwater shock focusing is one of most efficient method to generate a controlled high pressure in a small region [2]. In order to overcome limitations of existing methods, we aimed to develop a new catheter ablation system with underwater shock waves that can treat myocardium at arbitrary depth without causing heat.

  7. Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

    PubMed Central

    Zhao, Jichao; Kharche, Sanjay R.; Hansen, Brian J.; Csepe, Thomas A.; Wang, Yufeng; Stiles, Martin K.; Fedorov, Vadim V.

    2015-01-01

    Atrial fibrillation (AF) is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA) is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation. PMID:25984605

  8. Approaches to catheter ablation for persistent atrial fibrillation.

    PubMed

    Verma, Atul; Jiang, Chen-yang; Betts, Timothy R; Chen, Jian; Deisenhofer, Isabel; Mantovan, Roberto; Macle, Laurent; Morillo, Carlos A; Haverkamp, Wilhelm; Weerasooriya, Rukshen; Albenque, Jean-Paul; Nardi, Stefano; Menardi, Endrj; Novak, Paul; Sanders, Prashanthan

    2015-05-07

    Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation. We randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (263 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (259 patients). The duration of follow-up was 18 months. The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than 30 seconds after a single ablation procedure. Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures (P<0.001). After 18 months, 59% of patients assigned to pulmonary-vein isolation alone were free from recurrent atrial fibrillation, as compared with 49% of patients assigned to pulmonary-vein isolation plus complex electrogram ablation and 46% of patients assigned to pulmonary-vein isolation plus linear ablation (P=0.15). There were also no significant differences among the three groups for the secondary end points, including freedom from atrial fibrillation after two ablation procedures and freedom from any atrial arrhythmia. Complications included tamponade (three patients), stroke or transient ischemic attack (three patients), and atrioesophageal fistula (one patient). Among patients with persistent atrial fibrillation, we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01203748.).

  9. Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Kim, In-Soo; Yang, Pil-Sung; Kim, Tae-Hoon; Park, Junbeum; Park, Jin-Kyu; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung

    2016-01-01

    Purpose The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. Materials and Methods We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 µg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). Results 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. Conclusion The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted. PMID:26632385

  10. Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation.

    PubMed

    Kim, In Soo; Yang, Pil Sung; Kim, Tae Hoon; Park, Junbeum; Park, Jin Kyu; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui Nam

    2016-01-01

    The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 μg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted.

  11. Epicardial catheter ablation of ventricular tachycardia in no entry left ventricle: mechanical aortic and mitral valves.

    PubMed

    Soejima, Kyoko; Nogami, Akihiko; Sekiguchi, Yukio; Harada, Tomoo; Satomi, Kazuhiro; Hirose, Takeshi; Ueda, Akiko; Miwa, Yousuke; Sato, Toshiaki; Nishio, Satoru; Shirai, Yasuhiro; Kowase, Shinya; Murakoshi, Nobuyuki; Kunugi, Shinobu; Murata, Hiroshige; Nitta, Takashi; Aonuma, Kazutaka; Yoshino, Hideaki

    2015-04-01

    In patients with mechanical aortic and mitral valves and left ventricular tachycardia, catheter ablation may be prevented by limited access to the left ventricle. In our series of 6 patients, 2 patients underwent direct surgical ablation and 4 underwent epicardial catheter ablation via a pericardial window. All patients had abnormal low voltage areas with fractionated or delayed isolated potentials on the apical epicardium. Most of the ventricular tachycardias were targeted by pace mapping. Sites with a good pace match or abnormal electrograms were ablated using an irrigated radiofrequency ablation catheter. A microscopic pathological evaluation of the resected tissue from 2 of the open-heart ablation patients revealed dense fibrosis on the epicardium compared with the endocardium, supporting the feasibility of an epicardial ablation for the ventricular tachycardia. Epicardial catheter ablation of ventricular tachycardia is a potentially useful therapy in patients who have mechanical aortic and mitral valves. © 2015 American Heart Association, Inc.

  12. An E/e' ratio on echocardiography predicts the existence of left atrial low-voltage areas and poor outcomes after catheter ablation for atrial fibrillation.

    PubMed

    Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Tsujimura, Takuya; Matsuda, Yasuhiro; Ohashi, Takuya; Uematsu, Masaaki

    2017-06-22

    An elevated left atrial pressure has been reported to play an important role in the development of atrial remodelling in atrial fibrillation (AF) patients. The study aimed at elucidating the association between the diastolic early transmitral flow velocity/mitral annular velocity (E/e', a non-invasive surrogate of left atrial pressure) and left atrial low-voltage-area existence, and the prognostic impact of the E/e' on procedural outcomes in patients undergoing AF ablation. Total of 215 consecutive patients were divided into 3 groups based on the estimated left atrial pressure: normal (E/e' < 8.0, n = 58), undetermined (E/e' = 8.0-14.0, n = 114), and elevated (E/e' > 14.0, n = 43). Left atrial endocardial voltage mapping was performed following pulmonary vein isolation. Patients with a high E/e' more frequently had low-voltage areas (E/e' < 8.0, 31%, E/e' = 8.0-14.0, 35%; E/e' > 14.0, 67%; P = 0.0001). After adjusting for other correlates, a high E/e' was an independent predictor of low-voltage-area existence (HR = 1.11, 95% CI = 1.02-1.21, P = 0.017). During a mean follow-up period of 12 ± 6 months, recurrent atrial tachyarrhythmias occurred in 22 (10%) patients after multiple (1.4 ± 0.5) procedures. Patients with an E/e' > 14 had more frequent recurrent atrial tachyarrhythmias after multiple ablation procedures than those with an E/e' ≤ 14 (23% vs. 7%, P = 0.001). A high E/e' obtained by pre-ablation echocardiography was associated with a left atrial arrhythmogenic substrate in patients undergoing AF ablation. Furthermore, a high E/e' predicted poor procedural outcomes after pulmonary vein isolation.

  13. Temperature-Guided Radiofrequency Catheter Ablation of Accessory Pathway

    PubMed Central

    Choi, Yun Shik; Nam, Gi Byoung; Kim, Hyo Soo; Sohn, Dae Won; Oh, Byung Hee; Lee, Myung Mook; Park, Young Bae; Seo, Jung Don; Lee, Young Woo

    1997-01-01

    Objectives This study was performed to evaluate the usefulness of temperature-guided radiofrequency catheter ablation for the elimination of accessory pathway conduction in patients with Wolff-Parkinson-White syndrome. Methods Temperature-guided radiofrequency catheter ablation was attempted in 138 patients with 144 accessory pathways (88 pathways along the left free wall, 5 in the anteroseptal region, 2 in the midseptal region, 19 in the posteroseptal region and 30 along the right free wall). The energy source was a HAT 200S which regulated the power automatically to the set temperature of 70°C. Radiofrequency current was delivered through a thermocatheter to the atrial or ventricular side of mitral or tricuspid annulus. Results Accessory pathway conduction was eliminated in 130 of 144 pathways (90.3%). The mean power outputs of the successful ablations at the atrial side of the annulus were higher than those at the ventricular side (34.0±8.9W versus 20.0±7.6W, p<0.01). but the maximum temperatures were lower at the atrial side of the annulus than those at the ventricular side (66.4±14.0°C versus 77.2±6.4°C, p<0.01). There were 3 non-fatal complications (2.1%), 2 patients with hemopericardium and 1 with femoral artery thrombus, during or after ablation procedures. Recurrences of AV re-entrant tachycardia or delta wave on the electrocardiogram occured in 4 patients (2.8%) who had successful second procedures. There were no late complications during a mean follow-up period of 41±25 months (range, 3 to 55). Conclusion We conclude that 1) temperature-guided radiofrequency catheter ablation can be performed reliably and safely in eliminating accessory pathway conduction in patients with WPW syndrome, and 2) temperature monitoring and adjustment of the power to the set temperature during ablation would be useful for the avoidance of impedance rises and coagulum formation. PMID:9439158

  14. [Patient selection for catheter ablation of atrial fibrillation].

    PubMed

    Márquez, Manlio F

    2007-01-01

    The present report describes the program of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients referred to the AF Clinic of the National Institute of Cardiology. Specific inclusion criteria are required for RFCA of AF. If the patient fulfills it, then an electrophysiological study is performed. A transseptal approach and special mapping catheters are used to detect abnormal electrical activity (AEA). Pulmonary vein isolation is performed at the ostium/ antrum of those veins with AEA if the patient had paroxysmal AF. Global pulmonary vein isolation with some additional lines guided by electroanatomical mapping is performed in the case of chronic AF. Postoperative follow-up includes consultation, ECG and Holter monitoring at 1, 3, 6 and 12-month. RFCA is a useful and relatively safe procedure for the treatment of AF and the only one with curative potential.

  15. Does diffuse irrigation result in improved radiofrequency catheter ablation? A prospective randomized study of right atrial typical flutter ablation.

    PubMed

    Ramoul, Khaled; Wright, Matthew; Sohal, Manav; Shah, Ashok; Castro-Rodriguez, Jose; Verbeet, Thierry; Knecht, Sébastien

    2015-02-01

    Recent developments of open irrigated catheters have sought to create uniform cooling of the entire ablating electrode. The aim of this randomized study was to assess whether the diffuse irrigation of the Coolflex(®) (CF) catheter results in improved short-term procedural benefits in patients undergoing ablation of right atrial typical flutter. Sixty consecutive patients (age 62 ± 13) with typical atrial flutter were prospectively randomized to ablation of the cavotricuspid isthmus (CTI) using either a standard 3.5 mm tip ablation catheter with six distal irrigation channels (6C) (30 patients) or a 4 mm tip fully irrigated ablation catheter (CF) (30 patients). There were no significant differences seen between procedures performed with the diffusely irrigated CF catheter and the standard six-channel irrigated-tip catheter. This concerned the total procedural duration RF duration, fluoroscopic duration, the total amount of irrigation fluid, and the occurrence of steam pop. The use of a diffuse irrigation at the ablation catheter tip does neither facilitate lesion formation nor reduce the amount of irrigation during RF ablation for typical right atrial flutter using recommended flow and power settings. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  16. Cardiac tissue ablation with catheter-based microwave heating.

    PubMed

    Rappaport, C

    2004-11-01

    The common condition of atrial fibrillation is often treated by cutting diseased cardiac tissue to disrupt abnormal electrical conduction pathways. Heating abnormal tissue with electromagnetic power provides a minimally invasive surgical alternative to treat these cardiac arrhythmias. Radio frequency ablation has become the method of choice of many physicians. Recently, microwave power has also been shown to have great therapeutic benefit in medical treatment requiring precise heating of biological tissue. Since microwave power tends to be deposited throughout the volume of biological media, microwave heating offers advantages over other heating modalities that tend to heat primarily the contacting surface. It is also possible to heat a deeper volume of tissue with more precise control using microwaves than with purely thermal conduction or RF electrode heating. Microwave Cardiac Ablation (MCA) is used to treat heart tissue that allows abnormal electrical conduction by heating it to the point of inactivation. Microwave antennas that fit within catheter systems can be positioned close to diseased tissue. Specialized antenna designs that unfurl from the catheter within the heart can then radiate specifically shaped fields, which overcome problems such as excessive surface heating at the contact point. The state of the art in MCA is reviewed in this paper and a novel catheter-based unfurling wide aperture antenna is described. This antenna consists of the centre conductor of a coaxial line, shaped into a spiral and insulated from blood and tissue by a non-conductive fluid filled balloon. Initially stretched straight inside a catheter for transluminal guiding, once in place at the cardiac target, the coiled spiral antenna is advanced into the inflated balloon. Power is applied in the range of 50-150 W at the reserved industrial, scientific and medical (ISM) frequency of 915 MHz for 30-90 s to create an irreversible lesion. The antenna is then retracted back into the

  17. Cost analysis of radiofrequency catheter ablation for atrial fibrillation.

    PubMed

    Gorenek, Bulent; Kudaiberdieva, Gulmira

    2013-09-10

    Atrial fibrillation is the most common arrhythmia associated with increased mortality and morbidity. Its management requires high healthcare expenditures; 52%-70% of expenses for AF care are constituted by hospitalization costs. The current management strategies of pharmacological rhythm control and pharmacological or invasive rate control show no difference in impact on major outcomes in patients with AF. Radiofrequency catheter ablation (RFA) has been shown to reduce the risk of AF recurrence, improve quality of life and reduce hospitalization rate as compared to pharmacological rhythm control and rate control strategies. This review summarizes current knowledge on cost and cost-effectiveness analysis of RFA for patients with atrial fibrillation.

  18. Modeling bipolar phase-shifted multielectrode catheter ablation.

    PubMed

    Tungjitkusolmun, Supan; Haemmerich, Dieter; Cao, Hong; Tsai, Jang-zern; Choy, Young Bin; Vorperian, Vicken R; Webster, John G

    2002-01-01

    Atrial fibrillation (AFIB) is a common clinical problem affecting approximately 0.5-1% of the United States population. Radio-frequency (RF) multielectrode catheter (MEC) ablation has successes in curing AFIB. We utilized finite-element method analysis to determine the myocardial temperature distribution after 30 s, 80 degrees C temperature-controlled unipolar ablation using three 7F 12.5-mm electrodes with 2-mm interelectrode spacing MEC. Numerical results demonstrated that cold spots occurred at the edges of the middle electrode and hot spots at the side electrodes. We introduced the bipolar phase-shifted technique for RF energy delivery of MEC ablation. We determined the optimal phase-shift (phi) between the two sinusoidal voltage sources of a simplified two-dimensional finite-element model. At the optimal phi, we can achieve a temperature distribution that minimizes the difference between temperatures at electrode edges. We also studied the effects of myocardial electric conductivity (sigma), thermal conductivity (k), and the electrode spacing on the optimal phi. When we varied sigma and kappa from 50% to 150%, optimal phi ranged from 29.5 degrees to 23.5 degrees, and in the vicinity of 26.5 degrees, respectively. The optimal phi for 3-mm spacing MEC was 30.5 degrees. We show the design of a simplified bipolar phase-shifted MEC ablation system.

  19. Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter.

    PubMed

    Leite, Luiz; Su, Wilber; Johnson, Susan B; Milton, Mark; Henz, Benhur; Sarabanda, Alvaro; Santos, Simone N; Packer, Douglas L

    2009-12-01

    Pulmonary vein isolation (PVI) with balloon catheter has been used as the endpoint for AF ablation. To determine the usefulness of intracardiac ultrasound (ICUS) to guide PVI using laser balloon catheter. 59 PVs were ablated in 27 dogs. Doppler imaging was used to identify blood flow leaks between PV and balloon. After each energy delivery, the circular mapping catheter was repositioned to check if isolation had been achieved. The leak position was then correlated with the gap position at the pathological study. Multivariate logistic regression analysis was undertaken. 59 PV were ablated. Mean burn time was 279+/-177 sec, mean balloon diameter was 23+/-3 mm, and mean balloon length was 25+/-4 mm. Complete isolation was achieved in 38/59 (64%) cases, and it was significantly more common when there was no leak: [30/38 (79%) versus 8/23 (35%), p<0.001]. This occurred regardless of time of laser application (302+/-223 sec. vs. 266+/-148 sec., p=ns), laser power (3.5 W/cm, 4.5 W/cm, and 5.5 W/cm), balloon diameter (24+/- 3 mm vs. 22+/- 3 mm, p=ns) and length (27+/-4 mm vs. 24+/-4mm, p=ns). The positive predictive value for predicting incomplete isolation was 65% and the negative predictive value was 83%. An identifiable leak between PV and the LBA device seen at the ICUS is predictive of lower PV isolation rates. ICUS may be useful for leak detection to avoid ineffective energy application during circumferential PV ablation. This could also be helpful when other types of energy are used.

  20. Chronic incomplete atrioventricular block induced by radiofrequency catheter ablation

    SciTech Connect

    Huang, S.K.; Bharati, S.; Graham, A.R.; Gorman, G.; Lev, M. )

    1989-10-01

    To determine if catheter ablation of the atrioventricular (AV) junction with radiofrequency energy can induce chronic incomplete (first- and second-degree) AV block to avoid the need for a permanent pacemaker, 20 closed-chest dogs were studied. Group 1 (10 dogs) received radiofrequency energy (750 kHz) with a fixed power setting (5 or 10 W) while increasing the pulse duration from 10 to 50 seconds for each application. Group 2 (10 dogs) received energy with a fixed pulse duration (20 or 30 seconds) while increasing the power setting from 5 to 10 W or from 10 to 20 W during each energy delivery. Radiofrequency energy was delivered between a chest-patch electrode and the distal electrode of a regular 7F tripolar His bundle catheter. For each application, the energy delivery was interrupted when (1) the PR interval prolonged (greater than 50%) or (2) second-degree or complete AV block occurred and persisted up to 5 seconds. The ablation procedure ended when there was (1) persistent PR prolongation (greater than 50%) or persistent second-degree AV block (lasting greater than 30 minutes) after ablation, (2) occurrence of two consecutive transient (less than 1 minute) complete AV blocks after each energy delivery, or (3) complete AV block (lasting greater than 2 minutes) after ablation. Of seven dogs in group 1 and five dogs in group 2 in which incomplete AV block was achieved 1 hour after the procedure, six in group 1 and five in group 2 remained in incomplete AV block 2-3 months after ablation. One dog in group 1 progressed into complete AV block. Of the remaining three dogs in group 1 and five dogs in group 2 in which complete AV block was initially achieved 1 hour after ablation, two in group 1 and four in group 2 continued to have complete AV block, whereas one in each group had AV conduction returned to incomplete at 1-2 months of follow-up.

  1. MediGuide-impact on catheter ablation techniques and workflow.

    PubMed

    Pillarisetti, Jayasree; Kanmanthareddy, Arun; Reddy, Yeruva Madhu; Lakkireddy, Dhanunjaya

    2014-09-01

    Since the introduction of percutaneous intervention in modern medical science, specifically cardiovascular medicine fluoroscopy has remained the gold standard for navigation inside the cardiac structures. As the complexity of the procedures continue to increase with advances in interventional electrophysiology, the procedural times and fluoroscopy times have proportionately increased and the risks of radiation exposure both to the patients as well as the operator continue to rise. 3D electroanatomic mapping systems have to some extent complemented fluoroscopic imaging in improving catheter navigation and forming a solid platform for exploring the electroanatomic details of the target substrate. The 3D mapping systems are still limited as they continue to be static representations of a dynamic heart without being completely integrated with fluoroscopy. The field needed a technological solution that could add a dynamic positioning system that can be successfully incorporated into fluoroscopic imaging as well as electroanatomic imaging modalities. MediGuide is one such innovative technology that exploits the geo-positioning system principles. It employs a transmitter mounted on the X-ray panel that emits an electromagnetic field within which sensor-equipped diagnostic and ablation catheters are tracked within prerecorded fluoroscopic images. MediGuide is also integrated with NavX mapping system and helps in developing better 3D images by field scaling-a process that reduces field distortions that occur from impedance mapping alone. In this review, we discuss about the principle of MediGuide technology, the catheter ablation techniques, and the workflow in the EP lab for different procedures.

  2. Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters.

    PubMed

    Klug, D; Lacroix, D; Marquié, C; Mairesse, G; Alix, D; Dennetière, S; d'Hautefeuille, B; Zghal, N; Kacet, S

    2001-07-01

    Intra-atrial conduction block within the inferior vena cava-tricuspid annulus isthmus (IVCT) has been shown to predict successful common atrial flutter ablation. However, its demonstration requires the use of several electrode catheters and mapping of the line of block. The aim of this study was prospectively to test the feasibility of a simplified ablation procedure using only two catheters. Radio frequency (RF) ablation of common atrial flutter was performed in 30 patients with the sole use of a catheter for atrial pacing and a RF catheter. RF ablation lesions were created in the IVCT. Surface ECG criteria were used to monitor the conduction within the IVCT. The end point during low lateral atrial pacing was an increment in the interval between the pacing artefact and the peak of the R wave in surface lead II >50 ms and clockwise rotation of the P wave axis beyond -30 degrees and inferiorly. Then, the line of lesions was mapped during atrial pacing with the RF catheter. Additional RF lesions were applied if mapping disclosed a zone of residual conduction. Otherwise the procedure was stopped if mapping showed parallel double potentials all along the line. Finally, the block was reassessed with a 'Halo' catheter. Surface ECG criteria were met in 26 patients. Mapping the line of lesions showed a complete corridor of parallel double potentials in these 26 cases and in 3 of the 4 patients in whom ECG criteria were not met. Conduction evaluated with the Halo catheter showed bi-directional complete block in these 29 patients. After a follow-up of 16 +/- 4 months there was no recurrence of atrial flutter. Surface ECG criteria combined with mapping of the line of block demonstrate evidence of bi-directional IVCT block. This simplified RF ablation of common atrial flutter is feasible with a low recurrence rate.

  3. Radiofrequency Ablation with an Enhanced-Irrigation Flexible-Tip Catheter versus a Standard-Irrigation Rigid-Tip Catheter.

    PubMed

    Hussein, Ayman A; Oberti, Carlos; Wazni, Oussama M; Hegrenes, Jami A; Sral, John A; Lopez, John; Kowalewski, William; Kattar, Jacqueline; Kanj, Mohamed; Lindsay, Bruce; Saliba, Walid

    2015-10-01

    The flexible-tip irrigated ablation catheter Cool Flex™ (St. Jude Medical, St. Paul, MN, USA) was introduced to enhance cooling of the catheter-tissue interface and to conform to endocardial surface with better contact. Little is known about the performance of such catheter design compared to the widely used rigid-tip catheters. In a thigh muscle preparation, ablation using the flexible-tip and rigid-tip catheters was performed in seven pigs across a range of ablation settings and catheter orientation. Postprocedure, the thigh muscle was stained with 2,3,5-triphenyltetrazolium-chloride injected into the femoral artery. The muscle was excised, fixed with formalin, and examined grossly. A total of 196 lesions (95 flexible tip, 101 rigid tip) were evaluated. The flexible-tip catheter was associated with enhanced cooling of catheter-tissue interface (31.1 ± 3.3°C vs 36.3 ± 3.7°C, P = 0.0001) in both perpendicular and nonperpendicular catheter orientations. This allowed more energy delivery (37.3 ± 8.9 W vs 33.7 ± 8.1 W, P = 0.004) to targeted tissue and resulted in larger lesions (median 194.7 [interquartile range: 113.1-333.8] mm(3) vs 170.9 [88.7-261.6] mm(3) , P = 0.03) than the rigid-tip catheter with larger maximum diameter (11.1 ± 2.6 mm vs 10.3 ± 2.1 mm, P = 0.03) and larger diameter at tissue surface (10.3 ± 2.4 mm vs 9.6 ± 1.7 mm, P = 0.01). Catheter orientation during ablation affected the efficiency of rigid-tip but not the flexible-tip catheter. The use of the flexible-tip catheter was associated with significantly less char formation on tissue (none vs 5.1% with rigid tip, P = 0.009). The Cool Flex™ catheter performed better than a rigid-tip catheter with enhanced cooling, larger ablation lesions, and no charring of targeted tissue. © 2015 Wiley Periodicals, Inc.

  4. Visualizing intramyocardial steam formation with a radiofrequency ablation catheter incorporating near-field ultrasound.

    PubMed

    Wright, Matthew; Harks, Erik; Deladi, Szabolcs; Fokkenrood, Steven; Zuo, Fei; Van Dusschoten, Anneke; Kolen, Alexander F; Belt, Harm; Sacher, Frederic; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre

    2013-12-01

    Steam pops are a risk of irrigated RF ablation even when limiting power delivery. There is currently no way to predict gas formation during ablation. It would be useful to visualize intramyocardial gas formation prior to a steam pop occurring using near-field ultrasound integrated into a RF ablation catheter. In an in vivo open-chest ovine model (n = 9), 86 lesions were delivered to the epicardial surface of the ventricles. Energy was delivered for 15-60 seconds, to achieve lesions with and without steam pops, based on modeling data. The ultrasound image was compared to a digital audio recording from within the pericardium by a blinded observer. Of 86 lesions, 28 resulted in an audible steam pop. For lesions that resulted in a steam pop compared to those that did not (n = 58), the mean power delivered was 8.0 ± 1.8 W versus 6.7 ± 2.0 W, P = 0.006. A change in US contrast due to gas formation in the tissue occurred in all lesions that resulted in a steam pop. In 4 ablations, a similar change in US contrast was observed in the tissue and RF delivery was stopped; in these cases, no pop occurred. The mean depth of gas formation was 0.9 ± 0.8 mm, which correlated with maximal temperature predicted by modeling. Changes in US contrast occurred 7.6 ± 7.2 seconds before the impedance rise and 7.9 ± 6.2 seconds (0.1-17.0) before an audible pop. Integrated US in an RF ablation catheter is able to visualize gas formation intramyocardially several seconds prior to a steam pop occurring. This technology may help prevent complications arising from steam pops. © 2013 Wiley Periodicals, Inc.

  5. Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

    PubMed

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Schneider, Heike E; Paul, Thomas

    2016-08-01

    Monitoring of catheter contact force during catheter ablation of atrial fibrillation has been shown to increase efficacy and safety. However, almost no data exists on the use of this technology in catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. The aim of the present study was to evaluate the impact of contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in those patients. Catheter ablation of intraatrial reentrant tachycardia using monitoring of catheter contact force was performed in 28 patients with congenital heart disease (CHD). Thirty-two patients matched according to gender, age, and body weight with congenital heart disease undergoing catheter ablation without contact force monitoring served as control group. Parameters reflecting acute procedural success, long-term efficacy, and safety were compared. Acute procedural success was statistically not different in both groups (contact force 93 % vs. control 84 %, p = 0.3). Likewise the recurrence rate 1 year after ablation as shown by Kaplan-Meier analysis did not differ (contact force 28 % vs. control 37 %, p = 0.63). Major complications were restricted to groin vessel injuries and occurred in 3 out of 60 patients (contact force n = 1; control n = 2). Complications related to excessive catheter contact force were not observed. The present study did not show superiority of catheter contact force monitoring during ablation of intraatrial reentrant tachycardia in patients with CHD in terms of efficacy and safety. Higher contact force compared to pulmonary vein isolation might therefore be required to increase the efficacy of catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

  6. Induction of ventricular tachycardia during radiofrequency ablation via pulmonary vein ablation catheter in a patient with an implanted pacemaker.

    PubMed

    Hammwöhner, Matthias; Stachowitz, Jörg; Willich, Tobias; Goette, Andreas

    2012-02-01

    Pulmonary vein isolation in a dual-chamber pacemaker patient using the pulmonary vein ablation catheter (PVAC) system resulted in perpetual induction of ventricular tachycardia (VT) during radio frequency energy application. Induction of VT was abolished by programming the PVAC-system to a pure bipolar ablation mode. Patients with implanted devices should be closely monitored when using the PVAC system in unipolar modes.

  7. Catheter ablation for ventricular tachycardia in structural heart disease.

    PubMed

    Macintyre, Ciorsti J; Sapp, John L

    2014-02-01

    The management of ventricular tachyarrhythmias has changed significantly over the past several decades. The advent of readily available implantable cardioverter defibrillators (ICDs) has had the greatest effect, with important mortality effects in patients with ventricular tachycardia and structural heart disease. ICDs have been shown to reduce sudden death in patients with ischemic and nonischemic cardiomyopathies; evidence of adverse consequences of ICD shocks, however, is mounting. In addition to the negative effects on patient-reported quality of life, anxiety, and depression, frequent ventricular arrhythmias and ICD shocks have also been associated with increased mortality. It is therefore important to identify and implement effective ventricular tachycardia-suppressive strategies. Antiarrhythmic drugs represent one such method, but are challenged by unfavourable side effect profiles and proarrhythmic risk. Catheter ablation of ventricular tachycardia is now a well-accepted intervention, which has been demonstrated to reduce recurrent arrhythmias. Questions persist regarding the optimal role for ablation compared with drug therapy. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  8. Initial impedance decrease as an indicator of good catheter contact: insights from radiofrequency ablation with force sensing catheters.

    PubMed

    Reichlin, Tobias; Knecht, Sven; Lane, Christopher; Kühne, Michael; Nof, Eyal; Chopra, Nagesh; Tadros, Thomas M; Reddy, Vivek Y; Schaer, Beat; John, Roy M; Osswald, Stefan; Stevenson, William G; Sticherling, Christian; Michaud, Gregory F

    2014-02-01

    Good catheter-tissue contact force (CF) is critical for transmural and durable lesion formation during radiofrequency (RF) ablation but is difficult to assess in clinical practice. Tissue heating during RF application results in an impedance decrease at the catheter tip. The purpose of this study was to correlate achieved CF and initial impedance decreases during atrial fibrillation (AF) ablation. We correlated achieved CF and initial impedance decreases in patients undergoing ablation for AF with two novel open-irrigated CF-sensing RF catheters (Biosense Webster SmartTouch, n = 647 RF applications; and Endosense TactiCath, n = 637 RF applications). We then compared those impedance decreases to 691 RF applications with a standard open-irrigated RF catheter (Biosense Webster ThermoCool). When RF applications with the CF-sensing catheters were analyzed according to an achieved average CF <5 g, 5-10 g, 10-20 g, and >20 g, the initial impedance decreases during ablation were larger with greater CF. Corresponding median values at 20 seconds were 5 Ω (interquartile range [IQR] 2-7), 8 Ω (4-11), 10 Ω (7-16), and 14 Ω (10-19) with the SmartTouch and n/a, 4 Ω (0-10), 8 Ω (5-12), and 13 Ω (8-18) with the TactiCath (P <.001 between categories for both catheters). When RF applications with the SmartTouch (CF-sensing catheter, median achieved CF 12 g) and ThermoCool (standard catheter) were compared, the initial impedance decrease was significantly greater in the CF-sensing group with median decreases of 10 Ω (6-14 Ω) vs 5 Ω (2-10 Ω) at 20 seconds (P <.001 between catheters). The initial impedance decrease during RF applications in AF ablations is larger when greater catheter contact is achieved. Monitoring of the initial impedance decrease is a widely available indicator of catheter contact and may help to improve formation of durable ablation lesions. © 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

  9. Medical Devices; Cardiovascular Devices; Classification of the Steerable Cardiac Ablation Catheter Remote Control System. Final order.

    PubMed

    2015-09-30

    The Food and Drug Administration (FDA) is classifying the steerable cardiac ablation catheter remote control system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the steerable cardiac ablation catheter remote control system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  10. [Discussion on the electromagnetic compatibility testing and evaluation of radio frequency ablation catheter].

    PubMed

    Wang, Yuji; Yang, Jiangang

    2014-11-01

    With the enforcement of YY 0505-2012, the testing items and evaluation points of radio frequency ablation catheter in electromagnetic compatibility field should be studied and discussed. Based on the requirements of relevant standards, this paper discusses on the testing items that should be applied and the evaluation points that should be focused on by analyzing the intended use and the structure of radio frequency ablation catheter, when it intends to apply registration individually with the basic knowledge of electromagnetic compatibility field.

  11. Catheter Ablation of Ventricular Tachycardia: Lessons Learned from Past Clinical Trials and Implications for Future Clinical Trials

    PubMed Central

    Pokorney, Sean D.; Friedman, Daniel J.; Calkins, Hugh; Callans, David J.; Daoud, Emile G.; Della-Bella, Paolo; Jackson, Kevin P.; Shivkumar, Kalyanam; Saba, Samir; Sapp, John; Stevenson, William G.; Al-Khatib, Sana M.

    2016-01-01

    Catheter ablation of ventricular tachycardia (VT) has evolved in recent years, especially in patients with ischemic heart disease. Data from prospective studies show that VT catheter ablation reduces the risk of recurrent VT; however, there is paucity of data on the effect of VT catheter ablation on mortality and patient centered outcomes such as quality of life. Performing randomized clinical trials of VT catheter ablation can be fraught with challenges, and as a result, several prior trials of VT catheter ablation had to be stopped prematurely. The main challenges are inability to blind the patient to therapy to obtain a traditional control group, high cross-over rates between the two arms of the study, patient refusal to participate in trials in which they have an equal chance of receiving a “pill” versus an invasive procedure, heterogeneity of mapping and ablation techniques as well as catheters and equipment, rapid evolution of technology that may make findings of any long trial less relevant to clinical practice, lack of consensus on what constitutes acute procedural and long-term success, and presentation of patients to electrophysiologists late in the course of their disease. In this paper, a panel of experts on VT catheter ablation and/or clinical trials of VT catheter ablation review challenges faced in conducting prior trials of VT catheter ablation and offer potential solutions for those challenges. It is hoped that the proposed solutions will enhance the feasibility of randomized clinical trials of VT catheter ablation. PMID:27050910

  12. Catheter ablation of ventricular tachycardia: Lessons learned from past clinical trials and implications for future clinical trials.

    PubMed

    Pokorney, Sean D; Friedman, Daniel J; Calkins, Hugh; Callans, David J; Daoud, Emile G; Della-Bella, Paolo; Jackson, Kevin P; Shivkumar, Kalyanam; Saba, Samir; Sapp, John; Stevenson, William G; Al-Khatib, Sana M

    2016-08-01

    Catheter ablation of ventricular tachycardia (VT) has evolved in recent years, especially in patients with ischemic heart disease. Data from prospective studies show that VT catheter ablation reduces the risk of recurrent VT; however, there is a paucity of data on the effect of VT catheter ablation on mortality and patient-centered outcomes such as quality of life. Performing randomized clinical trials of VT catheter ablation can be fraught with challenges, and, as a result, several prior trials of VT catheter ablation had to be stopped prematurely. The main challenges are inability to blind the patient to therapy to obtain a traditional control group, high crossover rates between the 2 arms of the study, patient refusal to participate in trials in which they have an equal chance of receiving a "pill" vs an invasive procedure, heterogeneity of mapping and ablation techniques as well as catheters and equipment, rapid evolution of technology that may make findings of any long trial less relevant to clinical practice, lack of consensus on what constitutes acute procedural and long-term success, and presentation of patients to electrophysiologists late in the course of their disease. In this article, a panel of experts on VT catheter ablation and/or clinical trials of VT catheter ablation review challenges faced in conducting prior trials of VT catheter ablation and offer potential solutions for those challenges. It is hoped that the proposed solutions will enhance the feasibility of randomized clinical trials of VT catheter ablation.

  13. Radiofrequency catheter ablation of the atrioventricular junction from the left ventricle

    SciTech Connect

    Sousa, J.; el-Atassi, R.; Rosenheck, S.; Calkins, H.; Langberg, J.; Morady, F. )

    1991-08-01

    The purpose of this study was to describe a new technique for catheter ablation of the atrioventricular junction using radiofrequency energy delivered in the left ventricle. Catheter ablation of the atrioventricular (AV) junction using a catheter positioned across the tricuspid annulus was unsuccessful in eight patients with a mean {plus minus} SD age of 51 {plus minus} 19 years who had AV nodal reentry tachycardia (three patients), orthodromic tachycardia using a concealed midseptal accessory pathway, atrial tachycardia, atrial flutter (two patients), or atrial fibrillation. Before attempts at catheter ablation of the AV junction, each patient had been refractory to pharmacological therapy, and four had failed attempts at either catheter modification of the AV node using radiofrequency energy or surgical and catheter ablation of the accessory pathway. Conventional right-sided catheter ablation of the AV junction using radiofrequency energy in six patients and both radiofrequency energy and direct current shocks in two patients was ineffective. The mean amplitude of the His bundle potential recorded at the tricuspid annulus at the sites of unsuccessful AV junction ablation was 0.1 {plus minus} 0.08 mV, with a maximum His amplitude of 0.03-0.28 mV. A 7F deflectable-tip quadripolar electrode catheter with a 4-mm distal electrode was positioned against the upper left ventricular septum using a retrograde aortic approach from the femoral artery. Third-degree AV block was induced in each of the eight patients with 20-36 W applied for 15-30 seconds. The His bundle potential at the sites of successful AV junction ablation ranged from 0.06 to 0.99 mV, with a mean of 0.27 {plus minus} 0.32 mV. There was no rise in the creatine kinase-MB fraction and no complications occurred. An intrinsic escape rhythm of 30-60 beats/min was present in seven of the eight patients.

  14. Procedural outcomes of fluoroless catheter ablation outside the traditional catheterization lab.

    PubMed

    Bigelow, Amee M; Smith, Philip C; Timberlake, Dylan T; McNinch, Neil L; Smith, Grace L; Lane, John R; Clark, John M

    2017-08-01

    Non-fluoroscopic catheter ablation is becoming routine. In experienced centres, fluoroscopy is rarely required. The use of a traditional catheterization lab (cath lab) may no longer be necessary. We began performing catheter ablations at a paediatric centre outside the traditional cardiac cath lab in 2013. The purpose of this study was to compare procedural features of paediatric catheter ablation performed outside the cath lab to those performed within a cath lab. We prospectively looked at patients presenting to the paediatric centre with supraventricular tachycardia (SVT) undergoing catheter ablation outside the cath lab in a standard operating room (OR group). We compared retrospectively to a control group matched for age, type, and location of arrhythmia who had ablations in a traditional cath lab (CL group). Catheter visualization was exclusively by electro-anatomic mapping. Fifty-nine patients with SVT underwent catheter ablation in the OR from October 2013 to December 2015. Thirty-three patients had accessory pathways, 29 were manifest, and 13 of those were left sided. Twenty-six had atrioventricular nodal re-entrant tachycardia. Transseptal puncture with transoesophageal echocardiography guidance was used for 10 left-sided pathways, whereas the other 3 had patent foramen ovales. Procedure time did not differ significantly between groups (OR group mean 131 min, range 57-408; CL group mean 152 min, range 68-376; P = 0.12). Acute success was similar in both groups [OR group: 58/59 (98.3%) and CL group: 57/59 (96.6%)]. There were no major complications in either group. There was no fluoroscopy used in either group. Although performing paediatric catheter ablations outside the traditional cath lab is early in our experience, we produced similar outcomes and results without encountering procedural difficulties of performing ablations in a non-conventional setting. Larger multi-centred trials will be essential to determine the feasibility of this practice.

  15. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode-phased radiofrequency catheter ablation of pulmonary vein ostia.

    PubMed

    Haines, David E; Stewart, Mark T; Dahlberg, Sarah; Barka, Noah D; Condie, Cathy; Fiedler, Gary R; Kirchhof, Nicole A; Halimi, Franck; Deneke, Thomas

    2013-02-01

    Cerebral diffusion-weighted MRI lesions have been observed after catheter ablation of atrial fibrillation. We hypothesized that conditions predisposing to microembolization could be identified using a porcine model of pulmonary vein ablation and an extracorporeal circulation loop. Ablations of the pulmonary veins were performed in 18 swine with echo monitoring. The femoral artery and vein were cannulated and an extracorporeal circulation loop with 2 ultrasonic bubble detectors and a 73-μm filter were placed in series. Microemboli and microbubbles were compared between ablation with an irrigated radiofrequency system (Biosense-Webster) and a phased radiofrequency multielectrode system (pulmonary vein ablation catheter [PVAC], Medtronic, Inc, Carlsbad, CA) in unipolar and 3 blended unipolar/bipolar modes. Animal pathology was examined. The size and number of microbubbles observed during ablation ranged from 30 to 180 μm and 0 to 3253 bubbles per ablation. Microbubble volumes with PVAC (29.1 nL) were greater than with irrigated radiofrequency (0.4 nL; P=0.045), and greatest with type II or III microbubbles on transesophageal echocardiography. Ablation with the PVAC showed fewest microbubbles in the unipolar mode (P=0.012 versus bipolar). The most occurred during bipolar energy delivery with overlap of proximal and distal electrodes (median microbubble volume, 1744 nL; interquartile range, 737-4082 nL; maximum, 19 516 nL). No cerebral MRI lesions were seen, but 2 animals had renal embolization. Left atrial ablation with irrigated radiofrequency and PVAC catheters in swine is associated with microbubble and microembolus production. Avoiding overlap of electrodes 1 and 10 on PVAC should reduce the microembolic burden associated with this procedure.

  16. Racial disparities in the use of catheter ablation for atrial fibrillation and flutter.

    PubMed

    Tamariz, Leonardo; Rodriguez, Alexis; Palacio, Ana; Li, Hua; Myerburg, Robert

    2014-12-01

    Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. Catheter ablation is an expensive but potentially curable treatment of AF. We explored differences in the use of catheter ablation for AF in the state of Florida and compared the findings to ablation for atrial flutter. We conducted a cross-sectional analysis of all ambulatory and hospital discharge procedures between 2006 and 2009 in Florida. We identified all subjects with AF and atrial flutter, using International Classification of Diseases, 9th Revision codes along with the race/ethnicity of each individual. We used logistic regression to determine the odds ratio (OR) of having a catheter ablation per disease by race and ethnicity adjusted for Charlson score, insurance status, year of the procedure, and facility location. We identified 923,590 subjects with AF and 28,714 with atrial flutter. Catheter ablations were more commonly used in atrial flutter than in AF. The adjusted OR of having catheter ablation for AF for blacks was 0.67 (95% confidence interval [CI]: 0.60-0.75, P < 0.01), and for Hispanics it was 0.83 (95% CI: 0.75-0.91, P < 0.01) when compared to whites. The adjusted OR of having an ablation for atrial flutter for blacks was 1.08 (95% CI: 0.96-1.21, P = 0.16), and for Hispanics it was 0.90 (95% CI: 0.78-1.08, P = 0.20) when compared to whites. In the state of Florida, black and Hispanic subjects with AF received less catheter ablations, whereas the same minority subjects with atrial flutter received a similar number of ablations compared to white subjects, with the same insurance and comorbidity burden. © 2014 Wiley Periodicals, Inc.

  17. Role of catheter ablation of ventricular tachycardia associated with structural heart disease

    PubMed Central

    Ponti, Roberto De

    2011-01-01

    In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the short- and long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT. PMID:22125669

  18. Radiofrequency Catheter Ablation Targeting the Vein of Marshall in Difficult Mitral Isthmus Ablation or Pulmonary Vein Isolation.

    PubMed

    Lee, Ji Hyun; Nam, Gi-Byoung; Kim, Minsu; Hwang, You Mi; Hwang, Jongmin; Kim, Jun; Choi, Kee-Joon; Kim, You-Ho

    2017-04-01

    The ligament of Marshall may hinder the creation of mitral isthmus (MI) block or pulmonary vein (PV) isolation (PVI) in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). We aimed to assess the benefit of RF ablation targeting the vein of Marshall (VOM) in failed cases of MI block or PVI. We reviewed the medical records of patients who underwent RF ablation targeting the VOM after failed MI ablation or left PVI using the conventional method, which included circumferential point-by-point ablation around the PV antrum and carina for PVI, and endocardial MI and epicardial distal coronary sinus (CS) ablation for MI block. The VOM was identified by using selective VOM venography with an external irrigation RF ablation catheter. RF ablation targeting the VOM was performed with RF application at the ostium of the VOM inside the CS or at the endocardial region facing the VOM course. During the set period, CS venography was performed in 42 patients after failure of left PVI (n = 5) or MI block (n = 37). Under CS venography, the VOM was visualized in 22 of 42 patients (MI = 19 and PVI = 3). During selective venography of the VOM, no procedure-related complication was observed. RF application targeting the VOM successfully achieved MI block in 13 patients (68.4%) and PVI in 2 patients (66.7%). Selective VOM venography using an irrigated ablation catheter is feasible and safe. RF ablation targeting the VOM may provide additional benefit in failed cases of MI block or PVI. © 2017 Wiley Periodicals, Inc.

  19. Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation.

    PubMed

    Yetter, Elizabeth; Brazg, Jared; Del Valle, Diane; Mulvey, Laura; Dickman, Eitan

    2016-11-17

    Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT. Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain. Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2]. Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].

  20. Ablation with an internally irrigated radiofrequency catheter: learning how to avoid steam pops.

    PubMed

    Cooper, Joshua M; Sapp, John L; Tedrow, Usha; Pellegrini, Christine P; Robinson, David; Epstein, Laurence M; Stevenson, William G

    2004-09-01

    The aim of this study was to assess the feasibility of using electrode temperature, impedance, and power to predict and thereby potentially prevent steam pops during cooled radiofrequency (RF) ablation. When myocardial temperature reaches 100 degrees C during RF catheter ablation, steam explosions are seen. Saline-cooled RF ablation reduces temperatures at the electrode-tissue interface, but excessive intramyocardial heating still may occur. In anesthetized swine, 26 cooled RF applications were made in the right and left atria while observing with intracardiac echocardiography (ICE). Power delivery was increased gradually until a steam explosion was seen or a maximum output of 50 W was reached. ICE identified steam explosions in 21 RF applications. Steam explosions were associated with a large impedance increase, >25 Omega in only three cases, whereas small increases <10 Omega (mean 5.3 +/- 2.6 Omega) occurred in 18 cases. Mean electrode temperature at the time of steam explosion was 43.6 degrees C +/- 5.3; 18 of 21 explosions occurred when temperature reached >/=40 degrees C. Mean power and impedance drop were similar for applications with and without steam explosions. Five steam explosions were associated with a sudden drop in electrode temperature. Steam explosions are common when cooled electrode temperature exceeds 40 degrees C and are not predictable from power or impedance drop. Small impedance rises and sudden drops in measured electrode temperature indicate possible steam formation. Maintaining cooled electrode temperature <40 degrees C during RF likely will reduce the risk of steam explosions.

  1. PATH OPTIMIZATION AND CONTROL OF A SHAPE MEMORY ALLOY ACTUATED CATHETER FOR ENDOCARDIAL RADIOFREQUENCY ABLATION

    PubMed Central

    Wiest, Jennifer H.; Buckner, Gregory D.

    2014-01-01

    This paper introduces a real-time path optimization and control strategy for shape memory alloy (SMA) actuated cardiac ablation catheters, potentially enabling the creation of more precise lesions with reduced procedure times and improved patient outcomes. Catheter tip locations and orientations are optimized using parallel genetic algorithms to produce continuous ablation paths with near normal tissue contact through physician-specified points. A nonlinear multivariable control strategy is presented to compensate for SMA hysteresis, bandwidth limitations, and coupling between system inputs. Simulated and experimental results demonstrate efficient generation of ablation paths and optimal reference trajectories. Closed-loop control of the SMA-actuated catheter along optimized ablation paths is validated experimentally. PMID:25684857

  2. Left atrial function and scar after catheter ablation of atrial fibrillation.

    PubMed

    Wylie, John V; Peters, Dana C; Essebag, Vidal; Manning, Warren J; Josephson, Mark E; Hauser, Thomas H

    2008-05-01

    Catheter ablation of atrial fibrillation (AF) involves extensive radiofrequency ablation (RFA) of the left atrium (LA) around the pulmonary veins. The effect of this therapy on LA function is not fully characterized. The purpose of this study was to determine whether catheter ablation of AF is associated with a change in LA function. LA and right atrial (RA) systolic function was assessed in 33 consecutive patients with paroxysmal or persistent AF referred for ablation using cardiovascular magnetic resonance (CMR) imaging. Steady-state free precession ECG cine CMR imaging was performed before and after (mean 48 days) AF ablation. All patients underwent circumferential pulmonary vein isolation using an 8-mm tip RFA catheter. High spatial resolution late gadolinium enhancement CMR images of LA scar were obtained in 16 patients. Maximum LA volume decreased by 15% (P <.001), and LA ejection fraction decreased by 14% (P <.001) after AF ablation. Maximum RA volume decreased by 13% (P = .018), but RA ejection fraction increased by 5% (P = .008). Mean LA scar volume was 8.1 +/- 3.7 mL. A linear correlation was observed between change in LA ejection fraction and scar volume (r = -0.75, P <.001). Catheter ablation of AF is associated with decreased LA size and reduced atrial systolic function. This change strongly correlates with the volume of LA scar. This finding may have implications for postprocedural thromboembolic risk and for procedures involving more extensive RFA.

  3. The role of catheter ablation for ventricular tachycardia in patients with ischemic heart disease.

    PubMed

    El-Damaty, Ahmed; Sapp, John L

    2011-01-01

    Catheter ablation has evolved remarkably over the last 2 decades, bringing nonpharmacologic therapy to complex arrhythmias like atrial fibrillation and scar-related ventricular tachycardia. As our therapeutic options have increased for patients with ventricular tachycardia, choosing the right therapy for the right patient has become more complex. Ablation carries acute and perhaps longer-term procedural risk and variable success, whereas drug therapy likewise is limited by both side-effects and efficacy. Early randomized trials of catheter ablation for ventricular tachycardia and multicenter experiences have recently been published, and further studies are underway to define the appropriate application of this therapy. Randomized trials have demonstrated that catheter ablation can reduce ventricular tachycardia episodes with relatively low risk. Multicenter experience has demonstrated a moderate risk of serious procedural adverse events in this very sick population, but ablation has never been compared directly with antiarrhythmic drug therapy. There is still little evidence to clarify the relative merits of antiarrhythmic drug therapy in comparison with ablation. The optimal role of either therapy will remain uncertain until the completion of trials currently in progress. Until further evidence is available, most clinicians advocate first-line antiarrhythmic drug therapy, and reserve catheter ablation for when this fails or is not tolerated.

  4. Assessment of atrial electromechanical interval using echocardiography after catheter ablation in patients with persistent atrial fibrillation

    PubMed Central

    Chen, Xiaodong; Chen, Minglong; Wang, Yingying; Yang, Bing; Ju, Weizhu; Zhang, Fengxiang; Cao, Kejiang

    2016-01-01

    Abstract We sought to investigate variation of atrial electromechanical interval after catheter ablation procedure in patients with persistent atrial fibrillation using pulse Doppler (PW) and pulse tissue Doppler imaging (PW-TDI). A total of 25 consecutive in-patients with persistent atrial fibrillation, who restored sinus rhythm after ablation procedure, were recruited in our cardiac center. Echocardiography was performed on each patient at 2 hours, 1 day, 5 days, 1 month and 3 months after the ablation therapy, and atrial electromechanical delay was measured simultaneously by PW and PW-TDI. There was no significant difference between PW and TDI in measuring atrial electromechanical delay. However, at postoperative 2 hours, peak A detection rates were mathematically but nonsignificantly greater by PW-TDI than by PW. Second, there was a significant decreasing trend in atrial electromechanical interval from postoperative 2 hours to 3 months, but only postoperative 2-hour atrial electromechanical interval was significantly greater than atrial electromechanical interval at other time. Lastly, patients without postoperative 2-hour atrial electromechanical interval had a significantly longer duration of atrial fibrillation as compared to those with postoperative 2-hour atrial electromechanical interval, by the PW or by PW-TDI, respectively. In patients with persistent atrial fibrillation, atrial electromechanical interval may decrease significantly within the first 24 hours after ablation but remain consistent later, and was significantly related to patients’ duration of atrial fibrillation. Atrial electromechanical interval, as a potential predicted factor, is recommended to be measured by either PW or TDI after 24 hours, when patients had recovered sinus rhythm by radiofrequency ablation. PMID:27924066

  5. Considerations for theoretical modeling of thermal ablation with catheter-based ultrasonic sources: implications for treatment planning, monitoring and control

    PubMed Central

    Prakash, Punit; Diederich, Chris J.

    2012-01-01

    Purpose To determine the impact of including dynamic changes in tissue physical properties during heating on feedback controlled thermal ablation with catheter-based ultrasound. Additionally, we compared impact several indicators of thermal damage on predicted extents of ablation zones for planning and monitoring ablations with this modality. Methods A 3D model of ultrasound ablation with interstitial and transurethral applicators incorporating temperature based feedback control was used to simulate thermal ablations in prostate and liver tissue. We investigated five coupled models of heat dependent changes in tissue acoustic attenuation/absorption and blood perfusion of varying degrees of complexity.. Dimensions of the ablation zone were computed using temperature, thermal dose, and Arrhenius thermal damage indicators of coagulative necrosis. A comparison of the predictions by each of these models was illustrated on a patient-specific anatomy in the treatment planning setting. Results Models including dynamic changes in blood perfusion and acoustic attenuation as a function of thermal dose/damage predicted near-identical ablation zone volumes (maximum variation < 2.5%). Accounting for dynamic acoustic attenuation appeared to play a critical role in estimating ablation zone size, as models using constant values for acoustic attenuation predicted ablation zone volumes up to 50% larger or 47% smaller in liver and prostate tissue, respectively. Thermal dose (t43 ≥ 240min) and thermal damage (Ω ≥ 4.6) thresholds for coagulative necrosis are in good agreement for all heating durations, temperature thresholds in the range of 54 °C for short (< 5 min) duration ablations and 50 °C for long (15 min) ablations may serve as surrogates for determination of the outer treatment boundary. Conclusions Accounting for dynamic changes in acoustic attenuation/absorption appeared to play a critical role in predicted extents of ablation zones. For typical 5—15 min ablations

  6. Considerations for theoretical modelling of thermal ablation with catheter-based ultrasonic sources: implications for treatment planning, monitoring and control.

    PubMed

    Prakash, Punit; Diederich, Chris J

    2012-01-01

    To determine the impact of including dynamic changes in tissue physical properties during heating on feedback controlled thermal ablation with catheter-based ultrasound. Additionally, we compared the impact of several indicators of thermal damage on predicted extents of ablation zones for planning and monitoring ablations with this modality. A 3D model of ultrasound ablation with interstitial and transurethral applicators incorporating temperature-based feedback control was used to simulate thermal ablations in prostate and liver tissue. We investigated five coupled models of heat dependent changes in tissue acoustic attenuation/absorption and blood perfusion of varying degrees of complexity. Dimensions of the ablation zone were computed using temperature, thermal dose, and Arrhenius thermal damage indicators of coagulative necrosis. A comparison of the predictions by each of these models was illustrated on a patient-specific anatomy in the treatment planning setting. Models including dynamic changes in blood perfusion and acoustic attenuation as a function of thermal dose/damage predicted near-identical ablation zone volumes (maximum variation < 2.5%). Accounting for dynamic acoustic attenuation appeared to play a critical role in estimating ablation zone size, as models using constant values for acoustic attenuation predicted ablation zone volumes up to 50% larger or 47% smaller in liver and prostate tissue, respectively. Thermal dose (t(43) ≥ 240 min) and thermal damage (Ω ≥ 4.6) thresholds for coagulative necrosis are in good agreement for all heating durations, temperature thresholds in the range of 54°C for short (<5 min) duration ablations and 50°C for long (15 min) ablations may serve as surrogates for determination of the outer treatment boundary. Accounting for dynamic changes in acoustic attenuation/absorption appeared to play a critical role in predicted extents of ablation zones. For typical 5-15 min ablations with this

  7. Radiofrequency catheter ablation of ventricular tachycardia in a military parachuter.

    PubMed

    Ozturk, Cengiz; Cakmak, Tolga; Aparci, Mustafa; Metin, Suleyman; Yildirim, Ali Osman

    2013-10-01

    Premature ventricular contractions (PVCs) presenting as isolated complexes are insignificant, but if they present as salvos they are considered indicators of high risk for potentially fatal arrhythmias. We present the case of a 39-yr-old male military parachuter with PVCs and ventricular tachycardia that were incidentally detected on ECG and treated with radiofrequency catheter ablation (RFCA). He had no significant past medical history. Physical examination and biochemical tests were normal. Transthoracic echocardiography showed no structural heart disease. Due to frequent ventricular extrasystoles (VES) detected on his ECG, 24-h Holter monitoring was conducted and revealed VES, including 13,351 isolated PVCs, 1427 episodes of bigeminy, 397 of trigeminy, 30 couplets, and 4 salvo periods. After beta-blocker and calcium channel blocker treatment for 1 mo, his repeat 24-h Holter monitoring showed 18,414 isolated PVCs, 819 episodes of bigeminy, 181 of trigeminy, and 6 couplet VES, but no episodes of salvos. Electrophysiological studies (EPS) were performed and the baseline measurements were: basic cycle length: 890 ms; atrium His interval: 78 ms; and ventricular His interval: 54 ms. VES were found to orginate from the right ventricular outflow tract and were terminated by RFCA. Medical treatment was stopped. Repeat Holter showed no VES. The parachuter was qualified for full duties. As the patient is an aircrew member and further usage of antiarrhythmic agents will interfere with his flying status, instead of initiating a drug therapy again, we performed EPS and RFCA as an effective and dependable method in order to treat and to determine his fitness.

  8. Catheter ablation of organized atrial arrhythmias in orthotopic heart transplantation.

    PubMed

    Mouhoub, Yamina; Laredo, Mikael; Varnous, Shaida; Leprince, Pascal; Waintraub, Xavier; Gandjbakhch, Estelle; Hébert, Jean-Louis; Frank, Robert; Maupain, Carole; Pavie, Alain; Hidden-Lucet, Françoise; Duthoit, Guillaume

    2017-07-21

    Organized atrial arrhythmias (OAAs) are common after orthotopic heart transplantation (OHT). Some controversies remain about their clinical presentation, relationship with atrial anastomosis and electrophysiologic features. The objectives of this retrospective study were to determine the mechanisms of OAAs after OHT and describe the outcomes of radiofrequency catheter ablation (RFCA). Thirty consecutive transplanted patients (mean age 48 ± 17 years, 86.6% male) underwent 3-dimensional electroanatomic mapping and RFCA of their OAA from 2004 to 2012 at our center. Twenty-two patients had biatrial anastomosis and 8 had bicaval anastomosis. Macro-reentry was the arrhythmia mechanism for 96% of patients. The electrophysiologic diagnoses were: cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) in 93% of patients (n = 28); perimitral AFL in 3% (n = 1); and focal atrial tachycardia (FAT) in 3% (n = 1). In 5 patients with biatrial anastomosis, a right FAT was inducible. Primary RFCA success was obtained in 93% of patients. Mean follow-up time was 39 ± 26.8 months. Electrical repermeation between recipient and donor atria, present in 20% of patients (n = 6), did not account for any of the OAAs observed. Survival without OAA relapse at 12, 24 and 60 months was 93%, 89% and 79%, respectively. CTI-dependent AFL accounted for most instances of OAA after OHT, regardless of anastomosis type. Time from transplantation to OAA was shorter with bicaval than with biatrial anastomosis. RFCA was safe and provided good long-term results. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  9. Impact of catheter and surgical ablation on arrhythmia treatment in a tertiary referral centre.

    PubMed Central

    Cunningham, D; Rowland, E

    1992-01-01

    Invasive cardiac electrophysiology studies began as diagnostic studies. The past decade has seen the introduction of several new treatments which have broadened the scope of invasive electrophysiology studies. In particular, the development of catheter ablation techniques increasingly allows curative treatment to be delivered in the catheter laboratory. The workload of electrophysiological procedures has steadily increased in our tertiary referral centre. Over 1000 patients have been treated in the past 20 years and it is projected that 219 new patients will be treated in 1991 and 342 procedures will be carried out. Over 25% of patients now receive either catheter or surgical ablation and almost 80% of these are cured permanently without the need for further drug treatment. The development of safer techniques for catheter ablation has led to its increased use and a decline in surgical ablations. Because catheter ablation is a much simpler and less traumatic procedure than surgical ablation there are great advantages both for the patient and in terms of cost-effectiveness. Antitachycardia pacing, relatively common in 1985, has now largely been supplanted by ablation and implantation of defibrillators. As the tendency to non-pharmacological treatment increases and evidence mounts that cost-effectiveness is greater for electrophysiological treatments, the implications for the funding of electrophysiology services grow. The initially high cost of curative treatment needs to be balanced against the longer term and potentially higher costs of palliative drug treatment. The potential to cure patients with catheter procedures may lead to a greater demand for this expertise and a need for an increase in training and facilities. PMID:1739536

  10. Clinical experience with contact-force and flexible-tip ablation catheter designs.

    PubMed

    Deubner, N; Greiss, H; Akkaya, E; Berkowitsch, A; Zaltsberg, S; Hamm, C W; Kuniss, M; Neumann, T

    2016-10-01

    Lesion formation is a critical determinant of technical and clinical success of pulmonary vein isolation. Different catheter designs aim to enhance tissue contact during ablation to enable optimized lesion formation. We analyzed procedural characteristics and predictors of clinical success in patients ablated with three different contemporary ablation catheters. Two hundred sixty-eight sequentially included patients receiving pulmonary vein isolation (PVI) with conventional (n = 122), contact-force (n = 96) and flexible-tip (n = 60) catheters were followed for a median of 14.1 months with 7d-Holter-monitoring and TTE at 3, 6, 12, and 24 months. Baseline characteristics and follow-up times were homogeneous across all groups. Multivariable Cox proportional hazard regression for arrhythmia recurrence demonstrated a favorable hazard ratio for contact-force and flexible-tip catheters vs. conventional open irrigation catheters. Procedure time and fluoroscopy time were shorter for contact-force and flexible-tip catheters versus conventional catheters, but equal between. Linear lesions were applied in 58 % of contact-force and 66 % of flexible-tip cases, and CFAEs were targeted in 26 % of either. Our non-randomized prospectively collected data do not show a difference in observed procedure characteristics and in clinical outcome for flexible-tip versus contact-force catheter designs, while both display improved performance against conventional open irrigated-tip catheters. Linear lesions and CFAEs ablation were not associated with improved arrhythmia-free survival.

  11. Catheter ablation of atrial fibrillation in patients with severely impaired left ventricular systolic function.

    PubMed

    Kato, Ken; Ejima, Koichiro; Fukushima, Noritoshi; Ishizawa, Makoto; Wakisaka, Osamu; Henmi, Ryuta; Yoshida, Kentaro; Nuki, Toshiaki; Arai, Kotaro; Yashiro, Bun; Manaka, Tetsuyuki; Ashihara, Kyomi; Shoda, Morio; Hagiwara, Nobuhisa

    2016-04-01

    Little is known about the outcome of catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) and a severely reduced left ventricular ejection fraction (LVEF). We aimed to clarify the effectiveness of catheter ablation of AF in patients with a severely low LVEF. This retrospective study included 18 consecutive patients with HF and an LVEF of ≤ 35 % who underwent catheter ablation of AF. We investigated the clinical parameters, echocardiographic parameters and the incidence of hospitalizations for HF. During a median follow-up of 21 months (IQR, 13-40) after the final procedure (9 with repeat procedures), 11 patients (61 %) maintained sinus rhythm (SR) (6 with amiodarone). The LVEF and NYHA class significantly improved at 6 months after the CA in 12 patients (67 %) who were in SR or had recurrent paroxysmal AF (from 25.8 ± 6.3 to 37.0 ± 11.7 %, P = 0.02, and from 2.3 ± 0.5 to 1.5 ± 0.7, P < 0.01, respectively) but not in patients who experienced recurrent persistent AF. The patients with SR or recurrent paroxysmal AF had significantly fewer hospitalizations for HF than those with recurrent persistent AF after the AF ablation (log-rank test; P < 0.01). Catheter ablation of AF improved the clinical status in patients with an LVEF of ≤ 35 %. A repeat ablation procedure and amiodarone were often necessary to obtain a favorable outcome.

  12. Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial.

    PubMed

    Al-Khatib, Sana M; Daubert, James P; Anstrom, Kevin J; Daoud, Emile G; Gonzalez, Mario; Saba, Samir; Jackson, Kevin P; Reece, Tammy; Gu, Joan; Pokorney, Sean D; Granger, Christopher B; Hess, Paul L; Mark, Daniel B; Stevenson, William G

    2015-02-01

    We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at reducing mortality. Patients were enrolled at 4 sites if they had ischemic heart disease, an implantable cardioverter defibrillator (ICD), and received ≥1 ICD shock or ≥3 antitachycardia pacing therapies for VT. Patients were randomized to 2 arms: (1) antiarrhythmic medication (n = 14) and (2) catheter ablation (n = 13); patients were followed at 3 and 6 months. Endpoints included recurrent VT, time to first ICD therapy for VT, and death. Of 243 screened patients, 27 were enrolled. Main reasons for screen failures were: (1) patient was already on an antiarrhythmic medication (88 [41%]), (2) VT due to a reversible cause (23 [11%]), and (3) incessant VT (20 [9%]). Fourteen patients had recurrent VT, 8 (62%) in the ablation arm and 6 (43%) in the antiarrhythmic medication arm. Median time to recurrent VT was 75 days (25th, 75th: 51, 89) in the ablation arm and 57 days (30, 145) in the antiarrhythmic arm. Four patients died, 2 in each arm. This clinical trial shows that most patients in clinical practice have already failed antiarrhythmic drug therapy before catheter ablation is considered, and the VT recurrence rates and death in these patients are high. For a large clinical trial to be feasible, factors limiting early consideration of catheter ablation need to be identified and addressed. © 2014 Wiley Periodicals, Inc.

  13. Initial human feasibility of infusion needle catheter ablation for refractory ventricular tachycardia.

    PubMed

    Sapp, John L; Beeckler, Christopher; Pike, Robert; Parkash, Ratika; Gray, Christopher J; Zeppenfeld, Katja; Kuriachan, Vikas; Stevenson, William G

    2013-11-19

    Ablation of ventricular tachycardia (VT) is sometimes unsuccessful when ablation lesions are of insufficient depth to reach arrhythmogenic substrate. We report the initial experience with the use of a catheter with an extendable/retractable irrigated needle at the tip capable of intramyocardial mapping and ablation. Sequential consenting patients with recurrent VT underwent ablation with the use of a needle-tipped catheter. At target sites, the needle was advanced 7 to 9 mm into the myocardium, permitting pacing and recording. Infusion of saline/iodinated contrast mixture excluded perforation and ensured intramyocardial deployment. Further infusion was delivered before and during temperature-controlled radiofrequency energy delivery through the needle. All 8 patients included (6 male; mean age, 54) with a mean left ventricular ejection fraction of 29% were refractory to multiple antiarrhythmic drugs, and 1 to 4 previous catheter ablation attempts (epicardial in 4) had failed. Patients had 1 to 7 (median, 2) VTs present or inducible; 2 were incessant. Some intramyocardial VT mapping was possible in 7 patients. A mean of 22 (limits, 3-48) needle ablation lesions were applied in 8 patients. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs occur at some point during follow-up. Two died of the progression of preexisting heart failure without recurrent VT. Complications included tamponade in 1 patient and heart block in 2 patients. Intramyocardial infusion-needle catheter ablation is feasible and permits control of some VTs that have been refractory to conventional catheter ablation therapy, warranting further study.

  14. Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children.

    PubMed

    Backhoff, David; Klehs, Sophia; Müller, Matthias J; Schneider, Heike E; Kriebel, Thomas; Paul, Thomas; Krause, Ulrich

    2016-11-01

    Catheter ablation of the slow conducting pathway (SP) is treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT). Although there are abundant data on AVNRT ablation in adult patients, little is known about the long-term results ≥3 years after AVNRT ablation in pediatric patients. Follow-up data from 241 patients aged ≤18 years who had undergone successful AVNRT ablation were analyzed. Median age at ablation had been 12.5 years, and median follow-up was 5.9 years. Radiofrequency current had been used in 168 patients (70%), whereas cryoenergy had been used in 73 patients (30%). Procedural end point of AVNRT ablation had been either SP ablation (no residual dual atrioventricular nodal physiology) or SP modulation (residual SP conduction allowing for a maximum of one atrial echo beat). After the initial AVNRT ablation, calculated freedom from AVNRT was 96% at 1 year, 94% at 3 years, 93% at 5 years, and 89% at 8 years. Age, sex, body weight, the choice of ablation energy, and the procedural end point of AVNRT ablation did not impact freedom from AVNRT. Six of 22 AVNRT recurrences (27%) occurred ≥5 years after ablation. No late complications including atrioventricular block were noted. Cumulatively, catheter ablation of AVNRT continued to be effective in >90% of our pediatric patients during the long-term course. A significant part of recurrences occurred >5 years post ablation. Body weight, energy source, and the end point of ablation had no impact on long-term results. No adverse sequelae were noted. © 2016 American Heart Association, Inc.

  15. Catheter Ablation of Ventricular Tachycardia in Patients with Post-Infarction Cardiomyopathy

    PubMed Central

    Nazer, Babak

    2014-01-01

    Monomorphic ventricular tachycardia (VT) in patients with post-infarction cardiomyopathy (CMP) is caused by reentry through slowly conducting tissue with in areas of myocardial scar. The use of implantable cardioverter-defibrillators (ICDs) has helped to decrease the risk of arrhythmic death in patients with post-infarction CMP, but the symptomatic and psychological burden of ICD shocks remains significant. Experience with catheter ablation has progressed substantially in the past 20 years, and is now routinely used to treat patients with post-infarction CMP who experience VT or receive ICD therapy. Depending on the hemodynamic tolerance of VT, a variety of mapping techniques may be used to identify sites for catheter ablation, including activation and entrainment mapping for mappable VTs, or substrate mapping for unmappable VTs. In this review, we discuss the pathophysiology of VT in post-infarction CMP patients, and the contemporary practice of catheter ablation. PMID:25089131

  16. Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter.

    PubMed

    Dewland, Thomas A; Glidden, David V; Marcus, Gregory M

    2014-01-01

    Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84-0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54-0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90-0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81-0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81-1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.

  17. Healthcare Utilization and Clinical Outcomes after Catheter Ablation of Atrial Flutter

    PubMed Central

    Dewland, Thomas A.; Glidden, David V.; Marcus, Gregory M.

    2014-01-01

    Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84–0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54–0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90–0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81–0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81–1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter. PMID:24983868

  18. Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation.

    PubMed

    Patel, Nileshkumar; Deshmukh, Abhishek; Thakkar, Badal; Coffey, James O; Agnihotri, Kanishk; Patel, Achint; Ainani, Nitesh; Nalluri, Nikhil; Patel, Nilay; Patel, Nish; Patel, Neil; Badheka, Apurva O; Kowalski, Marcin; Hendel, Robert; Viles-Gonzalez, Juan; Noseworthy, Peter A; Asirvatham, Samuel; Lo, Kaming; Myerburg, Robert J; Mitrani, Raul D

    2016-04-01

    Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p <0.001]), black (0.49 [95% CI 0.44 to 0.55; p <0.001]), and Hispanic race (0.64 [95% CI 0.56 to 0.72; p <0.001]) were associated with lower likelihoods of undergoing an AF ablation. Medicare (0.93, 0.88 to 0.98, <0.001) or Medicaid (0.67, 0.59 to 0.76, <0.001) coverage and uninsured patients (0.55, 0.49 to 0.62, <0.001) also had lower rates of AF ablation compared to patients with private insurance. In conclusion we found differences in utilization of catheter ablation for AF based on gender, race, and insurance status that persisted over time.

  19. Ablation of atrial fibrillation using novel 4-dimensional catheter tracking within autoregistered left atrial angiograms.

    PubMed

    Rolf, Sascha; Sommer, Philipp; Gaspar, Thomas; John, Silke; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher

    2012-08-01

    We describe a novel fluoroscopy coregistered, 4-dimensional catheter tracking technology (MediGuide Technology [MGT]) used for treatment of patients with atrial fibrillation. The aim of the study was to investigate (1) the feasibility of nonfluoroscopic catheter manipulation within dynamic left atrial chamber models; (2) the integration of the technology into an established electroanatomical mapping system; and (3) potential clinical impact. Forty-nine patients received atrial fibrillation ablation using MGT-enabled NavX-EnSite. Matched patients ablated with a conventional NavX-EnSite system served as a control group. MGT was used for the deployment of diagnostic catheters within preacquired cine loops, for nonfluoroscopic chamber mapping within dynamic angiograms, and for 4-dimensional tagging of anatomical landmarks. Integration with the electroanatomical mapping system allowed correction of field distortions and a reference tool to detect and correct map shifts. Catheter ablation was done without MGT because the ablation catheter was not MGT enabled. MGT worked safely and stably in all 49 patients. Catheter deployment within the preacquired cine loops was successfully performed in 45 of 49 (92%) patients. Catheter tracking within dynamic left atrial angiograms allowed nearly nonfluoroscopic creation of NavX-EnSite geometries with subsequent computed tomography model registration in all 49 patients. Overall, MGT significantly reduced total procedural fluoroscopy time (median [quartiles]) from 31 minutes (25, 43 minutes) to 16 minutes (10, 23 minutes) and irradiation dose from 14 453±7403 to 7363±5827 cGy*cm(2) (mean±SD), respectively (P<0.001). MGT is a tracking technology that allows 4-dimensional visualization of dedicated catheters within moving chamber models. Integration of the MGT with an established electroanatomical mapping system provided algorithms to facilitate mapping in the electroanatomical mapping system environment. As a first measurable

  20. Association of SCN10A Polymorphisms with the Recurrence of Atrial Fibrillation after Catheter Ablation in a Chinese Han Population

    PubMed Central

    Wu, Haiqing; Xu, Juan; Chen, Songwen; Zhou, Genqing; Qi, Baozhen; Wei, Yong; Hu, En; Tang, Dongdong; Chen, Gang; Li, Hongli; Zhao, Liqun; Shi, Yongyong; Liu, Shaowen

    2017-01-01

    The nonsynonymous SCN10A single nucleotide polymorphism (SNP) rs6795970 has been reported to associate with PR interval and atrial fibrillation (AF) and in strong linkage disequilibrium (LD) with the AF-associated SNP rs6800541. In this study, we investigated whether rs6795970 polymorphisms are associated with AF recurrence after catheter ablation. A total of 502 consecutive patients with AF who underwent catheter ablation were included. AF recurrence was defined as a documented episode of any atrial arrhythmias lasting ≥30 s after a blanking period of 3 months. AF recurrence was observed between 3 and 12 months after catheter ablation in 24.5% of the patients. There was a significant difference in the allele distribution (p = 7.86 × 10−5) and genotype distribution (p = 1.42 × 10−5) of rs6795970 between the AF recurrence and no recurrence groups. In a multivariate analysis, we identified the following independent predictors of AF recurrence: the rs6795970 genotypes in an additive model (OR 0.36, 95%CI 0.22~0.60, p = 7.04 × 10−5), a history of AF ≥36 months (OR 3.57, 95%CI 2.26~5.63, p = 4.33 × 10−8) and left atrial diameter (LAD) ≥40 mm (OR 1.85, 95%CI 1.08~3.19, p = 0.026). These data suggest that genetic variation in SCN10A may play an important role in predicting AF recurrence after catheter ablation in the Chinese Han population. PMID:28281580

  1. Association of SCN10A Polymorphisms with the Recurrence of Atrial Fibrillation after Catheter Ablation in a Chinese Han Population.

    PubMed

    Wu, Haiqing; Xu, Juan; Chen, Songwen; Zhou, Genqing; Qi, Baozhen; Wei, Yong; Hu, En; Tang, Dongdong; Chen, Gang; Li, Hongli; Zhao, Liqun; Shi, Yongyong; Liu, Shaowen

    2017-03-10

    The nonsynonymous SCN10A single nucleotide polymorphism (SNP) rs6795970 has been reported to associate with PR interval and atrial fibrillation (AF) and in strong linkage disequilibrium (LD) with the AF-associated SNP rs6800541. In this study, we investigated whether rs6795970 polymorphisms are associated with AF recurrence after catheter ablation. A total of 502 consecutive patients with AF who underwent catheter ablation were included. AF recurrence was defined as a documented episode of any atrial arrhythmias lasting ≥30 s after a blanking period of 3 months. AF recurrence was observed between 3 and 12 months after catheter ablation in 24.5% of the patients. There was a significant difference in the allele distribution (p = 7.86 × 10(-5)) and genotype distribution (p = 1.42 × 10(-5)) of rs6795970 between the AF recurrence and no recurrence groups. In a multivariate analysis, we identified the following independent predictors of AF recurrence: the rs6795970 genotypes in an additive model (OR 0.36, 95%CI 0.22~0.60, p = 7.04 × 10(-5)), a history of AF ≥36 months (OR 3.57, 95%CI 2.26~5.63, p = 4.33 × 10(-8)) and left atrial diameter (LAD) ≥40 mm (OR 1.85, 95%CI 1.08~3.19, p = 0.026). These data suggest that genetic variation in SCN10A may play an important role in predicting AF recurrence after catheter ablation in the Chinese Han population.

  2. Towards patient-specific modelling of lesion formation during radiofrequency catheter ablation for atrial fibrillation

    PubMed Central

    Soor, Navjeevan; Morgan, Ross; Varela, Marta; Aslanidi, Oleg V.

    2017-01-01

    Radiofrequency catheter ablation procedures are a first-line method of clinical treatment for atrial fibrillation. However, they suffer from suboptimal success rates and are also prone to potentially serious adverse effects. These limitations can be at least partially attributed to the inter- and intra- patient variations in atrial wall thickness, and could be mitigated by patient-specific approaches to the procedure. In this study, a modelling approach to optimising ablation procedures in subject-specific 3D atrial geometries was applied. The approach enabled the evaluation of optimal ablation times to create lesions for a given wall thickness measured from MRI. A nonliner relationship was revealed between the thickness and catheter contact time required for fully transmural lesions. Hence, our approach based on MRI reconstruction of the atrial wall combined with subject-specific modelling of ablation can provide useful information for improving clinical procedures.

  3. Respiratory motion influence on catheter contact force during radio frequency ablation procedures

    NASA Astrophysics Data System (ADS)

    Koch, Martin; Brost, Alexander; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation is a common treatment option for atrial fibrillation. A common treatment strategy is pulmonary vein isolation. In this case, individual ablation points need to be placed around the ostia of the pulmonary veins attached to the left atrium to generate transmural lesions and thereby block electric signals. To achieve a durable transmural lesion, the tip of the catheter has to be stable with a sufficient tissue contact during radio-frequency ablation. Besides the steerable interface operated by the physician, the movement of the catheter is also influenced by the heart and breathing motion - particularly during ablation. In this paper we investigate the influence of breathing motion on different areas of the endocardium during radio frequency ablation. To this end, we analyze the frequency spectrum of the continuous catheter contact force to identify areas with increased breathing motion using a classification method. This approach has been applied to clinical patient data acquired during three pulmonary vein isolation procedures. Initial findings show that motion due to respiration is more pronounced at the roof and around the right pulmonary veins.

  4. Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types.

    PubMed

    Oloriz, Teresa; Silberbauer, John; Maccabelli, Giuseppe; Mizuno, Hiroya; Baratto, Francesca; Kirubakaran, Senthil; Vergara, Pasquale; Bisceglia, Caterina; Santagostino, Giulia; Marzi, Alessandra; Sora, Nicoleta; Roque, Carla; Guarracini, Fabrizio; Tsiachris, Dimitris; Radinovic, Andrea; Cireddu, Manuela; Sala, Simone; Gulletta, Simone; Paglino, Gabriele; Mazzone, Patrizio; Trevisi, Nicola; Della Bella, Paolo

    2014-06-01

    The aim was to relate distinct scar distributions found in nonischemic cardiomyopathy with ventricular tachycardia (VT) morphology, late potential distribution, ablation strategy, and outcome. Eighty-seven patients underwent catheter ablation for drug-refractory VT. Based on endocardial unipolar voltage, 44 were classified as predominantly anteroseptal and 43 as inferolateral. Anteroseptal patients more frequently fulfilled diagnostic criteria for dilated cardiomyopathy (64% versus 36%), associated with more extensive endocardial unipolar scar (41 [22-83] versus 9 [1-29] cm(2); P<0.001). Left inferior VT axis was predictive of anteroseptal scar (positive predictive value, 100%) and right superior axis for inferolateral (positive predictive value, 89%). Late potentials were infrequent in the anteroseptal group (11% versus 74%; P<0.001). Epicardial late potentials were common in the inferolateral group (81% versus 4%; P<0.001) and correlated with VT termination sites (κ=0.667; P=0.014), whereas no anteroseptal patient had an epicardial VT termination (P<0.001). VT recurred in 44 patients (51%) during a median follow-up of 1.5 years. Anteroseptal scar was associated with higher VT recurrence (74% versus 25%; log-rank P<0.001) and redo procedure rates (59% versus 7%; log-rank P<0.001). After multivariable analysis, clinical predictors of VT recurrence were electrical storm (hazard ratio, 3.211; P=0.001) and New York Heart Association class (hazard ratio, 1.608; P=0.018); the only procedural predictor of VT recurrence was anteroseptal scar pattern (hazard ratio, 5.547; P<0.001). Unipolar low-voltage distribution in nonischemic cardiomyopathy allows categorization of scar pattern as inferolateral, often requiring epicardial ablation mainly based on late potentials, and anteroseptal, which frequently involves an intramural septal substrate, leading to a higher VT recurrence. © 2014 American Heart Association, Inc.

  5. The effect of radiofrequency catheter ablation on permanent pacemakers: an experimental study.

    PubMed

    Chin, M C; Rosenqvist, M; Lee, M A; Griffin, J C; Langberg, J J

    1990-01-01

    Radiofrequency current is being investigated as an alternative to direct current shock for transcatheter ablation of cardiac arrhythmias. Permanent pacemakers are known to be susceptible to high frequency electromagnetic interference. This study was performed to examine the effects of transcatheter radiofrequency ablation on permanent pacemakers in a worst-case scenario. Nineteen pulse generators representing 16 models from seven manufacturers were acutely implanted in 12 dogs to assess their function during and after ablation. Pulse generators were implanted subcutaneously in the neck and connected to a transvenous permanent pacing lead positioned in the right ventricular apex. A 6F quadripolar electrode catheter was positioned approximately 1 cm from the tip of the permanent pacing lead. Radiofrequency current from an electrosurgical unit was applied between the distal electrode of the catheter and a large diameter skin electrode placed below the left scapula. Three additional ablation sessions were performed with the catheter situated 4-5 cm from the permanent pacing lead. Each ablation consisted of 15 W of radiofrequency power, delivered for up to 30 seconds. Twelve pulse generators were falsely inhibited during radiofrequency ablation while programmed to the VVI or DDD mode, nine of which continued to be inhibited while programmed to the VOO or DOO mode. Five pulse generators paced at abnormal rates, including three examples of one pulse generator model that displayed pacemaker runaway. Runaway was observed during eight ablations, resulting in two episodes of ventricular fibrillation. Eleven pulse generators reverted to noise mode behavior during ablation. Only three pulse generators were unaffected during ablation. No reprogramming or pacing system malfunctions were observed after cessation of radiofrequency current application or during ablations greater than 4 cm from the permanent lead.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Catheter ablation of atrial fibrillation supported by novel nonfluoroscopic 4D navigation technology.

    PubMed

    Rolf, Sascha; John, Silke; Gaspar, Thomas; Dinov, Boris; Kircher, Simon; Huo, Yan; Bollmann, Andreas; Richter, Sergio; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher; Sommer, Philipp

    2013-09-01

    The MediGuide technology (MGT) represents a novel sensor-based electromagnetic 4-dimensional (4D) navigation system allowing real-time catheter tracking in the environment of prerecorded X-ray loops. To report on our clinical experience in atrial fibrillation (AF) ablation with recently available MGT-enabled ablation catheters. The MGT was used in addition to a conventional 3D mapping system in 80 patients with AF (age 61 ± 10 years; 47 men; 40 with persistent AF), who underwent circumferential pulmonary vein isolation and voltage mapping with and without substrate modification. Short native right anterior oblique/left anterior oblique loops were used as background movies for the nonfluoroscopic placement of sensor-equipped diagnostic catheters into the coronary sinus and the right ventricle. After single transseptal puncture, selective angiograms of the pulmonary veins were used as background movies for near nonfluoroscopic left atrial reconstruction. Computed tomography registration as well as mapping/ablation was performed by using the new open-irrigated MGT-enabled ablation catheter. MGT application was not associated with a change in established workflow. Large parts of the procedure (mean entire duration 167 ± 47 minutes) could be done without additional fluoroscopy, whereas median residual fluoroscopy duration of 4.6 (interquartile range: 2.9, 7.1) minutes was mainly used for the acquisition of background loops, transseptal puncture, occasional verification of transseptal sheath position, and manipulation of the circular mapping catheter. Three (4%) minor complications occurred. The MGT integrates easily into the workflow of standard AF ablation and allows for high-quality nonfluoroscopic 4D catheter tracking. This results in low radiation exposure for patients and staff without complicating the workflow of the procedure. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  7. Catheter ablation of arrhythmic storm triggered by monomorphic ectopic beats in patients with coronary artery disease.

    PubMed

    Peichl, Petr; Cihák, Robert; Kozeluhová, Markéta; Wichterle, Dan; Vancura, Vlastimil; Kautzner, Josef

    2010-01-01

    Frequent episodes of polymorphic ventricular tachycardias/ventricular fibrillation (VT/VF) in patients with coronary artery disease can be triggered by monomorphic ventricular premature beats (VPBs) and thus, amenable to catheter ablation. The goal of this study was to review single-center experience in catheter ablation of electrical storm caused by focally triggered polymorphic VT/VF. Catheter ablation of electrical storm due to focally triggered polymorphic VT/VF was performed in nine patients (mean age, 62+/-7 years; two females). All patients had previous myocardial infarction (interval of 3 days to 171 months). Mean left ventricular ejection fraction was 27+/-6 percent. All patients presented with repeated runs of polymorphic VT/VF triggered by monomorphic VPBs. Based on mapping data, the ectopic beats originated from scar border zone on interventricular septum (n=5), inferior wall (n=3), and lateral wall (n=1). Catheter ablation was performed to abolish the triggering ectopy and to modify the arrhythmogenic substrate by linear lesions within the infarct border zone. The ablation procedure was acutely successful in eight out of nine patients. During the follow-up of 13+/-7 months, two patients died due to progressive heart failure. One patient had late recurrence of electrical storm due to ectopic beats of different morphology and was successfully reablated. Electrical storm due to focally triggered polymorphic VT/VF may occur either in subacute phase of myocardial infarction or substantially later after index event. Catheter ablation of ectopic beats triggering these arrhythmias can successfully abolish electrical storm and become a life-saving procedure.

  8. Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

    PubMed Central

    Santangeli, Pasquale; Lin, David

    2015-01-01

    Pulmonary vein isolation (PVI) is the cornerstone of current ablation techniques to eliminate atrial fibrillation (AF), with the greatest efficacy as a stand-alone procedure in patients with paroxysmal AF. Over the years, techniques for PVI have undergone a profound evolution, and current guidelines recommend PVI with confirmation of electrical isolation. Despite significant efforts, PV reconnection is still the rule in patients experiencing post-ablation arrhythmia recurrence. In recent years, use of general anesthesia with or without jet ventilation, open-irrigated ablation catheters, and steerable sheaths have been demonstrated to increase the safety and efficacy of PVI, reducing the rate of PV reconnection over follow-up. The widespread clinical availability of ablation catheters with real-time contact force information will likely further improve the effectiveness and safety of PVI. In a small but definite subset of patients, post-ablation recurrent arrhythmia is due to non-PV triggers, which should be eliminated in order to improve success. Typically, non-PV triggers cluster in specific regions such as the coronary sinus, the inferior mitral annulus, the interatrial septum, the left atrial appendage, the Eustachian ridge, the crista terminalis region, the superior vena cava, and the ligament of Marshall. Focal ablation targeting the origin of the trigger is recommended in most cases. Empirical non-PV ablation targeting the putative substrate responsible for AF maintenance with ablation lines and/or elimination of complex fractionated electrograms has not been shown to improve success compared to PVI alone. Similarly, the role of novel substrate-based ablation approaches targeting putative localized sources of AF (e.g., rotors) identified by computational mapping techniques is unclear, as they have never been compared to PVI and non-PV trigger ablation in an adequately designed randomized trial. This review highlights PVI techniques and outcomes in treating

  9. ACUTE TERMINATION OF HUMAN ATRIAL FIBRILLATION BY IDENTIFICATION AND CATHETER ABLATION OF LOCALIZED ROTORS AND SOURCES

    PubMed Central

    Shivkumar, Kalyanam; Ellenbogen, Kenneth A.; Hummel, John D.; Miller, John M.; Steinberg, Jonathan S.

    2012-01-01

    Catheter ablation of atrial fibrillation (AF) currently relies on eliminating triggers, and no reliable method exists to map the arrhythmia itself to identify ablation targets. The aim of this multicenter study was to define the use of Focal Impulse and Rotor Modulation (FIRM) for identifying ablation targets. METHODS We prospectively enrolled the first (n=14, 11 males) consecutive patients undergoing FIRM guided ablation for persistent (n=11) and paroxysmal AF at 5 centers. A 64 pole basket catheter was used for panoramic right and left atrial mapping during AF. AF electrograms were analyzed using a novel system to identify sustained rotors (spiral waves), or focal beats (centrifugal activation to surrounding atrium). Ablation was performed first at identified sources. The primary endpoints were acute AF termination or organization (>10 % cycle length prolongation). Conventional ablation was performed only after FIRM guided ablation. RESULTS 12/14 cases were mapped. AF sources were demonstrated in all patients (average of 1.9±0.8 per patient). Sources were left atrial in 18 cases, and right atrial in 5 cases, and 21/23 were rotors. FIRM guided ablation achieved the acute endpoint in all patients, consisting of AF termination in n=8 (4.9±3.9 min at the primary source), and organization in n=4. Total FIRM time for all patients was 12.3±8.6 min. CONCLUSIONS FIRM guided ablation revealed localized AF rotors/focal sources in patients with paroxysmal, persistent and longstanding persistent AF. Brief targeted FIRM guided ablation at a priori identified sites terminated or substantially organized AF in all cases prior to any other ablation. PMID:23130890

  10. Mapping and ablation of ventricular arrhythmias with magnetic navigation: comparison between 4- and 8-mm catheter tips.

    PubMed

    Di Biase, Luigi; Burkhardt, J David; Lakkireddy, Dhanunjaya; Pillarisetti, Jayasree; Baryun, Esam Nuri; Biria, Mazda; Horton, Rodney; Sanchez, Javier; Gallinghouse, G Joseph; Bailey, Shane; Beheiry, Salwa; Hongo, Richard; Hao, Steven; Tomassoni, Gery; Natale, Andrea

    2009-11-01

    Remote magnetic navigation (RMN) has been reported as an effective and safe tool to overcome the need for advanced operator skill in the treatment of complex arrhythmias. We report a series of patients undergoing radiofrequency catheter ablation of ventricular arrhythmias (VAs) using RMN with either a 4-mm catheter tip or an 8-mm catheter tip at four different centers. Sixty-five patients with clinical and symptomatic history of Vas were included. Two different magnetic catheters were used to deliver radiofrequency applications remotely. When ablation with the RMN catheters failed, a manual irrigated catheter was used to eliminate the VAs. Post-ablation pacing maneuvers were utilized to verify the inducibility of Vas. Twenty-eight patients (43%) had ischemic cardiomyopathy [coronary artery disease (CAD)], 16 patients (25%) had non-ischemic cardiomyopathy [idiopathic dilated cardiomyopathy (IDC)], and 21 patients (32%) had structurally normal hearts (SNH) or right ventricle outflow tract tachycardia (RVOT). In patients with structural heart disease (CAD, IDC), success was achieved in 22% with the 4-mm catheter tip and in 59% with the 8-mm catheter tip (p = 0.014). In patients with SNH/RVOT, success was achieved in 85% with the 4-mm catheter tip and in 87% with the 8-mm catheter tip (p = 1.00). Our findings showed that, with RMN, there is an increased success related to the catheter tip utilized. However, in patients with right ventricular outflow origin, the standard 4-mm tip provided adequate lesions for successful ablation in most patients.

  11. Persistent Visual Aura following Catheter Ablation in a Patient with WPW Syndrome

    PubMed Central

    Koyama, Shinichi; Kawamura, Mitsuru

    2007-01-01

    We report a patient who has had persistent visual disturbances since she underwent catheter ablation to treat her Wolff-Parkinson-White (WPW) syndrome. We examined her visual symptoms carefully and quantitatively by means of our newly developed method combining image-processing and psychophysics. We first simulated the patient’s visual symptoms using image-processing techniques. Since the simulation indicated that she would be very sensitive to the edges of the visual stimuli, we evaluated her sensitivity to the edges using psychophysics. The results indicated that she was hypersensitive to the clear-cut edges of the visual stimuli. Her visual symptoms were very similar to those of visual aura of migraine, rather than those of photosensitive epilepsy. Magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT), electroenchepalogram (EEG), and visual-evoked potentials (VEP) in the patient were normal. No abnormalities in her fundus, visual field, or electroretinogram were found, either. Transesophageal echocardiography with bubble study indicated that she had a preexisting right-to-left shunt. We hypothesize that visual aura of migraine was triggered and made persistent by the catheter ablation in this patient. Although the relationship between migraine, catheter ablation, and right-to-left shunts is unknown, previous studies on the transcatheter closure of patent foramen ovale suggest a possible link between them. Catheter ablation in patients with migraine and preexisting shunts may lead to exacerbations in migraine symptoms. PMID:17726248

  12. Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry.

    PubMed

    Brachmann, Johannes; Lewalter, Thorsten; Kuck, Karl-Heinz; Andresen, Dietrich; Willems, Stephan; Spitzer, Stefan G; Straube, Florian; Schumacher, Burghard; Eckardt, Lars; Danilovic, Dejan; Thomas, Dierk; Hochadel, Matthias; Senges, Jochen

    2017-05-01

    To analyse outcomes of supraventricular tachycardia (SVT) ablations performed within a prospective German Ablation Quality Registry. Data from 12 566 patients who underwent catheter ablation of SVT between January 2007 and January 2010 to treat atrial fibrillation (AFIB, 37.2% of procedures), atrial flutter (AFL, 29.9%), atrioventricular nodal re-entrant tachycardia (AVNRT, 23.2%), atrioventricular re-entrant tachycardia (6.3%), and focal atrial tachycardia (AT, 3.4%) were prospectively collected. Patients were followed for at least 1 year. The periprocedural success rate was 96.3%, ranging from 84.3% (focal AT) to 98.9% (AVNRT). Kaplan-Meier mortality estimate at 1 year was 1.4% overall, and as high as 2.6% in the AFL group and 2.8% in the focal AT group. Recurrence of ablated or another symptomatic SVT was observed in 3783 (32.6%) of patients, ranging from 17.2% (AVNRT) to 45.6% (AFIB). Repeat ablation was performed in 12.0% of patients. After 1 year, 74.1% of survivors perceived ablation therapy as successful, 15.7% as partly successful, and 9.6% as unsuccessful. Even in those patients with arrhythmia recurrence, 76.0% perceived ablation as successful or partly successful and 89.6% would still undergo repeat ablation in the same institution. Ablation therapy for SVT is a safe procedure bringing symptomatic improvement and satisfaction to three quarters of patients after 1 year. Even in patients with arrhythmia recurrence, a high satisfaction level and adherence to the ablating institution could be documented. Strikingly high mortality and stroke rates in follow-up were observed in AFL patients, who apparently need consistent long-term anticoagulation and more medical attention.

  13. Catheter ablation of idiopathic ventricular tachycardia without the use of fluoroscopy.

    PubMed

    Lamberti, Filippo; Di Clemente, Francesca; Remoli, Romolo; Bellini, Cesare; De Santis, Antonella; Mercurio, Marina; Dottori, Serena; Gaspardone, Achille

    2015-01-01

    Catheter ablation is the treatment of choice for many patients with idiopathic ventricular tachycardia (VT). Unfortunately, conventional catheter ablation is guided by fluoroscopy, which is associated with a small but definite radiation risk for patients and laboratory personnel. The aim of our study is to assess feasibility, success rate and safety of idiopathic VT ablation procedure performed without the use of fluoroscopy. Nineteen consecutive patients undergoing idiopathic VT ablation at our institution have been included. The ablation procedures were performed under the guidance of electroanatomical mapping (EAM) system and intracardiac echocardiography (ICE). Nineteen patients (mean age 38.7 years) underwent ablation procedure for idiopathic VT. Twelve (63%) had outflow tract VT, 3 (18%) fascicular tachycardia, 2 (11%) peri-tricuspidal VT, 1 (5%) peri-mitral VT, and 1 (5%) lateral left free-wall VT. The mean procedural time was 170.2 ± 45.7 min. No fluoroscopy was used in any procedural phase. Acute success rate was 100%. No complication was documented in any patients. After a mean follow up of 18 ± 4 months, recurrences occurred in 2 patients. In our preliminary experience idiopathic VT ablation without the use of fluoroscopy was feasible and safe, using a combination of EAM and ICE. Success rate was excellent with no complication. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Outcomes of Catheter Ablation of Ventricular Tachycardia in the Setting of Structural Heart Disease.

    PubMed

    Betensky, B P; Marchlinski, F E

    2016-07-01

    Sustained ventricular tachycardias are common in the setting of structural heart disease, either due to prior myocardial infarction or a variety of non-ischemic etiologies, including idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Over the past two decades, percutaneous catheter ablation has evolved dramatically and has become an effective tool for the control of ventricular arrhythmias. Single and multicenter observational studies as well as several prospective randomized trials have begun to investigate long-term outcomes after catheter ablation procedures. These studies encompass a wide range of mapping and ablation techniques, including conventional activation mapping/entrainment criteria, substrate modification guided by pacemapping, late potential and abnormal electrogram ablation, scar de-channeling, and core isolation. While large-scale, multicenter prospective randomized clinical trials are somewhat limited, the published data demonstrate favorable outcomes with respect to a reduction in overall ventricular tachycardia (VT) burden, reduction of implantable cardioverter defibrillator (ICD) shocks, and discontinuation of anti-arrhythmic medications across varying disease subtypes and convincingly support the use of catheter ablation as the standard of care for many patients with VT in the setting of structural heart disease.

  15. Lasso catheter guided ablation for paroxysmal atrial fibrillation: the first experience in Thailand.

    PubMed

    Raungratanaamporn, Ongkarn; Bhurippanyo, Kiertijai; Chotinaiwattarakul, Chunhakasem; Suksap, Suthisak; Chirapastan, Anna; Ninmaneechot, Nuntaya; Numee, Malee

    2003-05-01

    The authors used the 10-pole pulmonary vein sized loop-shaped, lasso, catheter via a transatrial septal long sheath in 10 patients who had symptomatic refractory paroxysmal atrial fibrillation (PAF) in order to map and guide for catheter ablation. The radiofrequency current was delivered at the junction between atrial tissue and the pulmonary vein which was the earliest endocardial activation time of the premature atrial contraction (PAC) initiating the PAF and at the pulmonary vein potential during sinus rhythm. Twenty two foci of PAC, 10 and 7, 4 and 1 from left and right superior and left and right inferior pulmonary veins, respectively, and 5 pulmonary vein potentials, 2 and 3 from left and right superior pulmonary veins, respectively, were ablated. After AF ablation, classical atrial flutter (AFl) could be induced in 9 patients. Isthmus line of block for AFl was performed in all patients. Two patients had atrial tachycardia at the high right atrium and also successfully ablated. The mean fluoroscopic and procedure times were 87 and 300 minutes, respectively. One patient had deep vein thrombosis which resolved after anticoagulant therapy. One patient had recurrent PAF which was successfully reablated but he still had very mild symptoms. During the mean follow-up period of 5.8 months, 9 patients remained free of symptoms. Lasso catheter is an effective tool for mapping and guiding of ablation for PAF. However, more experience and long-term follow-up are required.

  16. Catheter Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia.

    PubMed

    Katritsis, Demosthenes G; Marine, Joseph E; Contreras, Fernando M; Fujii, Akira; Latchamsetty, Rakesh; Siontis, Konstantinos C; Katritsis, George D; Zografos, Theodoros; John, Roy M; Epstein, Lawrence M; Michaud, Gregory F; Anter, Elad; Sepahpour, Ali; Rowland, Edward; Buxton, Alfred E; Calkins, Hugh; Morady, Fred; Stevenson, William G; Josephson, Mark E

    2016-11-22

    Because of its low prevalence, data on atypical atrioventricular nodal reentrant tachycardia (AVNRT) are scarce, and the optimal ablation method has not been established. Our study aimed at assessing the efficacy and safety of conventional slow pathway ablation, as applied for typical cases, in atypical AVNRT. We studied 2079 patients with AVNRT subjected to slow pathway ablation. In 113 patients, mean age 48.5±18.1 years, 68 female, atypical AVNRT or coexistent atypical and typical AVNRT without other concomitant arrhythmia was diagnosed. Ablation data and outcomes were compared with a group of age- and sex-matched control patients with typical AVNRT. Fluoroscopy and radiofrequency current delivery times were not different in the atypical and typical groups, 20.3±12.2 versus 20.8±12.9 minutes (P=0.730) and 5.9±5.0 versus 5.5±4.5 minutes (P=0.650), respectively. Slow pathway ablation was accomplished from the right septum in 110 patients, and from the left septum in 3 patients, in the atypical group. There was no need for additional ablation lesions at other anatomic sites, and no cases of atrioventricular block were encountered. Recurrence rates of the arrhythmia were 5.6% in the atypical (6/108 patients) and 1.8% in the typical (2/111 patients) groups in the next 3 months following ablation (P=0.167). Conventional ablation at the anatomic area of the slow pathway is the therapy of choice for symptomatic AVNRT, regardless of whether the typical or atypical form is present. © 2016 American Heart Association, Inc.

  17. Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy.

    PubMed

    Dello Russo, Antonio; Casella, Michela; Pelargonio, Gemma; Santangeli, Pasquale; Bartoletti, Stefano; Bencardino, Gianluigi; Al-Mohani, Ghaliah; Innocenti, Ester; Di Biase, Luigi; Avella, Andrea; Pappalardo, Augusto; Carbucicchio, Corrado; Bellocci, Fulvio; Fiorentini, Cesare; Natale, Andrea; Tondo, Claudio

    2016-06-01

    Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.

  18. An Approach to Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

    PubMed Central

    O’Neill, Mark D; Jais, Pierre; Jönsson, Anders; Takahashi, Yoshihide; Sacher, Frédéric; Hocini, Mélèze; Sanders, Prashanthan; Rostock, Thomas; Rotter, Martin; Clémenty, Jacques; Haïssaguerre, Michel

    2006-01-01

    Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI) dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter. PMID:16943901

  19. [Infectious mitral endocarditis after radiofrequency catheter ablation of a left lateral accessory pathway].

    PubMed

    Benito Bartolomé, F; Sánchez Fernández-Bernal, C

    2001-08-01

    A 2-years-old child with Wolff-Parkinson-White syndrome associated with life-threatening symptoms underwent radiofrequency ablation of a left lateral accessory pathway. A deflectable 5F bipolar electrode catheter positioned above the atrioventricular groove by transeptal approach was used for ablation. The catheters were repeatedly used after ethylene oxide sterilisation. Although immediate post-ablation echocardiography demonstrated no complications, the patient was readmitted two days later with fever and a new mitral murmur. Penicillin-susceptible Staphylococcus aureus was isolated and intravenous antibiotics were administered. In the following weeks, the patient developed constrictive pericarditis requiring surgical treatment and acute hemiplegia caused by brain embolism arising from valvular vegetation. At 5 years of follow-up the patient presents residual hemiparesia and grade II/IV mitral insufficiency.

  20. Acute Failure of Catheter Ablation for Ventricular Tachycardia Due to Structural Heart Disease: Causes and Significance

    PubMed Central

    Tokuda, Michifumi; Kojodjojo, Pipin; Tung, Stanley; Tedrow, Usha B.; Nof, Eyal; Inada, Keiichi; Koplan, Bruce A.; Michaud, Gregory F.; John, Roy M.; Epstein, Laurence M.; Stevenson, William G.

    2013-01-01

    Background Acute end points of catheter ablation for ventricular tachycardia (VT) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer‐term management and outcomes. Methods and Results From 2002 to 2010, 518 consecutive patients (84% male, 62±14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT. Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P=0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P<0.001). Conclusions With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality. PMID:23727700

  1. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial.

    PubMed

    Wilber, David J; Pappone, Carlo; Neuzil, Petr; De Paola, Angelo; Marchlinski, Frank; Natale, Andrea; Macle, Laurent; Daoud, Emile G; Calkins, Hugh; Hall, Burr; Reddy, Vivek; Augello, Giuseppe; Reynolds, Matthew R; Vinekar, Chandan; Liu, Christine Y; Berry, Scott M; Berry, Donald A

    2010-01-27

    Antiarrhythmic drugs are commonly used for prevention of recurrent atrial fibrillation (AF) despite inconsistent efficacy and frequent adverse effects. Catheter ablation has been proposed as an alternative treatment for paroxysmal AF. To determine the efficacy of catheter ablation compared with antiarrhythmic drug therapy (ADT) in treating symptomatic paroxysmal AF. A prospective, multicenter, randomized (2:1), unblinded, Bayesian-designed study conducted at 19 hospitals of 167 patients who did not respond to at least 1 antiarrhythmic drug and who experienced at least 3 AF episodes within 6 months before randomization. Enrollment occurred between October 25, 2004, and October 11, 2007, with the last follow-up on January 19, 2009. Catheter ablation (n = 106) or ADT (n = 61), with assessment for effectiveness in a comparable 9-month follow-up period. Time to protocol-defined treatment failure. The proportion of patients who experienced major treatment-related adverse events within 30 days of catheter ablation or ADT was also reported. At the end of the 9-month effectiveness evaluation period, 66% of patients in the catheter ablation group remained free from protocol-defined treatment failure compared with 16% of patients treated with ADT. The hazard ratio of catheter ablation to ADT was 0.30 (95% confidence interval, 0.19-0.47; P < .001). Major 30-day treatment-related adverse events occurred in 5 of 57 patients (8.8%) treated with ADT and 5 of 103 patients (4.9%) treated with catheter ablation. Mean quality of life scores improved significantly in patients treated by catheter ablation compared with ADT at 3 months; improvement was maintained during the course of the study. Among patients with paroxysmal AF who had not responded to at least 1 antiarrhythmic drug, the use of catheter ablation compared with ADT resulted in a longer time to treatment failure during the 9-month follow-up period. clinicaltrials.gov Identifier: NCT00116428.

  2. Catheter ablation of pediatric AV nodal reentrant tachycardia: results in small children.

    PubMed

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Kriebel, Thomas; Paul, Thomas; Schneider, Heike E

    2015-11-01

    AV nodal reentrant tachycardia (AVNRT) is commonly encountered in pediatric patients. Definite treatment can be achieved by catheter ablation. The purpose of the study was to evaluate the efficacy and safety of AVNRT ablation focusing on children with a body weight ≤25 kg. Catheter ablation of AVNRT was attempted in 253 patients. Median age was 12.5 years; median body weight was 48.7 kg. 25 (9.9 %) children had a body weight ≤25 kg. Congenital heart disease was present in 6 patients (2.4 %). Procedural success was achieved in 98 % using radiofrequency, in 100 % using cryoenergy alone, and in 94 % using both energy sources. In patients with a body weight ≤25 kg, success was achieved in 96 %. In patients ≤25 kg, fluoroscopy and procedure duration did not differ from those >25 kg. The rate of major complications was significantly higher in the patients ≤25 kg (12 vs. 2.2 %, p = 0.04). Permanent AV block after RF ablation occurred in 2 patients with congenital heart disease and one infant with a body weight of 8.7 kg. Catheter ablation of AVNRT in children and adolescents was safe and effective. Infants and small children with a body weight ≤25 kg had a higher prevalence of serious complications. This should alert physicians in decision making toward catheter ablation in these patients. In patients with congenital heart disease and different anatomy of the cardiac conduction system, operators must be aware of an increased risk for AV block.

  3. Cost-Effectiveness of Catheter Ablation for Rhythm Control of Atrial Fibrillation

    PubMed Central

    Blackhouse, Gord; Assasi, Nazila; Xie, Feng; Gaebel, Kathryn; Campbell, Kaitryn; Healey, Jeff S.; O'Reilly, Daria

    2013-01-01

    Objective. The objective of this study is to evaluate the cost-effectiveness of catheter ablation for rhythm control compared to antiarrhythmic drug (AAD) therapy in patients with atrial fibrillation (AF) who have previously failed on an AAD. Methods. An economic model was developed to compare (1) catheter ablation and (2) AAD (amiodarone 200 mg/day). At the end of the initial 12 month phase of the model, patients are classified as being in normal sinus rhythm or with AF, based on data from a meta-analysis. In the 5-year Markov phase of the model, patients are at risk of ischemic stroke each 3-month model cycle. Results. The model estimated that, compared to the AAD strategy, ablation had $8,539 higher costs, 0.033 fewer strokes, and 0.144 more QALYS over the 5-year time horizon. The incremental cost per QALY of ablation compared to AAD was estimated to be $59,194. The probability of ablation being cost-effective for willingness to pay thresholds of $50,000 and $100,000 was estimated to be 0.89 and 0.90, respectively. Conclusion. Based on current evidence, pulmonary vein ablation for treatment of AF is cost-effective if decision makers willingness to pay for a QALY is $59,194 or higher. PMID:24089640

  4. Radiofrequency catheter ablation versus balloon cryoablation of atrial fibrillation: markers of myocardial damage, inflammation, and thrombogenesis.

    PubMed

    Antolič, Bor; Pernat, Andrej; Cvijić, Marta; Žižek, David; Jan, Matevž; Šinkovec, Matjaž

    2016-07-01

    Evidence from animal and human studies suggests that cryoablation might be associated with a lesser inflammatory response and activation of coagulation compared with radiofrequency ablation. The study was aimed at comparing the effect of cryoballoon and radiofrequency catheter ablation of paroxysmal atrial fibrillation on markers of myocardial damage, inflammation, and activation of coagulation. Forty-one patients received either cryoballoon (n = 23) or radiofrequency (n = 18) ablation of atrial fibrillation. We measured troponin I, high-sensitivity CRP, and interleukin 6 at baseline from the cubital vein, and from the right and left atrium before and after ablation, and from the cubital vein the following day. Prothrombin fragments 1 + 2, soluble P‑selectin, and D‑dimer were measured before and after ablation from both atria. We observed higher troponin I release in the cryoballoon than in the radiofrequency group (7.01 mcg/l (interquartile range [IQR]: 5.30-9.09) vs 2.32 mcg/l (IQR: 1.45-2.98), p < 0.001). The levels of inflammatory markers (high-sensitivity CRP and interleukin 6) in the two groups were comparable, as were the levels of markers of coagulation activation. Procedure duration, fluoroscopy times, and mid-term success (23 months, IQR 7-32) of the two groups were also comparable. Cryoballoon ablation of atrial fibrillation causes more significant myocardial damage, that is, more extensive ablation lesions, compared with radiofrequency catheter ablation. However, no major differences between these two ablation techniques with regard to the inflammatory response and activation of the coagulation system were observed.

  5. The Incidence of Audible Steam Pops Is Increased and Unpredictable With the ThermoCool® Surround Flow Catheter During Left Atrial Catheter Ablation: A Prospective Observational Study.

    PubMed

    Theis, Cathrin; Rostock, Thomas; Mollnau, Hanke; Sonnenschein, Sebastian; Himmrich, Ewald; Kämpfner, Denise; Ocete, Blanca Quesada; Bock, Karsten; Münzel, Thomas; Konrad, Torsten

    2015-06-08

    Open irrigated radiofrequency (RF) ablation catheters with a porous tip (56 holes, TC-SF) permit delivering RF energy in a temperature-controlled mode without temperature rise. This prospective observational study investigated the association of different catheter parameters on the occurrence of audible steam pops during left atrial (LA) ablation. A total of 226 patients underwent TC-SF catheter ablation for atrial fibrillation. RF power delivery, impedance and catheter tip temperature were continually recorded throughout the ablation. Pulmonary vein isolation was performed with a maximum of 27 W and LA electrogram-guided or linear ablation with a maximum of 30 W. A total of 59 audible steam pops occurred, 2 of them resulting in pericardial tamponade. In the initial 89 patients, with an irrigation flow rate of 10 mL/min, 18 steam pops with one tamponade occurred in 12 (14%) patients. Subsequently, the irrigation flow rate was increased to 20 mL/min in the following 137 patients, resulting in the occurrence of 41 steam pops including one case of tamponade in a total of 30 (22%) patients. The maximal power was significantly higher in RF applications associated with a pop than those that did not. In only 12 (20%) steam pops, a significant impedance change occurred immediately before pop occurrence (4 [7%] impedance rise >10 ohm, 8 [13%] impedance drop >15 ohm). The TC-SF catheter does not provide sufficient feedback from the ablated tissue to prevent steam popping. © 2015 Wiley Periodicals, Inc.

  6. Computed tomography-fluoroscopy overlay evaluation during catheter ablation of left atrial arrhythmia.

    PubMed

    Knecht, Sébastien; Skali, Hicham; O'Neill, Mark D; Wright, Matthew; Matsuo, Seiichiro; Chaudhry, Ghulam Muqtada; Haffajee, Charles I; Nault, Isabelle; Gijsbers, Geert H M; Sacher, Frederic; Laurent, Francois; Montaudon, Michel; Corneloup, Olivier; Hocini, Mélèze; Haïssaguerre, Michel; Orlov, Michael V; Jaïs, Pierre

    2008-08-01

    Proper visualization of left atrial (LA) and pulmonary vein (PV) anatomy is of crucial importance during atrial fibrillation (AF) ablation. This two-centre study evaluated a new automatic computed tomography (CT)-fluoroscopy overlay system (EP navigator, Philips Medical Systems, Best, The Netherlands) and the accuracy of different registration methods. Fifty-six consecutive patients (age: 56 +/- 14) with symptomatic AF underwent contrast CT of the LA/PV prior to ablation. Three registration methods were evaluated and validated by comparison with LA angiography: (i) catheter registration: the placement of catheters in identifiable anatomical structures; (ii) heart contour: based on aligning the fluoroscopy heart contours and the 3D-rendered CT volume; and (iii) spine registration: based on automatically aligning the segmented CT spine on fluoroscopy. Computed tomography segmentation was achieved in all but one patient due to motion artefacts. The mean duration of segmentation was 10 min and average registration lasted 7 min. Catheter and heart contour registration were highly accurate (discrepancy of 1.3 +/- 0.6 and 0.3 +/- 0.5 mm, respectively) when compared with spine registration (17 +/- 9 mm, P < 0.05). The EP navigator was helpful during trans-septal puncture, gave an internal view of the atria and allowed tracking of ablation lesions. The EP navigator enabled accurate live integration of CT images and real-time fluoroscopy. Registration utilizing catheter placement or heart contours was stable and reliable.

  7. Robust tracking of a virtual electrode on a coronary sinus catheter for atrial fibrillation ablation procedures

    NASA Astrophysics Data System (ADS)

    Wu, Wen; Chen, Terrence; Strobel, Norbert; Comaniciu, Dorin

    2012-02-01

    Catheter tracking in X-ray fluoroscopic images has become more important in interventional applications for atrial fibrillation (AF) ablation procedures. It provides real-time guidance for the physicians and can be used as reference for motion compensation applications. In this paper, we propose a novel approach to track a virtual electrode (VE), which is a non-existing electrode on the coronary sinus (CS) catheter at a more proximal location than any real electrodes. Successful tracking of the VE can provide more accurate motion information than tracking of real electrodes. To achieve VE tracking, we first model the CS catheter as a set of electrodes which are detected by our previously published learning-based approach.1 The tracked electrodes are then used to generate the hypotheses for tracking the VE. Model-based hypotheses are fused and evaluated by a Bayesian framework. Evaluation has been conducted on a database of clinical AF ablation data including challenging scenarios such as low signal-to-noise ratio (SNR), occlusion and nonrigid deformation. Our approach obtains 0.54mm median error and 90% of evaluated data have errors less than 1.67mm. The speed of our tracking algorithm reaches 6 frames-per-second on most data. Our study on motion compensation shows that using the VE as reference provides a good point to detect non-physiological catheter motion during the AF ablation procedures.2

  8. Capturing Pain in the Cortex during General Anesthesia: Near Infrared Spectroscopy Measures in Patients Undergoing Catheter Ablation of Arrhythmias

    PubMed Central

    Yücel, Meryem A.; Steele, Sarah C.; Alexander, Mark E.; Boas, David A.; Borsook, David; Becerra, Lino

    2016-01-01

    The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia. Anesthetic technique was standardized and intraoperative NIRS signals recorded continuously with markers placed in the data set for the timing and duration of each cardiac ablation event. Frontal cortical signals only were suitable for analysis in five of eight patients studied (mean age 14 ± 1 years, weight 66.7 ± 17.6 kg, 2 males). Thirty ablative lesions were recorded for the five patients. Radiofrequency or cryoablation was temporally associated with a hemodynamic response function in the frontal cortex characterized by a significant decrease in oxyhemoglobin concentration (paired t-test, p<0.05) with the nadir occurring in the period 4 to 6 seconds after application of the ablative lesion. Cortical signals produced by catheter ablation of arrhythmias in patients under general anesthesia mirrored those seen with noxious stimulation in awake, healthy volunteers, during sedation for colonoscopy, and functional Magnetic Resonance Imaging activations in response to pain. This study demonstrates the feasibility and potential utility of functional near-infrared spectroscopy as an objective measure of cortical activation under general anesthesia. PMID:27415436

  9. Long-term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

    PubMed Central

    Goya, Masahiko; Fukunaga, Masato; Hiroshima, Ken-ichi; Hayashi, Kentaro; Makihara, Yu; Nagashima, Michio; An, Yoshimori; Ohe, Seiji; Yamashita, Kennosuke; Ando, Kenji; Yokoi, Hiroyoshi; Iwabuchi, Masashi; Katayama, Kouji; Ito, Tomoaki; Niu, Harushi

    2014-01-01

    Background Catheter ablation of ventricular tachycardia (VT) is feasible. However, the long-term outcomes for different underlying diseases have not been well defined. Methods Eighty-eight consecutive patients who underwent catheter ablation of VT using a three-dimensional mapping system were analyzed. The primary endpoint was any VT or ventricular fibrillation (VF) recurrence. Secondary endpoints were a composite of death or any VT/VF recurrence. Underlying heart diseases were remote myocardial infarction (remote MI) in 51 patients and non-ischemic cardiomyopathy in 37 (arrhythmogenic right ventricular cardiomyopathy [ARVC] in 18 patients, and dilated cardiomyopathy [NIDCM] in 19). Results Acute success was achieved in 82 of 88 (93%) patients. During a follow-up period of 39.2±4.6 months, VT recurred in 26 of 87 (30%), and VT/VF recurrence or death occurred in 39 of 87 (45%) patients. ARVC had better outcomes than NIDCM for the primary (p<0.05) and secondary endpoints (p<0.05). Remote MI-VT revealed a midrange outcome. Conclusions The long-term outcomes after catheter ablation of VT varied according to the underlying heart disease. ARVC-VT ablation was associated with better long-term prognosis than NIDCM. Remote MI-VT demonstrated a midrange outcome. PMID:26336519

  10. Long-term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease.

    PubMed

    Goya, Masahiko; Fukunaga, Masato; Hiroshima, Ken-Ichi; Hayashi, Kentaro; Makihara, Yu; Nagashima, Michio; An, Yoshimori; Ohe, Seiji; Yamashita, Kennosuke; Ando, Kenji; Yokoi, Hiroyoshi; Iwabuchi, Masashi; Katayama, Kouji; Ito, Tomoaki; Niu, Harushi

    2015-02-01

    Catheter ablation of ventricular tachycardia (VT) is feasible. However, the long-term outcomes for different underlying diseases have not been well defined. Eighty-eight consecutive patients who underwent catheter ablation of VT using a three-dimensional mapping system were analyzed. The primary endpoint was any VT or ventricular fibrillation (VF) recurrence. Secondary endpoints were a composite of death or any VT/VF recurrence. Underlying heart diseases were remote myocardial infarction (remote MI) in 51 patients and non-ischemic cardiomyopathy in 37 (arrhythmogenic right ventricular cardiomyopathy [ARVC] in 18 patients, and dilated cardiomyopathy [NIDCM] in 19). Acute success was achieved in 82 of 88 (93%) patients. During a follow-up period of 39.2±4.6 months, VT recurred in 26 of 87 (30%), and VT/VF recurrence or death occurred in 39 of 87 (45%) patients. ARVC had better outcomes than NIDCM for the primary (p<0.05) and secondary endpoints (p<0.05). Remote MI-VT revealed a midrange outcome. The long-term outcomes after catheter ablation of VT varied according to the underlying heart disease. ARVC-VT ablation was associated with better long-term prognosis than NIDCM. Remote MI-VT demonstrated a midrange outcome.

  11. Aneurysm-related ischemic ventricular tachycardia: safety and efficacy of catheter ablation

    PubMed Central

    Guo, Jin-Rui; Zheng, Li-Hui; Wu, Ling-Min; Ding, Li-Gang; Yao, Yan

    2017-01-01

    Abstract Left ventricular aneurysm (LVA) postmyocardial infarction (MI) might be an arrhythmogenic substrate. We examined the safety and efficacy of catheter ablation of LVA-related ventricular tachycardia (VT). Thirty-three consecutive patients who underwent primary catheter ablation of ischemic VT were divided into LVA group (11 patients, mean age 61.9 years, 10 men) and none LVA group. Acute procedural outcomes, complications, and long-term outcomes were assessed. In LVA group, average number of induced VTs were 3.2 ± 2.6 (range 1–7), clinical VTs were located in the ventricular septum scar zone in 4 (36.4%) patients, acute success was achieved in 7 (63.6%) patients, partial success in 3 (27.3%) and failure in 1 patient, while none LVA group showing a statistically similar distribution of acute procedural outcomes (P = 0.52). There were no major or life-threatening complications. VT-free survival rate at median 19 (1–44) months follow-up was numerically but not significantly lower in LVA versus none LVA group (48.5% vs 62.8%, log-rank P = 0.40). Catheter ablation of ischemic VT in the presence of LVA appears feasible and effective, with about one-third of cases having septal ablation targets. Further studies are warranted. PMID:28353573

  12. Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

    PubMed Central

    Filgueiras-Rama, David; Estrada, Alejandro; Shachar, Josh; Castrejón, Sergio; Doiny, David; Ortega, Marta; Gang, Eli; Merino, José L.

    2013-01-01

    New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate. PMID:23628883

  13. Optimal transseptal puncture location for robot-assisted left atrial catheter ablation.

    PubMed

    Jayender, Jagadeesan; Patel, Rajni V; Michaud, Gregory F; Hatal, Nobuhiko

    2009-01-01

    The preferred method of treatment for Atrial Fibrillation (AF) is by catheter ablation wherein a catheter is guided into the left atrium through a transseptal puncture. However, the transseptal puncture constrains the catheter, thereby limiting its maneuverability and increasing the difficulty in reaching various locations in the left atrium. In this paper, we address the problem of choosing the optimal transseptal puncture location for performing cardiac ablation to obtain maximum maneuverability of the catheter. We have employed an optimization algorithm to maximize the Global Isotropy Index (GII) to evaluate the optimal transseptal puncture location. As part of this algorithm, a novel kinematic model for the catheter has been developed based on a continuum robot model. Preoperative MR/CT images of the heart are segmented using the open source image-guided therapy software, Slicer 3, to obtain models of the left atrium and septal wall. These models are input to the optimization algorithm to evaluate the optimal transseptal puncture location. Simulation results for the optimization algorithm are presented in this paper.

  14. Irrigated-tip catheters for radiofrequency ablation of right-sided accessory pathways in adolescents.

    PubMed

    Telishevska, Marta; Faelchle, Johannes; Buiatti, Allessandra; Busch, Sonia; Reents, Tilko; Bourier, Felix; Semmler, Verena; Kaess, Bernhardt; Horndasch, Michaela; Kornmayer, Marielouise; Kottmaier, Marc; Deisenhofer, Isabel; Hessling, Gabriele

    2017-09-01

    Catheter ablation of right sided accessory pathways (AP) has lower success and higher recurrence rates compared to left-sided substrates. Irrigated-tip catheter (ITC) ablation might offer an advantage in this setting but data about its use in patients below 18 years is scarce. Aim of this study was to compare an ITC approach to conventional catheter ablation. A retrospective analysis of all patients < 18 years undergoing radiofrequency ablation (RFA) for right-sided APs from 2004 to 2014 at our institution was performed. Patients either underwent an ITC approach in combination with 3-D mapping (Group 1; n = 53) or a conventional non-ITC approach (Group 2; n = 52). Study endpoints were acute procedural success, safety and recurrence rate. A total of 105 mostly adolescent patients (56.2% male; median age 14 years) with 107 right sided- APs were included. The prevailing anatomic AP locations were right posteroseptal (44.9%), right anterior/anterolateral (24.3%) and right lateral (13.1%). Acute success (94.3% vs 94.2%) did not differ between the groups. One major complication (pericardial effusion) occurred in the non-ITC group. Overall, freedom from AP recurrence was 94% at 4 year in the ITC group, and 81% at 4 year in the non-ITC group (p = 0.04). The use of irrigated tip catheters in combination with 3-D mapping system for ablation of right- sided APs in adolescents has a high acute success rate, is safe and associated with a significantly reduced recurrence rate compared to a non-ITC/conventional approach. It might be considered as alternative approach in this age group. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Catheter Ablation of Pediatric Focal Atrial Tachycardia: Ten-Year Experience Using Modern Mapping Systems.

    PubMed

    Dieks, Jana-K; Müller, Matthias J; Schneider, Heike E; Krause, Ulrich; Steinmetz, Michael; Paul, Thomas; Kriebel, Thomas

    2016-03-01

    Experience of catheter ablation of pediatric focal atrial tachycardia (FAT) is still limited. There are data which were gathered prior to the introduction of modern 3D mapping and navigation systems into the clinical routine. Accordingly, procedures were associated with significant fluoroscopy and low success rates. The aim of this study was to present clinical and electrophysiological details of catheter ablation of pediatric FAT using modern mapping systems. Since March 2003, 17 consecutive patients <20 years underwent electrophysiological study (EPS) for FAT using the NavX(®) system (n = 7), the non-contact mapping system (n = 6) or the LocaLisa(®) system (n = 4), respectively. Radiofrequency was the primary energy source; cryoablation was performed in selected patients with a focus close to the AV node. In 16 patients, a total number of 19 atrial foci (right-sided n = 13, left-sided n = 6) could be targeted. In the remaining patient, FAT was not present/inducible during EPS. On an intention-to-treat basis, acute success was achieved in 14/16 patients (87.5 %) with a median number of 11 (1-31) energy applications. Ablation was unsuccessful in two patients due to an epicardial location of a right atrial focus (n = 1) and a focus close to the His bundle (n = 1), respectively. Median procedure time was 210 (84-332) min, and median fluoroscopy time was 13.1 (4.5-22.5) min. In pediatric patients with FAT, 3D mapping and catheter ablation provided improved clinical quality of care. Catheter ablation may be considered early in the course of treatment of this tachyarrhythmia in symptomatic patients.

  16. U22 protocol as measure of symptomatic improvement after catheter ablation of atrial fibrillation

    PubMed Central

    Höglund, Niklas; Rönn, Folke; Tollefsen, Titti; Jensen, Steen m.

    2013-01-01

    Introduction. Left atrial catheter ablation is useful as symptomatic treatment in selected patients with atrial fibrillation (AF). Evaluation requires measurement of arrhythmia-related symptoms. Many of the published protocols have drawbacks and have been used in AF only, with no possible comparison to other ablations that compete for the same resources. U22 is a published protocol that quantifies paroxysmal tachycardia symptoms through scales with 11 answer alternatives, translated into discrete numerical scales 0–10. It has been shown to reflect the clinical improvement after ablation of supraventricular tachycardia. Here we report the use of U22 in measuring improvement after catheter ablation for AF. Material and methods. A total of 105 patients underwent first-time ablation for AF and answered U22 and SF-36 forms at baseline and follow-up 304 (SD 121) days after ablation. Independently, the patients underwent a clinical follow-up. All decisions regarding medication and reablation were taken without knowledge of the symptom scores. Results. The U22 scores for well-being, arrhythmia as cause for impaired well-being, derived time-aspect score for arrhythmia, and discomfort during attack detected relevant improvements of symptoms after the ablation. U22 showed larger improvement in patients undergoing only one procedure than in patients who later underwent repeated interventions, thus reflecting the independent clinical decision for reablation. Conclusion.U22 quantifies the symptomatic improvement after AF ablation with adequate internal consistency and construct validity. U22 mirrors aspects of the arrhythmia symptomatology other than SF-36. PMID:24102147

  17. Intracardiac rhabdomyomas producing symptoms in infancy: the role of radiofrequency catheter ablation

    PubMed Central

    Emmel, M.; Brockmeier, K.; Sreeram, N.

    2006-01-01

    Background Cardiac rhabdomyomas, although benign, may produce symptoms related to arrhythmia or mechanical obstruction. Surgical excision is the therapy of choice for symptomatic rhabdomyomas in infancy. Patients and Methods Two infants with intracardiac rhabdomyomas producing symptoms underwent radiofrequency catheter ablation of the tumour. In patient 1 the diagnosis of multiple rhabdomyomas associated with recurrent supraventricular tachyarrhythmias and foetal hydrops was made in utero. After birth, several antiarrhythmic agents were administered, without successful suppression of the tachyarrhythmia. At seven months of age, the infant had one large residual tumour on the left atrial aspect of the anterior mitral valve leaflet with associated pre-excitation and re-entrant supraventricular tachyarrhythmia suggestive of a left-sided pathway. Catheter ablation of the accessory pathway was performed via a retrograde femoral arterial approach, targeting the earliest site of ventricular activation. Patient 2 presented as a neonate with multiple rhabdomyomas, one of which, measuring 15 mm × 15 mm, was producing severe mitral valve inflow obstruction resulting in symptoms of heart failure due to a large left-to-right shunt at atrial level and persistent pulmonary hypertension. Via the femoral vein, a 5F ablation catheter was advanced across the atrial septum, and the tumour directly ablated. Results Echocardiography performed 24 hours later demonstrated alteration in tumour morphology, with the development of a large central echolucent area, followed by progressive tumour shrinkage in both infants. Patient 1 was discharged at 24 hours, and patient 2 at seven days post-ablation, without symptoms. Follow-up at four weeks confirmed further tumour shrinkage. Conclusion Transcatheter tumour ablation may be beneficial in selected infants and children. ImagesFigure 2AFigure 2BFigure 2CFigure 3AFigure 3BFigure 3C PMID:25696636

  18. 3D X-ray imaging methods in support catheter ablations of cardiac arrhythmias.

    PubMed

    Stárek, Zdeněk; Lehar, František; Jež, Jiří; Wolf, Jiří; Novák, Miroslav

    2014-10-01

    Cardiac arrhythmias are a very frequent illness. Pharmacotherapy is not very effective in persistent arrhythmias and brings along a number of risks. Catheter ablation has became an effective and curative treatment method over the past 20 years. To support complex arrhythmia ablations, the 3D X-ray cardiac cavities imaging is used, most frequently the 3D reconstruction of CT images. The 3D cardiac rotational angiography (3DRA) represents a modern method enabling to create CT like 3D images on a standard X-ray machine equipped with special software. Its advantage lies in the possibility to obtain images during the procedure, decreased radiation dose and reduction of amount of the contrast agent. The left atrium model is the one most frequently used for complex atrial arrhythmia ablations, particularly for atrial fibrillation. CT data allow for creation and segmentation of 3D models of all cardiac cavities. Recently, a research has been made proving the use of 3DRA to create 3D models of other cardiac (right ventricle, left ventricle, aorta) and non-cardiac structures (oesophagus). They can be used during catheter ablation of complex arrhythmias to improve orientation during the construction of 3D electroanatomic maps, directly fused with 3D electroanatomic systems and/or fused with fluoroscopy. An intensive development in the 3D model creation and use has taken place over the past years and they became routinely used during catheter ablations of arrhythmias, mainly atrial fibrillation ablation procedures. Further development may be anticipated in the future in both the creation and use of these models.

  19. Catheter Ablation of Arrhythmias Exclusively Using Electroanatomic Mapping: A Series of Cases

    PubMed Central

    Pires, Leonardo Martins; Leiria, Tiago Luiz Luz; Kruse, Marcelo Lapa; Ronsoni, Rafael; Gensas, Caroline Saltz; de Lima, Gustavo Glotz

    2013-01-01

    Background Catheter ablation is a treatment that can cure various cardiac arrhythmias. Fluoroscopy is used to locate and direct catheters to areas that cause arrhythmias. However, fluoroscopy has several risks. Electroanatomic mapping (EAM) facilitates three-dimensional imaging without X-rays, which reduces risks associated with fluoroscopy. Objective We describe a series of patient cases wherein cardiac arrhythmia ablation was exclusively performed using EAM. Methods Patients who presented with cardiac arrhythmias that were unresponsive to pharmacological therapy were prospectively selected between March 2011 and March 2012 for arrhythmia ablation exclusively through EAM. Patients with indications for a diagnostic electrophysiology study and ablation of atrial fibrillation, left atrial tachyarrhythmias as well as hemodynamically unstable ventricular arrhythmia were excluded. We documented the procedure time, success rate and complications as well as whether fluoroscopy was necessary during the procedure. Results In total, 11 patients were enrolled in the study, including seven female patients (63%). The mean age of the patients was 50 years (SD ±16.5). Indications for the investigated procedures included four cases (35%) of atrial flutter, three cases (27%) of pre-excitation syndrome, two cases (19%) of paroxysmal supraventricular tachycardia and two cases (19%) of ventricular extrasystoles. The mean procedure duration was 86.6 min (SD ± 26 min). Immediate success (at discharge) of the procedure was evident for nine patients (81%). There were no complications during the procedures. Conclusion This study demonstrates the feasibility of performing an arrhythmia ablation exclusively using EAM with satisfactory results. PMID:23877742

  20. Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality.

    PubMed

    Santangeli, Pasquale; Muser, Daniele; Zado, Erica S; Magnani, Silvia; Khetpal, Sumun; Hutchinson, Mathew D; Supple, Gregory; Frankel, David S; Garcia, Fermin C; Bala, Rupa; Riley, Michael P; Lin, David; Rame, J Eduardo; Schaller, Robert; Dixit, Sanjay; Marchlinski, Francis E; Callans, David J

    2015-02-01

    The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; P=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P=0.045), ischemic cardiomyopathy (86% versus 52%; P=0.002), chronic obstructive pulmonary disease (41% versus 13%; P=0.001), and VT storm (77% versus 43%; P=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P<0.001; left ventricular ejection fraction: 26±10% versus 36±16%, P=0.003); and more often received periprocedural general anesthesia (59% versus 29%; P=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P<0.001). AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia. © 2014 American Heart Association, Inc.

  1. Fiber-optic catheter-based polarization-sensitive OCT for radio-frequency ablation monitoring

    PubMed Central

    Fu, Xiaoyong; Wang, Zhao; Wang, Hui; Wang, Yves T; Jenkins, Michael W; Rollins, Andrew M

    2015-01-01

    An all-fiber optic catheter-based polarization-sensitive optical coherence tomography system is demonstrated. A novel multiplexing method was used to illuminate the sample, splitting the light from a 58.5kHz Fourier-domain mode-locked laser such that two different polarization states, alternated in time, are generated by two semiconductor optical amplifiers. A 2.3mm forward-view cone-scanning catheter probe was designed, fabricated, and used to acquire sample scattering intensity and phase retardation images. The system was first verified with a quarter-wave plate and then by obtaining intensity and phase retardation images of high-birefringence plastic, human skin in vivo, and untreated and thermally ablated porcine myocardium ex vivo. The system can potentially in vivo image of the cardiac wall to aid radio-frequency ablation therapy for cardiac arrhythmias. PMID:25166075

  2. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Aldhoon, Bashar; Kautzner, Josef

    2016-01-01

    Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures. PMID:27617094

  3. Materials for multifunctional balloon catheters with capabilities in cardiac electrophysiological mapping and ablation therapy

    NASA Astrophysics Data System (ADS)

    Kim, Dae-Hyeong; Lu, Nanshu; Ghaffari, Roozbeh; Kim, Yun-Soung; Lee, Stephen P.; Xu, Lizhi; Wu, Jian; Kim, Rak-Hwan; Song, Jizhou; Liu, Zhuangjian; Viventi, Jonathan; de Graff, Bassel; Elolampi, Brian; Mansour, Moussa; Slepian, Marvin J.; Hwang, Sukwon; Moss, Joshua D.; Won, Sang-Min; Huang, Younggang; Litt, Brian; Rogers, John A.

    2011-04-01

    Developing advanced surgical tools for minimally invasive procedures represents an activity of central importance to improving human health. A key challenge is in establishing biocompatible interfaces between the classes of semiconductor device and sensor technologies that might be most useful in this context and the soft, curvilinear surfaces of the body. This paper describes a solution based on materials that integrate directly with the thin elastic membranes of otherwise conventional balloon catheters, to provide diverse, multimodal functionality suitable for clinical use. As examples, we present sensors for measuring temperature, flow, tactile, optical and electrophysiological data, together with radiofrequency electrodes for controlled, local ablation of tissue. Use of such ‘instrumented’ balloon catheters in live animal models illustrates their operation, as well as their specific utility in cardiac ablation therapy. The same concepts can be applied to other substrates of interest, such as surgical gloves.

  4. Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center.

    PubMed

    Fernández-Gómez, Juan M; Moriña-Vázquez, Pablo; Morales, Elena Del Rio; Venegas-Gamero, José; Barba-Pichardo, Rafael; Carranza, Manuel Herrera

    2014-06-01

    Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited. To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system. During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture. A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group). RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective. © 2014 Wiley Periodicals, Inc.

  5. Force-Sensing Catheters During Pediatric Radiofrequency Ablation: The FEDERATION Study.

    PubMed

    Dalal, Aarti S; Nguyen, Hoang H; Bowman, Tammy; Van Hare, George F; Avari Silva, Jennifer N

    2017-05-17

    Based on data from studies of atrial fibrillation ablations, optimal parameters for the TactiCath (TC; St. Jude Medical, Inc) force-sensing ablation catheter are a contact force of 20 g and a force-time integral of 400 g·s for the creation of transmural lesions. We aimed to evaluate TC in pediatric and congenital heart disease patients undergoing ablation. Comprehensive chart and case reviews were performed from June 2015 to March 2016. Of the 102 patients undergoing electrophysiology study plus ablation, 58 (57%) underwent ablation initially with a force-sensing catheter. Patients had an average age of 14 (2.4-23) years and weight of 58 (18-195) kg with 15 patients having abnormal cardiac anatomy. Electrophysiology diagnoses for the +TC group included 30 accessory pathway-mediated tachycardia, 24 atrioventricular nodal reentrant tachycardia, and 7 other. Baseline generator settings included a power of 20 W, temperature of 40°, and 6 cc/min flow during lesion creation with 11 patients (19%) having alterations to parameters. Seventeen patients (30%) converted to an alternate ablation source. A total of 516 lesions were performed using the TC with a median contact force of 6 g, force-time integral of 149 g·s, and lesion size index of 3.3. Median-term follow-up demonstrated 5 (10%) recurrences with no acute or median-term complications. TactiCath can be effectively employed in the treatment of pediatric patients with congenital heart disease with lower forces than previously described in the atrial fibrillation literature. Patients with atrioventricular nodal reentrant tachycardia or atrioventricular reciprocating tachycardia may not require transmural lesions and the TC may provide surrogate markers for success during slow pathway ablation. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  6. High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia.

    PubMed

    Münkler, Paula; Attanasio, Philipp; Parwani, Abdul Shokor; Huemer, Martin; Boldt, Leif-Hendrik; Haverkamp, Wilhelm; Wutzler, Alexander

    2017-02-27

    Patients' satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients' experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients' pain and discomfort during and after the procedure using a standardized questionnaire. One-hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g. postprocedural nausea and episodes of headache. The results of our study show, that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia. This article is protected by copyright. All rights reserved.

  7. Monoplane 3D reconstruction of mapping ablation catheters: a feasibility study.

    PubMed

    Fallavollita, P

    2010-01-01

    Radiofrequency (RF) catheter ablation has transformed treatment for arrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours). This study evaluates the feasibility of using only single plane C-arm images in order to estimate the 3D coordinates of RF catheter electrodes in a cardiac phase. The method makes use of a priori 3D model of the RF mapping catheter assuming rigid body motion equations in order to estimate the 3D locations of the catheter tip-electrodes in single view C-arm fluoroscopy images. Validation is performed on both synthetic and clinical data using computer simulation models. The authors' monoplane reconstruction algorithm is applied to a 3D helix mimicking the shape of a catheter and undergoing solely rigid motion. Similarly, the authors test the feasibility of recovering nonrigid motion by applying their method on true 3D coordinates of 13 ventricular markers from a sheep's ventricle. The results of this study showed that the proposed monoplane algorithm recovers rigid motion adequately when using the spatial positions of a catheter in six consecutive C-arm image frames yielding maximum 3D root mean squares errors of 4.3 mm. On the other hand, the suggested algorithm did not recover nonrigid motion precisely as suggested by a maximum 3D root mean square value of 8 mm. Since RF catheter electrodes are rigid structures, the authors conclude that there is promise in recovering the 3D coordinates of the electrodes when making use of only single view images. Future work will involve adding nonrigid motion equations to their algorithm, which will then be applied to actual clinical data.

  8. An augmented reality system for patient-specific guidance of cardiac catheter ablation procedures.

    PubMed

    De Buck, Stijn; Maes, Frederik; Ector, Joris; Bogaert, Jan; Dymarkowski, Steven; Heidbüchel, Hein; Suetens, Paul

    2005-11-01

    We present a system to assist in the treatment of cardiac arrhythmias by catheter ablation. A patient-specific three-dimensional (3-D) anatomical model, constructed from magnetic resonance images, is merged with fluoroscopic images in an augmented reality environment that enables the transfer of electrocardiography (ECG) measurements and cardiac activation times onto the model. Accurate mapping is realized through the combination of: a new calibration technique, adapted to catheter guided treatments; a visual matching registration technique, allowing the electrophysiologist to align the model with contrast-enhanced images; and the use of virtual catheters, which enable the annotation of multiple ECG measurements on the model. These annotations can be visualized by color coding on the patient model. We provide an accuracy analysis of each of these components independently. Based on simulation and experiments, we determined a segmentation error of 0.6 mm, a calibration error in the order of 1 mm and a target registration error of 1.04 +/- 0.45 mm. The system provides a 3-D visualization of the cardiac activation pattern which may facilitate and improve diagnosis and treatment of the arrhytmia. Because of its low cost and similar advantages we believe our approach can compete with existing commercial solutions, which rely on dedicated hardware and costly catheters. We provide qualitative results of the first clinical use of the system in 11 ablation procedures.

  9. Spectral and spatiotemporal variability ECG parameters linked to catheter ablation outcome in persistent atrial fibrillation.

    PubMed

    Hidalgo-Muñoz, Antonio R; Latcu, Decebal G; Meo, Marianna; Meste, Olivier; Popescu, Irina; Saoudi, Nadir; Zarzoso, Vicente

    2017-09-01

    With the increasing prevalence of atrial fibrillation (AF), there is a strong clinical interest in determining whether a patient suffering from persistent AF will benefit from catheter ablation (CA) therapy at long term. This work presents several regression models based on noninvasive measures automatically computed from the standard 12-lead electrocardiogram (ECG) such as AF dominant frequency (DF), spectral concentration and spatiotemporal variability (STV). Sixty-two AF patients referred to CA were enrolled in this study. Forty-seven of them had no recurrence after CA during an average follow-up of 14 ± 8 months. The ECG features were extracted from an ECG recorded before the CA intervention and they were combined by means of logistic regression. The combination of DF and STV values from different precordial leads reached AUC = 0.939, outperforming the best results by using only one kind of features, such as DF (AUC = 0.801), and yielding a global accuracy of 93.5% for discriminating the best long-term responders to CA. These results point out the need to take into consideration the spatial variation of spectral ECG parameters to build predictive models dealing with AF. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation.

    PubMed

    Hur, Jin; Pak, Hui-Nam; Kim, Young Jin; Lee, Hye-Jeong; Chang, Hyuk-Jae; Hong, Yoo Jin; Choi, Byoung Wook

    2013-07-15

    Noninvasive imaging that provides anatomic information while excluding intracardiac thrombus would be of significant clinical value for patients referred for catheter ablation of atrial fibrillation (AF). This study assessed the diagnostic performance of a dual-enhancement single-phase cardiac computed tomography (CT) protocol for thrombus and circulatory stasis detection in AF patients before catheter ablation. We studied 101 consecutive symptomatic AF patients (71 men and 30 women; mean age, 61.8 years) who were scheduled to have catheter ablation. All patients had undergone pre-AF ablation CT imaging and transesophageal echocardiography on the same day. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Mean left atrial appendage (LAA)/ascending aorta Hounsfield unit (HU) ratios were measured on CT images. Among the 101 patients, 9 thrombi and 18 spontaneous echo contrasts were detected by transesophageal echocardiography. The overall sensitivity, specificity, positive predictive value, and negative predictive value of CT for the detection of thrombi in the LAA were 89%, 100%, 100%, and 99%, respectively. The mean LAA/ascending aorta HU ratios were significantly different between thrombus and circulatory stasis (0.17 vs 0.33, p = 0.002). Dual-enhancement single-scan cardiac CT is a sensitive modality for detecting and differentiating LAA thrombus and circulatory stasis.

  11. Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

    PubMed Central

    Liang, Jackson J; Dixit, Sanjay; Santangeli, Pasquale

    2016-01-01

    Early recurrence of atrial arrhythmias (ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo post-ablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of long-term ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA. PMID:27957250

  12. Identification of transmural necrosis along a linear catheter ablation lesion during atrial fibrillation and sinus rhythm.

    PubMed

    Sanchez, Javier E; Kay, G Neal; Benser, Michael E; Hall, Jeffrey A; Walcott, Gregory P; Smith, William M; Ideker, Raymond E

    2003-02-01

    Determining whether a linear catheter radio frequency (RF) ablation lesion is transmural may be difficult, especially during atrial fibrillation. We hypothesized that changes in pacing thresholds and electrogram amplitude during atrial fibrillation and sinus rhythm could be used to assess whether a radiofrequency ablation resulted in transmural necrosis. A hexapolar, linear, RF ablation catheter was positioned between the caval veins in the right atrium of seven sheep. Pacing thresholds and electrogram amplitudes during atrial fibrillation and sinus rhythm were measured before and after the application of RF energy. Sites along the linear lesion were assessed histologically. The electrogram amplitude in atrial fibrillation decreased significantly more at transmural sites (unipolar recording: 33 +/- 11% transmural vs. 22 +/- 13% non-transmural, p < or = 0.01; bipolar recording: 62 +/- 9% transmural vs. 43 +/- 15% non-transmural, p < or = 0.01). The electrogram amplitude in sinus rhythm decreased significantly more at transmural sites (unipolar recording: 49 +/- 18% transmural vs. 15 +/- 20% non-transmural, p < 0.001; bipolar recording: 63 +/- 17% transmural vs. 42 +/- 19% non-transmural, p = 0.002). The pacing threshold increased significantly more at sites with transmural necrosis (unipolar: increased by 378 +/- 103% transmural vs. 207 +/- 93% non-transmural, p < 0.001; bipolar: 370 +/- 80% transmural vs. 259 +/- 60% non-transmural, p < 0.001). The amplitude of the atrial electrogram from an ablation catheter can be used to discriminate areas with transmural necrosis from those without transmural necrosis during either atrial fibrillation or sinus rhythm. Termination of atrial fibrillation may not be necessary to estimate the histologic characteristics of an ablation lesion.

  13. The results of electrophysiological study and radio-frequency catheter ablation in pediatric patients with tachyarrhythmia.

    PubMed

    Celiker, Alpay; Kafali, Gülden; Karagöz, Tevfik; Ceviz, Naci; Ozer, Sema

    2003-01-01

    A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 years of age (median age 11 years) underwent electrophysiological study (EPS) between January 1994 and July 2001. Tachycardia could not be induced in 38 of 135 pts (28%) and studies in these patients were accepted as the normal EPS. Supraventricular tachyarrhythmia mechanisms were atrioventricular (AV) accessory pathways in 47 patients (manifest accessory pathways in 23 patients, concealed accessory pathways in 17 patients, permanent junctional reciprocating tachycardia in 7 patients), re-entry without accessory pathway in 26 patients (AV nodal reentry tachycardia in 20 patients, atrial flutter in 5 patients, sinus node re-entry tachycardia in 1 patient) and atrial ectopic tachycardia in eight patients. The diagnosis of ventricular tachycardia (VT) was made in 16 patients. Seventy-three of the 97 patients with the diagnosis of tachyarrhythmia as a result of EPS underwent radiofrequency (RF) catheter ablation. The indications, early results, complications, safety and efficacy of RF catheter ablation were reviewed in these patients. Among the 73 patients who underwent RF ablation (85 procedures), the overall final success rate for all the diagnoses was 82% (60 of 73 patients). The median follow-up period for all patients was 16 months (range 2 to 60 months). Total recurrence rate in 73 patients was 4% (3 patients). Re-ablation was performed in only one of them and was successful. Procedure-related complications occurred in eight patients (11%): transient third-degree AV block in one patient, transient second-degree AV block in one patient, atrial flutter in two patients (1 needed direct current cardioversion), and atrial fibrillation in three patients (2 needed defibrillation and transient pacemaker implantation). In one patient with permanent third-degree AV block a transvenous pacemaker implantation was required. These midterm results suggest that RF catheter ablation

  14. Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease: Outcome After Catheter Ablation.

    PubMed

    Papagiannis, John; Beissel, Daniel Joseph; Krause, Ulrich; Cabrera, Michel; Telishevska, Marta; Seslar, Stephen; Johnsrude, Christopher; Anderson, Charles; Tisma-Dupanovic, Svjetlana; Connelly, Diana; Avramidis, Dimosthenis; Carter, Christopher; Kornyei, Laszlo; Law, Ian; Von Bergen, Nicholas; Janusek, Jan; Silva, Jennifer; Rosenthal, Eric; Willcox, Mark; Kubus, Peter; Hessling, Gabriele; Paul, Thomas

    2017-07-01

    The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately. A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients' growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation). Procedure times (251±117 versus 174±94 minutes; P=0.0006) and fluoroscopy times (median 20.8 versus 16.6 minutes; P=0.037) were longer in group A versus group B. There were significant differences between groups in the acute success of ablation (82% versus 97%; P=0.04), risk of atrioventricular block (14 versus 0%; P=0.004), and need for chronic pacing (10% versus 0%; P=0.008). There was no permanent atrioventricular block in patients who underwent cryoablation. After 3.2±2.7 years of follow-up, long-term success was 86% in group A and 100% in group B (P=0.004). Atrioventricular nodal reentrant tachycardia can complicate the course of patients with CHD. This study demonstrates that the outcome of catheter ablation is favorable in patients with simple CHD. Patients with complex CHD have increased risk of procedural failure and atrioventricular block. © 2017 American Heart Association, Inc.

  15. Cardiac ablation catheter guidance by means of a single equivalent moving dipole inverse algorithm.

    PubMed

    Lee, Kichang; Lv, Wener; Ter-Ovanesyan, Evgeny; Barley, Maya E; Voysey, Graham E; Galea, Anna M; Hirschman, Gordon B; Leroy, Kristen; Marini, Robert P; Barrett, Conor; Armoundas, Antonis A; Cohen, Richard J

    2013-07-01

    We developed and evaluated a novel system for guiding radiofrequency catheter ablation therapy of ventricular tachycardia. This guidance system employs an inverse solution guidance algorithm (ISGA) using a single equivalent moving dipole (SEMD) localization method. The method and system were evaluated in both a saline tank phantom model and in vivo animal (swine) experiments. A catheter with two platinum electrodes spaced 3 mm apart was used as the dipole source in the phantom study. A 40-Hz sinusoidal signal was applied to the electrode pair. In the animal study, four to eight electrodes were sutured onto the right ventricle. These electrodes were connected to a stimulus generator delivering 1-ms duration pacing pulses. Signals were recorded from 64 electrodes, located either on the inner surface of the saline tank or on the body surface of the pig, and then processed by the ISGA to localize the physical or bioelectrical SEMD. In the phantom studies, the guidance algorithm was used to advance a catheter tip to the location of the source dipole. The distance from the final position of the catheter tip to the position of the target dipole was 2.22 ± 0.78 mm in real space and 1.38 ± 0.78 mm in image space (computational space). The ISGA successfully tracked the locations of electrodes sutured on the ventricular myocardium and the movement of an endocardial catheter placed in the animal's right ventricle. In conclusion, we successfully demonstrated the feasibility of using an SEMD inverse algorithm to guide a cardiac ablation catheter. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  16. First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

    PubMed Central

    Stephens, Douglas N.; Truong, Uyen T.; Nikoozadeh, Amin; Oralkan, Ömer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O’Donnell, Matt; Sahn, David J.

    2012-01-01

    Objectives The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. Methods The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. Results The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Conclusions Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures. PMID:22298868

  17. First in vivo use of a capacitive micromachined ultrasound transducer array-based imaging and ablation catheter.

    PubMed

    Stephens, Douglas N; Truong, Uyen T; Nikoozadeh, Amin; Oralkan, Omer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O'Donnell, Matt; Sahn, David J

    2012-02-01

    The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures.

  18. Effect of Irrigant Characteristics on Lesion Formation After Radiofrequency Energy Delivery Using Ablation Catheters with Actively Cooled Tips.

    PubMed

    Nguyen, Duy T; Olson, Matthew; Zheng, Lijun; Barham, Waseem; Moss, Joshua D; Sauer, William H

    2015-07-01

    The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter. An ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37°C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes. Ablation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation. In ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation

  19. New-onset ventricular arrhythmias post radiofrequency catheter ablation for atrial fibrillation

    PubMed Central

    Wu, Lingmin; Lu, Yanlai; Yao, Yan; Zheng, Lihui; Chen, Gang; Ding, Ligang; Hou, Bingbo; Qiao, Yu; Sun, Wei; Zhang, Shu

    2016-01-01

    Abstract As a new complication, new-onset ventricular arrhythmias (VAs) post atrial fibrillation (AF) ablation have not been well defined. This prospective study aimed to describe the details of new-onset VAs post AF ablation in a large study cohort. One thousand fifty-three consecutive patients who underwent the first radiofrequency catheter ablation for AF were enrolled. All patients had no evidence of pre-ablation VAs. New-onset VAs were defined as new-onset ventricular tachycardia (VT) or premature ventricular contractions (PVC) ≥1000/24 h within 1 month post ablation. There were 46 patients (4.4%) who had 62 different new-onset VAs, among whom 42 were PVC alone, and 4 were PVC coexisting with nonsustained VT. Multivariate analysis showed that increased serum leukocyte counts ≥50% post ablation were independently associated with new-onset VAs (OR: 1.9; 95% CI: 1.0–3.5; P = 0.043). The median number of PVC was 3161 (1001–27,407) times/24 h. Outflow tract VAs were recorded in 35 (76.1%) patients. No significant differences were found in origin of VAs (P = 0.187). VAs disappeared without any treatment in 6 patients (13.0%). No VAs-related adverse cardiac event occurred. The study revealed a noticeable prevalence but relatively benign prognosis of new-onset VAs post AF ablation. Increased serum leukocyte counts ≥50% post ablation appeared to be associated with new-onset VAs, implying that inflammatory response caused by ablation might be the mechanism. PMID:27603357

  20. Catheter ablation for ventricular tachycardia following surgical treatment of pulmonary stenosis with intact ventricular septum.

    PubMed

    Hou, Bingbo; Zheng, Lihui; Niu, Guodong; Wu, Lingmin; Qiao, Yu; Sun, Wei; Ding, Ligang; Chen, Gang; Zhang, Shu; Liew, Reginald; Yao, Yan

    2016-12-01

    This study was aimed to report the characteristics and treatment of ventricular tachycardia (VT) following surgical treatment of pulmonary stenosis with intact ventricular septum. Five patients underwent radiofrequency catheter ablation for sustained monomorphic left bundle branch block (LBBB) type VT who previously underwent surgical treatment of pulmonary stenosis. Except stimulation, voltage and activation mapping was performed using three-dimensional (3D) electro-anatomic mapping and ablation was applied accordingly. Four VTs were induced during EP study. Two VTs were focal and the earliest activity was targeted in the right ventricular apex (RVA). The other two VTs were reentrant and the critical isthmus located in the mid-lateral wall and anterior wall of right ventricle, respectively. Ablation abolished all inducible VTs in four patients. In the patient whose VT was non-inducible, radiofrequency (RF) energy was delivered to the RVA where pacing mapping matched the clinical VT. One focal VT recurred 60 months after the initial RF ablation. Repeat mapping and ablation was performed and no VT recurred over a 24-month period. The mechanism of VT following surgical treatment of pulmonary stenosis can be either focal or reentrant. Ablation of this subgroup of VT is feasible. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  1. Electrophysiologic basis of catheter ablation in atrial flutter.

    PubMed

    Touboul, P; Saoudi, N; Atallah, G; Kirkorian, G

    1989-12-05

    A reentrant mechanism is believed to be responsible for atrial flutter. The recent development of the entrainment criteria further supports this theory, and there is a general consensus that circus movement is the underlying abnormality that supports this arrhythmia. In most clinical studies, abnormal fragmented (or double spike) electrograms, suggesting the presence of areas of localized slowing of conduction or block, have been reported. They are almost always recorded in the lower and posterior portion of the right interatrial septum, but also frequently in the high lateral portion of the right atrium. The determination of their involvement in the reentry pathway is important for designing curative procedures such as surgery or ablation. The low atrial septal area surrounding the mouth of the coronary sinus was suspected as being the critical area of slow conduction in atrial flutter. Rapid pacing at that site can yield a surface electrocardiographic pattern similar to the clinically occurring arrhythmias. Additionally, the flutter circuit can be accelerated during atrial pacing at fixed and slightly faster rates than the intrinsic tachycardia rate--the so-called entrainment phenomenon. When entrainment criteria are fulfilled, tachycardia termination being by definition ruled out, any concomitant recorded local type II block identifies an area that must be outside the circuit. Such local block may be recorded either spontaneously or during entrainment and therefore helps in identifying atrial slow conduction areas that do not belong to the reentrant path. This approach was applied to identify the optimal ablation site in 8 patients with long-standing drug resistant atrial flutter. In 7 of 8 patients, we were able to identify a fragmented potential in the low posteroseptal area during sustained atrial flutter.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation.

    PubMed

    Kumar, Saurabh; Barbhaiya, Chirag; Nagashima, Koichi; Choi, Eue-Keun; Epstein, Laurence M; John, Roy M; Maytin, Melanie; Albert, Christine M; Miller, Amy L; Koplan, Bruce A; Michaud, Gregory F; Tedrow, Usha B; Stevenson, William G

    2015-02-01

    Cardiac sarcoid-related ventricular tachycardia (VT) is a rare disorder; the underlying substrate and response to ablation are poorly understood. We sought to examine the ventricular substrate and outcomes of catheter ablation in this population. Of 435 patients with nonischemic cardiomyopathy referred for VT ablation, 21 patients (5%) had cardiac sarcoidosis. Multiple inducible VTs were observed with mechanism consistent with scar-mediated re-entry in all VTs. Voltage maps showed widespread and confluent right ventricular scarring. Left ventricular scarring was patchy with a predilection for the basal septum, anterior wall, and perivalvular regions. Epicardial right ventricular scar overlay and exceeded the region of corresponding endocardial scar. After ≥1 procedures, ablation abolished ≥1 inducible VT in 90% and eliminated VT storm in 78% of patients; however, multiple residual VTs remained inducible. Failure to abolish all inducible VTs was because of septal intramural circuits or extensive right ventricular scarring. Multiple procedure VT-free survival was 37% at 1 year, but VT control was achievable in the majority of patients with fewer antiarrhythmic drugs compared with preablation (2.1±0.8 versus 1.1±0.8; P<0.001). Patients with cardiac sarcoidosis and VT exhibit ventricular substrate characterized by confluent right ventricular scarring and patchy left ventricular scarring capable of sustaining a large number of re-entrant circuits. Catheter ablation is effective in terminating VT storm and eliminating ≥1 inducible VT in the majority of patients, but recurrences are common. Ablation in conjunction with antiarrhythmic drugs can help palliate VT in this high-risk population. © 2014 American Heart Association, Inc.

  3. Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve.

    PubMed

    Laranjo, Sérgio; Oliveira, Mário; Trigo, Conceição

    2015-08-01

    Left anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

  4. Real-time circumferential mapping catheter tracking for motion compensation in atrial fibrillation ablation procedures

    NASA Astrophysics Data System (ADS)

    Brost, Alexander; Bourier, Felix; Wimmer, Andreas; Koch, Martin; Kiraly, Atilla; Liao, Rui; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) has been identified as a major cause of stroke. Radiofrequency catheter ablation has become an increasingly important treatment option, especially when drug therapy fails. Navigation under X-ray can be enhanced by using augmented fluoroscopy. It renders overlay images from pre-operative 3-D data sets which are then fused with X-ray images to provide more details about the underlying soft-tissue anatomy. Unfortunately, these fluoroscopic overlay images are compromised by respiratory and cardiac motion. Various methods to deal with motion have been proposed. To meet clinical demands, they have to be fast. Methods providing a processing frame rate of 3 frames-per-second (fps) are considered suitable for interventional electrophysiology catheter procedures if an acquisition frame rate of 2 fps is used. Unfortunately, when working at a processing rate of 3 fps, the delay until the actual motion compensated image can be displayed is about 300 ms. More recent algorithms can achieve frame rates of up to 20 fps, which reduces the lag to 50 ms. By using a novel approach involving a 3-D catheter model, catheter segmentation and a distance transform, we can speed up motion compensation to 25 fps which results in a display delay of only 40 ms on a standard workstation for medical applications. Our method uses a constrained 2-D/3-D registration to perform catheter tracking, and it obtained a 2-D tracking error of 0.61 mm.

  5. Robust classification of contact orientation between tissue and an integrated spectroscopy and radiofrequency ablation catheter

    NASA Astrophysics Data System (ADS)

    Zaryab, Mohammad; Singh-Moon, Rajinder P.; Hendon, Christine P.

    2017-02-01

    Using light-based catheters for radiofrequency ablation (RFA) therapies grants the ability to accurately derive tissue properties such as lesion depth and overtreatment from spectroscopic information. However, this information is heavily reliant on contact quality with the treatment area and the orientation of the catheter. Thus to improve assessments of tissue properties, this work utilizes Bayesian modelling to classify whether the catheter is indeed in proper contact with the tissue. Initially in-laboratory experiments were conducted with ten fresh swine hearts submerged in blood. A total of 1555 unique near infrared spectra were collected from a spectrometer using a light-based catheter and manually tagged as "full perpendicular contact," "angled contact," and "no contact," between the catheter and heart tissue. Three features were prominent in all spectra for distinguishing purposes: area underneath the spectra, an intensity "valley" between 730 nm and 800 nm, along with the slope between 850 nm and 1150 nm. A classifier featuring bootstrapping, adaboost, and k-means techniques was thus created and achieved a 96.05% accuracy in classifying full contact, 98.33% accuracy in classifying angled contact, and 100% accuracy in classifying no contact.

  6. Endovascular radiofrequency ablation. Effect on the vein diameter using the ClosureFast(®) catheter.

    PubMed

    Bauzá Moreno, Hernán; Dotta, Mariana; Katsini, Roxana; Marquez Fosser, Carolina; Rochet, Sofía; Pared, Carlos; Martinez, Hugo

    2016-01-01

    Endovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. Retrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. Between 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9±3.1mm showing a reduction of it after 6 months with a mean value of 5.2±0.8mm (P<.0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. A significant reduction in venous diameter after endovascular treatment with the new ClosureFast(®) catheters was checked, even in veins with diameters greater than 12mm. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Successful catheter ablation of incessant atrial tachycardia in pregnancy using three-dimensional electroanatomical mapping with minimal radiation.

    PubMed

    Wu, H; Ling, L-H; Lee, G; Kistler, P M

    2012-06-01

    Arrhythmias during pregnancy are not an infrequent problem and present a difficult therapeutic challenge to physicians. Anti-arrhythmic medication is used with some trepidation given concerns for the unborn foetus. Catheter ablation is typically avoided due to concerns regarding foetal exposure to radiation and delayed until the post-partum period. With the availability of three-dimensional mapping systems, catheter ablation may be performed with minimal radiation. We report a pregnant woman who underwent successful ablation of focal atrial tachycardia using three-dimensional electroanatomical mapping with minimal radiation exposure.

  8. [Catheter ablation for paroxysmal atrial fibrillation: new generation cryoballoon or contact force sensing radiofrequency ablation?].

    PubMed

    Nagy, Zsófia; Kis, Zsuzsanna; Som, Zoltán; Földesi, Csaba; Kardos, Attila

    2016-05-29

    Contact force sensing radiofrequency ablation and the new generation cryoballoon ablation are prevalent techniques for the treatment of paroxysmal atrial fibrillation. The authors aimed to compare the procedural and 1-year outcome of patients after radiofrequency and cryoballoon ablation. 96 patients with paroxysmal atrial fibrillation (radiofrequency ablation: 58, cryoballoon: 38 patients; 65 men and 31 women aged 28-70 years) were enrolled. At postprocedural 1, 3, 6 and 12 months ECG, Holter monitoring and telephone interviews were performed. Procedure and fluorosocopy time were: radiofrequency ablation, 118.5 ± 15 min and 15.8 ± 6 min; cryoballoon, 73.5 ± 16 min (p<0.05) and 13.8 ± 4.,1 min (p = 0.09), respectively. One year later freedom from atrial fibrillation was achieved in 76.5% of patients who underwent radiofrequency ablation and in 81% of patients treated with cryoballoon. Temporary phrenic nerve palsy occurred in two patients and pericardial tamponade developed in one patient. In this single center study freedom from paroxysmal atrial fibrillation was similar in the two groups with significant shorter procedure time in the cryoballoon group.

  9. [Catheter ablation of atrial fibrillation: Health Technology Assessment Report from the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)].

    PubMed

    Themistoclakis, Sakis; Tritto, Massimo; Bertaglia, Emanuele; Berto, Patrizia; Bongiorni, Maria Grazia; Catanzariti, Domenico; De Fabrizio, Giuseppe; De Ponti, Roberto; Grimaldi, Massimo; Pandozi, Claudio; Tondo, Claudio; Gulizia, Michele

    2011-11-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and significantly impact patients' quality of life, morbidity and mortality. The number of affected patients is expected to increase as well as the costs associated with AF management, mainly driven by hospitalizations. Over the last decade, catheter ablation techniques targeting pulmonary vein isolation have demonstrated to be effective in treating AF and preventing AF recurrence. This Health Technology Assessment report of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) aims to define the current role of catheter ablation of AF in terms of effectiveness, efficiency and appropriateness. On the basis of an extensive review of the available literature, this report provides (i) an overview of the epidemiology, clinical impact and socio-economic burden of AF; (ii) an evaluation of therapeutic options other than catheter ablation of AF; and (iii) a detailed presentation of clinical outcomes and cost-benefit ratio associated with catheter ablation. The costs of catheter ablation of AF in Italy were obtained using a bottom-up analysis of a resource utilization survey of 52 hospitals that were considered a representative sample, including 4 Centers that contributed with additional unit cost information in a separate questionnaire. An analysis of budget impact was also performed to evaluate the impact of ablation on the management costs of AF. Results of this analysis show that (1) catheter ablation is effective, safe and superior to antiarrhythmic drug therapy in maintaining sinus rhythm; (2) the cost of an ablation procedure in Italy typically ranges from €8868 to €9455, though current reimbursement remains insufficient, covering only about 60% of the costs; (3) the costs of follow-up are modest (about 8% of total costs); (4) assuming an adjustment of reimbursement to the real cost of an ablation procedure and a 5-10% increase in the annual rate of ablation procedures, after

  10. Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system.

    PubMed

    Sommer, Philipp; Wojdyla-Hordynska, Agnieszka; Rolf, Sascha; Gaspar, Thomas; Eitel, Charlotte; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher

    2013-04-01

    Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D catheter tracking system has been introduced integrating 3D non-fluoroscopic catheter navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation catheter (IBI, SJM). In all 10 patients both sensor-equipped MG catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation catheter was not yet available for use in the study.

  11. Gold-tip electrodes--a new "deep lesion" technology for catheter ablation? In vitro comparison of a gold alloy versus platinum-iridium tip electrode ablation catheter.

    PubMed

    Lewalter, Thorsten; Bitzen, Alexander; Wurtz, Sabine; Blum, Robert; Schlodder, Karsten; Yang, Alexander; Lickfett, Lars; Schwab, Jörg O; Schrickel, Jan W; Tiemann, Klaus; Linhart, Markus; Zima, Endre; Merkely, Bela; Lüderitz, Berndt

    2005-07-01

    Gold-tip electrodes. Radiofrequency (RF) catheter ablation is widely used to induce focal myocardial necrosis using the effect of resistive heating through high-frequency current delivery. It is current standard to limit the target tissue-electrode interface temperature to a maximum of 60-70 degrees C to avoid char formation. Gold (Au) exhibits a thermal conductivity of nearly four times greater than platinum (Pt-Ir) (3.17 W/cm Kelvin vs 0.716 W/cm Kelvin), it was therefore hypothesized that RF ablation using a gold electrode would create broader and deeper lesions as a result of a better heat conduction from the tissue-electrode interface and additional cooling of the gold electrode by "heat loss" to the intracardiac blood. Both mechanisms would allow applying more RF power to the tissue before the electrode-tissue interface temperature limit is reached. To test this hypothesis, we performed in vitro isolated liver and pig heart investigations comparing lesion depths of a new Au-alloy-tip electrode to standard Pt-Ir electrode material. Mean lesion depth in liver tissue for Pt-Ir was 4.33+/-0.45 mm (n=60) whereas Au electrode was able to achieve significantly deeper lesions (5.86+/-0.37 mm [n=60; P<0.001]). The mean power delivered using Pt-Ir was 6.95+/-2.41 W whereas Au tip electrode delivered 9.64+/-3.78 W indicating a statistically significant difference (P<0.05). In vitro pig heart tissue Au ablation (n=20) increased significantly the lesion depth (Au: 4.85+/-1.01 mm, Pt-Ir: 2.96+/-0.81 mm, n=20; P<0.001). Au tip electrode again applied significantly more power (P<0.001). Gold-tip electrode catheters were able to induce deeper lesions using RF ablation in vitro as compared to Pt-Ir tip electrode material. In liver and in pig heart tissue, the increase in lesion depth was associated with a significant increase in the average power applied with the gold electrode at the same level of electrode-tissue temperature as compared to platinum material.

  12. A novel catheter design for laser photocoagulation of the myocardium to ablate ventricular tachycardia.

    PubMed

    Wagshall, Alan; Abela, George S; Maheshwari, Alok; Gupta, Anoop; Bowden, Russell; Huang, S K Stephen

    2002-08-01

    Nd:YAG laser energy has been proposed as an alternative to radiofrequency energy for ablation of ventricular tachycardia (VT) associated with coronary artery disease (CAD) in an effort to increase lesion size and success rates. However, issues of catheter design to maintain flexibility and ensure adequate tissue contact have hindered development of laser catheters. We developed and tested a prototype 8 Fr. steerable catheter with a flexible and extendible tip (designed to ensure tissue contact and efficient ventricular mapping), which projects the laser beam through a side port containing a lens-tipped optical fiber that rests against the endocardial surface. The catheter has a channel for simultaneous saline irrigation to displace the interceding blood and discharge a laser beam between two electrodes for bipolar mapping and a thermocouple for temperature monitoring. The catheter was tested on bench top using the epicardial surface of freshly slaughtered bovine hearts and in vivo using six anaesthetized closed-chest sheep. In vitro experiments demonstrated that lesion size increased linearly with applied power up to 40 watts. When compared to radio frequency, laser energy penetrated more deeply into the myocardium. In the in vivo studies, using increasing powers of up to 40 watts for application times of 60 to 120 seconds created circular or elliptical lesions with surface dimensions up to 12 mm x 12 mm and depth of 9 mm (full LV wall thickness with a mean lesion diameter of 9.9 +/- 5.2 mm and depth 5.8 +/- 3.2 mm). Most lesions, 16 total in both right and left ventricular walls were transmural or near transmural in thickness. Lesions demonstrated coagulation necrosis with smooth well-demarcated borders. No animal suffered cardiac perforation, hypotension, hemopericardium, damage to cardiac valves, or cavitation effect from any of the ablations. Runs of VT were seen during energy application at the highest laser outputs in two animals. In conclusion, this catheter

  13. Materials for Multifunctional Balloon Catheters With Capabilities in Cardiac Electrophysiological Mapping and Ablation Therapy

    PubMed Central

    Kim, Dae-Hyeong; Lu, Nanshu; Ghaffari, Roozbeh; Kim, Yun-Soung; Lee, Stephen P.; Xu, Lizhi; Wu, Jian; Kim, Rak-Hwan; Song, Jizhou; Liu, Zhuangjian; Viventi, Jonathan; de Graff, Bassel; Elolampi, Brian; Mansour, Moussa; Slepian, Marvin J.; Hwang, Sukwon; Moss, Joshua D.; Won, Sang-Min; Huang, Younggang; Litt, Brian; Rogers, John A.

    2011-01-01

    Development of advanced surgical tools for minimally invasive procedures represents an activity of central importance to improvements in human health. A key materials challenge is in the realization of bio-compatible interfaces between the classes of semiconductor and sensor technologies that might be most useful in this context and the soft, curvilinear surfaces of the body. This paper describes a solution based on biocompatible materials and devices that integrate directly with the thin elastic membranes of otherwise conventional balloon catheters, to provide multimodal functionality suitable for clinical use. We present sensors for measuring temperature, flow, tactile, optical and electrophysiological data, together with radio frequency (RF) electrodes for controlled, local ablation of tissue. These components connect together in arrayed layouts designed to decouple their operation from large strain deformations associated with deployment and repeated inflation/deflation. Use of such ‘instrumented’ balloon catheter devices in live animal models and in vitro tests illustrates their operation in cardiac ablation therapy. These concepts have the potential for application in surgical systems of the future, not only those based on catheters but also on other platforms, such as surgical gloves. PMID:21378969

  14. Documentation of pulmonary vein isolation improves long term efficacy of persistent atrial fibrillation catheter ablation.

    PubMed

    Bertaglia, Emanuele; Stabile, Giuseppe; Senatore, Gaetano; Pratola, Claudio; Verlato, Roberto; Lowe, Martin; Raatikainen, Pekka; Lamberti, Filippo; Turco, Pietro

    2014-02-01

    The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation (AF) and the predictors of arrhythmia recurrence. Absence of atrial tachyarrhythmia (AT) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy. Electrophysiological success of ablation was declared when all identified PVs were isolated (confirmation of entry and exit block). Patients were followed for a maximum of 24 months after the blanking period with outpatient visits, ECG recordings, 24-hour Holter monitoring, and weekly transtelephonic monitoring for 30s. Electrophysiological success was documented in 38/82 (46.3%) patients. During a mean follow-up of 24.7 ± 4.2 months, 69/82 (84.1%) patients presented at least one episode of AT after the 2 month blanking period. According to univariate and multivariate logistic regression analyses, only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse (OR 5.32, 95% CL 1.02-27.72; p=.0472). Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients. Copyright © 2013. Published by Elsevier Ireland Ltd.

  15. THE MECHANISM OF LESION FORMATION BY FOCUSED ULTRASOUND ABLATION CATHETER FOR TREATMENT OF ATRIAL FIBRILLATION

    PubMed Central

    Sinelnikov, Y.D.; Fjield, T.; Sapozhnikov, O.A.

    2009-01-01

    The application of therapeutic ultrasound for the treatment of atrial fibrillation (AF) is investigated. The results of theoretical and experimental investigation of ultrasound ablation catheter are presented. The major components of the catheter are the high power cylindrical piezoelectric element and parabolic balloon reflector. Thermal elevation in the ostia of pulmonary veins is achieved by focusing the ultrasound beam in shape of a torus that transverses the myocardial tissue. High intensity ultrasound heating in the focal zone results in a lesion surrounding the pulmonary veins that creates an electrical conduction blocks and relief from AF symptoms. The success of the ablation procedure largely depends on the correct choice of reflector geometry and ultrasonic power. We present a theoretical model of the catheter’s acoustic field and bioheat transfer modeling of cardiac lesions. The application of an empirically derived relation between lesion formation and acoustic power is shown to correlate with the experimental data. Developed control methods combine the knowledge of theoretical acoustics and the thermal lesion formation simulations with experiment and thereby establish rigorous dosimetry that contributes to a safe and effective ultrasound ablation procedure. PMID:20161431

  16. The mechanism of lesion formation by focused ultrasound ablation catheter for treatment of atrial fibrillation

    NASA Astrophysics Data System (ADS)

    Sinelnikov, Y. D.; Fjield, T.; Sapozhnikov, O. A.

    2009-10-01

    The application of therapeutic ultrasound for the treatment of atrial fibrillation (AF) is investigated. The results of theoretical and experimental investigation of ultrasound ablation catheter are presented. The major components of the catheter are the high power cylindrical piezoelectric element and parabolic balloon reflector. Thermal elevation in the ostia of pulmonary veins is achieved by focusing the ultrasound beam in shape of a torus that transverses the myocardial tissue. High intensity ultrasound heating in the focal zone results in a lesion surrounding the pulmonary veins that creates an electrical conduction blocks and relief from AF symptoms. The success of the ablation procedure largely depends on the correct choice of reflector geometry and ultrasonic power. We present a theoretical model of the catheter’s acoustic field and bioheat transfer modeling of cardiac lesions. The application of an empirically derived relation between lesion formation and acoustic power is shown to correlate with the experimental data. Developed control methods combine the knowledge of theoretical acoustics and the thermal lesion formation simulations with experiment and thereby establish dosimetry that contributes to a safe and effective ultrasound ablation procedure.

  17. Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP-VT Multicenter Trial.

    PubMed

    Skoda, Jan; Arya, Arash; Garcia, Fermin; Gerstenfeld, Edward; Marchlinski, Francis; Hindricks, Gerhard; Miller, John; Petru, Jan; Sediva, Lucie; Sha, Qun; Janotka, Marek; Chovanec, Milan; Waldauf, Petr; Neuzil, Petr; Reddy, Vivek Y

    2016-03-01

    Catheter ablation is an effective treatment of scar-related ventricular tachycardia (VT), but the overall complexity of the procedure has precluded its widespread use. Remote magnetic navigation (RMN) has been shown to facilitate cardiac mapping and ablation of VT in a retrospective series. STOP-VT is the first multicenter, prospective, single-arm and single-procedure study evaluating RMN-based mapping and ablation of post-infarction VT. Patients with documented VT and prior MI, in whom an ICD was implanted either for primary or secondary prevention, were recruited from four EU and US centers. Either a transseptal (48 patients) or transaortic (5 patients) approach was employed to gain access for ventricular endocardial mapping/ablation during VT (entrainment mapping, activation mapping) and/or substrate mapping in sinus rhythm (elimination of fractionated/late potentials, variable extent of substrate modification) with RMN and irrigated RF ablation. The primary endpoints were as follows: (i) non-inducibility of the target VT or any other sustained VT; (ii) elimination of sustained VT/VF during ICD follow-up of up to 12 months. The cohort included 53 consecutive patients (median age 67 years, 49 men, median LVEF 31%). One hemodynamically unstable patient was excluded at the onset of mapping. Inducibility of sustained VT was achieved an average of 2.2 times per patient (1-8), with mean tachycardia cycle length (TCL) 374 milliseconds (179-510). Mean total procedure and fluoroscopy times were 223 minutes and 8.7 minutes, respectively; mean cumulative fluoroscopy time during mapping and ablation was 0.95 minutes; maximum power averaged 42.3 W with nominal saline 30 cc/min irrigation; mean cumulative RF time was 38 minutes. Non-inducibility of the target VT was achieved in 49/52 patients (94.2%) and non-inducibility of any VT was achieved in 38/52 patients (73.1%). A combination of RMN and manual ablation was performed in two patients, rendering one non-inducible. During

  18. Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support.

    PubMed

    Lü, Fei; Eckman, Peter M; Liao, Kenneth K; Apostolidou, Ioanna; John, Ranjit; Chen, Taibo; Das, Gladwin S; Francis, Gary S; Lei, Han; Trohman, Richard G; Benditt, David G

    2013-10-09

    Catheter ablation of hemodynamically unstable ventricular tachycardia (VT) is possible with mechanical circulatory support (MCS), little is known regarding the relative safety and efficacy of different supporting devices for such procedures. Sixteen consecutive patients (aged 63 ± 11 years with left ventricular ejection fraction of 20 ± 9%) who underwent ablation of hemodynamically unstable VT were included in this study. Hemodynamic support included percutaneous (Impella® 2.5, n = 5) and implantable left ventricular assist devices (LVADs, n = 6) and peripheral cardiopulmonary bypass (CPB, n = 5). Except for 2 Impella cases, hemodynamic support was adequate (with consistent mean arterial pressure of > 60 mmHg) to permit sufficient activation mapping for ablation. In the Impella and CPB groups, mean time under hemodynamic support was 185 ± 86 min, and time in VT was 78 ± 36 min. Clinical VT could be terminated at least once by ablation in all patients except 1 case with Impella due to hemodynamic instability. Peri-procedural complications included hemolysis in 1 patient with Impella and surgical intervention for percutaneous Impella placement problems in another 2. The median number of appropriately delivered defibrillator therapies was significantly decreased from 6 in the month before VT ablation to 0 in the month following ablation (p = 0.001). Our data suggest that peripheral CPB and implantable LVAD provide adequate hemodynamic support for successful ablation of unstable VT. Impella® 2.5, on the other hand, was associated with increased risk of complications, and may not provide sufficient hemodynamic support in some cases. © 2013.

  19. Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Lehmann, H. I.; Johnson, S. B.; Packer, D. L.

    2016-03-01

    Patients with ventricular arrhythmias typically exhibit myocardial scarring, which is believed to be an important anatomic substrate for reentrant circuits, thereby making these regions a key target in catheter ablation therapy. In ablation therapy, a catheter is guided into the left ventricle and radiofrequency energy is delivered into the tissue to interrupt arrhythmic electrical pathways. Low bipolar voltage regions are typically localized during the procedure through point-by-point construction of an electroanatomic map by sampling the endocardial surface with the ablation catheter and are used as a surrogate for myocardial scar. This process is time consuming, requires significant skill, and has the potential to miss low voltage sites. This has led to efforts to quantify myocardial scar preoperatively using delayed, contrast-enhanced MRI. In this paper, we evaluate the utility of left ventricular scar identification from delayed contrast enhanced magnetic resonance imaging for guidance of catheter ablation of ventricular arrhythmias. Myocardial infarcts were created in three canines followed by a delayed, contrast enhanced MRI scan and electroanatomic mapping. The left ventricle and myocardial scar is segmented from preoperative MRI images and sampled points from the procedural electroanatomical map are registered to the segmented endocardial surface. Sampled points with low bipolar voltage points visually align with the segmented scar regions. This work demonstrates the potential utility of using preoperative delayed, enhanced MRI to identify myocardial scarring for guidance of ventricular catheter ablation therapy.

  20. Pacemakers implantation and radiofrequency catheter ablation procedures during medical missions in Morocco: an 8-year experience.

    PubMed

    Bun, Sok-Sithikun; Latcu, Decebal Gabriel; Errahmouni, Abdelkarim; Zarqane, Naïma; Yaïci, Khelil; Moustaghfir, Abdelhamid; Tazi-Mezalek, Amale; Saoudi, Nadir

    2016-07-01

    Radiofrequency catheter ablation (RFCA) for arrhythmias in the context of short-term medical missions (MM) in a developing country has not been reported so far. We describe here our experience with RFCA and pacemaker implantation in Morocco with a fully portable electrophysiological (EP) system under the auspice of the Monaco-Morocco Cardiology Association. Since November 2007, two to three MM (mean duration 4 days including transportation) per year were conducted (including two physicians and one nurse from Monaco) and were alternately located in Marrakech, Fes, Agadir, Casablanca, Rabat, Essaouira, and Oujda. All patients' files were sent by local teams and/or referring Moroccan cardiologists before MM. Each case was discussed with the Monaco EP team before the MM. Pacemakers and leads were donated by companies (Sorin Group, Medtronic, Saint-Jude Medical). The EP system (EP Tracer, CardioTek) as well as diagnostic/ablation catheters were brought for RFCA procedures. After the procedures, follow-up was performed by local teams. Procedures took place in gynaecological or orthopaedic operating room, or, when available, in the interventional cardiology cathlab. Thirty-one RFCA were performed during 11 MM (atrioventricular node re-entrant tachycardia = 12; atrioventricular re-entrant tachycardia/Mahaïm fibre = 15; typical atrial flutter = 3; ventricular ectopy = 1). Acute success was 93.5% for RFCA. Two major RFCA-related complications occurred (air embolism and complete atrioventricular block). No complication was related to pacemaker implantations (n = 44; mean 4 pacemakers per mission). Radiofrequency catheter ablation for arrhythmias in developing countries is technically challenging but feasible, despite technical and cultural difficulties. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  1. Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis.

    PubMed

    Muser, Daniele; Santangeli, Pasquale; Pathak, Rajeev K; Castro, Simon A; Liang, Jackson J; Magnani, Silvia; Hayashi, Tatsuya; Garcia, Fermin C; Hutchinson, Mathew D; Supple, Gregory E; Frankel, David S; Riley, Michael P; Lin, David; Schaller, Robert D; Desjardins, Benoit; Dixit, Sanjay; Callans, David J; Zado, Erica S; Marchlinski, Francis E

    2016-08-01

    Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival. © 2016 American Heart Association, Inc.

  2. Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned

    PubMed Central

    De Ponti, Roberto

    2015-01-01

    Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable (ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 mSv and in some cases > 50 mSv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, non-fluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zero-fluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for

  3. Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation

    PubMed Central

    Li, Jin-yi; Jiang, Jing-bo; He, Yan; Luo, Jian-chun

    2017-01-01

    A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT). Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB) by transthoracic echocardiography (TTE). Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT. PMID:28197345

  4. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation

    PubMed Central

    Lee, Ji Hyun; Kim, Jun; Kim, Minsu; Hwang, Jongmin; Hwang, You Mi; Kang, Joon-Won; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2017-01-01

    Abstract Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369–8690 cGy cm2) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF. Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups. The 4-FPS group showed higher median DAP (599.9 cGy cm2; interquartile range [IR], 371.4–1337.5 cGy cm2 vs. 392.0 cGy cm2; IR, 289.7–591.4 cGy cm2; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5–34.9 min vs. 15.1 min; IR, 10.7–20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7–2.5 mSv vs. 0.7 mSv; IR, 0.6–1.1 mSv; P < .01) compared with the 2-FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan–Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25). In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional

  5. [Successful radiofrequency catheter ablation of the symptomatic ventricular tachycardia in structurally normal heart. Case report].

    PubMed

    Maciag, Aleksander; Sterliński, Maciej; Pytkowski, Mariusz; Jankowska, Agnieszka; Szwed, Hanna

    2003-12-01

    Radiofrequency catheter ablation (RFA) in structurally normal heart ventricular arrhythmias has been found to be promising direction of develop. Authors presented the case of successful RFA of symptomatic ventricular tachycardia originating from right ventricle outflow tract (RVOT). Arrhythmogenic locus was localised basing on ECG pattern, analyze of endocardial potentials and pace mapping method. In two-year follow up she was free of symptoms and ventricular arrhythmia, no medication needed. RFA is an effective and safe therapy in ventricular tachycardia in structurally normal heart.

  6. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation

    PubMed Central

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-01-01

    Abstract Background: Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. Methods: We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Results: Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Conclusion: Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture. PMID:27661047

  7. Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

    PubMed Central

    Janse, P.; Alings, M.; Scholten, M. F.; Mekel, J. M.; Miltenburg, M.; Jessurun, E.; Jordaens, L.

    2008-01-01

    Objectives To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters. Methods Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and the analgesics were recorded. Patients were followed for at least 3 months. Results The acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144 ± 48 min for RF, vs 158 ± 49 min for cryo). More applications were given with RF than with cryo (26 ± 17 vs. 18 ± 10, p < 0.05). Fluoroscopy time was longer with RF (29 ± 15 vs. 19 ± 12 min, p < 0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly less analgesia (p < 0.01), and no use of long sheaths (p < 0.005). The isthmus tended to be longer in the failed procedures (p = 0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success. Conclusions In this randomized study there was no statistical difference but a trend to less favorable outcome with 8 mm tip cryocatheters compared to RF catheters for atrial flutter ablation. Cryoablation was associated with less discomfort, fewer applications, shorter fluoroscopy times and similar procedure times. The recurrence rate was very low. Cryotherapy can be considered for atrial flutter ablation under certain circumstances especially when it has been used previously in the same patient, such as in an AF ablation. PMID:18363087

  8. Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.

    PubMed

    Hoyt, Hana; Bhonsale, Aditya; Chilukuri, Karuna; Alhumaid, Fawaz; Needleman, Matthew; Edwards, David; Govil, Ashul; Nazarian, Saman; Cheng, Alan; Henrikson, Charles A; Sinha, Sunil; Marine, Joseph E; Berger, Ronald; Calkins, Hugh; Spragg, David D

    2011-12-01

    The reported complication rate of catheter ablation of atrial fibrillation (AF) varies. Our goal was to assess temporal trends and the effect of both institutional and individual operators' experience on the incidence of complications. All patients undergoing AF ablation at Johns Hopkins Hospital between February 2001 and December 2010 were prospectively enrolled in a database. Major complications were defined as those that were life-threatening, resulted in permanent harm, required intervention, or significantly prolonged hospitalization. Fifty-six major complications occurred in 1190 procedures (4.7%). The majority of complications were vascular (18; 1.5%), followed by pericardial tamponade (13; 1.1%) and cerebrovascular accident (12; 1.1%). No cases of death or atrioesophageal fistula occurred. The overall complication rate decreased from 11.1% in 2002 to 1.6% in 2010 (P <.05). On univariate analysis, demographic and clinical factors associated with the increased risk of complications were CHADS(2) score of ≥2 (hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.4-4.4; P = .002), female gender (HR = 2.0; 95% CI = 1.2-3.5; P = .014), and age (HR = 1.03; 95% CI = 1.0-1.1; P = .042). Gender and CHADS(2) score of ≥2 remained independent predictors of complication on multivariable analysis. The complication rate of catheter ablation of AF decreased with increased institutional experience. Female gender and CHADS(2) score of ≥2 are significant independent risk factors for complications and should be considered when referring patients for AF ablation. Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  9. Effect of Substrate Modification in Catheter Ablation of Paroxysmal Atrial Fibrillation

    PubMed Central

    Nam, Gi-Byoung; Jin, Eun-Sun; Choi, HyungOh; Song, Hae-Geun; Kim, Sung-Hwan; Kim, Ki-Hun; Hwang, Eui-Seock; Park, Kyoung-Min; Kim, Jun; Rhee, Kyoung-Suk; Choi, Kee-Joon; Kim, You-Ho

    2012-01-01

    Catheter ablation of atrial fibrillation that targets complex fractionated electrogram sites has been widely applied in the management of persistent atrial fibrillation. The clinical outcomes of pulmonary vein isolation alone and pulmonary vein isolation plus the use of complex fractionated electrogram-guided ablation (CFEA) have not been fully compared in patients with paroxysmal atrial fibrillation. This prospective study included 70 patients with symptomatic paroxysmal atrial fibrillation that remained inducible after pulmonary vein isolation. For radio-frequency catheter ablation, patients were nonrandomly assigned to a control group (pulmonary vein isolation alone, Group 1, n=35) or a CFEA group (pulmonary vein isolation plus additional CFEA, Group 2, n=35). The times to first recurrence of atrial tachyarrhythmias were compared between the 2 groups. In Group 2, CFEA rendered atrial fibrillation noninducible in 16 patients (45.7%) and converted inducible atrial fibrillation into inducible atrial flutters in 12 patients (34.3%). Atrial fibrillation remained inducible in 7 patients (20%) after the combined ablation procedures. After a mean follow-up of 23 months, freedom from recurrence of atrial tachyarrhythmias was significantly higher in Group 2 than in Group 1 (P=0.037). In Group 1, all of the recurrent tachyarrhythmias were atrial fibrillation, whereas regular tachycardia was the major mechanism of recurrent arrhythmias in Group 2 (atrial tachycardia or atrial flutter in 5 of 6 patients and atrial fibrillation in 1 patient). We found that CFEA after pulmonary vein isolation significantly reduced recurrent atrial tachyarrhythmia and might modify the pattern of arrhythmia recurrence in patients with paroxysmal atrial fibrillation. PMID:22719147

  10. In vitro assessment of a combined radiofrequency ablation and cryo-anchoring catheter for treatment of mitral valve prolapse.

    PubMed

    Boronyak, Steven M; Merryman, W David

    2014-03-21

    Percutaneous approaches to mitral valve repair are an attractive alternative to surgical repair or replacement. Radiofrequency ablation has the potential to approximate surgical leaflet resection by using resistive heating to reduce leaflet size, and cryogenic temperatures on a percutaneous catheter can potentially be used to reversibly adhere to moving mitral valve leaflets for reliable application of radiofrequency energy. We tested a combined cryo-anchoring and radiofrequency ablation catheter using excised porcine mitral valves placed in a left heart flow loop capable of reproducing physiologic pressure and flow waveforms. Transmitral flow and pressure were monitored during the cryo-anchoring procedure and compared to baseline flow conditions, and the extent of radiofrequency energy delivery to the mitral valve was assessed post-treatment. Long term durability of radiofrequency ablation treatment was assessed using statically treated leaflets placed in a stretch bioreactor for four weeks. Transmitral flow and pressure waveforms were largely unaltered during cryo-anchoring. Parameter fitting to mechanical data from leaflets treated with radiofrequency ablation and cryo-anchoring revealed significant mechanical differences from untreated leaflets, demonstrating successful ablation of mitral valves in a hemodynamic environment. Picrosirius red staining showed clear differences in morphology and collagen birefringence between treated and untreated leaflets. The durability study indicated that statically treated leaflets did not significantly change size or mechanics over four weeks. A cryo-anchoring and radiofrequency ablation catheter can adhere to and ablate mitral valve leaflets in a physiologic hemodynamic environment, providing a possible percutaneous alternative to surgical leaflet resection of mitral valve tissue.

  11. Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia After Catheter Ablation.

    PubMed

    Siontis, Konstantinos C; Kim, Hyungjin Myra; Stevenson, William G; Fujii, Akira; Bella, Paolo Della; Vergara, Pasquale; Shivkumar, Kalyanam; Tung, Roderick; Do, Duc H; Daoud, Emile G; Okabe, Toshimasa; Zeppenfeld, Katja; Riva Silva, Marta de; Hindricks, Gerhard; Arya, Arash; Weber, Alexander; Kuck, Karl-Heinz; Metzner, Andreas; Mathew, Shibu; Riedl, Johannes; Yokokawa, Miki; Jongnarangsin, Krit; Latchamsetty, Rakesh; Morady, Fred; Bogun, Frank M

    2016-12-01

    Recurrence of ventricular tachycardia (VT) after ablation in patients with previous myocardial infarction is associated with adverse prognosis. However, the impact of the timing of VT recurrence on outcomes is unclear. We analyzed data from a multicenter collaborative database of patients who underwent catheter ablation for infarct-related VT. Multivariable Cox regression analyses investigated the effect of the timing of VT recurrence on the composite outcome of death or heart transplantation using VT recurrence as a time-varying covariate. A total of 1412 patients were included (92% men; age: 66.7±10.7 years), and 605 patients (42.8%) had a recurrence after median 116 days (188 [31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178 [29.4%] after 12 months). At median follow-up of 670 days, 375 patients (26.6%) experienced death or heart transplantation. The median time from recurrence to death or heart transplantation was 65 and 198.5 days in patients with recurrence ≤30 days and >30 days post ablation, respectively. The adjusted hazard ratio (95% confidence interval) for the effect of VT recurrence occurring immediately post ablation on death or heart transplantation was 3.45 (2.33-5.11) in reference to no recurrence. However, the magnitude of this effect decreased statistically significantly (P<0.001) as recurrence occurred later in the follow-up period. The respective risk estimates for VT recurrence at 30 days, 6 months, 1 year, and 2 years were 3.36 (2.29-4.93), 2.94 (2.09-4.14), 2.50 (1.85-3.37), and 1.81 (1.37-2.40). VT recurrence post ablation is associated with a mortality risk that is highest soon after the ablation and decreases gradually thereafter. © 2016 American Heart Association, Inc.

  12. Pain perception during esophageal warming due to radiofrequency catheter ablation in the left atrium.

    PubMed

    Galeazzi, Marco; Ficili, Sabina; Dottori, Serena; Elian, Mohamed Abdelkader; Pasceri, Vincenzo; Venditti, Franco; Russo, Maurizio; Lavalle, Carlo; Pandozi, Angela; Pandozi, Claudio; Santini, Massimo

    2010-03-01

    We investigated the relationship among esophageal warming, pain perception, and the site of radiofrequency (RF) delivery in the left atrium (LA) during the course of catheter ablation of atrial fibrillation. Such a procedure in awake patients is often linked to the development of visceral pain and esophageal warming. As a consequence, potentially dangerous complications have been described. Twenty patients undergoing RF ablation in the LA were studied. An esophageal probe (EP) capable of measuring endoesophageal temperature (ET) was positioned before starting the procedure. The relative position of the EP and the tip of the ablator were evaluated through fluoroscopy imaging before starting each RF delivery, during which the highest value of the temperature was collected. After RF withdrawal, the patients were asked to define the intensity of the experienced pain by using a score index ranging from 0 (no pain) to 4 (pain requiring immediate RF interruption). The mean ET value during ablation was 39.59 +/- 4.71 degrees C. The EP proximity to the ablator's tip showed a high correlation with the development of the highest ET values (Spearman's rank correlation coefficient r = 0.49, confidence interval (CI) 0.55-0.41). Moreover, the highest values of pain intensity were reported when the RF was delivered to the atrial zones close to the EP projection (r = 0.50, CI 0.55-0.42) and when the highest ET levels were reached (r = 0.38, CI 0.30-0.45). Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short- and long-term jeopardizing of the esophageal wall.

  13. Cardiac Memory in WPW Patients : Noninvasive Imaging of Activation and Repolarization Before and After Catheter Ablation

    PubMed Central

    Ghosh, Subham; Rhee, Edward K; Avari, Jennifer N; Woodard, Pamela K.; Rudy, Yoram

    2009-01-01

    Background Cardiac memory refers to change in ventricular repolarization induced by, and persisting for minutes to months after cessation of a period of altered ventricular activation (e.g. due to pacing or pre-excitation in Wolff-Parkinson-White [WPW] patients). Electrocardiographic imaging (ECGI) is a novel imaging modality for noninvasive electro-anatomic mapping of epicardial activation and repolarization. Methods and Results Fourteen pediatric WPW patients, in absence of any other congenital disease, were imaged with ECGI a day before, and 45 mins, 1 week and 1 month after successful catheter ablation. ECGI determined pre-excitation sites were consistent with sites of successful ablation in all cases to within one hour arc of each atrio-ventricular (AV) annulus. In the pre-excited rhythm, activation-recovery interval (ARI) was the longest (349±6 ms) in the area of pre-excitation leading to high average base-to-apex ARI dispersion (ARId) of 95±9 ms (normal is about 40 ms). The ARId remained the same 45 minutes post-ablation, though the activation sequence was restored to normal. ARId was still high (79±9 ms) one week later and returned to normal (45±6 ms) one month post-ablation. Conclusions The study demonstrates that ECGI can noninvasively localize ventricular insertion sites of accessory pathways and evaluate its outcome to guide ablation in pediatric WPW patients. WPW is associated with high ARId in the pre-excited rhythm which persists after ablation and gradually returns to normal over a period of one month, demonstrating the presence of cardiac memory. The one-month time course is consistent with transcriptional reprogramming and remodeling of ion-channels. PMID:18697818

  14. Delayed efficacy of radiofrequency catheter ablation on ventricular arrhythmias originating from the left ventricular anterobasal wall.

    PubMed

    Ding, Ligang; Hou, Bingbo; Wu, Lingmin; Qiao, Yu; Sun, Wei; Guo, Jinrui; Zheng, Lihui; Chen, Gang; Zhang, Linfeng; Zhang, Shu; Yao, Yan

    2017-03-01

    Ventricular arrhythmias (VAs) originating from the left ventricular anterobasal wall (LV-ABW) may represent a therapeutic challenge. The purpose of this study was to investigate the delayed efficacy of radiofrequency catheter (RFCA) ablation without an epicardial approach on VAs originating from the LV-ABW. Eighty patients (mean age 46.9 ± 14.9 years; 47 male) with VAs originating from the LV-ABW were enrolled. After systematic mapping of the right ventricular outflow tract, aortic root, adjacent LV endocardium, and coronary venous system, 3-4 ablation attempts were made at the earliest activation sites and/or best pace-mapping sites. Delayed efficacy was evaluated in patients with acute failure. During mean follow-up of 23.8 ± 21.9 months (range 3-72 months), complete elimination of all VAs was achieved in 47 patients (59%) and partial success in 19 (24%), for an overall success rate of 83%. In 25 of 37 patients (68%) with acute failure, VAs were eliminated or significantly reduced (>80% VA burden) by the delayed effect of RFCA during follow-up. Logistic regression analysis revealed that response time to ablation was a predictor of occurrence of delayed efficacy. No complications occurred during follow-up. Instead of extensive ablation, waiting for delayed efficacy of RFCA may be a reasonable choice for patients with VAs arising from the LV-ABW. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. Efficacy of an Anatomical Approach in Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Outflow Tract.

    PubMed

    Yamada, Takumi; Yoshida, Naoki; Doppalapudi, Harish; Litovsky, Silvio H; McElderry, H Thomas; Kay, G Neal

    2017-05-01

    When anatomic obstacles preclude radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT), an alternative approach from the anatomically opposite side (endocardial versus epicardial or above versus below the aortic valve) may be considered (anatomic ablation). The purpose of this study was to investigate the efficacy of an anatomic ablation in idiopathic LVOT VAs. We studied 229 consecutive patients with idiopathic LVOT VAs. Radiofrequency ablation from the first suitable site was successful in 190 patients, and in the remaining 39 patients, it was unsuccessful or had to be abandoned because of anatomic obstacles. In 22 of these 39 patients, an anatomic ablation was successful, and the VA origins were located in the intramural LVOT in 17 patients, basal left ventricular summit in 4, and LVOT septum near the His bundle in 1. The anatomic ablation was highly successful for idiopathic VAs originating from the intramural LVOT (>75%) and lateral LVOT, whereas it was unlikely to be successful for idiopathic VAs originating from the basal left ventricular summit (25%) and sepal LVOT. When a standard catheter ablation targeting the best electrophysiological measure of idiopathic LVOT VAs was unsuccessful or had to be abandoned because of anatomic obstacles, an anatomic ablation was moderately successful. These idiopathic LVOT VAs with a successful anatomic ablation commonly arose from the intramural LVOT among the left coronary cusp, aortomitral continuity, and epicardium, occasionally the basal left ventricular summit, and rarely the LVOT septum near the His bundle. © 2017 American Heart Association, Inc.

  16. An efficient cardiac mapping strategy for radiofrequency catheter ablation with active learning.

    PubMed

    Feng, Yingjing; Guo, Ziyan; Dong, Ziyang; Zhou, Xiao-Yun; Kwok, Ka-Wai; Ernst, Sabine; Lee, Su-Lin

    2017-07-01

    A major challenge in radiofrequency catheter ablation procedures is the voltage and activation mapping of the endocardium, given a limited mapping time. By learning from expert interventional electrophysiologists (operators), while also making use of an active-learning framework, guidance on performing cardiac voltage mapping can be provided to novice operators or even directly to catheter robots. A learning from demonstration (LfD) framework, based upon previous cardiac mapping procedures performed by an expert operator, in conjunction with Gaussian process (GP) model-based active learning, was developed to efficiently perform voltage mapping over right ventricles (RV). The GP model was used to output the next best mapping point, while getting updated towards the underlying voltage data pattern as more mapping points are taken. A regularized particle filter was used to keep track of the kernel hyperparameter used by GP. The travel cost of the catheter tip was incorporated to produce time-efficient mapping sequences. The proposed strategy was validated on a simulated 2D grid mapping task, with leave-one-out experiments on 25 retrospective datasets, in an RV phantom using the Stereotaxis Niobe(®) remote magnetic navigation system, and on a tele-operated catheter robot. In comparison with an existing geometry-based method, regression error was reduced and was minimized at a faster rate over retrospective procedure data. A new method of catheter mapping guidance has been proposed based on LfD and active learning. The proposed method provides real-time guidance for the procedure, as well as a live evaluation of mapping sufficiency.

  17. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients.

    PubMed

    Pappone, Carlo; Vicedomini, Gabriele; Manguso, Francesco; Saviano, Massimo; Baldi, Mario; Pappone, Alessia; Ciaccio, Cristiano; Giannelli, Luigi; Ionescu, Bogdan; Petretta, Andrea; Vitale, Raffaele; Cuko, Amarild; Calovic, Zarko; Fundaliotis, Angelica; Moscatiello, Mario; Tavazzi, Luigi; Santinelli, Vincenzo

    2014-09-02

    The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes. © 2014 American Heart Association, Inc.

  18. Radiofrequency catheter ablation: different cooled and noncooled electrode systems induce specific lesion geometries and adverse effects profiles.

    PubMed

    Dorwarth, Uwe; Fiek, Michael; Remp, Thomas; Reithmann, Cristopher; Dugas, Martin; Steinbeck, Gerhard; Hoffmann, Ellen

    2003-07-01

    The success and safety of standard catheter radiofrequency ablation may be limited for ablation of atrial fibrillation and ventricular tachycardia. The aim of this study was to characterize and compare different cooled and noncooled catheter systems in terms of their specific lesion geometry, incidence of impedance rise, and crater and coagulum formation to facilitate appropriate catheter selection for special indications. The study investigated myocardial lesion generation of three cooled catheter systems (7 Fr, 4-mm tip): two saline irrigation catheters with a showerhead-type electrode tip (sprinkler) and a porous metal tip and an internally cooled catheter. Noncooled catheters (7 Fr) had a large tip electrode (8 mm) and a standard tip electrode (4 mm). RF energy was delivered on isolated porcine myocardium superfused with heparinized pig blood (37 degrees C) at power settings of 10-40 W. Both irrigated systems were characterized by a large lesion depth (8.1 +/- 1.6 mm) and a large lesion diameter (13.8 +/- 1.6 mm). In comparison, internally cooled lesions showed a similar lesion depth (8.0 +/- 1.0 mm), but a significantly smaller lesion diameter (12.3 +/- 1.2 mm,P = 0.04). Large tip lesions had a similar lesion diameter (14.5 +/- 1.6 mm), but a significantly smaller lesion depth (6.3 +/- 1.0 mm,P = 0.002) compared to irrigated lesions. However, lesion volume was not significantly different between the three cooled and the large tip catheter. To induce maximum lesion size, power requirements were three times higher for the irrigation systems and two times higher for the internally cooled and the large tip catheter compared to the standard catheter. Impedance rise was rarest with irrigated and large tip ablation. In case of impedance rise crater formation was a frequent observation (61-93%). Irrigated catheters prevented coagulum formation most effectively. Irrigated rather than internally cooled ablation appears to be most adequate for the induction of deep and

  19. Successful catheter ablation of a slow AV-nodal pathway from the left posteroseptal region.

    PubMed

    Wieczorek, M; Höltgen, R; Djajadisastra, I

    2005-08-01

    We present the case of a 44 year old woman with recurrent episodes of supraventricular tachycardia due to AV-nodal reentry (AVNRT). She was refractory to conventional medical treatment and referred to our hospital with the view to catheter ablation of the slow AV-nodal pathway. AVNRT of the common type was easily induced performing stimulation from the high right atrium and proximal coronary sinus. Other forms of supraventricular tachycardia were definitely ruled out during further electrophysiologic study. Repetitive RF applications around the right posteroseptal region failed to cure the tachycardia which remained inducible with a typical jump in the AH interval. Extensive RF applications from posteroinferior to the midseptum including the area of the proximal coronary sinus and its os were ineffective as well.AVNRT was transiently but reproducibly eliminated while burns were applied to the high midseptum but AVNRT reoccured within 20 minutes. Finally after retrograde passage of the aortic valve with a 4 mm tip ablation catheter, RF was applied to the left postero to midseptal region. An accelerated junctional rhythm was immediately observed and AVNRT remained non-inducible from that time onwards. It is concluded that an atypical posterior extension of the AV node with predominant leftatrial course might be responsible for this unusual success of slow pathway elimination from left posteroseptal.

  20. Development of a simultaneous cryo-anchoring and radiofrequency ablation catheter for percutaneous treatment of mitral valve prolapse.

    PubMed

    Boronyak, Steven M; Merryman, W David

    2012-09-01

    Mitral valve prolapse (MVP) is one subtype of mitral valve (MV) disease and is often characterized by enlarged leaflets that are thickened and have disrupted collagen architecture. The increased surface area of myxomatous leaflets with MVP leads to mitral regurgitation, and there is need for percutaneous treatment options that avoid open-chest surgery. Radiofrequency (RF) ablation is one potential therapy in which resistive heating can be used to reduce leaflet size via collagen contracture. One challenge of using RF ablation to percutaneously treat MVP is maintaining contact between the RF ablation catheter tip and a functioning MV leaflet. To meet this challenge, we have developed a RF ablation catheter with a cryogenic anchor for attachment to leaflets in order to apply RF ablation. We demonstrate the effectiveness of the dual-energy catheter in vitro by examining changes in leaflet biaxial compliance, thermal distribution with infrared (IR) imaging, and cryogenic anchor strength. We report that 1250 J of RF energy with cryo-anchoring reduced the determinant of the deformation gradient tensor at systolic loading by 23%. IR imaging revealed distinct regions of cryo-anchoring and tissue ablation, demonstrating that the two modalities do not counteract one another. Finally, cryogenic anchor strength to the leaflet was reduced but still robust during the application of RF energy. These results indicate that a catheter having combined RF ablation and cryo-anchoring provides a novel percutaneous treatment strategy for MVP and may also be useful for other percutaneous procedures where anchored ablation would provide more precise spatial control.

  1. A finite-element model of a microwave catheter for cardiac ablation

    SciTech Connect

    Kaouk, Z.; Khebir, A.; Savard, P.

    1996-10-01

    To investigate the delivery of microwave energy by a catheter located inside the heart for the purpose of ablating small abnormal regions producing cardiac arrhythmias, a numerical model was developed. This model is based on the finite element method and can solve both the electromagnetic field and the temperature distribution resulting from the radiated power for axisymmetrical geometries. The antenna, which is fed by a coaxial cable with a 2.4 mm diameter, is constituted by a monopole which is terminated by a metallic cylindrical cap. The heart model can be either homogeneous or constituted of coaxial cylindrical shells with different electrical and thermal conductivities representing the intracavitary blood masses, the heart, and the torso. Experimental measurements obtained in an homogeneous tissue equivalent medium, such as the reflection coefficient of the antenna at different frequencies and for different monopole lengths, the radial and axial steady-state temperature profiles, and the time course of the temperature rise, were all in close agreement with the values computed with the model. Accurate modeling is a useful prerequisite for the design of antennas, and these results confirm the validity of the catheter-heart model for the investigation and the development of microwave catheters.

  2. Cost comparison of radiofrequency catheter ablation versus cryoablation for atrial fibrillation in hospitals using both technologies.

    PubMed

    Hunter, Tina D; Palli, Swetha R; Rizzo, John A

    2016-10-01

    The objective of this study was to compare the cost of radiofrequency (RF) ablation vs cryoablation (Cryo) for atrial fibrillation (AF). This retrospective cohort study used 2013-2014 records from the Premier Healthcare Database for adults with AF catheter ablation. Exclusions included non-AF ablation, surgical ablation, valve replacement or repair, or cardiac implant. Hospitals were required to perform ≥20 procedures using each technology, with the technology identifiable in at least 90% of cases. The primary endpoint was total variable visit cost, modeled separately for inpatient and outpatient visits, and adjusted for patient and hospital characteristics. Technology was categorized as RF or Cryo, with dual-technology procedures classified as Cryo. The Cryo cohort was further divided into Cryo only and Cryo with RF for sensitivity analyses. A composite adverse event endpoint was also compared. A total of 1261 RF procedures and 1276 Cryo procedures, of which 500 also used RF, met study criteria. RF patients were slightly older and sicker, and had more cardiovascular disease and additional arrhythmias. Adjusted inpatient costs were $2803 (30.0%) higher for Cryo, and adjusted outpatient costs were $2215 (19.5%) higher. Sensitivity models showed higher costs in both Cryo sub-groups compared with RF. Procedural complication rates were not significantly different between cohorts (p-values: 0.4888 inpatient, 0.5072 outpatient). AF ablation using RF results in significantly lower costs compared with Cryo, despite an RF population with more cardiovascular disease. This saving cannot be attributed to a difference in complication rates.

  3. Zero-fluoroscopy catheter ablation of severe drug-resistant arrhythmia guided by Ensite NavX system during pregnancy

    PubMed Central

    Chen, Guangzhi; Sun, Ge; Xu, Renfan; Chen, Xiaomei; Yang, Li; Bai, Yang; Yang, Shanshan; Guo, Ping; Zhang, Yan; Zhao, Chunxia; Wang, Dao Wen; Wang, Yan

    2016-01-01

    Abstract Background: Cardiac arrhythmias can occur during pregnancy. Owing to radiation exposure and other uncertain risks for the mother and fetus, catheter ablation has rarely been performed and is often delayed until the postpartum period. We reported 2 pregnant women who were experiencing severe arrhythmias and were successfully ablated without fluoroscopic guidance. We also carried out a literature review of cases of pregnant women who underwent zero-fluoroscopy ablation. Methods and Results: One woman had drug-resistant and poorly tolerated frequent premature ventricular contraction (PVC) and ventricular tachycardia (VT). The other one had persistent and hardly terminated supraventricular tachycardia (SVT) via a right accessory pathway. The 2 patients were successfully underwent zero-fluoroscopy ablation guided by Ensite NavX system. The procedure time was 42 and 71 minutes, respectively. Conclusion: Catheter ablation of SVT or PVC/VT in pregnant patients can be safely and effectively performed with a completely zero-fluoroscopy approach guided by the Ensite NavX system. In the case of a drug refractory, life-threatening arrhythmia during pregnancy, catheter ablation may be considered. PMID:27512864

  4. Catheter ablation of atrial fibrillation and atrial flutter in patients with diabetes mellitus: Who benefits and who does not? Data from the German ablation registry.

    PubMed

    Bogossian, Harilaos; Frommeyer, Gerrit; Brachmann, Johannes; Lewalter, Thorsten; Hoffmann, Ellen; Kuck, Karl Heinz; Andresen, Dietrich; Willems, Stephan; Spitzer, Stefan G; Deneke, Thomas; Thomas, Dierk; Hochadel, Matthias; Senges, Jochen; Eckardt, Lars; Lemke, Bernd

    2016-07-01

    Diabetes mellitus (DM) is an independent risk factor for cardiovascular disease and arrhythmias. Procedural data and complication rates in patients with DM undergoing catheter ablation for atrial arrhythmias are unknown. The German Ablation Registry has been designed as a multi-center prospective registry. Between January 2007 and January 2010 data from ablation of right atrial flutter (AFlut) and atrial fibrillation (AF) were collected from 51 German centres. Patients with DM and without DM were compared. We included 8175 patients who underwent catheter ablation of AFlut or AF. Patients with DM (n=944) were older and presented significantly more severe comorbidities. Major periprocedural complications did not significantly differ between patients with and without DM for both ablation of AFlut and AF. Kaplan-Meier survival analysis for 366days of follow-up, showed a significant increase of MACCE for DM patients as compared to controls after AFlut [6.1% vs. 3.4%(p=0.002)], but not after AF ablation [1.2% vs. 0.9%(p=0.59)]. Ablation of AFlut led to a comparable reduction of palpitations and NYHA class in both patient groups. AF ablation reduced palpitations and NYHA class in patients without DM, while patients with DM reported no improvement of NYHA class despite a reduction of palpitations. As compared to non-DM, patients with DM show no increased periprocedural risk and no increased arrhythmia recurrence after ablation of AFlut or AF. As expected patients with DM exhibit more comorbidities and an increased ongoing mortality after atrial flutter ablation presumably caused by the higher age of this group as compared to controls. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial.

    PubMed

    Di Biase, Luigi; Burkhardt, J David; Mohanty, Prasant; Mohanty, Sanghamitra; Sanchez, Javier E; Trivedi, Chintan; Güneş, Mahmut; Gökoğlan, Yalçın; Gianni, Carola; Horton, Rodney P; Themistoclakis, Sakis; Gallinghouse, G Joseph; Bailey, Shane; Zagrodzky, Jason D; Hongo, Richard H; Beheiry, Salwa; Santangeli, Pasquale; Casella, Michela; Dello Russo, Antonio; Al-Ahmad, Amin; Hranitzky, Patrick; Lakkireddy, Dhanunjaya; Tondo, Claudio; Natale, Andrea

    2016-11-01

    Longstanding persistent (LSP) atrial fibrillation (AF) is the most challenging type of AF. In addition to pulmonary vein isolation, substrate modification and triggers ablation have been reported to improve freedom from AF in patients with LSPAF. This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. This was an open-label, randomized study assessing the effectiveness of empirical electrical left atrial appendage isolation for the treatment of LSPAF. Patients were randomly assigned to undergo empirical electrical left atrial appendage isolation along with extensive ablation (group 1; n = 85) or extensive ablation alone (group 2; n = 88). Recurrence of atrial arrhythmias was the primary endpoint. Secondary endpoints included cardiac-related hospitalization, all-cause mortality, and stroke at follow-up. Major clinical characteristics were not different between the 2 groups. At 12-month follow-up, 48 (56%) patients in group 1 and 25 (28%) in group 2 were recurrence free after a single procedure (unadjusted hazard ratio [HR] for recurrence with standard ablation: 1.92; 95% confidence interval [CI]: 1.3 to 2.9; log-rank p = 0.001). After adjusting for age, sex, and left atrial size, standard ablation was predictive of recurrence (HR: 2.22; 95% CI: 1.29 to 3.81; p = 0.004). During repeat procedures, empirical electrical left atrial appendage isolation was performed in all patients. After an average of 1.3 procedures, cumulative success at 24-month follow-up was reported in 65 (76%) in group 1 and in 49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; log-rank p = 0.003). This randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications. (Effect of Empirical Left Atrial Appendage Isolation on Long

  6. Meta-Analysis of Catheter Ablation as an Adjunct to Medical Therapy for Treatment of Ventricular Tachycardia in Patients with Structural Heart Disease

    PubMed Central

    Mallidi, Jaya; Nadkarni, Girish N.; Berger, Ronald D.; Calkins, Hugh; Nazarian, Saman

    2010-01-01

    Background Most studies of catheter ablation for treatment of ventricular tachycardia (VT) are relatively small observational trials. Objectives To define the relative risk of VT recurrence in patients undergoing catheter ablation as an adjunct to medical therapy versus medical therapy alone in a pooled analysis of controlled studies. Methods Randomized and non-randomized controlled trials of patients who underwent adjunctive catheter ablation of VT versus medical therapy alone were sought. MEDLINE, EMBASE, the Cochrane Central register of controlled trials (CENTRAL), and Web of Science were searched from 1965 to July 2010. Supplemental searches included Internet resources, reference lists, and reports of arrhythmia experts. Three authors independently reviewed and extracted the data regarding baseline characteristics, ablation methodology, medical therapy, complications, VT recurrences, mortality, and study quality. Results Five studies were included totaling 457 participants with structural heart disease. Adjunctive catheter ablation was performed in 58% of participants whereas 42% received medical therapy alone for VT. Complications of catheter ablation included death (1%), stroke (1%), cardiac perforation (1%), and complete heart block (1.6%). Using a random effects model, a statistically significant 35% reduction in the number of patients with VT recurrence was noted with adjunctive catheter ablation (P < 0.001). There was no statistically significant difference in mortality. Conclusion Catheter ablation as an adjunct to medical therapy reduces VT recurrences in patients with structural heart disease and has no impact on mortality. PMID:21147263

  7. Lone Atrial Fibrillation Is Associated With Impaired Left Ventricular Energetics That Persists Despite Successful Catheter Ablation

    PubMed Central

    Wijesurendra, Rohan S.; Liu, Alexander; Eichhorn, Christian; Ariga, Rina; Levelt, Eylem; Clarke, William T.; Rodgers, Christopher T.; Karamitsos, Theodoros D.; Bashir, Yaver; Ginks, Matthew; Rajappan, Kim; Betts, Tim; Ferreira, Vanessa M.; Neubauer, Stefan

    2016-01-01

    Background: Lone atrial fibrillation (AF) may reflect a subclinical cardiomyopathy that persists after sinus rhythm (SR) restoration, providing a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics in patients with AF but no significant comorbidities. Methods: Fifty-three patients with symptomatic paroxysmal or persistent AF and without significant valvular disease, uncontrolled hypertension, coronary artery disease, uncontrolled thyroid disease, systemic inflammatory disease, diabetes mellitus, or obstructive sleep apnea (ie, lone AF) undergoing ablation and 25 matched control subjects in SR were investigated. Magnetic resonance imaging quantified LV ejection fraction (LVEF), peak systolic circumferential strain (PSCS), and left atrial volumes and function, whereas phosphorus-31 magnetic resonance spectroscopy evaluated ventricular energetics (ratio of phosphocreatine to ATP). AF burden was determined before and after ablation by 7-day Holter monitoring; intermittent ECG event monitoring was also undertaken after ablation to investigate for asymptomatic AF recurrence. Results: Before ablation, both LV function and energetics were significantly impaired in patients compared with control subjects (LVEF, 61% [interquartile range (IQR), 52%–65%] versus 71% [IQR, 69%–73%], P<0.001; PSCS, –15% [IQR, –11 to –18%] versus −18% [IQR, –17% to –19%], P=0.002; ratio of phosphocreatine to ATP, 1.81±0.35 versus 2.05±0.29, P=0.004). As expected, patients also had dilated and impaired left atria compared with control subjects (all P<0.001). Early after ablation (1–4 days), LVEF and PSCS improved in patients recovering SR from AF (LVEF, 7.0±10%, P=0.005; PSCS, –3.5±4.3%, P=0.001) but were unchanged in those in SR during both assessments (both P=NS). At 6 to 9 months after ablation, AF burden reduced significantly (from 54% [IQR, 1.5%–100%] to

  8. Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Park, Yae Min; Kook, Hyungdon; Kim, Woohyeon; Lee, Son Ki; Choi, Jong-Il; Lim, Hong Euy; Park, Sang Weon

    2013-01-01

    Background and Objectives The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF). Subjects and Methods A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. Results Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications. Conclusion The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation. PMID:23407327

  9. Metabolic syndrome and risk of recurrence of atrial fibrillation after catheter ablation.

    PubMed

    Tang, Ri-Bo; Dong, Jian-Zeng; Liu, Xing-Peng; Long, De-Yong; Yu, Rong-Hui; Kalifa, Jérôme; Ma, Chang-Sheng

    2009-03-01

    Metabolic syndrome (MetS), as well as several risk factors of cardiovascular diseases, is known to be associated with atrial fibrillation (AF), but its impact on the recurrence of AF after catheter ablation has not been explored. The data for 654 consecutive AF patients who underwent an index circumferential pulmonary vein ablation were retrospectively analyzed. Of them, 323 (49.4%) had MetS according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria and Chinese ethnic criteria. After a mean follow-up of 470+/-323 (91-1,245) days, patients with MetS had a significantly higher incidence of AF recurrence (43.7%) compared with non-MetS patients (30.5%, P<0.001). Univariate analysis revealed that nonparoxysmal AF, left atrial size, MetS and body mass index were predictors of AF recurrence. Multivariate analysis revealed that MetS (hazard ratio =1.64, 95% confidence interval (CI) 1.07-2.49, P=0.022) and nonparoxysmal AF (hazard ratio =1.57, 95% CI 1.15-2.14, P=0.004) were independent predictors of AF recurrence. The major complications rate did not differ between the MetS and the non-MetS groups (1.86% vs 2.42%, P=0.621). MetS diagnosed prior to AF ablation is an independent predictor of AF recurrence.

  10. Radiofrequency catheter ablation of intractable ventricular tachycardia in an infant following arterial switch operation.

    PubMed

    Costello, John P; He, Dingchao; Greene, Elizabeth A; Berul, Charles I; Moak, Jeffrey P; Nath, Dilip S

    2014-01-01

    A full-term male neonate presented with cyanosis upon delivery and was subsequently diagnosed with d-transposition of the great arteries, ventricular septal defect, and restrictive atrial septal defect. Following initiation of intravenous prostaglandins and balloon atrial septostomy, an arterial switch operation was performed on day 3 of life. The postoperative course was complicated by intractable ventricular tachycardia that was refractory to lidocaine, amiodarone, esmolol, fosphenytoin, and mexiletine drug therapy. Ventricular tachycardia was suppressed with overdrive atrial pacing but recurred upon discontinuation. Seven weeks postoperatively, radiofrequency catheter ablation was performed due to hemodynamically compromising persistent ventricular tachycardia refractory to medical therapy. The ventricular tachycardia was localized to the inferior-lateral right ventricular outlet septum. The procedure was successful without complications or recurrence. Antiarrhythmics were discontinued after the ablation procedure. Seven days after the ablation, a different, slower fascicular rhythm was noted to compete with the infant's sinus rhythm. This was consistent with the preablation amiodarone having reached subtherapeutic levels given its very long half-life. The patient was restarted on oral beta blockers and amiodarone. The patient was subsequently discharged home in predominantly sinus rhythm with intermittent fascicular rhythm.

  11. Catheter-based high-intensity ultrasound for epicardial ablation of the left ventricle: device design and in vivo feasiblity

    NASA Astrophysics Data System (ADS)

    Salgaonkar, Vasant A.; Nazer, Babak; Jones, Peter D.; Tanaka, Yasuaki; Martin, Alastair; Ng, Bennett; Duggirala, Srikant; Diederich, Chris J.; Gerstenfeld, Edward P.

    2015-03-01

    The development and in vivo testing of a high-intensity ultrasound thermal ablation catheter for epicardial ablation of the left ventricle (LV) is presented. Scar tissue can occur in the mid-myocardial and epicardial space in patients with nonischemic cardiomyopathy and lead to ventricular tachycardia. Current ablation technology uses radiofrequency energy, which is limited epicardially by the presence of coronary vessels, phrenic nerves, and fat. Ultrasound energy can be precisely directed to deliver targeted deep epicardial ablation while sparing intervening epicardial nerve and vessels. The proof-of-concept ultrasound applicators were designed for sub-xyphoid access to the pericardial space through a steerable 14-Fr sheath. The catheter consists of two rectangular planar transducers, for therapy (6.4 MHz) and imaging (5 MHz), mounted at the tip of a 3.5-mm flexible nylon catheter coupled and encapsulated within a custom-shaped balloon for cooling. Thermal lesions were created in the LV in a swine (n = 10) model in vivo. The ultrasound applicator was positioned fluoroscopically. Its orientation and contact with the LV were verified using A-mode imaging and a radio-opaque marker. Ablations employed 60-s exposures at 15 - 30 W (electrical power). Histology indicated thermal coagulation and ablative lesions penetrating 8 - 12 mm into the left ventricle on lateral and anterior walls and along the left anterior descending artery. The transducer design enabled successful sparing from the epicardial surface to 2 - 4 mm of intervening ventricle tissue and epicardial fat. The feasibility of targeted epicardial ablation with catheter-based ultrasound was demonstrated.

  12. Catheter ablation of ventricular tachycardia and mortality in patients with nonischemic dilated cardiomyopathy: can noninducibility after ablation be a predictor for reduced mortality?

    PubMed

    Dinov, Borislav; Arya, Arash; Schratter, Alexandra; Schirripa, Valentina; Fiedler, Lukas; Sommer, Philipp; Bollmann, Andreas; Rolf, Sascha; Piorkowski, Christopher; Hindricks, Gerhard

    2015-06-01

    Data on outcomes after catheter ablation of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy (NIDCM) are insufficient. We aimed to investigate the effects of successful catheter ablation of VT on cardiac mortality in patients with NIDCM. One hundred two patients with NIDCM (86 men; mean age, 58.8±15.2 years; mean ejection fraction, 33.3±11.9%) underwent VT ablation. After catheter ablation, a programmed ventricular stimulation to test for success was performed. Complete VT noninducibility was achieved in 62 (61%) patients and partial success or failure in 32 (31%) patients. During 2 years of follow-up, VT recurrence was observed in 33 patients (53%) without inducible VTs and in 24 patients (75%) with inducible VT inducible (P=0.041). VT inducibility was associated with higher VT recurrence (adjusted hazard ratio, 1.84; 95% confidence interval, 1.08-3.13; P=0.025). The primary end point of all-cause mortality was reached in 9 patients (15%) with noninducible VTs versus 11 patients (34%) with inducible sustained VTs (P=0.026). VT inducibility was associated with all-cause mortality (adjusted hazard ratio, 2.73; 95% confidence interval, 1.003-7.43; P=0.049). In patients with NIDCM and recurrent sustained VTs, a complete ablation of all inducible VTs may be achieved in 60% of the cases. The complete noninducibility may be a preferable end point of ablation because it was associated with better long-term success. Importantly, if possible to achieve through ablation, a complete VT noninducibility was associated with reduction of the likelihood for all-cause mortality in patients with NIDCM. © 2015 American Heart Association, Inc.

  13. Patient specific optimization-based treatment planning for catheter-based ultrasound hyperthermia and thermal ablation

    NASA Astrophysics Data System (ADS)

    Prakash, Punit; Chen, Xin; Wootton, Jeffery; Pouliot, Jean; Hsu, I.-Chow; Diederich, Chris J.

    2009-02-01

    to model thermal ablation, including the addition of temperature dependent attenuation, perfusion, and tissue damage. Pilot point control at the target boundaries was implemented to control power delivery to each transducer section, simulating an approach feasible for MR guided procedures. The computer model of thermal ablation was evaluated on representative patient anatomies to demonstrate the feasibility of using catheter-based ultrasound thermal ablation for treatment of benign prostate hyperplasia (BPH) and prostate cancer, and to assist in designing applicators and treatment delivery strategies.

  14. Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation.

    PubMed

    Hwang, Minki; Kwon, Soon-Sung; Wi, Jin; Park, Mijin; Lee, Hyun-Seung; Park, Jin-Seo; Lee, Young-Seon; Shim, Eun Bo; Pak, Hui-Nam

    2014-09-01

    Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. 1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols. Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Cryoablation versus radiofrequency ablation for treatment of atrioventricular nodal reentrant tachycardia: cryoablation with 6-mm-tip catheters is still less effective than radiofrequency ablation.

    PubMed

    Opel, Aaisha; Murray, Sam; Kamath, Nikhil; Dhinoja, Mehul; Abrams, Dominic; Sporton, Simon; Schilling, Richard; Earley, Mark

    2010-03-01

    The treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) is catheter ablation of the atrioventricular nodal slow pathway. The purpose of this study was to ascertain whether cryoablation (Cryo) with 6-mm-tip catheters is as effective as radiofrequency ablation (RF). Patients who had catheter ablation for AVNRT between 2005 and 2008 were identified. The main outcome measure was overall success without the use of an alternative energy source and no recurrence. Two hundred eighty-eight procedures in 272 patients were identified; 184 were female (68%), and the mean age was 53 +/- 14 (17-88) years. There were 123 Cryo and 149 RF procedures. Cryo had a lower overall success rate (83% vs. 93%; P = .02). Mean procedure times were similar in both groups (90 minutes; P = .5). Fluoroscopy time was longer with Cryo: 16 (7-48) versus 14 (5-50) minutes (P = .04). Only one case of atrioventricular block was observed in the RF group (0.7%). Cryo was more expensive than RF ( pounds sterling 3141 vs. pounds sterling 2153). Even when delivering multiple lesions with 6-mm-tip catheters, Cryo is less effective than RF. RF is recommended as a first-line treatment, although the only major complication occurred in the RF group. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  16. Value of superficial cultures for prediction of catheter-related bloodstream infection in long-term catheters: a prospective study.

    PubMed

    Guembe, M; Martín-Rabadán, P; Echenagusia, A; Camúñez, F; Rodríguez-Rosales, G; Simó, G; Echenagusia, M; Bouza, E

    2013-09-01

    Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports.

  17. Value of Superficial Cultures for Prediction of Catheter-Related Bloodstream Infection in Long-Term Catheters: a Prospective Study

    PubMed Central

    Martín-Rabadán, P.; Echenagusia, A.; Camúñez, F.; Rodríguez-Rosales, G.; Simó, G.; Echenagusia, M.; Bouza, E.

    2013-01-01

    Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports. PMID:23850957

  18. Propofol sedation administered by cardiologists for patients undergoing catheter ablation for ventricular tachycardia.

    PubMed

    Servatius, Helge; Höfeler, Thormen; Hoffmann, Boris A; Sultan, Arian; Lüker, Jakob; Schäffer, Benjamin; Willems, Stephan; Steven, Daniel

    2016-08-01

    Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision. Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed. The primary endpoint was change of sedation and/or discontinuation of propofol sedation due to side effects and/or haemodynamic instability. Propofol cessation was necessary in 24 of 205 procedures. These procedures (Group A; n = 24, 11.7%) were compared with those with continued propofol sedation (Group B; n = 181, 88.3%). Propofol sedation was discontinued due to hypotension (n = 22; 10.7%), insufficient oxygenation (n = 1, 0.5%), or hypersalivation (n = 1, 0.5%). Procedures in Group A were significantly longer (210 [180-260] vs. 180 [125-220] min, P = 0.005), had a lower per hour propofol rate (3.0 ± 1.2 vs. 3.8 ± 1.2 mg/kg of body weight/h, P = 0.004), and higher cumulative dose of fentanyl administered (0.15 [0.13-0.25] vs. 0.1 [0.05-0.13] mg, P < 0.001), compared with patients in Group B. Five (2.4%) adverse events occurred. Sedation using propofol can be safely performed for VT ablation under the supervision of cardiologists. Close haemodynamic monitoring is required, especially in elderly patients and during lengthy procedures, which carrying a higher risk for systolic blood pressure decline. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  19. Catheter Ablation of Ventricular Tachycardia in the Presence of an Old Endocavitary Thrombus Guided by Intracardiac Echocardiography.

    PubMed

    Peichl, Petr; Wichterle, Dan; Čihák, Robert; Aldhoon, Bashar; Kautzner, Josef

    2016-06-01

    Catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is effective in prevention of arrhythmia recurrences. However, endocardial ablation may be challenging in the presence of organized left ventricular (LV) endocavitary thrombus. Our goal was to analyze the results of VT ablation in patients with identified old thrombus. We reviewed clinical and procedural data of 344 consecutive patients who underwent VT ablation for SHD. Old endocavitary thrombus was identified in four patients by preprocedural transthoracic echocardiography (TTE) and in four more patients by intracardiac echocardiography (ICE). All together, the case series of eight patients with detectable thrombus is reported. All patients (one woman, age: 67 ± 7 years) had postinfarction aneurysm (20 ± 8 years after the index myocardial infarction) and the thrombus was well organized without mobile structures. Arrhythmogenic substrate could not be obviously targeted beneath the base of thrombus; however, catheter ablation was successfully performed in the close vicinity. A total of 2.4 ± 1.2 procedures were necessary to abolish VT recurrences. Epicardial ablation was performed in three of eight (38%) patients as a second elective procedure. No procedural or periprocedural complications were observed. During the follow-up of 14 ± 15 months, two patients (25%) had sporadic VT recurrences. ICE seems to be more sensitive for the detection of LV thrombi compared to TTE and is helpful in real-time navigation of mapping/ablation catheter. Besides potential thromboembolic risk, large thrombus may prevent accessibility to the "critical" portion of arrhythmia circuit and epicardial ablation is required in selected cases. © 2016 Wiley Periodicals, Inc.

  20. Radiation exposure to operator and patients during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures

    NASA Astrophysics Data System (ADS)

    Lee, C. H.; Cho, J. H.; Park, S. J.; Kim, J. S.; On, Y. K.; Huh, J.

    2015-10-01

    The purpose of this study was to measure the radiation exposure to operator and patient during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures and to calculate the allowable number of cases per year. We carried out 9 electrophysiology studies, 40 radiofrequency catheter ablation and 11 cardiac device implantation procedures. To measure occupational radiation dose and dose-area product (DAP), 13 photoluminescence glass dosimeters were placed at eyes (inside and outside lead glass), thyroids (inside and outside thyroid collar), chest (inside and outside lead apron), wrists, genital of the operator (inside lead apron), and 6 of photoluminescence glass dosimeters were placed at eyes, thyroids, chest and genital of the patient. Exposure time and DAP values were 11.7 ± 11.8 min and 23.2 ± 26.2 Gy cm2 for electrophysiology study; 36.5 ± 42.1 min and 822.4 ± 125.5 Gy cm2 for radiofrequency catheter ablation; 16.2 ± 9.3 min and 27.8 ± 16.5 Gy cm2 for cardiac device implantation procedure, prospectively. 4591 electrophysiology studies can be conducted within the occupational exposure limit for the eyes (150 mSv), and 658-electrophysiology studies with radiofrequency catheter ablation can be carried out within the occupational exposure limit for the hands (500 mSv). 1654 cardiac device implantation procedure can be conducted within the occupational exposure limit for the eyes (150 mSv). The amounts of the operator and patient's radiation exposure were comparatively small. So, electrophysiology study, radio frequency catheter ablation and cardiac device implantation procedures are safe when performed with modern equipment and optimized protective radiation protect equipment.

  1. Six year follow-up after catheter ablation of atrial fibrillation: a palliation more than a true cure.

    PubMed

    Sorgente, Antonio; Tung, Patricia; Wylie, Jack; Josephson, Mark E

    2012-04-15

    Long-term outcomes after pulmonary vein isolation for atrial fibrillation (AF) remain uncertain. In particular, the influence of rigorous arrhythmia monitoring on outcomes is not yet clear. In this study, 103 patients with symptomatic AF who underwent catheter ablation at a single academic medical center from 2002 to 2006 were evaluated, with a median follow-up time of 6 years. The primary end point was the success rate of catheter ablation, defined as the absence of any atrial arrhythmia recurrence lasting >10 seconds at the clinical visit and electrocardiographic or long-term cardiac rhythm recording after a single procedure and after the last procedure. In all, 153 procedures were performed, with a median of 1 (interquartile range 1 to 2) per patient as follows: 61 had 1, 35 had 2, 6 had 3, and 1 had 4 catheter ablations. Freedom from all atrial arrhythmias was present in 23% of patients at 6 years after a single procedure and in 39% of patients after the last procedure. No clinical predictors of AF recurrence were recognized after a single procedure, whereas after the last procedure, in univariate and multivariate Cox regression analysis, only nonparoxysmal AF (hazard ratio 1.92, 95% confidence interval 1.07 to 3.47, p = 0.02) was a predictor of recurrence. In conclusion, AF recurrence at 6-year follow-up after catheter ablation in a selected group of patients with symptomatic drug-refractory AF was relatively high, with 2/3 of AF relapses occurring in the first year of follow-up. Strict clinical surveillance after catheter ablation should be considered to help guide clinical decisions.

  2. Long-Term Outcome With Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.

    PubMed

    Santangeli, Pasquale; Zado, Erica S; Supple, Gregory E; Haqqani, Haris M; Garcia, Fermin C; Tschabrunn, Cory M; Callans, David J; Lin, David; Dixit, Sanjay; Hutchinson, Mathew D; Riley, Michael P; Marchlinski, Francis E

    2015-12-01

    Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy improves short-term VT-free survival. We sought to determine the long-term outcomes of VT control and need for antiarrhythmic drug therapy after endocardial (ENDO) and adjuvant epicardial (EPI) substrate modification in patients with arrhythmogenic right ventricular cardiomyopathy. We examined 62 consecutive patients with Task Force criteria for arrhythmogenic right ventricular cardiomyopathy referred for VT ablation with a minimum follow-up of 1 year. Catheter ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal substrate for unmappable VT. Adjuvant EPI ablation was performed when recurrent VT or persistent inducibility after ENDO-only ablation. Endocardial plus adjuvant EPI ablation was performed in 39 (63%) patients, including 13 who crossed over to ENDO-EPI after VT recurrence during follow-up, after ENDO-only ablation. Before ablation, 54 of 62 patients failed a mean of 2.4 antiarrhythmic drugs, including amiodarone in 29 (47%) patients. During follow-up of 56±44 months after the last ablation, VT-free survival was 71% with only a single VT episode in additional 9 patients (15%). At last follow-up, 39 (64%) patients were only on β-blockers or no treatment, 21 were on class 1 or 3 antiarrhythmic drugs (11 for atrial arrhythmias), and 2 were on amiodarone as a bridge to heart transplantation. The long-term outcome after ENDO and adjuvant EPI substrate ablation of VT in arrhythmogenic right ventricular cardiomyopathy is good. Most patients have complete VT control without amiodarone therapy and limited need for antiarrhythmic drugs. © 2015 American Heart Association, Inc.

  3. Inappropriate Sinus Tachycardia Diagnosed and Treated as Depression Successfully Treated by Radiofrequency Catheter Ablation.

    PubMed

    Masumoto, Akihiro; Takemoto, Masao; Mito, Takahiro; Tanaka, Atsushi; Kawano, Yuki; Kumeda, Hiroshi; Kang, Honsa; Matsuo, Atsutoshi; Hida, Satoru; Okazaki, Teiji; Tayama, Kei-Ichiro; Yoshitake, Kiyonobu; Kosuga, Kenichi

    2017-01-01

    We experienced a man in his 20s with inappropriate sinus tachycardia (IST) initially diagnosed and treated as depression who was steadily treated with radiofrequency catheter ablation (RFCA) using an EnSite™ system. The patient has remained well without any symptoms or medications, including antidepressants, for two years since the RFCA. To avoid missing IST and treating it as an emotional problem and/or mental illness such as depression, physicians - including cardiologists - should be aware of these conditions when examining patients with multiple and incapacitating complaints including palpitations and general fatigue and/or tachycardia, especially characterized by an elevated resting heart rate or a disproportionate increase in the heart rate with minimal exertion.

  4. Prevalence, characteristics, and predictors of pulmonary vein narrowing after isolation using the pulmonary vein ablation catheter.

    PubMed

    De Greef, Yves; Tavernier, Rene; Raeymaeckers, Steven; Schwagten, Bruno; Desurgeloose, Didier; De Keulenaer, Gilles; Stockman, Dirk; De Buyzere, Marc; Duytschaever, Mattias

    2012-02-01

    The risk of pulmonary vein narrowing (PVN) after pulmonary vein isolation, using a novel multi-electrode ablation catheter, is unknown. Left atrial volume and PV diameters were compared by computed tomography (CT) before and 3 months after pulmonary vein isolation using duty-cycled phased radio frequency energy (2:1 or 4:1 bipolar/unipolar ratio) in 50 patients. Pulmonary vein diameter was measured in a coronal and axial view at 3 levels (A, ostium; B, 1 cm more distal; C, 2 cm more distal). Moderate PVN was defined as a pulmonary vein diameter reduction of 25 to 50%, and severe PVN as >50%. Left atrial volume decreased by 12±12% (P<0.01). Axial pulmonary vein diameter shortened by a median of 16% (interquartile range [IQR] 28 to 5%), 13% (IQR 25 to 5%), and 9% (IQR 21 to -3%) at level A, B, and C, respectively (P<0.01 for all); coronal pulmonary vein diameter decreased by a median of 16% (IQR 24 to 7%), 11% (IQR 21 to 4%), and 8% (IQR 18 to -2%; P<0.01 for all). Moderate PVN occurred in 30% of the PVs, in 78% of the patients; severe PVN occurred in 4% of the PVs, in 15% of the patients. PV diameter reduction was not related to changes in left atrial volume. Isolation of the pulmonary veins using a multielectrode ablation catheter and duty cycled phased radiofrequency energy delivery results in a consistent moderate reduction of the PV diameters predominantly at the ostium. Severe PVN in 15% of patients raises concerns about the risk for clinical PV stenosis.

  5. Novel use of epidural catheter: Air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma

    PubMed Central

    Doctor, JR; Solanki, SL; Patil, VP; Divatia, JV

    2016-01-01

    Osteoid osteoma (OO) is a benign bone tumor, with a male-female ratio of approximately 2:1 and mainly affecting long bones. Ten percent of the lesions occur in the spine, mostly within the posterior elements. Treatment options for OO include surgical excision and percutaneous imaging-guided radiofrequency ablation (RFA). Lesions within the spine have an inherent risk of thermal damage to the vital structure because of proximity to the neural elements. We report a novel use of the epidural catheter for air injection for the neuroprotection of nerves close to the OO of the spine. A 12-year-old and 30 kg male child with an OO of the L3 vertebra was taken up for RFA. His preoperative examinations were within normal limits. The OO was very close to the L3 nerve root. Under general anesthesia, lumbar epidural catheter was placed in the L3-L4 space under imaging guidance. Ten ml of aliquots of air was injected under imaging guidance to avoid injury to the neural structures due to RFA. The air created a gap between neural elements and the tumor and served as an insulating material thereby protecting the neural elements from damage due to the RFA. Postoperatively, the patient did not develop any neurological deficit. PMID:27375396

  6. The biophysics of radiofrequency catheter ablation in the heart: the importance of temperature monitoring.

    PubMed

    Haines, D E

    1993-03-01

    Radiofrequency (RF) catheter ablation is a technique whereby high frequency alternating electrical current with frequencies of 350 kHz to 1 MHz is delivered through electrode catheters to myocardial tissue creating a thermal lesion. The mechanism by which RF current heats tissue is resistive (or ohmic) heating of a narrow rim (< 1 mm) of tissue that is in direct contact with the electrode. Deeper tissue planes are then heated by conduction from the small region of volume heating. Heat is dissipated from the region by further heat conduction into normothermic tissue, and by heat convection via the circulating blood pool and larger coronary vessels. The lesion size is proportional to the temperature at the electrode-tissue interface (which is also a function of power level if electrical factors remain constant), and to the size of the electrode. At temperatures above 100 degrees C, boiling occurs at the electrode-tissue contact point resulting in a rapid rise in electrical impedance. Therefore, a theoretical maximum lesion size exists for any given electrode geometry. Other factors that are important for RF lesion formation include electrode-tissue contact pressure and duration of RF delivery. Temperature rises monoexponentially, and duration of energy delivery should be at least 35 to 45 seconds to approach steady state.

  7. Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis

    PubMed Central

    Lin, Kueiyu Joshua; Cho, Soung Ick; Tiwari, Nidhish; Bergman, Michael; Kizer, Jorge R.; Palma, Eugen C.; Taub, Cynthia C.

    2015-01-01

    Purpose The impact of metabolic syndrome (MetS) on recurrence of atrial fibrillation (AF) after catheter ablation remains uncertain. We conducted a meta-analysis to summarize the relative risks (RR) of AF recurrence after catheter ablation in patients with vs. without MetS and its components. Methods Among 839 articles identified from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, we included 23 studies with a total of 12,924 patients (7,594 with paroxysmal AF and 5,330 with nonparoxysmal AF) for analysis. Five of these had complete information on MetS components. Variables assessed comprised study design and population characteristics, AF ablation methods, use of anti-arrhythmic drugs, AF recurrence ascertainment methods, adjustment variables, and other quality indicators. Results Our meta-analysis found an elevated risk of AF recurrence after ablation in patients with vs. without MetS (pooled RR, 1.63; 95 % confidence interval (CI), 1.25–2.12). Among components of MetS, hypertension was a predictor of AF post-ablation recurrence in studies without adjustment for other MetS components (RR, 1.62; 95 % CI, 1.23–2.13) but not in those adjusting for two or more additional MetS components (RR, 1.03; 95 % CI, 0.88–1.20). There was a borderline association between overweight/obesity and AF recurrence after ablation (RR, 1.27; 95 % CI, 0.99–1.64). Conclusions MetS is associated with an increased risk of AF recurrence after catheter ablation. Further study of the MetS and its components as determinants of AF risk could help refine patient selection and improve procedural outcomes. PMID:24346619

  8. Sinus node revisited in the era of electroanatomical mapping and catheter ablation.

    PubMed

    Sánchez-Quintana, D; Cabrera, J A; Farré, J; Climent, V; Anderson, R H; Ho, S Y

    2005-02-01

    To study the architecture of the human sinus node to facilitate understanding of mapping and ablative procedures in its vicinity. The sinoatrial region was examined in 47 randomly selected adult human hearts by histological analysis and scanning electron microscopy. The sinus node, crescent-like in shape, and 13.5 (2.5) mm long, was not insulated by a sheath of fibrous tissue. Its margins were irregular, with multiple radiations interdigitating with ordinary atrial myocardium. The distances from the node to endocardium and epicardium were variable. In 72% of the hearts, the whole nodal body was subepicardial and in 13 specimens (28%) the inner aspect of the nodal body was subendocardial. The nodal body cranial to the sinus nodal artery was more subendocardial than the remaining nodal portion, which was separated from the endocardium by the terminal crest. In 50% of hearts, the most caudal boundaries of the body of the node were at least 3.5 mm from the endocardium. When the terminal crest was > 7 mm thick (13 hearts, 28%), the tail was subepicardial or intramyocardial and at least 3 mm from the endocardium. The length of the node, the absence of an insulating sheath, the presence of nodal radiations, and caudal fragments offer a potential for multiple breakthroughs of the nodal wavefront. The very extensive location of the nodal tissue, the cooling effect of the nodal artery, and the interposing thick terminal crest caudal to this artery have implications for nodal ablation or modification with endocardial catheter techniques.

  9. Evaluation of exposure dose to patients undergoing catheter ablation procedures--a phantom study.

    PubMed

    Seguchi, S; Aoyama, T; Koyama, S; Kawaura, C; Fujii, K

    2008-11-01

    The aim of this study was to evaluate entrance skin dose (ESD), organ dose and effective dose to patients undergoing catheter ablation for cardiac arrhythmias, based on the dosimetry in an anthropomorphic phantom. ESD values associated with mean fluoroscopy time and digital cine frames were in a range of 0.12-0.30 Gy in right anterior oblique (RAO) and 0.05-0.40 Gy in left anterior oblique (LAO) projection, the values which were less than a threshold dose of 2 Gy for the onset of skin injury. Organs that received high doses in ablation procedures were lung, followed by bone surface, esophagus, liver and red bone marrow. Doses for lung were 24.8-122.7 mGy, and effective doses were 7.9-34.8 mSv for mean fluoroscopy time of 23.4-92.3 min and digital cine frames of 263-511. Conversion coefficients of dose-area product (DAP) to ESD were 8.7 mGy/(Gy cm(2)) in RAO and 7.4 mGy/(Gy cm(2)) in LAO projection. The coefficients of DAP to the effective dose were 0.37 mSv/(Gy cm(2)) in RAO, and 0.41 mSv/(Gy cm(2)) in LAO projection. These coefficients enabled us to estimate patient exposure in real time by using monitored values of DAP.

  10. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.

    PubMed

    Tung, Roderick; Vaseghi, Marmar; Frankel, David S; Vergara, Pasquale; Di Biase, Luigi; Nagashima, Koichi; Yu, Ricky; Vangala, Sitaram; Tseng, Chi-Hong; Choi, Eue-Keun; Khurshid, Shaan; Patel, Mehul; Mathuria, Nilesh; Nakahara, Shiro; Tzou, Wendy S; Sauer, William H; Vakil, Kairav; Tedrow, Usha; Burkhardt, J David; Tholakanahalli, Venkatakrishna N; Saliaris, Anastasios; Dickfeld, Timm; Weiss, J Peter; Bunch, T Jared; Reddy, Madhu; Kanmanthareddy, Arun; Callans, David J; Lakkireddy, Dhanunjaya; Natale, Andrea; Marchlinski, Francis; Stevenson, William G; Della Bella, Paolo; Shivkumar, Kalyanam

    2015-09-01

    The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT. Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P<.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P<.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence. Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. Bipolar radiofrequency ablation of spinal tumors: predictability, safety and outcome.

    PubMed

    Gazis, Angelos N; Beuing, Oliver; Franke, Jörg; Jöllenbeck, Boris; Skalej, Martin

    2014-04-01

    Bone metastases are often the cause of tumor-associated pain and reduction of quality of life. For patients that cannot be treated by surgery, a local minimally invasive therapy such as radiofrequency ablation can be a useful option. In cases in which tumorous masses are adjacent to vulnerable structures, the monopolar radiofrequency can cause severe neuronal damage because of the unpredictability of current flow. The aim of this study is to show that the bipolar radiofrequency ablation provides an opportunity to safely treat such spinal lesions because of precise predictability of the emerging ablation zone. Prospective cohort study of 36 patients undergoing treatment at a single institution. Thirty-six patients in advanced tumor stage with primary or secondary tumor involvement of spine undergoing radiofrequency ablation. Prediction of emerging ablation zone. Clinical outcome of treated patients. X-ray-controlled treatment of 39 lesions by bipolar radiofrequency ablation. Magnetic resonance imaging was performed pre- and postinterventionally. Patients were observed clinically during their postinterventional stay. The extent of the ablation zones was predictable to the millimeter because it did not cross the peri-interventional planned dorsal and ventral boundaries in any case. No complications were observed. Ablation of tumorous masses adjacent to vulnerable structures is feasible and predictable by using the bipolar radiofrequency ablation. Damage of neuronal structures can be avoided through precise prediction of the ablation area. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Efficacy and safety of driver-guided catheter ablation for atrial fibrillation: A systematic review and meta-analysis.

    PubMed

    Ramirez, F Daniel; Birnie, David H; Nair, Girish M; Szczotka, Agnieszka; Redpath, Calum J; Sadek, Mouhannad M; Nery, Pablo B

    2017-08-11

    Targeting localized drivers (electrical rotors or focal impulses) during catheter ablation for atrial fibrillation (AF) has been proposed as a strategy to improve procedural success. However, the strength and quality of the evidence to support this approach is unclear. Clinical studies reporting efficacy or safety outcomes of driver-guided ablation for AF were identified in Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Pubmed, and conference abstracts from major scientific meetings. Random-effects meta-analysis of efficacy outcomes from controlled studies was performed. Thirty-one reports from 30 studies were included: two randomized controlled trials, five nonrandomized controlled studies, and 23 uncontrolled studies. In controlled studies, driver-guided ablation has been associated with higher rates of acute AF termination (RR 2.08, 95% CI 1.43-3.05; P < 0.001) and increased freedom from AF/atrial tachycardia (AT) at ≥1 year (RR 1.34, 95% CI 1.05-1.70; P = 0.02). Similar rates of procedural complications have been reported between ablation strategies. Overall, current data on driver-guided ablation are predominantly from nonrandomized studies with considerable heterogeneity in mapping and ablation strategies used and in clinical outcomes reported. Pooled data on the efficacy of AF driver-guided catheter ablation suggest increased freedom from AF/AT relative to conventional strategies. However, most studies are nonrandomized and of moderate quality. Though promising data exist, there remains no conclusive evidence for the efficacy of AF driver ablation. Robust data from randomized trials are needed. © 2017 Wiley Periodicals, Inc.

  13. Two-dimensional echocardiographic features of the inferior right atrial isthmus: the role of vestibular thickness in catheter ablation of atrial flutter.

    PubMed

    Marcos-Alberca, Pedro; Sánchez-Quintana, Damián; Cabrera, José A; Farré, Jerónimo; Rubio, José M; de Agustín, Jose A; Almería, Carlos; Pérez-Isla, Leopoldo; Macaya, Carlos

    2014-01-01

    The aim of this study was to examine the feasibility of transthoracic two-dimensional (2D)-echocardiography in defining the cavo-tricuspid isthmus (CTI) anatomy and its value concerning the ease of catheter ablation of isthmic atrial flutter (AF). CTI analysis was accomplished in 39 cases: 16 necropsy specimens and 23 patients. Sixteen were patients with isthmus-dependent AF and seven controls with other supraventricular re-entrant tachycardias. Two-dimensional transthoracic echocardiography and a right atrium angiogram were performed before radiofrequency catheter ablation (RFCA). The measurements of the CTI with angiography were compared with those taken with echocardiography and correlation was excellent (r= 0.91; P < 0.0001). In normal patients, the dimension of the vestibular thickness was successfully compared and validated with the histological examination of the necropsy specimens: histology median 6.8 mm, range 4.4-10.5 vs. echo median 6.2 mm, range 5.4-8.7; P: NS. Vestibular thickness was greater in complex than in simple RFCA (13.6 ± 1.9 mm vs. 10.0 ± 2.3 mm; P = 0.01). When vestibular thickness ≥11.5 mm, the ablation prone to be complex (sensitivity 83.3%, specificity 80%, positive predictive value 71.4%, and negative predictive value 88.9%). Two-dimensional transthoracic echocardiography clearly depicts the inferior isthmus and, displaying the thickness of the tricuspid vestibule, it was related with complexity of the ablation procedure in isthmus-dependent AF.

  14. Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device.

    PubMed

    Aryana, Arash; Gearoid O'Neill, P; Gregory, David; Scotti, Dennis; Bailey, Sean; Brunton, Scott; Chang, Michael; d'Avila, André

    2014-07-01

    Hemodynamic support using percutaneous left ventricular assist devices (pLVADs) during catheter mapping and ablation of unstable ventricular tachycardia (VT) can provide effective end-organ perfusion. However, its effect on procedural and clinical outcomes remains unclear. To retrospectively evaluate the procedural and clinical outcomes after the catheter ablation of unstable VT with and without pLVAD support. Sixty-eight consecutive unstable, scar-mediated endocardial and/or epicardial VT ablation procedures performed in 63 patients were evaluated. During VT mapping and ablation, hemodynamic support was provided by intravenous inotropes with a pLVAD (n = 34) or without a pLVAD (control; n = 34). Baseline patient characteristics were similar. VT was sustained longer with a pLVAD (27.4 ± 18.7 minutes) than without a pLVAD (5.3 ± 3.6 minutes) (P < .001). A higher number of VTs were terminated during ablation with a pLVAD (1.2 ± 0.9 per procedure) than without a pLVAD (0.4 ± 0.6 per procedure) (P < .001). Total radiofrequency ablation time was shorter with a pLVAD (53 ± 30 minutes) than without a pLVAD (68 ± 33 minutes) (P = .022), but with similar procedural success rates (71% for both pLVAD and control groups; P = 1.000). Although during 19 ± 12 months of follow-up VT recurrence did not differ between pLVAD (26%) and control (41%) groups (P = .305), the composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality was lower with a pLVAD (12%) than without a pLVAD (35%) (P = .043). In this nonrandomized retrospective study, catheter ablation of unstable VT supported by a pLVAD was associated with shorter ablation times and reduced hospital length of stay. While pLVAD support did not affect VT recurrence, it was associated with a lower composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month

  15. One-year clinical outcome after ablation with a novel multipolar irrigated ablation catheter for treatment of atrial fibrillation: potential implications for clinical use.

    PubMed

    Wakili, Reza; Siebermair, Johannes; Fichtner, Stephanie; Sinner, Moritz F; Klocker, Eva; Olesch, Lucia; Hilberath, Jan N; Sarai, Samira; Clauss, Sebastian; Sattler, Stefan; Kääb, Stefan; Estner, Heidi L

    2016-08-01

    Pulmonary vein isolation (PVI) is an established therapy for atrial fibrillation (AF). However, PVI remains a time-consuming procedure. A novel multipolar irrigated radiofrequency (RF) ablation catheter (nMARQ™) is aiming to improve PVI. We investigated the influence on procedural parameters and assessed clinical outcomes after PVI using this novel catheter. Fifty-eight consecutive patients with paroxysmal AF were equally allocated (n = 29/group) to PVI treatment with (i) the novel multipolar ablation catheter (nMARQ™) and (ii) a standard single-tip ablation catheter (SAC). Study endpoints included procedure time, fluoroscopy time, radiation dose, RF time, number of energy applications, and clinical outcome defined as freedom from AF after a single procedure. Successful PVI was confirmed by a separate circular, multipolar mapping catheter in all patients treated with the nMARQ™. Pulmonary vein isolation was achieved in 100% in the SAC group. In the nMARQ™ group, PVI was suggested in all patients. However, confirmatory mapping revealed persistent pulmonary vein (PV) conduction in 19 out of 29 nMARQ™ patients. These patients underwent further ablation, which still failed to achieve PVI in 5 of the 29 nMARQ™ patients, mainly due to significant temperature rise in the oesophagus and device-related limitations reaching the right inferior PV. Mean fluoroscopy time (31 ± 12 vs. 23 ± 10 min, P < 0.05) and (132 ± 37 vs. 109 ± 30 min, P < 0.05) were longer in nMARQ™ vs. SAC patients. Radiofrequency time was shorter in nMARQ™ vs. SAC group (21 ± 9 vs. 35 ± 12 min, P < 0.001). Radiation dose and the number of energy applications did not differ between both groups. Clinical outcome analysis revealed no significant differences (nMARQ™: 72 vs. SAC: 72%) after a mean follow-up of 373 ± 278 days. The use of the nMARQ™ catheter is associated with important device-related limitations to achieve successful PVI. However, clinical outcomes were equivalent in n

  16. Long-term results of radiofrequency catheter ablation in non-ischemic sustained ventricular tachycardia with underlying heart disease. Nonuniform arrhythmogenic substrate and mode of ablation.

    PubMed

    Chinushi, M; Aizawa, Y; Ohhira, K; Abe, A; Shibata, A

    1996-03-01

    This study examined 12 VTs in 8 patients who underwent radiofrequency (RF) catheter ablation for ventricular tachycardia (VT) associated with non-ischemic underlying heart diseases, and who were followed-up for more than 24 months after ablation. The site of VT origin was determined to be within a narrow site (within 1.0 x 1.0 cm) in 5 VTs (4 patients), but VT originated from a wide origin (more than 1.0 x 1.0 cm) in the other 5 VTs (3 patients). The remaining patient had two macroreentrant VTs revolving around an anatomical obstacle in both the clockwise and counterclockwise directions. Two of 5 VTs originating from a narrow site were successfully ablated by 2-3 RF applications. In VT associated with a wide origin, two perpendicular linear RF lesions with 6.0 +/- 1.8 RF applications were required to ablate the VT. Eight of the 12 VTs (66.7%) were finally ablated by RF current (30-50 watts), and they did not recur during the follow-up period of 31.2 +/- 6.5 months. An excellent long-term outcome is expected, even in VT associated with non-ischemic underlying heart disease, if VT is successfully treated by RF ablation.

  17. Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation--prospective study of 704 cases.

    PubMed

    Mateos, José Carlos Pachón; Mateos, Enrique I Pachón; Peña, Tomas G Santillana; Lobo, Tasso Julio; Mateos, Juán Carlos Pachón; Vargas, Remy Nelson A; Pachón, Carlos Thiene C; Acosta, Juán Carlos Zerpa

    2015-01-01

    Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality. This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8 ± 14 [17-84] years old), with mean EF of 0.66 ± 0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmonary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiography transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. The mean esophageal displacement was 4 to 9.1cm (5.9 ± 0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40ºC/irrigated catheter or 50W/60ºC/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11 ± 0.13ºC versus 1.1 ± 0.4ºC respectively, P<0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echocardiography transducer insertion were observed. Mechanical esophageal displacement by transesophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid esophageal thermal lesion. In most cases, the esophageal displacement was

  18. Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases

    PubMed Central

    Mateos, José Carlos Pachón; Mateos, Enrique I Pachón; Peña, Tomas G Santillana; Lobo, Tasso Julio; Mateos, Juán Carlos Pachón; Vargas, Remy Nelson A; Pachón, Carlos Thiene C; Acosta, Juán Carlos Zerpa

    2015-01-01

    Introduction Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality. Objective This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. Methods Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8±14 [17-84] years old), with mean EF of 0.66±0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmonary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiography transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. Results The mean esophageal displacement was 4 to 9.1cm (5.9±0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40ºC/irrigated catheter or 50W/60ºC/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11±0.13ºC versus 1.1±0.4ºC respectively, P<0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echocardiography transducer insertion were observed. Conclusion Mechanical esophageal displacement by transesophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid esophageal thermal lesion. In most

  19. Long-Term Success of Irrigated Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia: Post-Approval THERMOCOOL VT Trial.

    PubMed

    Marchlinski, Francis E; Haffajee, Charles I; Beshai, John F; Dickfeld, Timm-Michael L; Gonzalez, Mario D; Hsia, Henry H; Schuger, Claudio D; Beckman, Karen J; Bogun, Frank M; Pollak, Scott J; Bhandari, Anil K

    2016-02-16

    Radiofrequency catheter ablation is used to treat recurrent ventricular tachycardia (VT). This study evaluated long-term safety and effectiveness of radiofrequency catheter ablation using an open-irrigated catheter. Patients with sustained monomorphic ventricular tachycardia associated with coronary disease were analyzed for cardiovascular-specific adverse events within 7 days of treatment, hospitalization duration, 6-month sustained monomorphic ventricular tachycardia recurrence, quality of life measured by the Hospital Anxiety and Depression Scale, long-term (1-, 2-, and 3-year) survival, symptomatic VT control, and amiodarone use. Overall, 249 patients, mean age 67.4 years, were enrolled. The cardiovascular-specific adverse events rate was 3.9% (9 of 233) with no strokes. Noninducibility of targeted VT was achieved in 75.9% of patients. Post-ablation median hospitalization was 2 days. At 6 months, 62.0% (114 of 184) of patients had no sustained monomorphic ventricular tachycardia recurrence; the proportion of patients with implantable cardioverter-defibrillator shocks decreased from 81.2% to 26.8% (p < 0.0001); the frequency of VT in implantable cardioverter-defibrillator patients with recurrences was reduced by ≥50% in 63.8% of patients; and the proportion with normal Hospital Anxiety and Depression Scale scores increased from 48.8% to 69.1% (p < 0.001). Patient-reported VT remained steady for 1, 2, and 3 years at 22.7%, 29.8%, and 24.1%, respectively. Amiodarone use and hospitalization decreased from 55% and 77.2% pre-ablation to 23.3% and 30.7%, 18.5% and 36.7%, 17.7% and 31.3% at 1, 2, and 3 years, respectively. Radiofrequency catheter ablation reduced implantable cardioverter-defibrillator shocks and VT episodes and improved quality of life at 6 months. A steady 3-year nonrecurrence rate with reduced amiodarone use and hospitalizations indicate improved long-term outcomes. (NaviStar ThermoCool Catheter for Endocardial RF Ablation in Patients With

  20. In vitro evaluation of ice-cold saline irrigation during catheter radiofrequency ablation.

    PubMed

    Squara, Fabien; Maeda, Shingo; Aldhoon, Bashar; Marginiere, Julie; Santangeli, Pasquale; Chik, William W; Michele, John; Zado, Erica; Marchlinski, Francis E

    2014-10-01

    Irrigated radiofrequency (RF) catheters allow tissue-electrode interface cooling, decreasing thrombus risk while enabling higher RF power delivery. The impact of irrigation with ice-cold saline (ICS) instead of conventional ambient-temperature saline (ATS) on lesion formation is unknown. We performed 120 RF ablations in vitro on porcine left ventricles, using ICS (<5 °C) or ATS (21 °C) irrigation. For ICS irrigation, the irrigation circuit was cooled externally to maintain delivery of cooled saline at the catheter's tip. We applied 20 g of contact force, and delivered 20 W (irrigation 8 or 17 mL/min) or 30 W (irrigation 17 or 30 mL/min) RF power. Temperatures at tissue-electrode interface and 3-mm depth were assessed by fluoroptic probes. Lesion dimensions were assessed. ICS irrigation cooled the tissue-electrode interface better than ATS (53.9 ± 9.6 °C vs. 63 ± 11.4 °C, P < 0.001). Temperatures at 3-mm depth were similar at 30 W using ICS and ATS (104.2 ± 9.3 °C vs. 105.8 ± 7.3 °C, P = 0.5), but were cooler at 20 W using ICS (71.3 ± 11.6 °C vs. 100.2 ± 11.9 °C, P < 0.001). This translated into smaller lesions at 20 W with ICS versus ATS. At 30 W with 17 mL/min flow rate, lesions had the same depth with ICS and ATS (4.9 ± 0.8 mm vs. 5.4 ± 0.7 mm, P = 0.13) but were narrower with ICS (7.7 ± 0.8 mm vs. 9.3 ± 1.2 mm, P = 0.001). At 30 mL/min, lesions had the same dimensions. Steam pop rate was similar using ICS or ATS irrigation. ICS irrigation more effectively cools tissue-electrode interface than ATS. This may improve RF safety by potentially decreasing thrombus formation, thus facilitating safe ablation at a low saline volume load. However at lower RF power, ICS reduced lesion size compared to ATS. © 2014 Wiley Periodicals, Inc.

  1. Vascular Complications During Catheter Ablation of Cardiac Arrhythmias: A Comparison Between Vascular Ultrasound Guided Access and Conventional Vascular Access.

    PubMed

    Sharma, Parikshit S; Padala, Santosh K; Gunda, Sampath; Koneru, Jayanthi N; Ellenbogen, Kenneth A

    2016-10-01

    Vascular access related complications are the most common complications from catheter based EP procedures and have been reported to occur in 1-13% of cases. We prospectively assessed vascular complications in a large series of consecutive patients undergoing catheter based electrophysiologic (EP) procedures with ultrasound (US) guided vascular access versus conventional access. Consecutive patients undergoing catheter ablation procedures at VCU medical center were included. US guided access was obtained in all cases starting June 2015 (US group) while modified Seldinger technique without US guidance (non-US group) was used in cases prior to this date. All vascular complications were recorded for a 30-day period after the procedure. A total of 689 patients underwent 720 procedures. Ablations for ventricular tachyarrhythmias (ventricular tachycardia: VT, premature ventricular contractions: PVCs) accounted for 89 (12%) cases; atrial fibrillation (AF) ablations accounted for 328 procedures (46%) and other catheter based procedures accounted for 42% of cases. A significantly higher incidence of complications was noted in the non-US group compared with the US group (19 [5.3%] vs. 4 [1.1%], respectively, P = 0.002). Major complications were also higher among the non-US group (9 [2.5%] vs. 2 [0.6%], P = 0.03). Increasing age (P = 0.04) and non-US guided vascular access (P = 0.002) were associated with a higher risk of vascular access complications. In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, US guided vascular access was associated with a significantly decreased 30-day risk of vascular complications. © 2016 Wiley Periodicals, Inc.

  2. Minimal Use of Fluoroscopy to Reduce Fetal Radiation Exposure during Radiofrequency Catheter Ablation of Maternal Supraventricular Tachycardia

    PubMed Central

    Raman, Ajay Sundara; Hariharan, Ramesh

    2015-01-01

    Electrophysiologic procedures in the young engender concern about the potential long-term effects of radiation exposure. This concern is manifold if such procedures are contemplated during pregnancy. Catheter ablations in pregnancy are indicated only in the presence of an unstable tachycardia that cannot be controlled by antiarrhythmic agents. This report describes the case of an 18-year-old pregnant woman and our stratagem to minimize irradiation of the mother and the fetus. PMID:25873828

  3. Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

    PubMed Central

    Swaans, Martin J.; Alipour, Arash; Rensing, Benno J.W.M.; Post, Martijn C.; Boersma, Lucas V.A.

    2013-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6. Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8. The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16. Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN

  4. A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome.

    PubMed

    Pappone, Carlo; Santinelli, Vincenzo; Manguso, Francesco; Augello, Giuseppe; Santinelli, Ornella; Vicedomini, Gabriele; Gulletta, Simone; Mazzone, Patrizio; Tortoriello, Valter; Pappone, Alessia; Dicandia, Cosimo; Rosanio, Salvatore

    2003-11-06

    Young age and inducibility of atrioventricular reciprocating tachycardia or atrial fibrillation during invasive electrophysiological testing identify asymptomatic patients with a Wolff-Parkinson-White pattern on the electrocardiogram as being at high risk for arrhythmic events. We tested the hypothesis that prophylactic catheter ablation of accessory pathways would provide meaningful and durable benefits as compared with no treatment in such patients. From 1997 to 2002, among 224 eligible asymptomatic patients with the Wolff-Parkinson-White syndrome, patients at high risk for arrhythmias were randomly assigned to radio-frequency catheter ablation of accessory pathways (37 patients) or no treatment (35 patients). The end point was the occurrence of arrhythmic events over a five-year follow-up period. Patients assigned to ablation had base-line characteristics that were similar to those of the controls. Two patients in the ablation group (5 percent) and 21 in the control group (60 percent) had arrhythmic events. One control patient had ventricular fibrillation as the presenting arrhythmia. The five-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7 percent among patients who underwent ablation and 77 percent among the controls (P<0.001 by the log-rank test); the risk reduction with ablation was 92 percent (relative risk, 0.08; 95 percent confidence interval, 0.02 to 0.33; P<0.001). Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff-Parkinson-White syndrome who are at high risk for such events. Copyright 2003 Massachusetts Medical Society

  5. Idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation.

    PubMed

    Yamada, Takumi; Doppalapudi, Harish; McElderry, Hugh T; Okada, Taro; Murakami, Yoshimasa; Inden, Yasuya; Yoshida, Yukihiko; Kaneko, Shinji; Yoshida, Naoki; Murohara, Toyoaki; Epstein, Andrew E; Plumb, Vance J; Kay, G Neal

    2010-01-01

    Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PAMs). This study investigated the prevalence, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of these VAs, and compared them with other LV VAs. We studied 71 patients with VAs originating from the LV anterolateral and posteroseptal regions among 159 patients undergoing successful catheter ablation of idiopathic LV VAs. PAM VAs were uncommon, rare in a sustained form, and more common from the posterior papillary muscle (PPM) than anterior papillary muscle (APM). A younger age was a good predictor for differentiating left posterior fascicular VAs from PPM VAs. There were several electrocardiographic features that accurately differentiated PAM and LV fascicular VAs from mitral annular VAs. However, an R/S ratio < or =1 in lead V6 in the LV anterolateral region and a QRS duration >160 ms in the LV posteroseptal region were the only reliable predictors for differentiating PAM VAs from LV fascicular VAs. A sharp ventricular prepotential was recorded at the successful ablation site during 42% of the PAM VAs. Radiofrequency current with an irrigated or conventional 8-mm tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins whereas that with a nonirrigated 4-mm tip ablation catheter produced excellent results in LV fascicular and mitral annular VAs. There are differences in the electrocardiographic and electrophysiological features among VAs originating from these regions that are helpful for their diagnosis and effective catheter ablation.

  6. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

    PubMed Central

    See, Jason; Amora, Jonah L; Lee, Sheldon; Lim, Paul; Teo, Wee Siong; Tan, Boon Yew; Ho, Kah Leng; Lee, Chee Wan; Ching, Chi Keong

    2016-01-01

    INTRODUCTION The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. METHODS We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSite™ NavX™ or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. RESULTS A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. CONCLUSION The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time. PMID:26805664

  7. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure.

    PubMed

    See, Jason; Amora, Jonah L; Lee, Sheldon; Lim, Paul; Teo, Wee Siong; Tan, Boon Yew; Ho, Kah Leng; Lee, Chee Wan; Ching, Chi-Keong

    2016-07-01

    The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time. Copyright © Singapore Medical Association.

  8. Sinus node revisited in the era of electroanatomical mapping and catheter ablation

    PubMed Central

    Sánchez-Quintana, D; Cabrera, J A; Farré, J; Climent, V; Anderson, R H; Ho, S Y

    2005-01-01

    Objective: To study the architecture of the human sinus node to facilitate understanding of mapping and ablative procedures in its vicinity. Methods: The sinoatrial region was examined in 47 randomly selected adult human hearts by histological analysis and scanning electron microscopy. Results: The sinus node, crescent-like in shape, and 13.5 (2.5) mm long, was not insulated by a sheath of fibrous tissue. Its margins were irregular, with multiple radiations interdigitating with ordinary atrial myocardium. The distances from the node to endocardium and epicardium were variable. In 72% of the hearts, the whole nodal body was subepicardial and in 13 specimens (28%) the inner aspect of the nodal body was subendocardial. The nodal body cranial to the sinus nodal artery was more subendocardial than the remaining nodal portion, which was separated from the endocardium by the terminal crest. In 50% of hearts, the most caudal boundaries of the body of the node were at least 3.5 mm from the endocardium. When the terminal crest was > 7 mm thick (13 hearts, 28%), the tail was subepicardial or intramyocardial and at least 3 mm from the endocardium. Conclusions: The length of the node, the absence of an insulating sheath, the presence of nodal radiations, and caudal fragments offer a potential for multiple breakthroughs of the nodal wavefront. The very extensive location of the nodal tissue, the cooling effect of the nodal artery, and the interposing thick terminal crest caudal to this artery have implications for nodal ablation or modification with endocardial catheter techniques. PMID:15657230

  9. FREEDOM FROM RECURRENT VENTRICULAR TACHYCARDIA AFTER CATHETER ABLATION IS ASSOCIATED WITH IMPROVED SURVIVAL IN PATIENTS WITH STRUCTURAL HEART DISEASE

    PubMed Central

    Tung, Roderick; Vaseghi, Marmar; Frankel, David S.; Vergara, Pasquale; DiBiase, Luigi; Nagashima, Koichi; Yu, Ricky; Vangala, Sitaram; Tseng, Chi-Hong; Choi, Eue-Keun; Khurshid, Shaan; Patel, Mehul; Mathuria, Nilesh; Nakahara, Shiro; Tzou, Wendy S.; Sauer, William H.; Vakil, Kairav; Tedrow, Usha; Burkhardt, David; Tholakanahalli, Venkat; Saliaris, Anastasios; Dickfeld, Timm; Weiss, J. Peter; Bunch, T. Jared; Reddy, Madhu; Kanmanthareddy, Arun; Callans, David; Lakkireddy, Dhanunjaya; Natale, Andrea; Marchlinski, Francis; Stevenson, William G.; Della Bella, Paolo; Shivkumar, Kalyanam

    2015-01-01

    Background The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. Objective To examine the association between VT recurrence after ablation and survival in patients with scar-related VT. Methods Analysis of 2,061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. Results One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in non-ischemic cardiomyopathy). 57 (3%) patients underwent cardiac transplantation and 216 (10%) died during follow-up. At one year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and non-ischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence compared to those with recurrence (90% vs. 71%, p<0.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality (HR 6.9 (5.3-9.0); p<0.001). In patients with EF<30% and across all NYHA classes, improved transplant-free survival was seen in those without VT recurrence. Conclusions Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity. PMID:26031376

  10. A method for the in vitro testing of cardiac ablation catheters

    SciTech Connect

    Hsu, S.S.; Hoh, L.; Rosenbaum, R.M.; Rosen, A.; Walinsky, P.; Greenspon, A.J.

    1996-10-01

    The authors have developed a flow-phantom model in order to measure the temperature profile of radio frequency (RF) and microwave (MW) catheters. The model consists of a muscle equivalent phantom in a perfusion chamber with constant saline infusion of 4 L/min immersed in a 37 C saline bath. RF (4 or 8 mm, 550 kHz) or MW (12 mm helical antenna, 915 MHz) catheters were placed on the surface of the phantom and various energies were applied. Temperature measurements were obtained with fiberoptic thermometry probes placed at various distances from the catheter. Temperature contours were generated, and lesion volumes were estimated using 47 C isotherm ({Delta}T {ge} 10 C). The dosimetry of power versus {Delta}T was linear. A 2.59 fold increase in power density was required to achieve a similar surface temperature with the 8 mm versus 4 mm electrode tip. The volumes of lesions created with an 8 mm electrode were 2.5x larger than those made with a 4 mm electrode at a similar surface temperature. The RF phantom data compared favorably with the lesion volumes seen in the in vivo canine left ventricular model. The temperature profile of the microwave electrode showed heating along the length of the catheter due to imperfect tuning of the antenna. Deeper heating was seen with 8 mm RF and MW electrodes than with an RF 4 mm electrode given the same surface temperature. Measurements obtained with both a static and flow-phantom model demonstrated the cooling effects of flow on surface temperature measured during power delivery. The flow-phantom model accurately predicts the lesion geometry but underestimates the lesion volume at higher temperature when compared to the in vivo left ventricular canine model. Static phantom models will overestimate lesion size due to the surface cooling effects of cardiac blood flow. Changes in microwave catheter design may be carefully analyzed with the flow-phantom model prior to in vivo testing.

  11. Tachycardiomyopathy Induced by Ventricular Premature Complexes: Complete Recovery after Radiofrequency Catheter Ablation

    PubMed Central

    Rhee, Kyoung-Hoon; Jung, Ju-Young; Kim, Hyun-Sook; Chae, Jei-Keon; Kim, Won-Ho; Ko, Jae-Ki

    2006-01-01

    Ventricular premature complexes (VPCs) are known to be one of the most benign cardiac arrhythmias when they occur in structurally normal hearts. We experienced a 32-year old man who presented with dyspnea, palpitations and very frequent VPCs (31% of the total heart beats). Echocardiography revealed a dilated left ventricle (LV 66 mm at end-diastole and 57 mm at end-systole) and a decreased ejection fraction (34%). Very frequent VPCs had been detected 10 years previously and he underwent a failed radiofrequency catheter ablation (RFCA) procedure at that time. The patient had been treated with heart failure medications including betablockers, ACE inhibitors and spironolactone for the two most recent years. Six months after we eliminated these VPCs with a second RFCA procedure, the heart returned to normal function and size. Long standing and very frequent VPCs could be the cause of left ventricular dysfunction in a subset of patients who suffer with dilated cardiomyopathy, and RFCA should be the choice of therapy for these patients. PMID:17017676

  12. [Radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome and sudden cardiac death who had been resuscitated].

    PubMed

    Benito Bartolomé, F; Sánchez Fernández-Bernal, C

    2001-04-01

    Sudden death may be the first manifestation of the Wolff-Parkinson-White syndrome, especially in children and adolescents. The aim of this study was to evaluate the usefulness of radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome with aborted sudden death. We report four patients with Wolff-Parkinson-White syndrome who survived cardiac arrest. The patients were aged from 2.5 months to 16 years. The two first patients were lactating infants; in the first sudden death occurred during digoxin treatment for supraventricular tachycardia secondary to Wolff-Parkinson-White syndrome and in the second the syndrome was diagnosed after an episode of sudden death. In these patients a free wall accessory pathway (left posterior and left lateral, respectively) was successfully ablated using a transseptal approach. The third patient was diagnosed with asymptomatic Wolff-Parkinson-White syndrome; sudden death occurred during exercise. In the fourth patient, sudden death occurred after intravenous therapy with adenosine triphosphate and amiodarone for rapid atrial fibrillation. In both patients, one accessory pathway, located in right posteroseptal and right anterior free wall, respectively, was ablated. After a mean follow-up of 43.5 26.4 months, no recurrence of sudden death had occurred and electrocardiogram showed sinus rhythm without delta wave. The third patient presented severe sequelae of hypoxemic encephalopathy, which persisted during the follow-up. Radiofrequency catheter ablation is the treatment of choice in Wolff-Parkinson-White syndrome with episodes of aborted sudden death.

  13. Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.

    PubMed

    Rodgers, M; McKenna, C; Palmer, S; Chambers, D; Van Hout, S; Golder, S; Pepper, C; Todd, D; Woolacott, N

    2008-11-01

    To determine the safety, clinical effectiveness and cost-effectiveness of radio frequency catheter ablation (RCFA) for the curative treatment of atrial fibrillation (AF) and typical atrial flutter. For the systematic reviews of clinical studies 25 bibliographic databases and internet sources were searched in July 2006, with subsequent update searches for controlled trials conducted in April 2007. For the review of cost-effectiveness a broad range of studies was considered, including economic evaluations conducted alongside trials, modelling studies and analyses of administrative databases. Systematic reviews of clinical studies and economic evaluations of catheter ablation for AF and typical atrial flutter were conducted. The quality of the included studies was assessed using standard methods. A decision model was developed to evaluate a strategy of RFCA compared with long-term antiarrhythmic drug (AAD) treatment alone in adults with paroxysmal AF. This was used to estimate the cost-effectiveness of RFCA in terms of cost per quality-adjusted life-year (QALY) under a range of assumptions. Decision uncertainty associated with this analysis was presented and used to inform future research priorities using the value of information analysis. A total of 4858 studies were retrieved for the review of clinical effectiveness. Of these, eight controlled studies and 53 case series of AF were included. Two controlled studies and 23 case series of typical atrial flutter were included. For atrial fibrillation, freedom from arrhythmia at 12 months in case series ranged from 28% to 85.3% with a weighted mean of 76%. Three RCTs suggested that RFCA is more effective than long-term AAD therapy in patients with drug-refractory paroxysmal AF. Single RCTs also suggested superiority of RFCA over electrical cardioversion followed by long-term AAD therapy and of RFCA plus AAD therapy over AAD maintenance therapy alone in drug-refractory patients. The available RCTs provided insufficient

  14. Number of ablated spots in the course of renal sympathetic denervation in CKD patients with uncontrolled hypertension: EnligHTN vs. Standard irrigated cardiac ablation catheter.

    PubMed

    Kiuchi, M G; Chen, S; Rodrigues Paz, L M; Pürerfellner, H

    2017-08-04

    Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability. The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation. Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (P<0.0001), and -13.9±4.8 vs. -36.3±4.3mmHg (P<0.0001). The comparisons between Δ estimated glomerular filtration rate (eGFR) according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, were: +2.7±4.0 vs. +6.0±8.4mL/min/1.73m(2) (P=0.2287), and +11.9±6.0 vs. +21.4±8.7mL/min/1.73m(2) (P=0.0222). The RSD reduced the mean 24-h ABPM in subjects with CKD and uncontrolled hypertension and improved the renal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures.

    PubMed

    Michowitz, Yoav; Rahkovich, Michael; Oral, Hakan; Zado, Erica S; Tilz, Roland; John, Silke; Denis, Arnaud; Di Biase, Luigi; Winkle, Roger A; Mikhaylov, Evgeny N; Ruskin, Jeremy N; Yao, Yan; Josephson, Mark E; Tanner, Hildegard; Miller, John M; Champagne, Jean; Della Bella, Paolo; Kumagai, Koichiro; Defaye, Pascal; Luria, David; Lebedev, Dmitry S; Natale, Andrea; Jais, Pierre; Hindricks, Gerhard; Kuck, Karl-Heinz; Marchlinski, Francis E; Morady, Fred; Belhassen, Bernard

    2014-04-01

    Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female sex is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. A systematic Medline search was used to locate academic electrophysiological centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to sex and their mode of management including any case of related mortality. Nineteen electrophysiological centers provided information on 34 943 ablation procedures involving 25 261 (72%) men. Overall, 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in women and 169 (0.67%) in men (odds ratio, 1.83; P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantially lower risk in high-volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; women tended to develop more tamponades during transseptal catheterization. No sex difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high-volume centers. Three cases of tamponade (1%) culminated in death. Tamponade during AF ablation procedures is relatively rare. Women have an ≈2-fold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high-volume centers. Surgical backup and acute management skills for treating tamponade are important in centers performing AF ablation.

  16. Interactive real-time mapping and catheter ablation of the cavotricuspid isthmus guided by magnetic resonance imaging in a porcine model

    PubMed Central

    Hoffmann, Boris A.; Koops, Andreas; Rostock, Thomas; Müllerleile, Kai; Steven, Daniel; Karst, Roman; Steinke, Mark U.; Drewitz, Imke; Lund, Gunnar; Koops, Susan; Adam, Gerhard; Willems, Stephan

    2010-01-01

    Aims We investigated the feasibility of real-time magnetic resonance imaging (RTMRI) guided ablation of the cavotricuspid isthmus (CTI) by using a MRI-compatible ablation catheter. Methods and results Cavotricuspid isthmus ablation was performed in an interventional RTMRI suite by using a novel 7 French, steerable, non-ferromagnetic ablation catheter in a porcine in vivo model (n = 20). The catheter was introduced and navigated by RTMRI visualization only. Catheter position and movement during manipulation were continuously visualized during the entire intervention. Two porcine prematurely died due to VT/VF. Anatomical completion of the CTI ablation line could be achieved after a mean of 6.3±3 RF pulses (RF energy: 1807±1016.4 Ws/RF pulse, temperature: 55.9±5.9°C) in n = 18 animals. In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab. Conclusion Completely non-fluoroscopic ablation guided by RTMRI using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology. PMID:19897495

  17. Predictors of sick sinus syndrome in patients after successful radiofrequency catheter ablation of atrial flutter.

    PubMed

    Song, Changho; Jin, Moo-Nyun; Lee, Jung-Hee; Kim, In-Soo; Uhm, Jae-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung

    2015-01-01

    The identification of sick sinus syndrome (SSS) in patients with atrial flutter (AFL) is difficult before the termination of AFL. This study investigated the patient characteristics used in predicting a high risk of SSS after AFL ablation. Out of 339 consecutive patients who had undergone radiofrequency ablation for AFL from 1991 to 2012, 27 (8%) had SSS (SSS group). We compared the clinical characteristics of patients with and without SSS (n=312, no-SSS group). The SSS group was more likely to have a lower body mass index (SSS: 22.5±3.2; no-SSS: 24.0±3.0 kg/m²; p=0.02), a history of atrial septal defects (ASD; SSS: 19%; no-SSS: 6%; p=0.01), a history of coronary artery bypass graft surgery (CABG; SSS: 11%; no-SSS: 2%; p=0.002), and a longer flutter cycle length (CL; SSS: 262.3±39.2; no-SSS: 243.0±40; p=0.02) than the no-SSS group. In multivariate analysis, a history of ASD [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.2-11.4, p=0.02] and CABG (7.1, 95% CI 1.5-32.8, p=0.01) as well as longer flutter CL (1.1, 95% CI 1.0-1.2, p=0.04) were independent risk factors for SSS. A history of ASD and CABG as well as longer flutter CL increased the risk of SSS after AFL ablation. While half of the patients with SSS after AFL ablation experienced transient SSS, heart failure was associated with irreversible SSS.

  18. Radiofrequency catheter ablation of atrial fibrillation guided by spectral mapping of atrial fibrillation nests in sinus rhythm.

    PubMed

    Mateos, José Carlos Pachón; Mateos, Enrique I Pachón; Lobo, Tasso J; Pachón, Maria Zélia C; Mateos, Juán Carlos Pachón; Pachón, Denilda Queiroz V; Vargas, Remy Nelson A; Piegas, Leopoldo S; Jatene, Adib D

    2007-09-01

    Two types of myocardia can be observed through the endocardial spectral mapping (SM) in sinus rhythm: the compact type with a smooth spectrum and the fibrillar type with a segmented spectrum (atrial fibrillation nests). During the atrial fibrillation (AF), the compact type has an organized activation and low frequency (passive), whereas the fibrillar type has a rather disorganized activation and high frequency (active/resonant), with both being activated by high-frequency sustained tachycardia--the background tachycardia (BT). To describe the treatment of AF by the ablation of the AF nests and BT. 1) Catheter ablation of the AF nests with RF [4/8 mm-60 masculine/30-40 J/30s] guided by SM in sinus rhythm, outside the pulmonary vein; 2) atrial stimulation -300 ppm; 3) Additional ablation of the AF nests if AF is induced; 4) Focal ablation if BT and/or Flutter is induced; 5) Clinical follow-up+ ECG+ Holter. A total of 50+/-18 AF nests/patient were treated. After 11.3+/-8 m, 81 patients (88%) did not present AF (28.3% with antiarrhythmic drugs). After the ablation of the AF nests, AF was not reinduced in 61 patients (71%) and BT was induced and treated in 24 patients (26%). There were two episodes of pericardial bleeding (1 treated clinically and 1 surgically), caused by sheaths that are no longer used The SM in sinus rhythm can be used in the ablation of AF nests. During the AF, the AF nests present a reactive-resonant pattern and the compact myocardium is passive, stimulated by the high frequency of the BT. After the ablation of the AF nests and the BT, it was not possible to reinduce the sustained AF. The Ablation of AF nests outside the pulmonary veins showed to be safe and highly effective in the cure and/or clinical control of the AF.

  19. The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation.

    PubMed

    Zadeh, Andrew A; Cannom, David S; Macrum, Bruce L; Ho, Ivan C

    2011-07-01

    With the increasing number of patients undergoing repeat catheter ablation procedures for atrial fibrillation, it is not uncommon to encounter a fibrotic interatrial septum that resists the conventional manual advancement of the transseptal sheath. Forceful advancement of the transseptal apparatus can reduce fine control and potentially lead to a higher rate of perforation. We report a case where adjunctive balloon atrial septostomy was used to facilitate transseptal access in a patient with fibrotic interatrial septum. Using a small-caliber angioplasty balloon and under direct fluoroscopic and transesophageal echocardiogram visualization, balloon septostomy was performed with hand inflation until a "waist" was seen. This technique provides a safe way to control the size of the transseptal access created, and allows the passage of a relatively soft-tipped transseptal sheath across a resistive septum. To our knowledge this is the first published use of balloon atrial septostomy during transseptal puncture for left atrium access in a catheter ablation procedure. Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths. © 2010 Wiley Periodicals, Inc.

  20. Effect of substrate modification in catheter ablation of paroxysmal atrial fibrillation: pulmonary vein isolation alone or with complex fractionated electrogram ablation.

    PubMed

    Nam, Gi-Byoung; Jin, Eun-Sun; Choi, HyungOh; Song, Hae-Geun; Kim, Sung-Hwan; Kim, Ki-Hun; Hwang, Eui-Seock; Park, Kyoung-Min; Kim, Jun; Rhee, Kyoung-Suk; Choi, Kee-Joon; Kim, You-Ho

    2012-01-01

    Catheter ablation of atrial fibrillation that targets complex fractionated electrogram sites has been widely applied in the management of persistent atrial fibrillation. The clinical outcomes of pulmonary vein isolation alone and pulmonary vein isolation plus the use of complex fractionated electrogram-guided ablation (CFEA) have not been fully compared in patients with paroxysmal atrial fibrillation.This prospective study included 70 patients with symptomatic paroxysmal atrial fibrillation that remained inducible after pulmonary vein isolation. For radio-frequency catheter ablation, patients were nonrandomly assigned to a control group (pulmonary vein isolation alone, Group 1, n=35) or a CFEA group (pulmonary vein isolation plus additional CFEA, Group 2, n=35). The times to first recurrence of atrial tachyarrhythmias were compared between the 2 groups.In Group 2, CFEA rendered atrial fibrillation noninducible in 16 patients (45.7%) and converted inducible atrial fibrillation into inducible atrial flutters in 12 patients (34.3%). Atrial fibrillation remained inducible in 7 patients (20%) after the combined ablation procedures. After a mean follow-up of 23 months, freedom from recurrence of atrial tachyarrhythmias was significantly higher in Group 2 than in Group 1 (P=0.037). In Group 1, all of the recurrent tachyarrhythmias were atrial fibrillation, whereas regular tachycardia was the major mechanism of recurrent arrhythmias in Group 2 (atrial tachycardia or atrial flutter in 5 of 6 patients and atrial fibrillation in 1 patient).We found that CFEA after pulmonary vein isolation significantly reduced recurrent atrial tachyarrhythmia and might modify the pattern of arrhythmia recurrence in patients with paroxysmal atrial fibrillation.

  1. Validation of electrical ostial pulmonary vein isolation verified with a spiral inner lumen mapping catheter during second-generation cryoballoon ablation.

    PubMed

    Miyazaki, Shinsuke; Kajiyama, Takatsugu; Watanabe, Tomonori; Taniguchi, Hiroshi; Nakamura, Hiroaki; Hamaya, Rikuta; Kusa, Shigeki; Igarashi, Miyako; Hachiya, Hitoshi; Hirao, Kenzo; Iesaka, Yoshito

    2017-08-01

    Achieve catheters are cryoballoon guidewires that enable pulmonary vein (PV) potential mapping. The single catheter approach in conjunction with the Achieve catheter is currently standard practice in second-generation cryoballoon ablation, yet circumferential mapping catheters are the gold standard for evaluating PV isolation (PVI). The study sought to validate the ostial PVI verified by an Achieve catheter alone. One hundred fifty-one paroxysmal atrial fibrillation patients undergoing PVI using exclusively 28-mm second-generation cryoballoons were enrolled. PV recordings were analyzed during (real-time recordings) and after cryoballoon applications with 20-mm Achieve mapping catheters, and subsequently validated by 20-mm conventional circumferential mapping catheters. Out of 596 PVs, 576 (96.6%) were isolated using cryoballoons, and 20 required touch-up ablation. PVI was verified during cryoballoon applications with real-time monitoring in 299, and after applications in 280 PVs by Achieve catheters alone. The time-to-isolation was 27.2 ± 22.0 seconds. Validation with standard circumferential mapping catheters confirmed ostial PVIs in 296 of 299 (99.0%) PVs that real-time PVI was obtained during applications, and in 242 of 280 (86.5%) PVs that PV activities were not visible during applications and PVI was verified after the applications. The accuracy of ostial PVIs with Achieve catheters in PVs without obtaining real-time PV recordings was 40/47 (85.1%), 58/65 (89.2%), 77/79 (97.5%), 61/81 (75.3%), and 6/8 (75.0%) in left superior, left inferior, right superior, right inferior, and left common PVs, respectively. In second-generation 28-mm cryoballoon ablation, verification of ostial PVIs using Achieve mapping catheters alone might not be sufficient to accurately confirm an ostial PVI when real-time PVI was not obtained. © 2017 Wiley Periodicals, Inc.

  2. Prediction tool for thrombi associated with peripherally inserted central catheters.

    PubMed

    Seeley, Maria A; Santiago, Mary; Shott, Susan

    2007-01-01

    The upper extremity deep vein thrombosis rate is increasing at the same time that the rate for insertions of peripherally inserted central catheters is on the rise. There is little information on whether the established risk factors for lower extremity deep vein thromboses are effective to predict the occurrence of upper extremity deep vein thrombosis. The purpose of this study was to identify patients at highest risk for upper extremity deep vein thrombosis in order to initiate effective prophylaxis. A retrospective review was undertaken of medical records of all patients with peripherally inserted central catheters inserted in a 6-month period at a Midwestern US hospital. Of the 233 charts reviewed, 17 (7.3%) recorded an upper extremity deep vein thrombosis during the patient's hospital stay. Of the multiple factors identified with deep vein thrombosis in the literature, a weighted risk factor measure, the upper extremity deep vein thrombosis prediction tool, was developed. Sensitivity of the instrument for upper extremity deep vein thrombosis is high (88%), as are its specificity (82%) and negative predictive value (99%), whereas the positive predictive value is low (28%). The total percentage of cases correctly classified is 82%. Further testing is indicated on a larger sample to extend the validity of this instrument.

  3. Interatrial Conduction Time Can Predict New-Onset Atrial Fibrillation After Radiofrequency Ablation of Isolated, Typical Atrial Flutter.

    PubMed

    Henmi, Ryuta; Ejima, Koichiro; Shoda, Morio; Yagishita, Daigo; Hagiwara, Nobuhisa

    2016-07-16

    Many patients with successful atrial flutter (AFL) ablation will develop atrial fibrillation (AF) during follow-up. This study aimed to determine whether prolonged interatrial conduction time (IACT) is associated with risk for new-onset AF after ablation of isolated, typical AFL. Participants were 80 consecutive patients who underwent successful radiofrequency ablation of isolated, typical AFL from 2004 to 2012. Patients with any history of AF prior to AFL ablation were excluded. IACT was defined as the interval from the earliest onset of the P-wave on the ECG to the latest activation in the coronary sinus catheter during sinus rhythm measured after AFL ablation. New-onset AF was identified from 12-lead ECGs, 24-hour ambulatory monitoring, and device interrogations. During a mean follow-up of 4.1 ± 2.5 years after successful AFL ablation, 22 patients (27.5%) developed new-onset AF. Cox regression multivariate analysis demonstrated that IACT was the independent predictor of new-onset AF after AFL ablation (hazard ratio: 1.03; 95% confidence interval: 1.00-1.06; P = 0.02). IACT was accurate in predicting new-onset AF (AUC = 0.70). The optimal cut-off point of IACT for predicting new-onset AF was 120 milliseconds (sensitivity 47.6%, specificity 89.8%). Kaplan-Meier curves showed that new-onset AF after AFL ablation was significantly higher in patients with IACT ≥120 milliseconds than in patients with IACT< 120 milliseconds (P = 0.0016). Prolonged IACT predicted new-onset AF after ablation of isolated AFL. This finding may contribute to guiding decisions regarding the maintenance of anticoagulation after AFL ablation. © 2016 Wiley Periodicals, Inc.

  4. Near-infrared spectroscopy integrated catheter for characterization of myocardial tissues: preliminary demonstrations to radiofrequency ablation therapy for atrial fibrillation

    PubMed Central

    Singh-Moon, Rajinder P.; Marboe, Charles C.; Hendon, Christine P.

    2015-01-01

    Effects of radiofrequency ablation (RFA) treatment of atrial fibrillation can be limited by the ability to characterize the tissue in contact. Parameters obtained by conventional catheters, such as impedance and temperature can be insufficient in providing physiological information pertaining to effective treatment. In this report, we present a near-infrared spectroscopy (NIRS)-integrated catheter capable of extracting tissue optical properties. Validation experiments were first performed in tissue phantoms with known optical properties. We then apply the technique for characterization of myocardial tissues in swine and human hearts, ex vivo. Additionally, we demonstrate the recovery of critical parameters relevant to RFA therapy including contact verification, and lesion transmurality. These findings support the application of NIRS for improved guidance in RFA therapeutic interventions. PMID:26203376

  5. Incidence and risk factors for symptomatic heart failure after catheter ablation of atrial fibrillation and atrial flutter.

    PubMed

    Huang, Henry D; Waks, Jonathan W; Contreras-Valdes, Fernando M; Haffajee, Charles; Buxton, Alfred E; Josephson, Mark E

    2016-04-01

    To determine the incidence and risk factors for development of symptomatic heart failure (HF) following catheter ablation for atrial fibrillation (AF) and atrial flutter. We prospectively enrolled consecutive patients undergoing pulmonary vein isolation (PVI) or cavotricuspid isthmus (CTI) ablation between November 2013 and June 2014. Post-discharge symptoms were assessed via telephone follow-up and clinic visits. The primary outcome was symptomatic HF requiring treatment with new/increased diuretic dosing. Secondary outcomes were prolonged index hospitalization and readmission for HF ≤30 days. Univariate and multivariable logistic regressions were used to assess the relationship between patient/procedural characteristic and post-ablation HF. Among 111 PVI patients [median age 62.0 years; left ventricular ejection fraction (LVEF) 55%], 29 patients (26.1%) developed symptomatic HF, 6 patients (5.4%) required prolonged index hospitalization, and 8 patients (7.2%) were readmitted for HF. In univariate analyses, persistent AF [odds ratio (OR) 2.97, P = 0.02], AF at start of the procedure (OR 2.99, P = 0.01), additional ablation lines (OR 11.07, P < 0.0001), and final left atrial pressure (OR 1.10 per 1 mmHg increase, P = 0.02) were associated with HF development. Peri-procedural diuresis, net fluid balance, and LVEF were not correlated. In multivariable analyses, only additional ablation lines (ORadj 9.17, P = 0.007) were independently associated with post-ablation HF. Six patients (16.7%) developed HF after CTI ablation. A 26.1% of patients undergoing PVI and 16.7% of patients undergoing CTI ablation developed symptomatic HF when prospectively and uniformly assessed. 12.6% of patients experienced prolonged index hospitalizations or readmission for management of HF within 1 week after PVI. Improved understanding of risk factors for post-ablation HF may be critical in developing strategies to address during AF ablation. Published on behalf of the European Society of

  6. Long-term stroke rates after catheter ablation or antiarrhythmic drug therapy for atrial fibrillation: a meta-analysis of randomized trials.

    PubMed

    Zheng, Ya-Ru; Chen, Zhi-Yun; Ye, Li-Fang; Wang, Li-Hong

    2015-09-01

    Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences (RDs) and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients (0.64%) in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients (0.23%) in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy (RD: 0.003, 95% CI: -0.006 to 0.012, P = 0.470), and no evidence of heterogeneity was observed (I (2) = 0, P = 0.981). No potential publication bias was found. There was also no difference in mortality between the two groups (RD: -0.004, 95% CI: -0.014 to 0.006, P = 0.472). This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.

  7. [Clinical analysis of 19 cases of pregnant women with rapid arrhythmia in the treatment of radiofrequency catheter ablation].

    PubMed

    Chu, L; Zhang, J; Li, Y N; Long, D Y

    2016-10-25

    Objective: To investigate the risk of radiofrequency catheter ablation and maternal and infant in pregnant women with rapid arrhythmia during pregnancy. Methods: The clinical data of the 19 cases of pregnancy complicated with rapid arrhythmia were retrospectively analyzed and followed up, including the gestational week, the type of arrhythmia, the treatment, and the outcome of the mother and child in Beijing Anzhen Hospital of Capital Medical University from January 2002 to March 2016. Results: (1)Clinical characteristics: the ages of the 19 cases were(31±4)years old(ranged from 26 to 35 years old), the onset gestational ages were(21±4)weeks(ranged from 15 to 32 weeks).

  8. The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association.

    PubMed

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard; Maggioni, Aldo P; Tavazzi, Luigi; Vardas, Panos; Laroche, Cécile; Anselme, Frédéric; Inama, Giuseppe; Jais, Pierre; Kalarus, Zbigniew; Kautzner, Josef; Lewalter, Thorsten; Mairesse, Georges H; Perez-Villacastin, Julian; Riahi, Sam; Taborsky, Milos; Theodorakis, George; Trines, Serge A

    2014-06-07

    The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications. Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure. A web-based case report form captured information on pre-procedural, procedural, and 1-year follow-up data. Between October 2010 and May 2011, 1410 patients were included and 1391 underwent an AFib ablation (98.7%). A total of 1300 patients (93.5%) completed a follow-up control 367 ± 42 days after the procedure. Arrhythmia documentation was done by an electrocardiogram in 76%, Holter-monitoring in 52%, transtelephonic monitoring in 8%, and/or implanted systems in 4.5%. Over 50% became asymptomatic. Twenty-one per cent were re-admitted due to post-ablation arrhythmias. Success without antiarrhythmic drugs was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib in a real-world setting. The methods used to assess the success of the procedure appeared at least suboptimal. Even in this context, the 12-month success rate appears to be somewhat lower to the one

  9. Electrophysiology testing and catheter ablation are helpful when evaluating asymptomatic patients with Wolff-Parkinson-White pattern: the con perspective.

    PubMed

    Skanes, Allan C; Obeyesekere, Manoj; Klein, George J

    2015-09-01

    The association between asymptomatic Wolff-Parkinson-White (WPW) syndrome and sudden cardiac death (SCD) has been well documented. The inherent properties of the accessory pathway determine the risk of SCD in WPW, and catheter ablation essentially eliminates this risk. An approach to WPW syndrome is needed that incorporates the patient's individualized considerations into the decision making. Patients must understand that there is a trade-off of a small immediate risk of an invasive approach for elimination of a small lifetime risk of the natural history of asymptomatic WPW. Clinicians can minimize the invasive risk by only performing ablation for patients with at-risk pathways. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation: A case report.

    PubMed

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-09-01

    Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture.

  11. Rivaroxaban for Periprocedural Anticoagulation Therapy in Japanese Patients Undergoing Catheter Ablation of Paroxysmal Non-Valvular Atrial Fibrillation.

    PubMed

    Kawabata, Mihoko; Sasaki, Takeshi; Maeda, Shingo; Shirai, Yasuhiro; Yamauchi, Yasuteru; Nitta, Junichi; Goya, Masahiko; Hirao, Kenzo

    2016-12-02

    Direct oral anticoagulants (DOACs) have been shown to be safe and effective for the prevention of stroke in nonvalvular atrial fibrillation (NVAF) patients, however, experience with peri-AF ablation management of DOACs is scarce. This study aimed to investigate the safety and feasibility of periprocedural anticoagulation therapy with rivaroxaban in Japanese patients undergoing paroxysmal non-valvular AF (NVAF) ablation using radiofrequency energy.This study was a multicenter, prospective pilot study. In paroxysmal NVAF patients, rivaroxaban (15 mg or 10 mg once-daily) was started at least 4 weeks prior to AF ablation, discontinued on the day of the procedure, resumed within 24 hours after ablation, and continued at least 3 months afterwards. During the interruption of rivaroxaban, bridging anticoagulation therapy with unfractionated heparin was given. Follow-up of the patients continued for 3 months.A total of consecutive 74 patients (mean age, 62 ± 9 years, 58 [78.4%] male) were enrolled. The mean follow-up period was 108 ± 79 days. Their mean CHADS2 score and CHA2DS2-VASc score were 1.2 ± 1.0 and 0.6 ± 0.7, respectively. Their mean HAS-BLED score was 1.0 ± 0.8. Neither major bleeding nor thromboembolic events, except in a case with bleeding from gastric cancer (1.4%), were observed in the periprocedural period of the AF ablation.The present multicenter study demonstrated the safety and feasibility of periprocedural anticoagulation therapy with rivaroxaban in Japanese patients undergoing catheter ablation of paroxysmal NVAF.

  12. Unintended Thermal Injuries from Radiofrequency Ablation: Organ Protection with an Angioplasty Balloon Catheter in an Animal Model

    PubMed Central

    Knuttinen, Martha-Grace; Van Ha, Thuong G.; Reilly, Christopher; Montag, Anthony; Straus, Christopher

    2014-01-01

    Objectives: The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA) of hepatic dome tumors in an animal model. Materials and Methods: All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. Results: Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. Conclusion: Using balloon interposition as a protective device has advantages over previous saline infusion or CO2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated. PMID:24678433

  13. Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.

    PubMed

    Patel, Divyang; Hasselblad, Vic; Jackson, Kevin P; Pokorney, Sean D; Daubert, James P; Al-Khatib, Sana M

    2016-03-01

    Patients with ischemic heart disease may have implantable cardioverter defibrillators (ICDs) implanted for primary or secondary prevention of sudden cardiac death. Although ICD shocks can be life saving, in some patients, they have been associated with increased mortality and/or morbidity. Several studies have suggested that catheter ablation may be superior to non-ablative strategies at preventing ICD shocks delivered for ventricular arrhythmias; however, this is still controversial. We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with non-ablative strategies in treatment of ventricular tachycardia (VT) in patients with ischemic heart disease and an ICD. The primary endpoints of interest were recurrent episodes of VT and death. We used a binary random effects method to calculate the cumulative odds ratios (OR) for recurrent VT and deaths. Of a total of 643 potential citations, our search yielded three citations that met our inclusion and exclusion criteria. In the three trials, a total of 262 patients were randomized to ablation (n = 129) or non-ablative interventions (beta-blockers ± use of antiarrhythmics) (n = 133) group. The cumulative OR for recurrent VT was 0.471 (95% confidence interval (CI) = 0.176-1.257) for catheter ablation compared with non-ablative strategies, and for death, it was 0.766 (95% CI = 0.351-1.674). Excluding one study for being appreciably smaller than the other two, the OR for recurrent VT was 0.298 (95% CI = 0.164-0.543). In this meta-analysis, the rate of recurrent VT was lower with VT catheter ablation compared with non-ablative strategies. There was not a significant difference in rate of death among patients receiving catheter ablation versus non-ablative strategies for management of VT. Given the lack of adequately powered RCTs comparing ablation versus medical management of VT in patients with ischemic heart disease and an ICD, larger studies with longer

  14. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study.

    PubMed

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E; Brennan, Rachel C; Shook, David R; Stokes, Dennis C; Monagle, Paul; Curtis, Nigel; Worth, Leon J; Allison, Kim; Sun, Yilun; Flynn, Patricia M

    2015-01-01

    Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar." Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8-21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0-22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for

  15. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study

    PubMed Central

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E.; Brennan, Rachel C.; Shook, David R.; Stokes, Dennis C.; Monagle, Paul; Curtis, Nigel; Worth, Leon J.; Allison, Kim; Sun, Yilun; Flynn, Patricia M.

    2015-01-01

    Background Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. Methods We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.” Results Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. Conclusions In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate

  16. Improvement of cardiac function and neurological remodeling in a patient with tachycardia-induced cardiomyopathy after catheter ablation.

    PubMed

    Omichi, Chikaya; Tanaka, Takeshi; Kakizawa, Yoshiko; Yamada, Ayako; Ishii, Yasuhiro; Nagashima, Hirotaka; Kanmatsuse, Katsuo; Endo, Masahiro

    2009-08-01

    Incessant ventricular tachycardia and long-standing ectopic beats lead to tachycardia-induced cardiomyopathy. Catheter ablation eliminates ventricular tachycardia and reverses left ventricular (LV) dysfunction. 201-Thallium ((201)Tl) scintigraphy demonstrates perfusion defects with ischemic cardiomyopathy. Reversible perfusion defects are observed even in non-ischemic cardiomyopathy, related to regional flow or metabolism derangements. 123-I-metaiodobezylguanidine ((123)I-MIBG) scintigraphy delineates regional cardiac sympathetic denervation and heterogeneity. We demonstrated the progression of tachycardia-induced cardiomyopathy in a patient with idiopathic LV outflow tract tachycardia using (201)Tl and (123)I-MIBG scintigraphic findings. Regional defects were reversed predominantly in the basal interventricular septal wall in (201)Tl scintigraphy and (123)I-MIBG scintigraphic findings. This report suggests that incessant ventricular tachycardia or long-standing ventricular ectopic beats may develop adverse myocardial remodeling and sympathetic neurological remodeling. Treatment with catheter ablation for tachycardia-induced cardiomyopathy can reverse sympathetic neurological remodeling as well as myocardial structural remodeling.

  17. Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents.

    PubMed

    Jan, Matevž; Žižek, David; Rupar, Katja; Mazić, Uroš; Kuhelj, Dimitrij; Lakič, Nikola; Geršak, Borut

    2016-11-01

    Electrophysiology study (EPS) and catheter ablation (CA) in children and adolescents carries a potentially harmful effect of radiation exposure when performed with the use of fluoroscopy. Our aim was to evaluate the feasibility, safety and effectiveness of fluoroless EPS and CA of various supra-ventricular tachycardias (SVTs) with the use of the 3D mapping system and intracardiac echocardiography (ICE). Forty-three consecutive children and adolescents (age 13 ± 3 years) underwent fluoroless EPS and CA for various supra-ventricular tachycardias. A three-dimensional (3D) mapping system NavX™ was used for guidance of diagnostic and ablation catheters in the heart. ICE was used as a fundamental imaging tool for transseptal punctures. Acute procedural success rate was 100 %. There were no procedure related complications and short-term follow up (10 ± 3 months) revealed 93 % arrhythmia free survival rate. Fluoroless CA of various SVTs in the paediatric population is feasible, safe and can be performed successfully with 3D mapping system and ICE.

  18. Isoproterenol infusion increases level of consciousness during catheter ablation of atrial fibrillation.

    PubMed

    O'Neill, Daniel K; Aizer, Anthony; Linton, Patrick; Bloom, Marc; Rose, Emily; Chinitz, Larry

    2012-08-01

    The objective of this study was to determine the effects of isoproterenol infusion on level of consciousness during ablation using total intravenous anesthesia. Seven patients undergoing total intravenous anesthesia for atrial fibrillation ablation were monitored for level of consciousness using bispectral EEG levels (BIS). Isoproterenol infusion was performed after the ablation during anesthesia. BIS levels prior to, during, and post-isoproterenol infusion were recorded and correlated to isoproterenol infusion doses. In all patients, BIS levels significantly increased during isoproterenol infusion (median BIS prior to infusion, 46; during infusion, 64 (p < 0.02)). With a subsequent increase in anesthetic medication, BIS levels could again be reduced. Isoproterenol infusion alters consciousness level during total intravenous anesthesia for atrial fibrillation ablation. BIS monitoring is a novel way to modulate anesthesia during ablation to potentially optimize patient comfort and ablation success.

  19. Catheter ablation of scar-based ventricular tachycardia: Relationship of procedure duration to outcomes and hospital mortality.

    PubMed

    Yu, Ricky; Ma, Sootkeng; Tung, Roderick; Stevens, Steven; Macias, Carlos; Bradfield, Jason; Buch, Eric; Vaseghi, Marmar; Fujimura, Osama; Gornbein, Jeffrey; Mandapati, Ravi; Shivkumar, Kalyanam; Boyle, Noel G

    2015-01-01

    Ablation has become an important option for treatment of ventricular tachycardia (VT). The influence of procedure duration on outcomes remains unexamined. The purpose of this study was to determine the influence of procedure duration on outcomes and complications over an 8-year period Patients referred for scar-mediated VT ablation from 2004 to 2011 were retrospectively analyzed. Procedure duration was defined as the time from the insertion of catheters through the femoral vein to the time of their withdrawal. Procedure duration was analyzed in relationship with baseline and intraoperative covariates, acute procedural outcomes, complications, and 6-month clinical outcomes. One hundred forty-eight patients underwent VT ablation with mean procedure duration of 5.7 ± 1.8 hours. VT recurrence and survival at 6 months were 46% and 82%, respectively, and were not associated with procedure duration. Hospital mortality increased with intraoperative intraaortic balloon pump insertion (adjusted odds ratio [OR] 13.7, 95% confidence interval [CI] 2.35-79.94, P = .004) and was improved with successful ablation of the clinical VT as a procedural end-point (adjusted OR 0.13, 95% Cl 0.03-0.54, P = .005). The association between procedure duration and hospital mortality remained after adjusting for significant baseline variables (adjusted OR 1.75, 95% CI 1.14-2.68, P = .0098) and intraoperative variables (adjusted OR 1.6, 95% CI 1.12-2.29, P = .0104). Hospital mortality was significantly increased by unsuccessful clinical VT ablation as a procedural end-point and intraoperative intraaortic balloon pump insertion. However, after adjusting for significant baseline and intraoperative covariates, procedure duration still was associated with increased hospital mortality. Procedure duration had no impact on VT recurrence and survival at 6 months. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  20. Electrocardiogram features of premature ventricular contractions/ventricular tachycardia originating from the left ventricular outflow tract and the treatment outcome of radiofrequency catheter ablation

    PubMed Central

    2012-01-01

    Background Radiofrequency catheter ablation (RFCA) has been used for the ablation of premature ventricular contractions (PVCs) or ventricular tachycardia (VT). To date, the mapping and catheter ablation of the arrhythmias originating from the left ventricular outflow tract (LVOT) has not been specified. This study investigates the electrocardiogram (ECG) feature of PVCs or VT originating from the LVOT. Moreover, the treatment outcome of RFCA is analyzed. Methods Mapping and ablation were performed on the supravalvular or subvalvular aorta in 52 cases with PVCs/VT originating from the LVOT. The data were compared with those from 104 patients with PVCs/VT originating from the right ventricular outflow tract (RVOT). A differential procedure was prepared based on the comparison of the ECG features of PVCs/VT originating from the RVOT, LVOT, and their different parts. Results Among 52 cases with PVCs originating from the LVOT, 47 were successfully treated by RFCA, with a success rate of 90.38%. Several differences among the 12-lead ECG features were observed from the RVOT and LVOT in the left and right coronary sinus groups, as well as under the left coronary sinus group (left fibrous trigone): (1) If the precordial leads transition 0 are considered as the diagnostic parameters of PVCs/VT originating from the LVOT, then the sensitivity, specificity, as well as positive and negative predictive values are 94.12%, 93.00%, 87.27%, and 96.88%, respectively; (2) The analysis of different subgroups of the LVOT are as follows: (a) A mainly positive wave of r or m pattern was recorded in the lead I in 72.73% of patients in the right coronary sinus group, versus 12.90% of patients in the left coronary sinus group, and 0% in the under left coronary sinus group. (b) All patients in the right coronary sinus group presented waves of RII>RIII and QSaVR>QSaVL, whereas most patients in the other two groups showed waves of RIII>RII and

  1. A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation: comparative analysis of two electroanatomical mapping systems.

    PubMed

    Macías, Rosa; Uribe, Inés; Tercedor, Luis; Jiménez-Jáimez, Juan; Jiménez, Juan; Barrio, Teresa; Álvarez, Miguel

    2014-08-01

    Electroanatomical mapping systems have reduced the amount of fluoroscopy required to ablate the cavotricuspid isthmus. The aims of this study are to evaluate the feasibility and safety of a zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system (Biosense Webster, Diamond Bar, CA, USA) and to compare the results of this approach with those of the zero-fluoroscopy approach using the Ensite-NavX™ system (St. Jude Medical, St. Paul, MN, USA). Twenty consecutive procedures guided by the Carto®3 system (Group A) were compared with two case-control groups matched from 146 procedures guided with the Ensite-NavX™ system. Group B consisted of 20 matched procedures from the first 50 procedures performed in the electrophysiology unit, and Group C consisted of 20 matched procedures from the last 50 procedures. Acute success (bidirectional block), complications, and recurrences were analyzed. The procedure times were also compared. There were no differences in the rates of acute success (95%, 100%, and 100%, respectively), complications (0%, 5%, and 0%), and recurrences (5.2%, 0%, and 5%) in the three groups. A zero-fluoroscopy approach was attempted in all procedures, and electroanatomical mapping made it possible to successfully avoid fluoroscopy in 90% of the procedures in Group A, 85% in B, and 95% in C. The total procedure time was shorter in Group C. The fluoroscopy and radiofrequency times were not different. A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system is feasible in most procedures. This approach has similar results to the zero-fluoroscopy approach using the Ensite-NavX™ system. ©2014 Wiley Periodicals, Inc.

  2. Catheter ablation of tachycardia arising from the pulmonary venous atrium after surgical repair of congenital heart disease.

    PubMed

    Moore, Jeremy P; Russell, Matthew; Mandapati, Ravi; Aboulhosn, Jamil A; Shannon, Kevin M

    2015-02-01

    Tachycardia arising from the pulmonary venous atrium (PVA) has not been adequately characterized in the setting of surgically repaired congenital heart disease (CHD). The purpose of this study was to determine the mechanisms, approach, and outcomes of catheter ablation of PVA tachycardia after CHD repair. The adult CHD procedural database was searched for consecutive ablation procedures over a 4-year period. Procedural characteristics of the population with tachycardia arising from the PVA were compared to those without PVA tachycardia. Groups were classified as (1) biventricular CHD, (2) single ventricle, or (3) d-transposition of the great arteries (DTGA)-baffle. Complete 3-dimensional mapping was possible for 113 of 124 sustained tachycardias during 81 procedures. Of these, 31 (19%) arose from the PVA, including 11 (15%) tachycardias in biventricular CHD, 8 (31%) in single ventricle, and 12 (80%) in DTGA-baffle procedures. Intra-atrial reentrant tachycardia was less frequently observed in the PVA vs the systemic venous atrium (SVA) (P = .012). Independent predictors of PVA tachycardia were absence of biventricular CHD (odds ratio 0.19, confidence interval 0.05-0.64, P = .010) and ipsilateral atrial surgery (odds ratio 15.7, confidence interval 4.8-59.9, P <.001). PVA procedure duration was greater than SVA-only procedures (median 5.3 hours vs 4.0 hours, P = .012), but acute success was similar (87% vs 82%, respectively, P = NS). PVA tachycardia is not unusual after surgical repair of CHD. Predictors include ipsilateral atrial surgery and absence of biventricular CHD. Such procedures involve increased complexity and unique tachycardia substrates but appear equally amenable to catheter ablation. Published by Elsevier Inc.

  3. A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study).

    PubMed

    Bertaglia, Emanuele; Stabile, Giuseppe; Senatore, Gaetano; Colella, Andrea; Del Greco, Maurizio; Goessinger, Heinz; Lamberti, Filippo; Lowe, Martin; Mantovan, Roberto; Peters, Nicholas; Pratola, Claudio; Raatikainen, Pekka; Turco, Pietro; Verlato, Roberto

    2007-03-01

    Catheter Ablation for the Cure of Atrial Fibrillation 2 study is a prospective, randomized trial aimed to demonstrate the efficacy of catheter ablation with combined lesions in the right and left atria, in preventing atrial fibrillation (AF) recurrences among patients with recurrent persistent AF refractory to one antiarrhythmic drug, in comparison with the best pharmacological therapy. Enrolment is limited to patients aged between 18 and 70 years who have experienced at least one documented relapse of persistent AF during antiarrhythmic drug therapy. One hundred and twenty-six patients will be randomized to ablation or antiarrhythmic drug therapy in a 2 : 1 manner. In the ablation group, the patients will undergo right and left atrial linear ablation. Control group patients will be treated with the best antiarrhythmic drug. After an initial blanking period of 2 months patients will be followed for 24 months. Primary endpoint of the study is the absence of documented persistent atrial tachyarrhythmias relapse during the first 24 months after the blanking period. Enrolment is scheduled in 14 centres in Italy, UK, Austria, and Finland. Seventy-two patients have currently been enrolled. This study will provide important data about the efficacy of catheter ablation in comparison with antiarrhythmic drugs for the treatment of persistent AF.

  4. Catheter Ablation to Treat Supraventricular Arrhythmia in Children and Adults With Congenital Heart Disease: What We Know and Where We Are Going

    PubMed Central

    Thomas, Patricia E.; Macicek, Scott L.

    2016-01-01

    Background: Catheter ablation has been used to manage supraventricular arrhythmia in children since 1990. This article reviews the history of catheter ablation used to treat arrhythmia in children and discusses new frontiers in the field. We also address ablation in adult patients with a history of congenital heart disease (CHD) that was diagnosed and initially treated in childhood. Methods: We conducted an evidence-based literature review to gather available data on ablation for supraventricular tachycardia in children and adult patients with CHD. Results: Ablations can be performed safely and effectively in children. Complication rates are higher in children <4 years and <15 kg. In one study, the overall success rate of radiofrequency ablation in pediatrics was 95.7%, with the highest success rate in left free wall pathways (97.8%). Recurrence was higher in septal pathways. Cryoablation has been reported to have a 93% acute success rate for atrioventricular (AV) nodal reentrant tachycardia and septal pathways with no risk of AV block and a 5%-9% risk of recurrence. Three-dimensional mapping, intracardiac echocardiography, remote magnetic navigation, and irrigated catheter ablation are new technologies used to treat pediatric and adult patients with CHD. The population of adult patients with CHD is growing, and these patients are at particularly high risk for arrhythmia. A paucity of data is available on ablation in adult patients with CHD. Conclusion: Electrophysiology for pediatric and adult patients with CHD is a rapidly growing and progressing field. We benefit from continuous development of ablation techniques for adults with structurally normal hearts and have the unique challenge and responsibility to ensure the safe and effective application of these techniques in the vulnerable population of pediatric and adult patients with CHD. PMID:27660579

  5. Multimodality imaging for patient evaluation and guidance of catheter ablation for atrial fibrillation - current status and future perspective.

    PubMed

    Bhagirath, P; van der Graaf, A W M; Karim, R; van Driel, V J H M; Ramanna, H; Rhode, K S; de Groot, N M S; Götte, M J W

    2014-08-20

    Left atrial catheter ablation is an established non-pharmacological therapy for the treatment of atrial fibrillation. The importance of a noninvasive multimodality imaging approach is emphasized by the current guidelines for the various phases of the ablation work-up e.g. patient identification, therapy guidance and procedural evaluation. Advances in the capabilities of imaging modalities and the increasing cost of healthcare warrant a review of the multimodality approach. This review discusses the application of cardiac imaging for pulmonary vein and left atrial ablation divided into stages: pre-procedural stage (assessment of left atrial dimensions, left atrial appendage thrombus and pulmonary vein anatomy), peri-procedural stage (integration of anatomical and electrical information) and post-procedural stage (evaluation of efficacy by assessment of tissue properties). Each section is dedicated to one of the subtopics of a stage, allowing a thorough comparison to be made between the strengths and weaknesses of the different imaging modalities and the identification of one that exhibits the potential for a single technique approach.

  6. Catheter ablation of atrial flutter in patients with left ventricular assist device improves symptoms of right heart failure.

    PubMed

    Hottigoudar, Rashmi U; Deam, Allen G; Birks, Emma J; McCants, Kelly C; Slaughter, Mark S; Gopinathannair, Rakesh

    2013-01-01

    Persistent atrial flutter (AFL) in left ventricular assist device (LVAD) recipients can result in loss of AV synchrony, impaired ventricular filling and right heart failure (RHF). The authors report the largest series of HeartMate II (HMII) patients who developed AFL with decompensated RHF, which successfully resolved with AFL ablation. Eight patients with HMII LVAD (mean age, 57±12 years) had medically refractory AFL, with 7 developing de novo AFL after LVAD implant (onset range, 2 days-22 months post-implant). Three patients developed recurrent syncope, 2 had inappropriate implantable cardioverter-defibrillator shocks, and 6 had new or escalating need for inotropes. All had features of decompensated RHF. Seven patients underwent electrophysiology testing where mapping confirmed typical counterclockwise AFL (mean AFL cycle length, 252±49 ms) and radiofrequency ablation of cavotricuspid isthmus restored sinus rhythm in all patients. Complete resolution of symptoms and signs of RHF with improved quality of life were noted in all. No procedural complications were noted. During a mean follow-up of 9±5 months, all patients remained free of atrial flutter. Catheter ablation of AFL in LVAD patients is safe and highly effective, resulting in immediate and significant improvement in symptoms of RHF, and should be considered first-line therapy for AFL in these patients. © 2013 Wiley Periodicals, Inc.

  7. Percutaneous right ventricular support during catheter ablation of intra-atrial reentrant tachycardia in an adult with a mustard baffle--a novel use of the Impella device.

    PubMed

    Fishberger, Steven B; Asnes, Jeremy D; Rollinson, Nancy L; Cleman, Michael W

    2010-10-01

    Late sequelea following a Mustard operation for transposition of the great arteries (TGA) include atrial arrhythmias and dysfunction of the systemic right ventricle. Catheter mapping and ablation of atrial tachycardia in the setting of significant right ventricular dysfunction may result in hemodynamic compromise. We report the novel use of the Impella percutaneous microaxial flow pump to support cardiac output in an adult patient with a Mustard operation for TGA who experienced a cardiac arrest during a prior ablation attempt. The Impella device was placed via a retrograde approach across the aortic valve into the right ventricle providing hemodynamic stability for successful mapping and ablation of intra-atrial reentrant tachycardia.

  8. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel pulmonary vein ablation catheter GOLD: results of the PRECISION GOLD trial.

    PubMed

    De Greef, Yves; Dekker, Lukas; Boersma, Lucas; Murray, Stephen; Wieczorek, Marcus; Spitzer, Stefan G; Davidson, Neil; Furniss, Steve; Hocini, Mélèze; Geller, J Christoph; Csanádi, Zoltan

    2016-05-01

    This prospective, multicentre study (PRECISION GOLD) evaluated the incidence of asymptomatic cerebral embolism (ACE) after pulmonary vein isolation (PVI) using a new gold multi-electrode radiofrequency (RF) ablation catheter, pulmonary vein ablation catheter (PVAC) GOLD. Also, procedural efficiency of PVAC GOLD was compared with ERACE. The ERACE study demonstrated that a low incidence of ACE can be achieved with a platinum multi-electrode RF catheter (PVAC) combined with procedural manoeuvres to reduce emboli. A total of 51 patients with paroxysmal atrial fibrillation (AF) (age 57 ± 9 years, CHA2DS2-VASc score 1.4 ± 1.4) underwent AF ablation with PVAC GOLD. Continuous oral anticoagulation using vitamin K antagonists, submerged catheter introduction, and heparinization (ACT ≥ 350 s prior to ablation) were applied. Cerebral magnetic resonance imaging (MRI) scans were performed within 48 h before and 16-72 h post-ablation. Cognitive function assessed by the Mini-Mental State Exam at baseline and 30 days post-ablation. New post-procedural ACE occurred in only 1 of 48 patients (2.1%) and was not detectable on MRI after 30 days. The average number of RF applications per patient to achieve PVI was lower in PRECISION GOLD (20.3 ± 10.0) than in ERACE (28.8 ± 16.1; P = 0.001). Further, PVAC GOLD ablations resulted in significantly fewer low-power (<3 W) ablations (15 vs. 23%, 5 vs. 10% and 2 vs. 7% in 4:1, 2:1, and 1:1 bipolar:unipolar energy modes, respectively). Mini-Mental State Exam was unchanged in all patients. Atrial fibrillation ablation with PVAC GOLD in combination with established embolic lowering manoeuvres results in a low incidence of ACE. Pulmonary vein ablation catheter GOLD demonstrates improved biophysical efficiency compared with platinum PVAC. ClinicalTrials.gov NCT01767558. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  9. Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.

    PubMed

    Sacher, Frédéric; Monahan, Kristi H; Thomas, Stuart P; Davidson, Neil; Adragao, Pedro; Sanders, Prashanthan; Hocini, Mélèze; Takahashi, Yoshihide; Rotter, Martin; Rostock, Thomas; Hsu, Li-Fern; Clémenty, Jacques; Haïssaguerre, Michel; Ross, David L; Packer, Douglas L; Jaïs, Pierre

    2006-06-20

    The purpose of this study was to characterize the occurrence of phrenic nerve injury (PNI) and its outcome after radiofrequency (RF) ablation of atrial fibrillation (AF). It is recognized that extra-myocardial damage may develop owing to penetration of ablative energy. Between 1997 and 2004, 3,755 consecutive patients underwent AF ablation at five centers. Among them, 18 patients (0.48%; 9 male, 54 +/- 10 years) had PNI (16 right, 2 left). The procedure consisted of pulmonary vein (PV) isolation in 15 patients and anatomic circumferential ablation in 3 patients, with additional left atrial lesions (n = 11) and/or superior vena cava (SVC) disconnection (n = 4). Right PNI occurred during ablation of right superior PV (n = 12) or SVC disconnection (n = 3). Left PNI occurred during ablation at the left atrial appendage. Immediate features were dyspnea, cough, hiccup, and/or sudden diaphragmatic elevation in 9, and in the remaining the diagnosis was made after ablation owing to dyspnea (n = 7) or on routine radiographic evaluation (n = 2). Four patients (22%) were asymptomatic. Complete recovery occurred in 12 patients (66%). Recovery occurred within 24 h in the two patients with left PNI and in one patient with right PNI occurring with SVC disconnection. In the other nine patients, right PNI recovery occurred after 4 +/- 5 months (1 to 12 months) with respiratory rehabilitation. After a mean follow-up of 36 +/- 33 months, six patients have persistent PNI (three with partial and three with no recovery). In this multicenter experience, PNI was a rare complication (0.48%) of AF ablation. Ablation of the right superior PV, SVC, and left atrial appendage were associated with PNI. Complete (66%) or partial (17%) recovery was observed in the majority.

  10. The safety and efficacy of trans-baffle puncture to enable catheter ablation of atrial tachycardias following the Mustard procedure: a single centre experience and literature review.

    PubMed

    Jones, David G; Jarman, Julian W E; Lyne, Jonathan C; Markides, Vias; Gatzoulis, Michael A; Wong, Tom

    2013-09-30

    Targets for catheter ablation of atrial tachyarrhythmias (AT) in post-Mustard procedure patients are often located in the pulmonary venous atrium (PVA). Traditional access to this chamber is retrograde via the aorta. However trans-baffle puncture may be a key determinant of successful ablation in many cases. All AT ablations performed in patients late after Mustard and Senning operations by a single operator from 2007 to 2012 were reviewed. Nine procedures were identified. In total, 12 ATs were treated, seven persistent, the remainder induced, consisting of counterclockwise cavotricuspid isthmus dependent flutter (5), macroreentrant with isthmus in the systemic venous atrium (SVA) (2), macroreentrant with isthmus in the PVA (1), focal from the PVA (3), and focal from the SVA (1). Ablation within the PVA was required in all procedures to treat AT. Retrograde access in one patient was impossible due to the presence of a Bjork-Shiley tricuspid valve replacement; retrograde access in another two patients was attempted but catheter manipulation was ineffective and AT could not be mapped and ablated. Trans-baffle puncture was performed with transoesophageal echocardiographic guidance in all cases without complications and resulted in successful ablation of AT. Access to the pulmonary venous atrium is essential for successful ablation of AT in many Mustard patients. Trans-baffle puncture remains a relevant technique to modern practice and can be performed safely and effectively. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Electrophysiological mapping and radiofrequency catheter ablation for ventricular tachycardia in a patient with peripartum cardiomyopathy.

    PubMed

    Tokuda, Michifumi; Stevenson, William G; Nagashima, Koichi; Rubin, David A

    2013-11-01

    A 38-year-old female with prior failed endocardial ablation for ventricular tachycardia (VT) was referred for further treatment. She had been diagnosed with peripartum cardiomyopathy 7 years before and had persistent left ventricular dysfunction with an ejection fraction of 20%. Epicardial voltage mapping showed extensive epicardial scar despite absence of endocardial scar. Five distinct VT morphologies were induced. Ablation was aided by electrogram characteristics, pace mapping, entrainment mapping, and establishing electrical inexcitability along areas of epicardial scar. After epicardial ablation no sustained VT was induced. She had been doing well without VT occurrence but died 1 year later unexpectedly at home.

  12. Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States.

    PubMed

    Palaniswamy, Chandrasekar; Kolte, Dhaval; Harikrishnan, Prakash; Khera, Sahil; Aronow, Wilbert S; Mujib, Marjan; Mellana, William Michael; Eugenio, Paul; Lessner, Seth; Ferrick, Aileen; Fonarow, Gregg C; Ahmed, Ali; Cooper, Howard A; Frishman, William H; Panza, Julio A; Iwai, Sei

    2014-11-01

    There is a paucity of data regarding the complications and in-hospital mortality after catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease. The purpose of this study was to determine the temporal trends in utilization, in-hospital mortality, and complications of catheter ablation of postinfarction VT in the United States. We used the 2002-2011 Nationwide Inpatient Sample (NIS) database to identify all patients ≥18 years of age with a primary diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and who also had a secondary diagnosis of prior history of myocardial infarction (ICD-9-CM 412). Patients with supraventricular arrhythmias were excluded. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Temporal trends in catheter ablation, in-hospital complications, and in-hospital mortality were analyzed. Of 81,539 patients with postinfarct VT, 4653 (5.7%) underwent catheter ablation. Utilization of catheter ablation increased significantly from 2.8% in 2002 to 10.8% in 2011 (Ptrend < .001). The overall rate of any in-hospital complication was 11.2% (523/4653), with vascular complications in 6.9%, cardiac in 4.3%, and neurologic in 0.5%. In-hospital mortality was 1.6% (75/4653). From 2002 to 2011, there was no significant change in the overall complication rates (8.4% to 10.2%, Ptrend = .101; adjusted odds ratio [per year] 1.02, 95% confidence interval 0.98-1.06) or in-hospital mortality (1.3% to 1.8%, Ptrend = .266; adjusted odds ratio [per year] 1.03, 95% confidence interval 0.92-1.15). The utilization rate of catheter ablation as therapy for postinfarct VT has steadily increased over the past decade. However, procedural complication rates and in-hospital mortality have not changed significantly during this period. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  13. Correlates and prognosis of early recurrence after catheter ablation for ventricular tachycardia due to structural heart disease.

    PubMed

    Nagashima, Koichi; Choi, Eue-Keun; Tedrow, Usha B; Koplan, Bruce A; Michaud, Gregory F; John, Roy M; Epstein, Laurence M; Tokuda, Michifumi; Inada, Keiichi; Kumar, Saurabh; Lin, Kaity Y; Barbhaiya, Chirag R; Chinitz, Jason S; Enriquez, Alan D; Helmbold, Alan F; Stevenson, William G

    2014-10-01

    Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in-hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation. Of 370 patients (313 men; aged 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis, early recurrence was associated with New York Heart Association classification ≥III (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.03-3.48; P=0.04), dilated cardiomyopathy (OR 1.93, 95% CI 1.03-3.57; P=0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48-4.65; P=0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07-1.45; P=0.006), and acute failure or no final induction test (OR 1.88, 95% CI 1.03-3.40; P=0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52-4.34; P=0.0005). Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group. © 2014 American Heart Association, Inc.

  14. Ex-vivo and simulation comparison of multi-angular ablation patterns using catheter-based ultrasound transducers

    NASA Astrophysics Data System (ADS)

    Ghoshal, Goutam; Salgaonkar, Vasant; Wooton, Jeffrey; Williams, Emery; Neubauer, Paul; Frith, Lance; Komadina, Bruce; Diederich, Chris; Burdette, E. Clif

    2013-02-01

    Catheter based ultrasound ablation devices have been suggested as the least minimally invasive procedure for thermal therapy. The success of such procedures depends on accurately delivering the thermal dose to the tissue. One of the main challenges of such therapy is to deliver thermal therapy at the target location without damaging the surrounding tissue or major vessels and veins. To achieve such multi-directional capability, a multi-angular beam pattern is required. The purpose of this study was to build a multi-sectored tubular ultrasonic transducer and control the directionality of the acoustic power delivered to the tissue by each sector simultaneously. Multi-zoned tubular ultrasonic transducer arrays with three active sectors were constructed. Using these transducer configurations, a multi-angular ablation pattern was created in ex vivo chicken breast tissue. Experiments were conducted by activating two and three zones separately to investigate the ablation pattern of each case. Simulations results were presented by solving the Penne bio-heat equation using finite element method. The simulation results were compared with ex vivo results with respect to temperature and dose distribution in the tissue. Thermocouples located at 15 mm radially from the applicator indicated a peak temperature of greater than 52-55° C and thermal dose of 103-104 EQ mins at 43°C. It was observed through visual inspection that the proposed technology could ablate a specific tissue region or multiple regions selectively while not damaging the desired surrounding tissue. Good agreement between experimental and simulation results was obtained.

  15. Influence of the concomitant use of heparin on the effects of warfarin during catheter ablation for atrial fibrillation.

    PubMed

    Inada, Keiichi; Matsuo, Seiichiro; Tokutake, Ken-Ichi; Yokoyama, Ken-Ichi; Hioki, Mika; Narui, Ryohsuke; Ito, Keiichi; Tanigawa, Shin-Ichi; Yamashita, Seigo; Tokuda, Michifumi; Shibayama, Kenri; Miyanaga, Satoru; Sugimoto, Ken-Ichi; Yoshimura, Michihiro; Yamane, Teiichi

    2016-03-01

    Warfarin is widely used to perform catheter ablation for atrial fibrillation (AF). Heparin is usually administered during this procedure to prevent thromboembolic events, while protamine is used to reduce the incidence of bleeding complications. The purpose of this study was to investigate the influence of heparin and protamine administration on the effects of warfarin and its safety. The subjects included 226 AF patients (206 males, 54.9 ± 9.1 years, paroxysmal/persistent AF: 118/108) undergoing AF ablation with the discontinuation of warfarin administration over 2 days. Heparin was administered to achieve an activated clotting time (ACT) above 300 s during the procedure. Several parameters of the coagulation status, including the prothrombin time international normalized ratio (PT-INR) and ACT values, measured immediately before and after protamine infusion were compared. The mean value of PT-INR prior to ablation was 1.9 ± 0.6. At the end of the procedure, the mean ACT and PT-INR values were 348.0 ± 52.9 and 2.9 ± 0.7, respectively. Following the infusion of 30 mg of protamine, both the ACT and PT-INR values significantly decreased, to 159.6 ± 31.0 (p < 0.0001) and 1.6 ± 0.3 (p < 0.0001), respectively. No cases of symptomatic cerebral infarction were observed, although femoral hematomas developed in 17 (7.5 %) of the patients without further consequence. The concomitant use of heparin augments the effect of warfarin. Meanwhile, protamine administration immediately reverses both the ACT and PT-INR, indicating the applicability of protamine for AF ablation in patients under the mixed administration of heparin and warfarin.

  16. Catheter ablation of atrial fibrillation in patients with concomitant left ventricular impairment: a systematic review of efficacy and effect on ejection fraction.

    PubMed

    Ganesan, Anand N; Nandal, Savvy; Lüker, Jakob; Pathak, Rajeev K; Mahajan, Rajiv; Twomey, Darragh; Lau, Dennis H; Sanders, Prashanthan

    2015-03-01

    Catheter ablation of atrial fibrillation (AF) is an established rhythm control strategy; however, the impact of co-existing LV systolic dysfunction (LVSD) on ablation success is less well understood. This systematic review compiles the outcomes of catheter ablation of atrial fibrillation in patients with LVSD. An electronic database (Pubmed, Scopus, Embase) search using the keywords 'atrial fibrillation AND ablation AND (ventricular dysfunction OR heart failure OR cardiomyopathy)' was performed for English scientific literature up to 01/01/2014. 2484 references were retrieved and evaluated for relevance by three reviewers. Reviews and reference lists of retrieved articles were also examined to ensure all relevant studies were included. Data was extracted from 19 studies, including a total of 914 patients. Single-procedure success in LVSD patients for AF ablation was 56.5% (95% CI: 48%-64%). Overall multiple-procedure (including the use of anti-arrhythmic drugs) in LVSD patients for AF ablation was 81.8% (95% CI: 75%-87%). The mean increase in LVEF following AF ablation was 13.3% (95% CI: 10.8%-15.9%). Seven studies reported improvements in exercise capacity and quality of life information using standardised criteria. The pooled rate of serious adverse events was 5.5% (95% CI: 3.7%-8.1%). Catheter ablation may be an effective therapy in AF patients with left ventricular systolic impairment, and can be associated with improvements in left ventricular function, quality of life, exercise capacity, and modest rates of serious adverse events. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

  17. Transmural ablation of the normal porcine common bile duct with catheter-directed irreversible electroporation is feasible and does not affect duct patency.

    PubMed

    Ueshima, Eisuke; Schattner, Mark; Mendelsohn, Robin; Gerdes, Hans; Monette, Sebastien; Takaki, Haruyuki; Durack, Jeremy C; Solomon, Stephen B; Srimathveeravalli, Govindarajan

    2017-05-10

    The aim of this study was to evaluate the feasibility and early safety of catheter-directed irreversible electroporation (IRE) of the normal common bile duct (CBD) in swine. IRE (2000 V, 90 pulses, 100 μs pulse) was performed in the CBD of 6 Yorkshire pigs using a catheter electrode under endoscopic guidance. Ductal patency was assessed with immediate retrograde cholangiography and contrast-enhanced CT imaging at 1 or 7 days after treatment. Animals were killed at either 1 day (n = 4, 2 ablations/animal) or 7 days (n = 2, 1 ablation/animal) after treatment. The biliary tract was extracted en bloc and the length of the ablation along the CBD mucosa was measured. The depth of ablation was quantified using cross-sections of the treated CBD wall stained with hematoxylin and eosin. Single-sample hypothesis testing was performed to verify whether the depth of ablation in the CBD was a representative outcome of IRE treatment. IRE of the CBD did not result in perforation or obstruction of the organ at 1 or 7 days after treatment. The length of ablation along the CBD mucosa was 17.27 ± 5.55 mm on day 1 samples, and transmural ablation of the CBD wall was a representative outcome of the treatment (7/8 samples, P < .05). Day 1 samples demonstrated loss of epithelium, transmural necrosis, with preservation of lumen integrity. Day 7 samples demonstrated re-epithelialization, with diffuse transmural fibrosis of the CBD wall. These findings were absent from sham tissue samples. Intraluminal catheter-directed IRE is feasible and safe for full-thickness ablation of the normal porcine CBD without affecting lumen patency up to 1 week after treatment. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  18. [Prognostic factors for success in catheter ablation of the right Kent bundle: report of 27 patients].

    PubMed

    Bodegas, A; Leenhardt, A; Cauchemez, B; Chouty, F; Leclercq, J F; Coumel, P

    1990-01-01

    In 27 patients with atrial fibrillation and/or reciprocating tachycardia, ablation of right-sided Kent bundles (23 in the right posterior paraseptal region and four of the right free wall) was performed. The anterograde refractory period of the accessory pathways was 253 +/- 70 msec and the shortest R-R interval during atrial fibrillation 211 +/- 47 msec. Cumulative energies of 589 +/- 396 J per patient were used, with 3 +/- 2 shocks and 195 +/- 312 J per shock. Accessory pathway ablation was effective in 16/27 patients (59%) during an 11 +/- 8 months of follow-up (in 15/16 pre-excitation disappeared; in nine of them the anterograde and retrograde conductions were abolished and in the other six the anterograde and retrograde conductions were severely altered; ablation was partially ineffective in 1/16 patients who remained asymptomatic on medical treatment and without inducible reciprocal rhythm). Ablation was ineffective in 11/27 patients. Three hours after ablation a patient died from electromechanical dissociation; during ablation a 200 J shock cancelled preexcitation, not being possible to produce reciprocal rhythm. The emergency echocardiography only showed a minimum posterior pericardial effusion. Ablation was effective in 15/23 patients (65%) right posterior paraseptal. Overall success in 1989 (10/27 patients) was 70% (7/10 patients). The success in 1989 was 70% (6/8 patients) right posterior paraseptal. The shortest RP' interval (was 82 +/- 19 msec) during the reciprocal rhythm, where the ablation was performed, was 82 +/- 19 msec (74 +/- 17 msec with success and 99 +/- 19 msec with failure).(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Procedural Complications, Rehospitalizations, and Repeat Procedures After Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Shah, Rashmee U.; Freeman, James V.; Shilane, David; Wang, Paul J.; Go, Alan S.; Hlatky, Mark A.

    2017-01-01

    Objectives The purpose of this study was to estimate rates and identify predictors of inpatient complications and 30-day readmissions, as well as repeat hospitalization rates for arrhythmia recurrence following atrial fibrillation (AF) ablation. Background AF is the most common clinically significant arrhythmia and is associated with increased morbidity and mortality. Radiofrequency or cryotherapy ablation of AF is a relatively new treatment option, and data on post-procedural outcomes in large general populations are limited. Methods Using data from the California State Inpatient Database, we identified all adult patients who underwent their first AF ablation from 2005 to 2008. We used multivariable logistic regression to identify predictors of complications and/or 30-day readmissions and Kaplan-Meier analyses to estimate rates of all-cause and arrhythmia readmissions. Results Among 4,156 patients who underwent an initial AF ablation, 5% had periprocedural complications, most commonly vascular, and 9% were readmitted within 30 days. Older age, female, prior AF hospitalizations, and less hospital experience with AF ablation were associated with higher adjusted risk of complications and/or 30-day readmissions. The rate of all-cause hospitalization was 38.5% by 1 year. The rate of readmission for recurrent AF, atrial flutter, and/or repeat ablation was 21.7% by 1 year and 29.6% by 2 years. Conclusions Periprocedural complications occurred in 1 of 20 patients undergoing AF ablation, and all-cause and arrhythmia-related rehospitalizations were common. Older age, female sex, prior AF hospitalizations, and recent hospital procedure experience were associated with a higher risk of complications and/or 30-day readmission after AF ablation. PMID:22222078

  20. Catheter Ablation of Ventricular Arrhythmias Arising from the Left Ventricular Summit.

    PubMed

    Santangeli, Pasquale; Lin, David; Marchlinski, Francis E

    2016-03-01

    The left ventricular summit is a common site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly ablated within the coronary venous system or from other adjacent structures, such as the right ventricular and left ventricular outflow tract or coronary cusp region. When ablation from adjacent structures fails, a percutaneous epicardial approach can be considered, but is rarely successful in eliminating the arrhythmias due to proximity to major coronary vessels and/or epicardial fat.

  1. Effect of vitamin K2 on the anticoagulant activity of warfarin during the perioperative period of catheter ablation: Population analysis of retrospective clinical data.

    PubMed

    Zhou, Zhi; Yano, Ikuko; Odaka, Sumiko; Morita, Yosuke; Shizuta, Satoshi; Hayano, Mamoru; Kimura, Takeshi; Akaike, Akinori; Inui, Ken-Ichi; Matsubara, Kazuo

    2016-01-01

    Catheter ablation is a non-medication therapy for atrial fibrillation, and during the procedure, warfarin is withdrawn in the preoperative period to prevent the risk of bleeding. In case of emergency, vitamin K2 can be intravenously administered to antagonize the anticoagulant activity of warfarin. The aims of this study were to conduct population pharmacokinetic/pharmacodynamic modeling for retrospective clinical data and to investigate the effect of vitamin K2 on the anticoagulant activity of warfarin in the perioperative period of catheter ablation. A total of 579 international normalized ratio (INR) values of prothrombin time from 100 patients were analyzed using the nonlinear mixed-effects modeling program NONMEM. A 1-compartment model was adapted to the pharmacokinetics of warfarin and vitamin K2, and the indirect response model was used to investigate the relationship between plasma concentration and the pharmacodynamic response of warfarin and vitamin K2. Since no plasma concentration data for warfarin and vitamin K2 were available, 3 literally available pharmacokinetic parameters were used to simultaneously estimate 1 pharmacokinetic parameter and 5 pharmacodynamic parameters. The population parameters obtained not only successfully explained the observed INR values, but also indicated an increase in sensitivity to warfarin in patients with reduced renal function. Simulations using these parameters indicated that vitamin K2 administration of more than 20 mg caused a slight dose-dependent decrease in INR on the day of catheter ablation and a delayed INR elevation after warfarin re-initiation. A pharmacokinetic/pharmacodynamic model was successfully built to explain the retrospective INR data during catheter ablation. Simulation studies suggest that vitamin K2 should be administered with care and that more than 20 mg is unnecessary in the preoperative period of catheter ablation.

  2. Optoacoustic monitoring of real-time lesion formation during radiofrequency catheter ablation

    NASA Astrophysics Data System (ADS)

    Pang, Genny A.; Bay, Erwin; Deán-Ben, Xosé L.; Razansky, Daniel

    2015-03-01

    Current radiofrequency cardiac ablation procedures lack real-time lesion monitoring guidance, limiting the reliability and efficacy of the treatment. The objective of this work is to demonstrate that optoacoustic imaging can be applied to develop a diagnostic technique applicable to radiofrequency ablation for cardiac arrhythmia treatment with the capabilities of real-time monitoring of ablated lesion size and geometry. We demonstrate an optoacoustic imaging method using a 256-detector optoacoustic imaging probe and pulsed-laser illumination in the infrared wavelength range that is applied during radiofrequency ablation in excised porcine myocardial tissue samples. This technique results in images with high contrast between the lesion volume and unablated tissue, and is also capable of capturing time-resolved image sequences that provide information on the lesion development process. The size and geometry of the imaged lesion were shown to be in excellent agreement with the histological examinations. This study demonstrates the first deep-lesion real-time monitoring for radiofrequency ablation generated lesions, and the technique presented here has the potential for providing critical feedback that can significantly impact the outcome of clinical radiofrequency ablation procedures.

  3. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study).

    PubMed

    Mont, Lluís; Bisbal, Felipe; Hernández-Madrid, Antonio; Pérez-Castellano, Nicasio; Viñolas, Xavier; Arenal, Angel; Arribas, Fernando; Fernández-Lozano, Ignacio; Bodegas, Andrés; Cobos, Albert; Matía, Roberto; Pérez-Villacastín, Julián; Guerra, José M; Ávila, Pablo; López-Gil, María; Castro, Victor; Arana, José Ignacio; Brugada, Josep

    2014-02-01

    Catheter ablation (CA) is a highly effective therapy for the treatment of paroxysmal atrial fibrillation (AF) when compared with antiarrhythmic drug therapy (ADT). No randomized studies have compared the two strategies in persistent AF. The present randomized trial aimed to compare the effectiveness of CA vs. ADT in treating persistent AF. Patients with persistent AF were randomly assigned to CA or ADT (excluding patients with long-standing persistent AF). Primary endpoint at 12-month follow-up was defined as any episode of AF or atrial flutter lasting >24 h that occurred after a 3-month blanking period. Secondary endpoints were any atrial tachyarrhythmia lasting >30 s, hospitalization, and electrical cardioversion. In total, 146 patients were included (aged 55 ± 9 years, 77% male). The ADT group received class Ic (43.8%) or class III drugs (56.3%). In an intention-to-treat analysis, 69 of 98 patients (70.4%) in the CA group and 21 of 48 patients (43.7%) in the ADT group were free of the primary endpoint (P = 0.002), implying an absolute risk difference of 26.6% (95% CI 10.0-43.3) in favour of CA. The proportion of patients free of any recurrence (>30 s) was higher in the CA group than in the ADT group (60.2 vs. 29.2%; P < 0.001) and cardioversion was less frequent (34.7 vs. 50%, respectively; P = 0.018). Catheter ablation is superior to medical therapy for the maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up. NCT00863213 (http://clinicaltrials.gov/ct2/show/NCT00863213).

  4. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study)

    PubMed Central

    Mont, Lluís; Bisbal, Felipe; Hernández-Madrid, Antonio; Pérez-Castellano, Nicasio; Viñolas, Xavier; Arenal, Angel; Arribas, Fernando; Fernández-Lozano, Ignacio; Bodegas, Andrés; Cobos, Albert; Matía, Roberto; Pérez-Villacastín, Julián; Guerra, José M.; Ávila, Pablo; López-Gil, María; Castro, Victor; Arana, José Ignacio; Brugada, Josep

    2014-01-01

    Background Catheter ablation (CA) is a highly effective therapy for the treatment of paroxysmal atrial fibrillation (AF) when compared with antiarrhythmic drug therapy (ADT). No randomized studies have compared the two strategies in persistent AF. The present randomized trial aimed to compare the effectiveness of CA vs. ADT in treating persistent AF. Methods and results Patients with persistent AF were randomly assigned to CA or ADT (excluding patients with long-standing persistent AF). Primary endpoint at 12-month follow-up was defined as any episode of AF or atrial flutter lasting >24 h that occurred after a 3-month blanking period. Secondary endpoints were any atrial tachyarrhythmia lasting >30 s, hospitalization, and electrical cardioversion. In total, 146 patients were included (aged 55 ± 9 years, 77% male). The ADT group received class Ic (43.8%) or class III drugs (56.3%). In an intention-to-treat analysis, 69 of 98 patients (70.4%) in the CA group and 21 of 48 patients (43.7%) in the ADT group were free of the primary endpoint (P = 0.002), implying an absolute risk difference of 26.6% (95% CI 10.0–43.3) in favour of CA. The proportion of patients free of any recurrence (>30 s) was higher in the CA group than in the ADT group (60.2 vs. 29.2%; P < 0.001) and cardioversion was less frequent (34.7 vs. 50%, respectively; P = 0.018). Conclusion Catheter ablation is superior to medical therapy for the maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up. Clinical Trial Registration Information NCT00863213 (http://clinicaltrials.gov/ct2/show/NCT00863213). PMID:24135832

  5. Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence.

    PubMed

    Liu, Yaowu; Fang, Zhen; Yang, Bing; Kojodjojo, Pipin; Chen, Hongwu; Ju, Weizhu; Cao, Kejiang; Chen, Minglong; Zhang, Fengxiang

    2015-12-01

    Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence. Consecutive patients undergoing FVT ablation at a single tertiary center were enrolled. Activation mapping was performed to identify the earliest presystolic Purkinje potential during FVT that was targeted by radiofrequency ablation. Follow-up with clinic visits, ECG, and Holter monitoring was performed at least every 6 months. A total of 120 consecutive patients (mean age, 29.3±12.7 years; 82% men; all patients with normal ejection fraction) were enrolled. FVT involved left posterior fascicle and left anterior fascicle in 118 and 2 subjects, respectively. VT was noninducible in 3 patients, and ablation was acutely successful in 117 patients. With a median follow-up of 55.7 months, VT of a similar ECG morphology recurred in 17 patients, and repeat procedure confirmed FVT recurrence involving the same fascicle. Shorter VT cycle length was the only significant predictor of FVT recurrence (P=0.03). Six other patients developed new-onset upper septal FVT that was successfully ablated. Ablation of FVT guided by activation mapping is associated with a single procedural success rate without the use of antiarrhythmic drugs of 80.3%. Arrhythmia recurrences after an initially successful ablation were caused by recurrent FVT involving the same fascicle in two thirds of patients or new onset of upper septal FVT in the remainder. © 2015 The Authors.

  6. Prediction of Treatment Outcomes After Global Endometrial Ablation

    PubMed Central

    El-Nashar, Sherif A.; Hopkins, Matthew R.; Creedon, Douglas J.; St. Sauver, Jennifer L.; Weaver, Amy L.; McGree, Michaela E.; Cliby, William A.; Famuyide, Abimbola O.

    2010-01-01

    Objective To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models. Methods From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radiofrequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or re-ablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes. Results The amenorrhea rate was 23% (95% confidence interval [CI], 19%–28%) and the 5-year cumulative failure rate was 16% (95% CI, 10%–20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR], 2.6; 95% CI, 1.6–4.3); uterine length less than 9 cm (aOR, 1.8; 95% CI, 1.1–3.1); endometrial thickness less than 4 mm (aOR, 2.7; 95% CI, 1.2–6.3); and use of radiofrequency ablation instead of thermal balloon ablation (aOR, 2.8; 95% CI, 1.7–4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR], 2.6; 95% CI, 1.3–5.1); parity of 5 or greater (aHR, 6.0; 95% CI, 2.5–14.8); prior tubal ligation (aHR, 2.2; 95% CI, 1.2–4.0); and history of dysmenorrhea (aHR, 3.7; 95% CI, 1.6–8.5). After global endometrial ablation, 23 women (5.1%; 95% CI, 3.2%–7.5%) had pelvic pain, 3 (0.7%; 95% CI, 0.1%–1.9%) were pregnant, and none (95% CI, 0%–0.8%) had endometrial cancer. Conclusion Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal

  7. A probabilistic framework for freehand 3D ultrasound reconstruction applied to catheter ablation guidance in the left atrium.

    PubMed

    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2009-09-01

    The catheter ablation procedure is a minimally invasive surgery used to treat atrial fibrillation. Difficulty visualizing the catheter inside the left atrium anatomy has led to lengthy procedure times and limited success rates. In this paper, we present a set of algorithms for reconstructing 3D ultrasound data of the left atrium in real-time, with an emphasis on automatic tissue classification for improved clarity surrounding regions of interest. Using an intracardiac echo (ICE) ultrasound catheter, we collect 2D-ICE images of a left atrium phantom from multiple configurations and iteratively compound the acquired data into a 3D-ICE volume. We introduce two new methods for compounding overlapping US data-occupancy-likelihood and response-grid compounding-which automatically classify voxels as "occupied" or "clear," and mitigate reconstruction artifacts caused by signal dropout. Finally, we use the results of an ICE-to-CT registration algorithm to devise a response-likelihood weighting scheme, which assigns weights to US signals based on the likelihood that they correspond to tissue-reflections. Our algorithms successfully reconstruct a 3D-ICE volume of the left atrium with voxels classified as "occupied" or "clear," even within difficult-to-image regions like the pulmonary vein openings. We are robust to dropout artifact that plagues a subset of the 2D-ICE images, and our weighting scheme assists in filtering out spurious data attributed to ghost-signals from multi-path reflections. By automatically classifying tissue, our algorithm precludes the need for thresholding, a process that is difficult to automate without subjective input. Our hope is to use this result towards developing 3D ultrasound segmentation algorithms in the future.

  8. Restoration of Atrial Mechanical Function after Successful Radio-Frequency Catheter Ablation of Atrial Flutter

    PubMed Central

    Rhee, Kyoung-Suk; Kang, Duk-Hyun; Song, Jae-Kwan; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2001-01-01

    Background: Atrial mechanical dysfunction and its recovery time course after successful radiofrequency ablation of chronic atrial flutter (AFL) has been largely unknown. We serially evaluated left atrial function by echocardiography after successful ablation of chronic atrial flutter. Methods: In 13 patients with chronic AFL, mitral E wave A wave, and the ratio of A/E velocity were measured at 1 day, 1 month, 3 months and 6–12 months after successful radiofrequency (RF) ablation. Doppler tissue imaging (DTI) technique was also used to avoid load-dependent variation in the flow velocity pattern. Results: Left atrial mechanical function, assessed by A wave velocity and the annular motion, was depressed at 1 day, but improved significantly at 1 month and maintained through 6–12 months after the ablation. Left atrial size did not change significantly. Conclusion: Left atrial mechanical function was depressed immediately after successful RF ablation of chronic AFL, but it improved significantly after 1 month and was maintained over one year. PMID:11590904

  9. Predictive analysis of optical ablation in several dermatological tumoral tissues

    NASA Astrophysics Data System (ADS)

    Fanjul-Vélez, F.; Blanco-Gutiérrez, A.; Salas-García, I.; Ortega-Quijano, N.; Arce-Diego, J. L.

    2013-06-01

    Optical techniques for treatment and characterization of biological tissues are revolutionizing several branches of medical praxis, for example in ophthalmology or dermatology. The non-invasive, non-contact and non-ionizing character of optical radiation makes it specially suitable for these applications. Optical radiation can be employed in medical ablation applications, either for tissue resection or surgery. Optical ablation may provide a controlled and clean cut on a biological tissue. This is particularly relevant in tumoral tissue resection, where a small amount of cancerous cells could make the tumor appear again. A very important aspect of tissue optical ablation is then the estimation of the affected volume. In this work we propose a complete predictive model of tissue ablation that provides an estimation of the resected volume. The model is based on a Monte Carlo approach for the optical propagation of radiation inside the tissue, and a blow-off model for tissue ablation. This model is applied to several types of dermatological tumoral tissues, specifically squamous cells, basocellular and infiltrative carcinomas. The parameters of the optical source are varied and the estimated resected volume is calculated. The results for the different tumor types are presented and compared. This model can be used for surgical planning, in order to assure the complete resection of the tumoral tissue.

  10. Acute myocardial infarction after radiofrequency catheter ablation of typical atrial flutter.

    PubMed

    Yune, Sehyo; Lee, Woo Joo; Hwang, Ji-won; Kim, Eun; Ha, Jung Min; Kim, June Soo

    2014-02-01

    A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.

  11. Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction

    PubMed Central

    Wang, Maojing; Cai, Shanglang; Ding, Wei; Deng, Yujie; Zhao, Qing

    2017-01-01

    Objective To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation. Methods From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) <50%) underwent DCC followed by amiodarone (n = 40) or circumferential pulmonary vein isolation (PVI; n = 57) according to patient’s preference were recruited in the study. Post-ablation recurrence was treated with atrial roof and mitral isthmus lines ablation with or without PVI based on restoration or not of pulmonary vein (PV) potential conduction. Study outcomes were 12-month rate of sustained sinus rhythm (SR) and cardiac function. Baseline characteristics were compared between patients with and without cardiac function improvement post ablation. Results With similarly distributed characteristics at baseline, ablation (mean 1.8 procedures) relative to DCC yielded significantly higher level of 12-month SR maintenance rate (68.42% vs. 35%, P = 0.001); and better LVEF and New York Heart Association class. with significant effect for DCC only in maintained SR cases. Post ablation LVEF increased (>20% or to over 55%) in 31 (54.39%) patients with worse baseline cardiac function and ventricular rate control. Conclusions Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group. PMID:28350861

  12. Impact of magnesium sulfate on serum magnesium concentrations and intracellular electrolyte concentrations among patients undergoing radio frequency catheter ablation.

    PubMed

    Shah, Sachin A; Clyne, Christopher A; Henyan, Nickole; Migeed, Magdy; Yarlagadda, Ravi; Silver, Burton B; Kluger, Jeffrey; White, C Michael

    2008-05-01

    We evaluated the impact of intravenous magnesium on intracellular magnesium (iMg) and serum magnesium (sMg) in patients undergoing radio frequency catheter ablation (RFCA) for atrial fibrillation (AF). Patients with AF received 4g intravenous magnesium sulfate or normal saline in a randomized, double-blinded fashion. Venous blood and buccal cells were collected for evaluation of sMg and iMg at baseline, postinfusion, at the end of ablation procedure and six-hours posttherapy. All subjects (n = 18) had baseline sMg within normal range but iMg concentrations below normal in 89% of subjects. Baseline sMg and iMg concentrations were similar between groups. After infusion, the magnesium group had significantly higher sMg concentration than the placebo group over the six hours. In contrast, iMg concentrations were significantly higher than placebo immediately after the infusion (P = 0.007) but not at the end of RFCA or six-hours postinfusion (P = 0.187 and P = 0.267). iMg deficiencies exist despite normal sMg concentrations in patients undergoing RFCA. Intravenous magnesium sulfate corrects iMg deficiencies immediately postinfusion.

  13. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis.

    PubMed

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Hou, Jian-Wen; Li, Yi-Gang

    2017-04-01

    Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.

  14. Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation.

    PubMed

    Nührich, Jana M; Geisler, Anne C; Steven, Daniel; Hoffmann, Boris A; Schäffer, Benjamin; Lund, Gunnar; Stehning, Christian; Radunski, Ulf K; Sultan, Arian; Schwarzl, Michael; Adam, Gerhard; Willems, Stephan; Muellerleile, Kai

    2017-02-01

    Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage-mapping after multiple persAF ablation procedures. We included 16 persAF patients who had ≥2 SM procedures and a control group (CG) of 21 persAF patients without prior ablation. CMR was performed in sinus rhythm at least 4 weeks after the last cardioversion. Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude <0.2 mV. We found median LA-AEF to be lower (13 [9-22] vs 32 [26-36] %, P < 0.001) and median LA scar burden to be higher (40 [20-68] vs nine [3-18] %, P < 0.05) in the SM group compared with the CG. Furthermore, a significant correlation was found between mean LA voltage and LA-AEF (r(2) = 0.62, P < 0.001). No significant differences were detected with respect to median RA-AEF (41 [28-48] vs 47 [35-50] %, P = 0.43) and median peak LAA emptying velocities (30 [16-40] vs 17 [13-28] cm/s, P = 0.07). Active LA function is preserved but significantly impaired and associated with ablation-related LA scar burden after multiple extensive persAF ablations. ©2016 Wiley Periodicals, Inc.

  15. Renal sympathetic denervation using an externally irrigated radiofrequency ablation catheter for treatment of resistant hypertension – Acute safety and short term efficacy

    PubMed Central

    Yalagudri, Sachin; Raju, Narayana; Das, Bharati; Daware, Ashwin; Maiya, Shreesha; Jothiraj, Kannan; Ravikishore, A.G.

    2015-01-01

    Objectives This study was conducted to assess the acute safety and short term efficacy of renal sympathetic denervation (RSDN) using solid tip radiofrequency ablation (RFA) catheter and saline irrigation through the renal guiding catheter to achieve effective denervation. Background RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension, the limitation being inadequate power delivery in renal arteries. So, we used solid-tip RFA catheter along with saline irrigation for RSDN. Methods Nine patients with resistant hypertension underwent CT and conventional renal angiography, followed by bilateral or unilateral RSDN using 5F RFA catheter with saline irrigation through renal guiding catheter. Repeat renal angiography was performed at the end of the procedure. In all patients, pre- and post-procedure serum creatinine was measured. Results Over 1-month period: 1) the systolic/diastolic blood pressure decreased by −57 ± 20/−25 ± 7.5 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least −36 mm Hg (range 36–98 mm Hg); 3) there was no evidence of renal artery injury immediate post-procedure. There was no significant change in serum creatinine level. Conclusions This data shows the acute procedural safety and short term efficacy of RSDN using modified externally irrigated solid tip RFA catheter. PMID:26138176

  16. Novel Computational Analysis of Left Atrial Anatomy Improves Prediction of Atrial Fibrillation Recurrence after Ablation.

    PubMed

    Varela, Marta; Bisbal, Felipe; Zacur, Ernesto; Berruezo, Antonio; Aslanidi, Oleg V; Mont, Lluis; Lamata, Pablo

    2017-01-01

    The left atrium (LA) can change in size and shape due to atrial fibrillation (AF)-induced remodeling. These alterations can be linked to poorer outcomes of AF ablation. In this study, we propose a novel comprehensive computational analysis of LA anatomy to identify what features of LA shape can optimally predict post-ablation AF recurrence. To this end, we construct smooth 3D geometrical models from the segmentation of the LA blood pool captured in pre-procedural MR images. We first apply this methodology to characterize the LA anatomy of 144 AF patients and build a statistical shape model that includes the most salient variations in shape across this cohort. We then perform a discriminant analysis to optimally distinguish between recurrent and non-recurrent patients. From this analysis, we propose a new shape metric called vertical asymmetry, which measures the imbalance of size along the anterior to posterior direction between the superior and inferior left atrial hemispheres. Vertical asymmetry was found, in combination with LA sphericity, to be the best predictor of post-ablation recurrence at both 12 and 24 months (area under the ROC curve: 0.71 and 0.68, respectively) outperforming other shape markers and any of their combinations. We also found that model-derived shape metrics, such as the anterior-posterior radius, were better predictors than equivalent metrics taken directly from MRI or echocardiography, suggesting that the proposed approach leads to a reduction of the impact of data artifacts and noise. This novel methodology contributes to an improved characterization of LA organ remodeling and the reported findings have the potential to improve patient selection and risk stratification for catheter ablations in AF.

  17. Novel Computational Analysis of Left Atrial Anatomy Improves Prediction of Atrial Fibrillation Recurrence after Ablation

    PubMed Central

    Varela, Marta; Bisbal, Felipe; Zacur, Ernesto; Berruezo, Antonio; Aslanidi, Oleg V.; Mont, Lluis; Lamata, Pablo

    2017-01-01

    The left atrium (LA) can change in size and shape due to atrial fibrillation (AF)-induced remodeling. These alterations can be linked to poorer outcomes of AF ablation. In this study, we propose a novel comprehensive computational analysis of LA anatomy to identify what features of LA shape can optimally predict post-ablation AF recurrence. To this end, we construct smooth 3D geometrical models from the segmentation of the LA blood pool captured in pre-procedural MR images. We first apply this methodology to characterize the LA anatomy of 144 AF patients and build a statistical shape model that includes the most salient variations in shape across this cohort. We then perform a discriminant analysis to optimally distinguish between recurrent and non-recurrent patients. From this analysis, we propose a new shape metric called vertical asymmetry, which measures the imbalance of size along the anterior to posterior direction between the superior and inferior left atrial hemispheres. Vertical asymmetry was found, in combination with LA sphericity, to be the best predictor of post-ablation recurrence at both 12 and 24 months (area under the ROC curve: 0.71 and 0.68, respectively) outperforming other shape markers and any of their combinations. We also found that model-derived shape metrics, such as the anterior-posterior radius, were better predictors than equivalent metrics taken directly from MRI or echocardiography, suggesting that the proposed approach leads to a reduction of the impact of data artifacts and noise. This novel methodology contributes to an improved characterization of LA organ remodeling and the reported findings have the potential to improve patient selection and risk stratification for catheter ablations in AF. PMID:28261103

  18. Catheter Ablation of Ventricular Arrhythmias using a Fluoroscopy Image Integration Module.

    PubMed

    Reents, Tilko; Buiatti, Allessandra; Ammar, Sonia; Dillier, Roger; Semmler, Verena; Telishevska, Marta; Bourier, Felix; Lennerz, Carsten; Grebmer, Christian; Kaess, Bernhardt; Kolb, Christof; Hessling, Gabriele; Deisenhofer, Isabel

    2015-06-01

    The impact of the CartoUnivu™ technology (Biosense Webster, Diamond Bar, CA, USA) on fluoroscopy exposure compared to a conventional approach using electroanatomical mapping (Carto 3™) was evaluated in patients undergoing radiofrequency ablation for ventricular tachyarrhythmias (VT). We prospectively evaluated 23 patients undergoing VT ablation using the CartoUnivu™ technology. The CartoUnivu™ Module integrates fluoroscopic images and cine loops into the electroanatomical mapping system. As a control group, 23 out of 88 VT patients (ablated using conventional fluoroscopy supplemented by electromagnetic mapping with the Carto 3™ System) were matched for age, gender, body surface area, operator, redo-procedure, presence of coronary artery disease, and left ventricular dysfunction using propensity score matching. A significant reduction in fluoroscopy exposure was observed in the CartoUnivu™ group when compared to the conventional group (10.57 ± 7.93 minutes vs 18.52 ± 11.24 minutes, P_= 0.008; 611 cGy/cm(2) vs 1650 cGy/cm(2) , P = 0.001). In multivariate analysis, the CartoUnivu™ module was an independent predictor of reduced fluoroscopy use. This is a report on the clinical application of the CartoUnivu system for VT ablation. CartoUnivu™ markedly reduced fluoroscopy time and dose compared to conventional fluoroscopy/electroanatomical mapping. ©2015 Wiley Periodicals, Inc.

  19. Catheter Ablation of Ventricular Tachycardia as the First-Line Therapy in Patients With Coronary Artery Disease and Preserved Left Ventricular Systolic Function: Long-Term Results.

    PubMed

    Clemens, Marcell; Peichl, Petr; Wichterle, Dan; Pavlů, Luděk; Čihák, Robert; Aldhoon, Bashar; Kautzner, Josef

    2015-10-01

    Patients with coronary artery disease (CAD), relatively preserved left ventricular ejection fraction (LVEF), and hemodynamically tolerated ventricular tachycardia (VT) may benefit from catheter ablation as the first-line treatment. Our aim was to analyze the long-term results of VT ablation in this population. Thirty-one patients (1 woman, mean age 67 ± 10 years) with CAD, tolerated VT, and LVEF ≥40% underwent catheter ablation as the first-line treatment of the arrhythmia. Catheter ablation was performed in order to abolish all inducible VTs. An ICD was implanted if sustained VT of any morphology remained inducible after the procedure. The mean LVEF was 48 ± 6% and the mean VT cycle length reached 348 ± 70 milliseconds in the study cohort. Clinical and all inducible VTs were abolished in 90% (28/31) and 58% (18/31) of the patients, respectively. An ICD was subsequently implanted in 42% of cases. Over a mean follow-up of 3.8 ± 2.9 years, 42% (13/31) patients died. Survival of the patients with or without the ICD was not significantly different (P = 0.47). VT recurrence was observed in 11% (2/18) of patients who had complete elimination of all inducible VTs. No sudden death occurred in patients without the ICD. Catheter ablation of VT as the first-line treatment in patients with CAD and relatively preserved LVEF is a viable strategy. It may prevent implantation of the ICD in a considerable proportion of patients. Abolition of all inducible VTs confers low VT recurrence rate over a long-term follow-up. © 2015 Wiley Periodicals, Inc.

  20. The usefulness of surface 12-lead electrocardiogram to predict intra-atrial conduction block after successful atrial flutter ablation.

    PubMed

    Mairesse, Georges H; Lacroix, Dominique; Klug, Didier; Le Franc, Pierre; Kouakam, Claude; Kacet, Salem

    2003-07-01

    Intraatrial conduction block at the inferior vena cava-tricuspid annulus isthmus was shown to predict successful atrial flutter ablation. However, its demonstration requires the use of several electrode catheters. Thus, a simple approach using surface 12-lead ECG to prove the conduction block would be valuable. Twenty-two patients were prospectively studied during low septal and low lateral atrial pacing before and after successful atrial flutter ablation. Creation of the conduction block was confirmed by comparing the sequence of atrial activation using 3 multipolar catheters during atrial pacing before and after ablation. During low septal pacing, there was no significant difference before and after ablation in P-wave width, axis, or morphology. During low lateral atrial pacing, there was a significant P-wave axis rotation towards the right (from -67 +/- 27 degrees to +13 +/- 35 degrees, P <.001), and P-wave polarity in limb lead II changed from predominantly negative to predominantly positive in 21 of 22 patients. There was also an increase in P-wave width (from 136 +/- 32 to 169 +/- 36 ms, P <.001) and stimulus-to-QRS interval (from 268 +/- 61 ms to 343 +/- 95 ms, P <.001) during low lateral pacing that was not observed during low septal pacing. We conclude that creation of a conduction block in the inferior vena cava-tricuspid annulus isthmus modifies surface 12-lead ECG during low lateral atrial pacing only. We also suggest that P-wave polarity in limb lead II during low lateral pacing could be used as a noninvasive marker of unidirectional counter-clockwise conduction block during atrial flutter ablation.

  1. Impact of Additional Transthoracic Electrical Cardioversion on Cardiac Function and Atrial Fibrillation Recurrence in Patients with Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation.

    PubMed

    Wang, Deguo; Zhang, Fengxiang; Wang, Ancai

    2016-01-01

    Backgrounds and Objective. During the procession of radiofrequency catheter ablation (RFCA) in persistent atrial fibrillation (AF), transthoracic electrical cardioversion (ECV) is required to terminate AF. The purpose of this study was to determine the impact of additional ECV on cardiac function and recurrence of AF. Methods and Results. Persistent AF patients received extensive encircling pulmonary vein isolation (PVI) and additional line ablation. Patients were divided into two groups based on whether they need transthoracic electrical cardioversion to terminate AF: electrical cardioversion (ECV group) and nonelectrical cardioversion (NECV group). Among 111 subjects, 35 patients were returned to sinus rhythm after ablation by ECV (ECV group) and 76 patients had AF termination after the ablation processions (NECV group). During the 12-month follow-ups, the recurrence ratio of patients was comparable in ECV group (15/35) and NECV group (34/76) (44.14% versus 44.74%, P = 0.853). Although left atrial diameters (LAD) decreased significantly in both groups, there were no significant differences in LAD and left ventricular cardiac function between ECV group and NECV group. Conclusions. This study revealed that ECV has no significant impact on the maintenance of SR and the recovery of cardiac function. Therefore, ECV could be applied safely to recover SR during the procedure of catheter ablation of persistent atrial fibrillation.

  2. Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: Clinical outcomes after a single endocardial ablation.

    PubMed

    Suzuki, Atsushi; Yoshida, Akihiro; Takei, Asumi; Fukuzawa, Koji; Kiuchi, Kunihiko; Takami, Kaoru; Itoh, Mitsuaki; Imamura, Kimitake; Fujiwara, Ryudo; Nakanishi, Tomoyuki; Yamashita, Soichiro; Matsumoto, Akinori; Shimane, Akira; Okajima, Katsunori; Hirata, Ken-Ichi

    2015-06-01

    Outcomes related to prophylactic catheter ablation (PCA) for ventricular tachycardia (VT) before implantable cardioverter-defibrillator (ICD) implantation in non-ischemic cardiomyopathy (NICM) are not well characterized. We assessed the efficacy of single endocardial PCA in NICM patients. We retrospectively analyzed 101 consecutive NICM patients with sustained VT. We compared clinical outcomes of patients who underwent PCA (ABL group) with those who did not (No ABL group). Successful PCA was defined as no inducible clinical VT. We also compared the clinical outcomes of patients with successful PCA (PCA success group) with those of the No ABL group. Endpoints were appropriate ICD therapy (shock and anti-tachycardia pacing) and the occurrence of electrical storm (ES). PCA was performed in 42 patients, and it succeeded in 20. The time to ES occurrence was significantly longer in the ABL group than in the No ABL group (p=0.04). The time to first appropriate ICD therapy and ES occurrence were significantly longer in the PCA success group than in the No ABL group (p=0.02 and p<0.01, respectively). Single endocardial PCA can decrease ES occurrence in NICM patients. However, high rates of VT recurrence and low success rates are issues to be resolved; therefore, the efficacy of single endocardial PCA is currently limited.

  3. Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: Clinical outcomes after a single endocardial ablation

    PubMed Central

    Suzuki, Atsushi; Yoshida, Akihiro; Takei, Asumi; Fukuzawa, Koji; Kiuchi, Kunihiko; Takami, Kaoru; Itoh, Mitsuaki; Imamura, Kimitake; Fujiwara, Ryudo; Nakanishi, Tomoyuki; Yamashita, Soichiro; Matsumoto, Akinori; Shimane, Akira; Okajima, Katsunori; Hirata, Ken-ichi

    2015-01-01

    Background Outcomes related to prophylactic catheter ablation (PCA) for ventricular tachycardia (VT) before implantable cardioverter-defibrillator (ICD) implantation in non-ischemic cardiomyopathy (NICM) are not well characterized. We assessed the efficacy of single endocardial PCA in NICM patients. Methods We retrospectively analyzed 101 consecutive NICM patients with sustained VT. We compared clinical outcomes of patients who underwent PCA (ABL group) with those who did not (No ABL group). Successful PCA was defined as no inducible clinical VT. We also compared the clinical outcomes of patients with successful PCA (PCA success group) with those of the No ABL group. Endpoints were appropriate ICD therapy (shock and anti-tachycardia pacing) and the occurrence of electrical storm (ES). Results PCA was performed in 42 patients, and it succeeded in 20. The time to ES occurrence was significantly longer in the ABL group than in the No ABL group (p=0.04). The time to first appropriate ICD therapy and ES occurrence were significantly longer in the PCA success group than in the No ABL group (p=0.02 and p<0.01, respectively). Conclusion Single endocardial PCA can decrease ES occurrence in NICM patients. However, high rates of VT recurrence and low success rates are issues to be resolved; therefore, the efficacy of single endocardial PCA is currently limited. PMID:26336545

  4. Heat distribution and heat transport in bone during radiofrequency catheter ablation.

    PubMed

    Rachbauer, F; Mangat, J; Bodner, G; Eichberger, P; Krismer, M

    2003-04-01

    To assess the feasibility of percutaneous radiofrequency ablation in large bone tumours, the heat distribution in cortical bone and marrow around inserted electrodes was measured. Fresh bovine cadaver tibial bones were locally heated through drill holes for a maximum of half an hour using water-cooled single radiofrequency electrodes (Radionics Instruments Inc) by pulsed energy. Temperatures were measured in the marrow canal as well as in cortical bone by thermocouples at various distances from the inserted probes. Perpendicular to the probe, hyperthermia of more than 50 degrees C could be created in bone marrow in a sphere of approximately 3 cm, and of approximately 1 cm in cortical bone. As irreversible cellular damage can be expected when increasing the temperature to 50 degrees C for a duration of 6 min, this method may be effective for the minimal invasive ablation of neoplasms within human bone in cigar-shaped regions of approximately 3-cm diameter.

  5. Data on procedural handling and complications of pulmonary vein isolation using the pulmonary vein ablation catheter GOLD®.

    PubMed

    Leitz, Patrick; Güner, Fatih; Wasmer, Kristina; Foraita, Philip; Pott, Christian; Dechering, Dirk Georg; Zellerhoff, Stephan; Kochhäuser, Simon; Lange, Philipp Sebastian; Eckardt, Lars; Mönnig, Gerold

    2016-05-01

    The second-generation multi-electrode-phased radiofrequency pulmonary vein ablation catheter (PVAC GOLD(®)) was redesigned with the intent to improve its safety and efficacy. Using a prospectively designed single-centre database, we retrospectively analysed 128 consecutive patients (102 paroxysmal and 43 female) who underwent their first pulmonary vein isolation with the PVAC GOLD(®). The analysis focused on procedural data as well as in-hospital complications. Baseline characteristics of the patient collective were as follows: mean age 57.9 years, mean CHA2DS2-VASC was 1.73 ± 1.30; structural heart disease was present in seven patients. The PVAC GOLD(®) exhibited procedure durations of 123.1 min ± 27.9, duration of energy delivery was 18.3 min ± 11.4, and fluoroscopy duration was 16.0 min ± 7.7. The redesigned catheter shows major complication [major bleeding, transitory ischaemic attack (TIA), and pericardial tamponade] rates of 2.3% (n = 3). The overall rate of adverse events was 5.4% (n = 7). Bleeding complications were observed in three patients (2.3%), in particular there were two cases (1.6%) of minor bleeding and one case (0.8%) of major bleeding. Two patients suffered pericardial effusion, but there was no need for pericardiocentesis. Besides one TIA, there was no other thrombo-embolic event. Furthermore, one case of post-procedural fever was observed. No deaths, stroke, or haemorrhagic shock occurred. Of the 510 pulmonary veins, 508 could be reached with the PVAC GOLD(®) device using a non-steerable long sheath. The PVAC GOLD(®) seems to have an acceptable safety profile. The handling is comparable with the previous generation PVAC(®). Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  6. Catheter Ablation of Atrial Fibrillation Raises the Plasma Level of NGF-β Which Is Associated with Sympathetic Nerve Activity.

    PubMed

    Park, Jae Hyung; Hong, Sung Yu; Wi, Jin; Lee, Da Lyung; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui-Nam

    2015-11-01

    The expression of nerve growth factor-β (NGF-β) is related to cardiac nerve sprouting and sympathetic hyper innervation. We investigated the changes of plasma levels of NGF-β and the relationship to follow-up heart rate variability (HRV) after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). This study included 147 patients with AF (117 men, 55.8±11.5 years, 106 paroxysmal AF) who underwent RFCA. The plasma levels of NGF-β were quantified using double sandwich enzyme linked immunosorbent assay method before (NGF-βpre) and 1 hour after RFCA (NGF-βpost-1 hr). HRV at pre-procedure (HRVpre), 3 months (HRVpost-3 mo), and 1 year post-procedure (HRVpost-1 yr) were analyzed and compared with plasma levels of NGF-β. 1) The plasma levels of NGF-β significantly increased after RFCA (20.05±11.09 pg/mL vs. 29.60±19.43 pg/mL, p<0.001). The patients who did not show increased NGF-βpost-1 hr were older (p=0.023) and had greater left atrial volume index (p=0.028) than those with increased NGF-βpost-1 hr. 2) In patients with NGF-βpre>18 pg/mL, low frequency components (LF)/high-frequency components (HF) (p=0.003) and the number of atrial premature contractions (APCs, p=0.045) in HRVpost-3 mo were significantly higher than those with ≤18 pg/mL. 3) The LF/HF at HRVpost-3 mo was linearly associated with the NGF-βpre (B=4.240, 95% CI 1.114-7.336, p=0.008) and the NGF-βpost-1 hr (B=7.617, 95% CI 2.106-13.127, p=0.007). 4) Both NGF-βpre (OR=1.159, 95% CI 1.045-1.286, p=0.005) and NGF-βpost-1 hr (OR=1.098, 95% CI 1.030-1.170, p=0.004) were independent predictors for the increase of LF/HF at HRVpost-3 mo. AF catheter ablation increases plasma level of NGF-β, and high plasma levels of NGF-βpre was associated with higher sympathetic nerve activity and higher frequency of APCs in HRVpost-3 mo.

  7. Genomic Contributors to Rhythm Outcome of Atrial Fibrillation Catheter Ablation – Pathway Enrichment Analysis of GWAS Data

    PubMed Central

    Ueberham, Laura; Dinov, Borislav; Sommer, Philipp; Arya, Arash; Hindricks, Gerhard; Bollmann, Andreas

    2016-01-01

    Background Left atrial enlargement and persistent atrial fibrillation (AF) are well-known predictors for arrhythmia recurrence after AF catheter ablation (LRAF). In this study, by using pathway enrichment analysis of GWAS data, we tested the hypothesis that genetic pathways associated with these phenotypes are also associated with LRAF. Methods Samples from 660 patients with paroxysmal (n = 370) or persistent AF (n = 290) undergoing de-novo AF catheter ablation were genotyped for ~1,000,000 SNPs. SNPs found to be significantly associated with left atrial diameter (LAD) or AF type were used for gene-based association tests in a systematic biological Knowledge-based mining system for Genome-wide Genetic studies (KGG). Associated genes were tested for pathway enrichment using WEB-based Gene SeT AnaLysis Toolkit (WebGestalt), the Gene Annotation Tool to Help Explain Relationships (GATHER) and the databases provided by Kyoto Encyclopedia of Genes and Genomes (KEGG). In a second step, the association of consistently enriched pathways and LRAF was tested. Results By using sequential 7-day Holter ECGs, LRAF between 3 and 12 months was observed in 48% and was associated with LAD (B = 1.801, 95% CI 0.760–2.841, p = 1.0E-3) and persistent AF (OR = 2.1; 95% CI 1.567–2.931, p = 2.0E-6). WebGestalt (adj. p = 2.7E-22) and GATHER (adj. p = 5.2E-3) identified the calcium signaling pathway (hsa04020) as the only consistently enriched pathway for LAD, while the extracellular matrix (ECM) -receptor interaction pathway (hsa04512) was the only consistently enriched pathway for AF type (adj. p = 2.1E-15 in WebGestalt; adj. p = 9.3E-4 in GATHER). Both calcium signaling (adj. p = 2.2E-17 in WebGestalt; adj. p = 2.9E-2 in GATHER) and ECM-receptor interaction (adj. p = 1.2E-10 in WebGestalt; adj. p = 2.9E-2 in GATHER) were significantly associated with LRAF. Conclusions Calcium signaling and ECM-receptor interaction pathways are associated with LAD and AF type and, in turn, with LRAF

  8. Efficacy and safety of catheter ablation vs. rate control of atrial fibrillation in systolic left ventricular dysfunction : A meta-analysis and systematic review.

    PubMed

    Zhang, B; Shen, D; Feng, S; Zhen, Y; Zhang, G

    2016-06-01

    It is unclear what constitutes the optimal strategy for management of atrial fibrillation (AF) in patients with systolic left ventricular (LV) dysfunction. We hypothesized that catheter ablation of AF had benefits compared with rate control in patients with systolic LV dysfunction. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. Weighted mean differences (WMD) and 95 % confidence intervals (CIs) were calculated to compare the improvement of left ventricular ejection fraction (LVEF), functional capacity, and quality of life between a catheter ablation group and a rate control group. Six trials with 324 patients were included in the analysis. Patients in the catheter ablation group had greater improvement of LVEF (WMD: 8.89; 95 % CI: 6.93-10.86; p < 0.001), 6-min walk distance (WMD: 46.9; 95 % CI: 28.5-65.4; p < 0.001), and lower Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores (WMD: - 19.6; 95 % CI: - 23.6-- 15.7; p < 0.001) compared with patients in the rate control group. Overall, there were only ten procedure-related events and the procedure-related events rate was 4.9 % per procedure and 5.6 % per patient. The present analysis suggests that catheter ablation of AF has benefits in terms of an improvement in LVEF, in functional capacity, and in quality of life compared with rate control in patients with systolic LV dysfunction, and the risk of complications related to procedures is acceptable.

  9. Effects of catheter ablation of idiopathic ventricular ectopic beats on left ventricular function and exercise capacity.

    PubMed

    Lelakowski, Jacek; Dreher, Adam; Majewski, Jacek; Bednarek, Jacek

    2009-08-01

    Frequent ventricular ectopic beats (VEB) in patients without significant cardiac disease are usually classified as benign arrhythmia. However, they may alter cardiac performance. RF ablation can effectively eliminate VEB. To evaluate the effects of RF ablation on selected haemodynamic parameters of left ventricular (LV) systolic and diastolic function and exercise capacity in patients with VEB. The study population consisted of 22 patients (8 males, 14 females, mean age 37.8+/-8.2 years) undergoing effective RF ablation for VEB. Those over 50 years of age, with concomitant cardiovascular disease, depressed global LV function (EF<50%) and segmental wall motion abnormalities were excluded from the study. All patients underwent at baseline and at 6 months after the procedure: physical examination, standard ECG recording, 24-hour Holter monitoring, transthoracic echocardiography to evaluate LV systolic and diastolic function, and treadmill exercise test using the modified Bruce protocol to evaluate exercise duration, peak heart rate and workload achieved. NYHA functional class improved in the whole population after RF ablation. The LV end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD) significantly decreased (33.1+/-4.6 vs. 29.3+/-3.4 mm and 49.0+/-5.4 vs. 44.4+/-2.8 mm, respectively; p<0.001), whereas LVEF increased (58.0+/-7.0 vs. 67.8+/-4.8%; p<0.001) along with fractional shortening (FS) improvement (34.2+/-2.4 vs. 37.6+/-1.4%; p<0.001). Parameters of LV diastolic function significantly changed: the E/A ratio, diastolic pulmonary vein flow D and LV flow propagation velocity Vp significantly increased (p<0.001), whereas systolic pulmonary venous flow S and pulmonary venous atrial reversal flow AR were significantly reduced (p<0.001). Furthermore, E wave deceleration time (EDT) and isovolumetric relaxation time (IVRT) were significantly shortened (p<0.001). The parameters of exercise capacity (exercise duration, peak heart rate and workload achieved

  10. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation.

    PubMed

    Fein, Adam S; Shvilkin, Alexei; Shah, Dhaval; Haffajee, Charles I; Das, Saumya; Kumar, Kapil; Kramer, Daniel B; Zimetbaum, Peter J; Buxton, Alfred E; Josephson, Mark E; Anter, Elad

    2013-07-23

    The aim of this study was to examine the effect of continuous positive airway pressure (CPAP) therapy on atrial fibrillation (AF) recurrence in patients with obstructive sleep apnea (OSA) undergoing pulmonary vein isolation (PVI). OSA is a predictor of AF recurrence following PVI. However, the impact of CPAP therapy on PVI outcome in patients with OSA is poorly known. Among 426 patients who underwent PVI between 2007 and 2010, 62 patients had a polysomnography-confirmed diagnosis of OSA. While 32 patients were "CPAP users" the remaining 30 patients were "CPAP nonusers." The recurrence of any atrial tachyarrhythmia, use of antiarrhythmic drugs, and need for repeat ablations were compared between the groups during a follow-up period of 12 months. Additionally, the outcome of patients with OSA was compared to a group of patients from the same PVI cohort without OSA. CPAP therapy resulted in higher AF-free survival rate (71.9% vs. 36.7%; p = 0.01) and AF-free survival off antiarrhythmic drugs or repeat ablation following PVI (65.6% vs. 33.3%; p = 0.02). AF recurrence rate of CPAP-treated patients was similar to a group of patients without OSA (HR: 0.7, p = 0.46). AF recurrence following PVI in CPAP nonuser patients was significantly higher (HR: 2.4, p < 0.02) and similar to that of OSA patients managed medically without ablation (HR: 2.1, p = 0.68). CPAP is an important therapy in OSA patients undergoing PVI that improves arrhythmia free survival. PVI offers limited value to OSA patients not treated with CPAP. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Safety and Efficacy of Switching Anticoagulation to Aspirin Three Months after Successful Radiofrequency Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Uhm, Jae-Sun; Won, Hoyoun; Joung, Boyoung; Nam, Gi-Byoung; Choi, Kee-Joon; Lee, Moon-Hyoung; Kim, You-Ho

    2014-01-01

    Purpose Although current guidelines recommend continuing the same antithrombotic strategy regardless of rhythm control after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), anticoagulation has a risk of major bleeding. We evaluated the safety of switching warfarin to aspirin in patients with successful AF ablation. Materials and Methods Among 721 patients who underwent RFCA of AF, 608 patients (age, 57.3±10.9 years; 77.0% male, 75.5% paroxysmal AF) who had no evidence of AF recurrence at 3 months post-RFCA were included. We compared the thromboembolic and hemorrhagic events in patients for whom warfarin was switched to aspirin (ASA group; n=296) and patients who were kept on warfarin therapy (W group; n=312). Results There were no significant differences in CHA2DS2-VASc or HAS-BLED scores between the groups. In 30 patients in the ASA group and 37 patients in W group, AF recurred and warfarin was restarted or maintained during the 18.0±12.2 months of follow-up. There were no significant differences in thromboembolic (0.3% vs. 1.0%, p=0.342) and major bleeding incidences (0.7% vs. 0.6%, p=0.958) between ASA and W groups during the follow-up period. In the 259 patients with a CHA2DS2-VASc score ≥2, there were no significant differences in thromboembolism (0.8% and 2.2%, p=0.380) or major bleeding incidences (0.8% and 1.4%, p=0.640) between ASA and W groups. Conclusion Switching warfarin to aspirin 3 months after successful RFCA of AF could be as safe and efficacious as long-term anticoagulation even in patients with CHA2DS2-VASc score ≥2. However, strict rhythm monitoring cannot be overemphasized. PMID:25048480

  12. The Role of Intravenous Dopamine on Hemodynamic Support during Radiofrequency Catheter Ablation of Poorly Tolerated Idiopathic Ventricular Tachycardia

    PubMed Central

    Ahn, Jinhee; Kim, Dong-Hyeok; Roh, Seung-Young; Lee, Kwang No; Lee, Dae-In; Shim, Jaemin; Choi, Jong-Il

    2017-01-01

    Background and Objectives Hemodynamically unstable idiopathic ventricular tachycardias (VTs) are a challenge for activation or entrainment mapping technique. Mechanical circulatory support is an option, but is not always readily available. In this study, we investigated the safety and efficacy of hemodynamic support using intravenous (IV) dopamine solely during radiofrequency catheter ablation (RFCA) of hemodynamically unstable VT. Subjects and Methods Seven out of 86 patients with hemodynamically unstable idiopathic VT underwent de novo RFCA using dopamine in our single center. They were included in the study and reviewed retrospectively to investigate the procedural characteristics and outcomes. Results All patients were male, and the mean age was 50.7±5.3 years. One patient had implantable cardioverter-defibrillator for the secondary prevention. No evidence of myocardial ischemia was found in all patients. During the procedure, the mean blood pressure during VT without dopamine was 52.3±4.1 mmHg and increased to 82.6±3.8 mmHg after administering dopamine (Δ28.8±3.2 mmHg; total average dopamine dosage was 1266.1±389.6 mcg/kg). In all patients, activation mapping was safely applied, and VTs were terminated during energy delivery. Non-inducibility of clinical VT was achieved in all cases. There was no evidence of deterioration due to hypoperfusion during the peri-procedural period. No recurrence of ventricular tachyarrhythmias was observed in any of the patients, during a median follow-up of 23.0±6.1 months. Conclusion Hemodynamic support using IV dopamine during RFCA of hemodynamically unstable idiopathic VT facilitated detailed mapping to guide successful ablation. PMID:28154593

  13. Pulmonary vein isolation and left atrial complex-fractionated atrial electrograms ablation for persistent atrial fibrillation with phased radio frequency energy and multi-electrode catheters: efficacy and safety during 12 months follow-up.

    PubMed

    Mulder, Anton A W; Wijffels, Maurits C E F; Wever, Eric F D; Boersma, Lucas V A

    2011-12-01

    Ablation for persistent atrial fibrillation (AF) remains a difficult and time-consuming procedure with varying degrees of success. We evaluated the long-term effects of a novel approach for ablation of persistent AF using multi-electrode catheters. In 89 patients with longstanding persistent AF (>1 year), multi-electrode ablation was performed with a pulmonary vein ablation catheter (PVAC), a multi-array septal catheter (MASC), and a multi-array ablation catheter (MAAC) for ablation of complex-fractionated atrial electrograms (CFAE) at the septum, left atrial (LA) roof, floor, posterior wall, and mitral isthmus. Follow-up was performed at 6 and 12 months with electrocardiogram, 7 days Holter, and occasionally ambulant event recordings. Average procedure and fluoroscopy times were 112 ± 32 and 21 ± 10 min. The pre-specified endpoint of pulmonary vein isolation and LA CFAE ablation was reached in all patients. No procedural complications were observed. At 12 months after a single treatment 44 of 89 (49%) remained in sinus rhythm, including direct current cardioversion in 12 patients. At 12 months, after a redo PVAC/MASC/MAAC, an additional 6 of 15 patients (40%) were free of AF. In 18 of 89 (20%) patients AF was changed to paroxysmal. In this single centre study, ablation for longstanding persistent AF with the PVAC/MASC/MAAC resulted in 56% freedom of AF at 1 year after 1.2 ± 0.4 procedures. This approach is time efficient and has a favourable safety profile.

  14. Clinical course of arrhythmogenic right ventricular cardiomyopathy in the era of implantable cardioverter-defibrillators and radiofrequency catheter ablation.

    PubMed

    Komura, Masatoshi; Suzuki, Jun-Ichi; Adachi, Susumu; Takahashi, Atsushi; Otomo, Kenichiro; Nitta, Junichi; Nishizaki, Mitsuhiro; Obayashi, Tohru; Nogami, Akihiko; Satoh, Yasuhiro; Okishige, Kaoru; Hachiya, Hitoshi; Hirao, Kenzo; Isobe, Mitsuaki

    2010-01-01

    This study investigated the clinical course of arrhythmogenic right ventricular cardiomyopathy (ARVC) patients and in particular evaluated the contribution of radiofrequency catheter ablation (RFCA) and an implantable cardioverter-defibrillator (ICD) to the treatment of ARVC. ARVC is a myocardial disorder and a cause of sudden cardiac death due to ventricular tachycardia (VT). Little is known about its prognosis in Japanese ARVC patients. Thirty-five ARVC patients were studied. Mean age of patients whose onset of ARVC was congestive heart failure (CHF) (66.0 +/- 4.0 years) was significantly higher than those whose onset was VT (44.5 +/- 14.8 years, P < 0.05). ARVC patients with CHF onset showed significantly higher death rates compared to those with VT onset. ICD treatment significantly reduced episodes of hospitalization due to VT (0.1 +/- 0.4 episodes) in comparison to treatment by RFCA (1.7 +/- 2.2 episodes, P < 0.03). RFCA treatment did not reduce recurrence of VT in the follow-up period. ICD therapy showed comparable mortality to RFCA treatment. The prognosis of ARVC with CHF onset is poor. ICD therapy significantly reduced hospitalization due to VT compared with RFCA treatment. ICD implantation in combination with medication may be a better treatment for ARVC.

  15. Prevention and Treatment of Lower Limb Deep Vein Thrombosis after Radiofrequency Catheter Ablation: Results of a Prospective active controlled Study

    PubMed Central

    Li, Lan; Zhang, Bao-jian; Zhang, Bao-ku; Ma, Jun; Liu, Xu-zheng; Jiang, Shu-bin

    2016-01-01

    We conducted a prospective, single-center, active controlled study from July 2013 to January 2015, in Chinese patients with rapid ventricular arrhythmia who had received radiofrequency catheter ablation (RFCA) treatment to determine formation of lower extremity deep vein thrombosis (LDVT) post RFCA procedure, and evaluated the effect of rivaroxaban on LDVT. Patients with asymptomatic pulmonary thromboembolism who had not received any other anticoagulant and had received no more than 36 hours of treatment with unfractionated heparin were included. Post RFCA procedure, patients received either rivaroxaban (10 mg/d for 14 days beginning 2–3 hours post-operation; n = 86) or aspirin (100 mg/d for 3 months beginning 2–3 hours post-operation; n = 90). The primary outcome was a composite of LDVT occurrence, change in diameter of femoral veins, and safety outcomes that were analyzed based on major or minor bleeding events. In addition, blood flow velocity was determined. No complete occlusive thrombus or bleeding events were reported with either of the group. The lower incidence rate of non-occluded thrombus in rivaroxaban (5.8%) compared to the aspirin group (16.7%) indicates rivaroxaban may be administered post-RFCA to prevent and treat femoral venous thrombosis in a secure and effective way with a faster inset of action than standard aspirin therapy. PMID:27329582

  16. Acute and long-term outcome after catheter ablation of supraventricular tachycardia in patients after the Mustard or Senning operation for D-transposition of the great arteries.

    PubMed

    Wu, Jinjin; Deisenhofer, Isabel; Ammar, Sonja; Fichtner, Stephanie; Reents, Tilko; Zhu, Pinjun; Jilek, Clemens; Kolb, Christof; Hess, John; Hessling, Gabriele

    2013-06-01

    Data about the acute and long-term outcome of catheter ablation in patients with D-transposition of the great arteries (d-TGA) post-Mustard/Senning operation are scarce. This single-centre retrospective analysis includes 26 patients (mean age 28.7 ± 6.7 years, 8 females) after Mustard (n = 15) or Senning (n = 11) operation who underwent catheter ablation for intra-atrial re-entrant tachycardia (IART) or atrioventricular nodal re-entrant tachycardia (AVNRT) from January 2004 to May 2011. The electrophysiological studies were performed using a three-dimensional mapping system (CARTO). Remote magnetic navigation (RMN) was available since 2008. Follow-up on an outpatient basis was conducted 3, 6, and 12 months after ablation and yearly thereafter. In the 26 patients, 34 procedures were performed (one procedure n = 19, two n = 6, and three n = 1). Overall, 34 tachycardia forms (IART n = 30; AVNRT n = 4) were ablated manually (n = 25) or by RMN (n = 9). Acute success reached in 29/34 forms (85.3%). Mean fluoroscopy time (FT) was 28.2 ± 20.7 min and mean procedure duration (PD) was 290.9 ± 107.6 min. After a mean follow-up of 34.1 ± 24.5 months, 25/26 (96.2%) patients were free from IART or AVNRT. In the nine RMN ablations (mean follow-up 14.2 ± 5.8 months) acute and long-term success was 100%. Fluoroscopy time and PD were significantly reduced using RMN compared with manual ablation (11.9 ± 6.2 vs. 34.6 ± 20.6 min, 225.7 ± 24.1 vs. 312 ± 118.2 min, P = 0.02). Catheter ablation of IART or AVNRT in patients post-Mustard/Senning operation for d-TGA has a high acute success rate. The recurrence rate for IART is about 30%; however, after a second ablation, long-term results are excellent. Remote magnetic navigation seems to improve single-procedure acute and long-term success and significantly reduces FT and PD.

  17. Interatrial block and interatrial septal thickness in patients with paroxysmal atrial fibrillation undergoing catheter ablation: Long-term follow-up study.

    PubMed

    Gul, Enes E; Pal, Raveen; Caldwell, Jane; Boles, Usama; Hopman, Wilma; Glover, Benedict; Michael, Kevin A; Redfearn, Damian; Simpson, Chris; Abdollah, Hoshiar; Baranchuk, Adrian

    2017-07-01

    Interatrial block (IAB) is a strong predictor of recurrence of atrial fibrillation (AF). IAB is a conduction delay through the Bachman region, which is located in the upper region of the interatrial space. During IAB, the impulse travels from the right atrium to the interatrial septum (IAS) and coronary sinus to finally reach the left atrium in a caudocranial direction. No relation between the presence of IAB and IAS thickness has been established yet. To determine whether a correlation exists between the degree of IAB and the thickness of the IAS and to determine whether IAS thickness predicts AF recurrence. Sixty-two patients with diagnosis of paroxysmal AF undergoing catheter ablation were enrolled. IAB was defined as P-wave duration ≥120 ms. IAS thickness was measured by cardiac computed tomography. Among 62 patients with paroxysmal AF, 45 patients (72%) were diagnosed with IAB. Advanced IAB was diagnosed in 24 patients (39%). Forty-seven patients were male. During a mean follow-up period of 49.8 ± 22 months (range 12-60 months), 32 patients (51%) developed AF recurrence. IAS thickness was similar in patients with and without IAB (4.5 ± 2.0 mm vs. 4.0 ± 1.4 mm; p = .45) and did not predict AF. Left atrial size was significantly enlarged in patients with IAB (40.9 ± 5.7 mm vs. 37.2 ± 4.0 mm; p = .03). Advanced IAB predicted AF recurrence after the ablation (OR: 3.34, CI: 1.12-9.93; p = .03). IAS thickness was not significantly correlated to IAB and did not predict AF recurrence. IAB as previously demonstrated was an independent predictor of AF recurrence. © 2016 Wiley Periodicals, Inc.

  18. Zero-fluoroscopy cryothermal ablation of atrioventricular nodal reentry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial).

    PubMed

    Luani, Blerim; Zrenner, Bernhard; Basho, Maksim; Genz, Conrad; Rauwolf, Thomas; Tanev, Ivan; Schmeisser, Alexander; Braun-Dullaeus, Rüdiger C

    2017-09-27

    Stochastic damage of the ionizing radiation to both patients and medical staff is a drawback of fluoroscopic guidance during catheter ablation of cardiac arrhythmias. Therefore, emerging zero-fluoroscopy catheter-guidance techniques are of great interest. We investigated in a prospective pilot study the feasibility and safety of the cryothermal (CA) slow-pathway ablation in patients with symptomatic atrioventricular-nodal-reentry-tachycardia (AVNRT) using solely intracardiac echocardiography (ICE) for endovascular and endocardial catheter visualization. Twenty-five consecutive patients (mean age 55.6±12.0 years, 17 female) with ECG-documentation or symptoms suggesting AVNRT underwent an electrophysiology study (EPS) in our laboratory utilizing ICE for catheter navigation. Supraventricular tachycardia was inducible in 23 (92%) patients; AVNRT was confirmed by appropriate stimulation maneuvers in 20 (80%) patients. All EPS in the AVNRT subgroup could be accomplished without need for fluoroscopy, relying solely on ICE-guidance. CA guided by anatomical location and slow-pathway potentials was successful in all patients, median cryo-mappings = 6 (IQR:3-10), median cryo-ablations = 2 (IQR:1-3). Fluoroscopy was used to facilitate the transseptal puncture and localization of the ablation substrate in the remaining 3 patients (one focal atrial tachycardia and 2 atrioventricular-reentry-tachycardias). Mean EPS duration in the AVNRT subgroup was 99.8±39.6 min, ICE guided catheter placement 11.9±5.8 min, time needed for diagnostic evaluation 27.1±10.8 min and cryo-application duration 26.3±30.8 min. ICE-guided zero-fluoroscopy CA in AVNRT patients is feasible and safe. Real-time visualization of the true endovascular borders and cardiac structures allow for safe catheter navigation during the ICE-guided EPS and might be an alternative to visualization technologies using geometry reconstructions. This article is protected by copyright. All rights reserved. This

  19. Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014).

    PubMed

    Gil-Ortega, Ignacio; Pedrote-Martínez, Alonso; Fontenla-Cerezuela, Adolfo

    2015-12-01

    This report presents the findings of the 2014 Spanish Catheter Ablation Registry. For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5±103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n=3026; 23.5%), cavotricuspid isthmus (n=2833; 22.0%), and atrial fibrillation (n=2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%. The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013).

    PubMed

    Ferrero de Loma-Osorio, Angel; Gil-Ortega, Ignacio; Pedrote-Martínez, Alonso

    2014-11-01

    This report presents the results of the 2013 Spanish Catheter Ablation Registry. Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods. Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%. In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  1. Successful radiofrequency ablation of atrial tachycardias in surgically repaired Ebstein's anomaly using the Carto XP system and the QwikStar catheter.

    PubMed

    Drago, Fabrizio; Brancaccio, Gianluca; Grutter, Giorgia; De Santis, Antonella; Fazio, Giovanni; Silvetti, Massimo Stefano

    2007-06-01

    We describe the case of a child with three different atrial tachyarrhythmias originating from the right atrium, in whom a limited modified maze procedure was performed during surgical repair of an Ebstein's anomaly. Successful radiofrequency transcatheter ablation of all atrial tachyarrhythmias, one re-entrant and two focal, was obtained using the Carto XP EP three-dimensional navigation and ablation system, the new QwikMap software technology and the new mapping/ablation QwikStar multipolar catheter. No conventional mapping was used in addition to the three-dimensional system. Total procedural time was about 3 h and fluoroscopy time was 40 min. There were neither recurrences of the tachycardias nor complications during the follow-up (15 months).

  2. Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures

    NASA Astrophysics Data System (ADS)

    Wielandts, J.-Y.; Smans, K.; Ector, J.; De Buck, S.; Heidbüchel, H.; Bosmans, H.

    2010-02-01

    There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose-area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 ± 1.4 mSv according to ICRP 60 and 6.6 ± 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.

  3. Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation.

    PubMed

    Clark, Bradley C; Sumihara, Kohei; McCarter, Robert; Berul, Charles I; Moak, Jeffrey P

    2016-08-01

    Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children's hospital. All patients that underwent EP and ablation procedures between January 2012 and August 2015 were included; demographic information, fluoroscopy time (FT), total radiation dose (RAD), and dose-area product (DAP) were collected. Patients were stratified by time period (before vs. after C3 introduction) in three groups: (1) normal heart, (2) congenital heart disease (CHD), and (3) those requiring trans-septal (TS) access. The normal heart group was further separated by arrhythmia diagnosis (accessory pathway (AP), AV nodal reentry tachycardia (AVNRT), atrial, or ventricular arrhythmia). Mean values were compared using a single sample t test, as well as analysis of covariance to control for age, weight, and arrhythmia diagnosis. Mean FT decreased after introduction of C3 in patients in all three patient groups (p < 0.01). When separated by arrhythmia diagnosis, FT decreased in the AP and AVNRT groups (p < 0.0001). After controlling for age, weight, and arrhythmia diagnosis, there was a statistically significant decrease in FT in all three groups and in both RAD and DAP in the normal heart group. Zero fluoroscopy was achieved in 50/159 (31 %) and ≤1 min of FT in 71/159 (45 %) of cases. We have shown a significant decrease in multiple measures of radiation after introduction of C3. Continued refinements are needed to further decrease radiation utilization and achieve the goal of zero fluoroscopy.

  4. Polymorphism rs2200733 at chromosome 4q25 is associated with atrial fibrillation recurrence after radiofrequency catheter ablation in the Chinese Han population

    PubMed Central

    Chen, Feifei; Yang, Yanzong; Zhang, Rongfeng; Zhang, Shulong; Dong, Yingxue; Yin, Xiaomeng; Chang, Dong; Yang, Zhiqiang; Wang, Kejing; Gao, Lianjun; Xia, Yunlong

    2016-01-01

    To test polymorphisms rs2200733 (chromosome 4q25) and rs2106261 (ZFHX3) were associated with AF recurrence after catheter ablation in a Chinese Han cohort. A total of 235 AF patients who underwent catheter ablation were recruited consecutively. Two polymorphisms were amplified by polymerase chain reaction and genotyped using high resolution melting analysis. Primary endpoints for AF recurrence were defined as the time to the first recurrence of atrial tachycardia/flutter/fibrillation (AT/AF). AT/AF recurrence was observed in 76 patients (35%). Allelic analysis demonstrated that rs2200733 was strongly associated with AF recurrence after ablation (P = 0.011) and the minor allele T increased the risk for recurrence (OR = 1.715). Diameters of the right atrium as well as the left and right superior pulmonary veins (PVs) were associated with rs2200733 in different genetic models (P = 0.040, 0.047 and 0.028, respectively). No significant association was detected between rs2106261 and AT/AF recurrence after ablation or atrial/PV diameters in any models. On multivariate Cox regression analysis, only rs2200733 was an independent factor of AF recurrence after ablation (HR = 0.532, P = 0.022). In Chinese Han population, rs2200733 but not rs2106261 is associated with AT/AF recurrence after ablation. The patients with genotype TT have larger size of right atrium and superior PVs than those of CC genotype. The findings suggest that rs2200733 may play a key role in regulating proper development and differentiation of atria/PVs. PMID:27158361

  5. Prevalence, risk, and benefits of radiofrequency catheter ablation at the aortic cusp for the treatment of mid- to anteroseptal supra-ventricular tachyarrhythmias.

    PubMed

    Park, Junbeom; Wi, Jin; Joung, Boyoung; Lee, Moon Hyoung; Kim, Young-Hoon; Hwang, Chun; Pak, Hui-Nam

    2013-08-10

    Some outflow tract ventricular tachycardias (VTs) are known to be successfully ablated from the aortic cusp (AC). However, radiofrequency catheter ablation (RFCA) at the AC for the treatment of supraventricular tachyarrhythmia (SVT) has limited experience. We performed RFCA at the AC in 19 patients (male 64.7%, 46.9 ± 21.9 years old) with mid- to anteroseptal SVTs (12 atrial tachycardias [AT], 7 atrioventricular reciprocating tachycardia [AVRT]), and analyzed the prevalence, electrophysiologic findings, clinical outcome, and compilation risk. 1. Among 113 patients with AT, 13 patients had mid- to anteroseptal AT and 12 patients (8.8%, 53.4 ± 19.8 years old, 58.3% female) underwent successful ablation from the non-coronary cusp (NCC; n=10), right CC (RCC; n=1) or left CC (LCC; n=1) without complication (3.1 ± 2.3 times RF delivery, 6.15 ± 3.08 s for termination). During 19.7 ± 9.8 months of follow-up, AT recurred in a patient with multiple foci. 2. Among 580 patients with AVRT, 27 patients had a mid- to anteroseptal bypass tract (4.7%), and 7 of them (1.1%, 2 pre-excitation syndrome, 5 concealed bypass tract) were successfully ablated at the NCC (n=2) or RCC (n=5) (7.0 ± 7.1 times RF delivery, 9.1 ± 4.4s for termination). Among 5 patients with AVRT successfully ablated at the RCC, one patient developed complete heart block 48 h after procedure, and 2 patients recurred AVRT or delta-wave in ECG during 13.9 ± 11.7 month follow-up. Catheter ablation within the AC is an effective procedure to eliminate mid- to anteroseptal SVTs. However, RFCA on RCC requires a caution for heart block in our limited experience. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Use of oral gadobenate dimeglumine to visualise the oesophagus during magnetic resonance angiography in patients with atrial fibrillation prior to catheter ablation.

    PubMed

    Faletti, Riccardo; Rapellino, Alessandro; Barisone, Francesca; Anselmino, Matteo; Ferraris, Federico; Fonio, Paolo; Gaita, Fiorenzo; Gandini, Giovanni

    2014-06-13

    Atrio-oesophageal fistula was first reported as a fatal complication of surgical endocardial and percutaneous endocardial radiofrequency ablation for atrial fibrillation, with an incidence after catheter ablation between 0.03% and 0.5%. Magnetic resonance angiography (MRA) was usually performed to obtain pre-procedural 3D images, used to merging into an electro-anatomical map, guiding step-by-step ablation strategy of AF. Our aim was to find an easy, safe and cost-effective way to enhance the oesophagus during MRA. In 105 consecutive patients, a right-left phase encoding, free breathing, 3D T1 MRA sequence was performed in the axial plane, >24 hours before catheter ablation, using an intravenous injection of gadobenate dimeglumine contrast medium. The oesophagus was enhanced using an oral gel solution of 0.7 mL gadobenate dimeglumine contrast medium mixed with approximately 40 mg thickened water gel, which was swallowed by the patients on the scanning table, immediately before the MRA sequence acquisition. The visualisation of the oesophagus was obtained in 104/105 patients and images were successfully merged, as left atrium and pulmonary veins, into an electro-anatomical map, during percutaneous endocardial radiofrequency ablation. All patients tolerated the study protocol and no immediate or late complication was observed with the oral contrast agent administration. The free-breathing MRA sequence used in our protocol took 7 seconds longer than MRA breath-hold conventional sequence. Oesophagus visualization with oral gadobenate dimeglumine is feasible for integration of oesophagus anatomy images into the electro-anatomical map during AF ablation, without undesirable side effects and without significantly increasing cost or examination time.

  7. Use of oral gadobenate dimeglumine to visualise the oesophagus during magnetic resonance angiography in patients with atrial fibrillation prior to catheter ablation

    PubMed Central

    2014-01-01

    Background Atrio-oesophageal fistula was first reported as a fatal complication of surgical endocardial and percutaneous endocardial radiofrequency ablation for atrial fibrillation, with an incidence after catheter ablation between 0.03% and 0.5%. Magnetic resonance angiography (MRA) was usually performed to obtain pre-procedural 3D images, used to merging into an electro-anatomical map, guiding step-by-step ablation strategy of AF. Our aim was to find an easy, safe and cost-effective way to enhance the oesophagus during MRA. Methods In 105 consecutive patients, a right-left phase encoding, free breathing, 3D T1 MRA sequence was performed in the axial plane, >24 hours before catheter ablation, using an intravenous injection of gadobenate dimeglumine contrast medium. The oesophagus was enhanced using an oral gel solution of 0.7 mL gadobenate dimeglumine contrast medium mixed with approximately 40 mg thickened water gel, which was swallowed by the patients on the scanning table, immediately before the MRA sequence acquisition. Results The visualisation of the oesophagus was obtained in 104/105 patients and images were successfully merged, as left atrium and pulmonary veins, into an electro-anatomical map, during percutaneous endocardial radiofrequency ablation. All patients tolerated the study protocol and no immediate or late complication was observed with the oral contrast agent administration. The free-breathing MRA sequence used in our protocol took 7 seconds longer than MRA breath-hold conventional sequence. Conclusion Oesophagus visualization with oral gadobenate dimeglumine is feasible for integration of oesophagus anatomy images into the electro-anatomical map during AF ablation, without undesirable side effects and without significantly increasing cost or examination time. PMID:24927953

  8. Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon.

    PubMed

    Kaess, Bernhard M; Ammar, Sonia; Reents, Tilko; Dillier, Roger; Lennerz, Carsten; Semmler, Verena; Grebmer, Christian; Bourier, Felix; Buiatti, Alessandra; Kolb, Christof; Deisenhofer, Isabel; Hessling, Gabriele

    2015-01-01

    Apixaban is increasingly used for stroke prevention in patients with atrial fibrillation. Data about the safety of left atrial radiofrequency ablation procedures under continuous apixaban therapy are lacking. We performed a matched-cohort study of patients undergoing left atrium ablation procedures for atrial fibrillation or left atrial flutter. For each patient on apixaban, 2 patients on phenprocoumon were matched by age, gender, and type of arrhythmia. The primary safety end point was a composite of bleeding, thromboembolic events, and death. We identified 105 consecutive patients (35 women; mean age 63 years) on apixaban and matched 210 phenprocoumon patients (70 women, mean age 64 years). The primary end point was met in 11 patients of the apixaban group and 26 patients of the phenprocoumon group (10.5% vs 12.3%, p = 0.71). Major bleeding complications occurred in 1 patient of the apixaban group and 1 patient of the phenprocoumon group (1% vs 0.5%, p >0.99). Minor bleeding complications were observed in 10 patients of the apixaban group and 25 patients of the phenprocoumon group (9.5% vs 11.9%, p = 0.61). No patient in either group experienced a thromboembolic event and no patient died. In patients on apixaban, no clinical variable was predictive for bleeding complications. Left atrial ablation procedures under continuous oral anticoagulation with apixaban are feasible and as safe as under continuous oral anticoagulation with phenprocoumon. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Selective tissue ablation using laser radiation at 355 nm in lead extraction by a hybrid catheter; a preliminary report.

    PubMed

    Herzog, Amir; Bogdan, Stefan; Glikson, Michael; Ishaaya, Amiel Abraham; Love, Charles

    2016-03-01

    Current lead extraction (LE) devices can harm the blood vessel endothelium, increasing the risk of perforation. Proof of concept for using a solid-state pulsed laser at 355 nm with a hybrid catheter in LE. A hybrid catheter was used comprising optical fibers for the delivery of 355 nm laser pulses at 30 Hz and 6 J/cm(2) combined with a blunt mechanical blade. Specific parameters were chosen to enable selectivity in ablation, thereby reducing the risk of blood vessel perforation. The design exploits differences in the mechanical properties of the fibrotic tissue and the normal blood vessel. Ex vivo ablation was performed to evaluate a hybrid catheter operation on various tissues. Two ex/in vivo pig studies used a free-floating electrode to which three bovine tendon pieces were glued. Finally, two in vivo dog model studies were performed on specimens with 4-5-year-old pacing lead implants, followed by a histopathology study. Catheter penetration rate in the ex vivo experiments was 0.1 mm/seconds for bovine tendon, 0.025 mm/seconds for porcine superior vena cava and 0.033 mm/seconds for porcine aorta. In the ex/in vivo pig study, the three tissue blocks were successfully dissected. In the in vivo dog study, the two leads were successfully extracted. In all in vivo tests, hemodynamic stability was maintained. Gross histopathology did not reveal any injury. Ablation using 355 nm laser pulses in combination with a mechanical blunt blade may potentially constitute a viable alternative for LE. © 2015 Wiley Periodicals, Inc.

  10. Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system.

    PubMed

    Maurer, Tilman; Sohns, Christian; Deiss, Sebastian; Rottner, Laura; Wohlmuth, Peter; Reißmann, Bruno; Heeger, Christian H; Lemes, Christine; Riedl, Johannes; Santoro, Francesco; Mathew, Shibu; Metzner, Andreas; Ouyang, Feifan; Kuck, Karl-Heinz; Wissner, Erik

    2017-09-01

    The magnetic navigation system (MNS) has shown to be safe and effective for catheter ablation of atrial fibrillation (AF). However, longer procedure duration as compared to manual catheter ablation may limit its widespread use. This study aimed to assess the impact of the newest generation MNS using an optimized mapping and ablation protocol on the efficacy and safety of remote magnetic catheter (RMC)-guided pulmonary vein isolation (PVI). This observational study included 52 patients with symptomatic AF who underwent RMC-guided PVI using the second-generation MNS Niobe II (initial 28 patients, group I) or the third-generation MNS Niobe ES in combination with an optimized mapping and ablation protocol (24 patients, group II). Acute PVI was achieved in 26/28 (93%) patients in group I and 24/24 patients (100%) in group II. Mean procedure time was 263.9 ± 81.9 min in group I and significantly lower in group II (139.7 ± 22.6 min, p < 0.01). Mean fluoroscopy time was 18.8 ± 8.7 min in group I and decreased to 7.9 ± 2.6 in group II (p < 0.01). After a median follow-up of 640.5 days (Q1 460.75; Q3 766.5), 16/24 (67%) patients undergoing RMC-guided PVI in group II remained in stable SR. No periprocedural complications were noted for either group. Use of the third-generation MNS for RMC-guided PVI is safe, effective, and drastically reduced procedure times.

  11. Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: Role of incisional and non-incisional scar.

    PubMed

    Zhou, Gong-Bu; Hu, Ji-Qiang; Guo, Xiao-Gang; Liu, Xu; Yang, Jian-du; Sun, Qi; Ma, Jian; Ouyang, Fei-Fan; Zhang, Shu

    2016-02-15

    The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation.

    PubMed

    Sairaku, Akinori; Yoshida, Yukihiko; Nakano, Yukiko; Maeda, Mayuho; Hirayama, Haruo; Hashimoto, Haruki; Kihara, Yasuki

    2016-09-01

    A worldwide survey reported that the success rate of atrial fibrillation (AF) ablation was higher in high-volume centers compared with low-volume centers. We tested whether the procedure volume of each operator was associated with the outcome of AF ablation in high-volume centres. We studied 471 patients with paroxysmal AF who underwent pulmonary vein (PV) isolation for the first time in three cardiovascular centers where the annual AF ablation volume was >100 procedures. We classified a total of 10 primary operators according to their operation volume on the basis of ACC/AHA/ACP CLINICAL COMPETENCE STATEMENT; high-volume operator (≥50 cases/year, N = 3) or low-volume operator (<50 cases/year, N = 7). The patients included were dichotomized according to the annual operation volume of their attending physician. The endpoints were the freedom from AF recurrence 1 year after the ablation, major complications including thromboembolisms, massive bleeding or death, and the procedural duration. A complete isolation of the four PVs was achieved in 99.1%. The freedom from AF recurrence was more common in patients treated by high-volume operators than those treated by low-volume operators (165/216 [76.4%] vs. 160/255 [62.8%]; P = 0.001). A high-volume operator was the only independent predictor of the freedom from AF recurrence (hazard ratio 1.73, 95% confidence interval 1.23-2.48; P = 0.002). The patients treated by high-volume operators were less likely to have major complications (1.4% vs. 7.8%; P = 0.001), and had a shorter procedural duration (139.9 ± 25.3 vs. 149.3 ± 27.1 min; P = 0.03). Operator proficiency may predict the outcome after AF ablation even in high-volume centres. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  13. Safety of continuous periprocedural rivaroxaban for patients undergoing left atrial catheter ablation procedures.

    PubMed

    Dillier, Roger; Ammar, Sonia; Hessling, Gabriele; Kaess, Bernhard; Pavaci, Herribert; Buiatti, Alessandra; Semmler, Verena; Kathan, Susanne; Hofmann, Monika; Lennerz, Carsten; Kolb, Christof; Reents, Tilko; Deisenhofer, Isabel

    2014-08-01

    This study aimed to evaluate the safety of continuous periprocedural rivaroxaban administration during left atrial radiofrequency ablation (RFA) in comparison with uninterrupted oral vitamin K antagonist administration. Data about the use of rivaroxaban in the setting of left atrial RFA procedures are lacking. The study cohort included 544 patients (mean age, 63±10 years) who underwent left atrial RFA procedures between February 2012 and May 2013. All patients (n=272) receiving uninterrupted periprocedural rivaroxaban 15 or 20 mg/d before the procedure (rivaroxaban) were matched by age, sex, and type of rhythm disorder with an equal number of patients managed with uninterrupted vitamin K antagonist phenprocoumon (international normalized ratio, 2-3). During RFA, heparin was given intravenously to maintain an activated clotting time at 270 to 300 s. The safety end point was a composite of bleeding, thromboembolic events, and death. There were no thromboembolic complications and no deaths in either group. The prevalence of major bleeding complications was similar in both groups (1 tamponade in RivG and 1 groin hematoma requiring transfusion in phenprocoumon). Minor bleeding complications occurred equally in both groups (20 of 272; 7% in the rivaroxaban versus 33 of 272, 12% in the phenprocoumon; P=0.08). In multivariable analyses, female sex was associated with a greater risk of complications (odds ratio, 1.96; 95% confidence interval, 1.10-3.49). In patients undergoing left atrial RFA, continuous periprocedural rivaroxaban use seems to be as safe as uninterrupted periprocedural phenprocoumon administration. © 2014 American Heart Association, Inc.

  14. Efficacy of Left Atrial Voltage-Based Catheter Ablation of Persistent Atrial Fibrillation.

    PubMed

    Yamaguchi, Takanori; Tsuchiya, Takeshi; Nakahara, Shiro; Fukui, Akira; Nagamoto, Yasutsugu; Murotani, Kenta; Eshima, Kenichi; Takahashi, Naohiko

    2016-09-01

    Low-voltage zones (LVZs) represent fibrotic tissue and are substrates for atrial fibrillation (AF). We hypothesized that LVZ-based substrate modification along with pulmonary vein isolation (PVI) would improve outcomes in persistent AF (PeAF) patients with LVZs, whereas PVI alone would work in patients without LVZs. Voltage mapping of the left atrium (LA) was performed during sinus rhythm in 101 PeAF patients in whom LVZ was defined as an area with bipolar electrograms <0.5 mV. Thirty-nine patients had LVZs and underwent ablation of the entire LVZ area after PVI (LVZabl group). In the remaining 62 patients without LVZs, PVI alone was performed with no further substrate modifications (PVI group). An additional group of 16 consecutive PeAF patients with LVZ did not undergo any substrate modification after PVI and were used as a comparison group (LVZnon-abl group) despite having similar size of LVZs to that in the LVZabl group. After a single session, 28 (72%) patients in the LVZabl group had no recurrence, whereas 49 (79%) patients in the PVI group had no recurrence during 18 ± 7 months of follow-up (log-rank, P = 0.400). In the LVZnon-abl group, only 6 patients (38%) had no recurrence during 32 ± 7 months of follow-up, even after a mean number of sessions of 1.8 (log-rank, P < 0.001, compared with the LVZabl group). Additional LVZ-based substrate modification after PVI improved the outcome in PeAF patients with LVZs, whereas PVI alone worked in patients without LVZs, even in those with PeAF. © 2016 Wiley Periodicals, Inc.

  15. Health-related quality of life changes in patients undergoing repeated catheter ablation for atrial fibrillation.

    PubMed

    Pezawas, Thomas; Ristl, Robin; Schukro, Christoph; Schmidinger, Herwig

    2016-01-01

    Pulmonary vein isolation (PVI) for paroxysmal or non-paroxysmal atrial fibrillation (AF) should increase health-related quality of life (QOL). Retrospective cohort study of consecutive patients scheduled for PVI. University Medical Center. QOL was assessed using the physical (PCS) and mental (MCS) component summary scores from the SF-12v2 in patients undergoing PVI (mean 50, range 0-100, with higher scores indicating greater QOL). SF-12v2 was obtained at initial presentation (3-months) before PVI and after PVI at the end of follow-up (mean 1.7 ± 1.4 years) which included: (1) Clinical status, ECG, and 24-h ECG every 3 months, (2) trans-telephonic ECGs for 4 weeks every 3 months, or (3) continuous ECG via implanted devices. A recurrence was any atrial arrhythmia >30 s. Out of 229 patients (73% males; 58 ± 11 years), 72% returned SF-12v2 regarding 187 PVI procedures: 56% for 1st PVI, 48% for 2nd PVI, 71% for 3rd PVI, and 44% for 4th PVI. The mean difference between before and after PVI was 10 for PCS and 9 for MCS. History of paroxysmal or non-paroxysmal AF did not influence QOL (p = 0.724). Patients with an estimated PCS improvement ≥ 10 or an estimated MCS improvement ≥ 9 had the best outcome after repeated PVI. Success rates were 72 or 82% after 1 year compared to 20 and 22% in patients not achieving this improvement, respectively (p < 0.0001). Improvement in QOL correlates with success of AF ablation after single and repeated PVI. Assessment of QOL pre- and post-PVI can complement ECG techniques for PVI success monitoring.

  16. Pulmonary vein reconnection and arrhythmia progression after antral linear catheter ablation of paroxysmal and persistent atrial fibrillation.

    PubMed

    Wasmer, Kristina; Dechering, Dirk G; Köbe, Julia; Mönnig, Gerold; Pott, Christian; Frommeyer, Gerrit; Lange, Philipp S; Kochhäuser, Simon; Eckardt, Lars

    2016-09-01

    Assumption of different substrates is the basis for different ablation strategies in patients with paroxysmal and persistent atrial fibrillation (AF). We aimed to investigate pulmonary vein reconnection and influence on progression of initial paroxysmal (pAF) versus persistent atrial fibrillation (perAF). Between January 2010 and November 2012, 149 patients (117 men, mean age 59 ± 11 years, range 27-80 years) underwent at least one redo antral pulmonary vein isolation (PVI) using NavX-guided irrigated-tip radiofrequency catheter ablation. We analyzed whether and where reconnection of pulmonary veins was detected, and whether there were differences between patients with pAF and perAF. Of the 149 patients who underwent a redo antral PVI, 80 patients had pAF and 69 had perAF. One, two and three redo PVIs were performed in 149, 26 and 6 patients, respectively. Reconnection of at least one PV was detected in all patients at the second PVI, in 19 of 26 patients (73 %) at the third PVI and 5 of 6 patients (83 %) at the fourth PVI. 20 (29 %) patients with perAF prior to the first PVI had pAF at the second PVI, whereas 15 (19 %) patients with initial pAF had persistent AF at the time of the first redo procedure. From the second to the third PVI, four patients had developed perAF after previous pAF and two with per AF now had pAF. PV reconnection was observed independent of underlying AF type. At the second redo procedure, of those with reconnected veins 12 had pAF and 13 perAF. At the third redo procedure, four patients had pAF and four perAF. Most patients with recurrent AF after PVI showed at least one reconnected vein during redo procedures. Reconnection was identified irrespective of the underlying AF type. Progression from pAF to perAF and vice versa was observed irrespective of the initial AF type.

  17. Postprocedural Aspiration Test to Predict Adequacy of Dialysis Following Tunneled Catheter Placement

    SciTech Connect

    Smith, Jason C. Sullivan, Kevin L.; Michael, Beckie

    2006-08-15

    The objective of the study was to determine if a timed aspiration technique with a 20-ml syringe can be used to predict adequacy of blood flow in tunneled dialysis catheters. Sixteen patients referred for de novo placement or manipulation of failing tunneled hemodialysis catheters had the time it takes to fill a 20-ml syringe with the plunger fully withdrawn measured to the nearest tenth of a second. These measurements were correlated with flow rates recorded in dialysis just prior to (if failed catheter) and in the following dialysis session with adequacy determined as at least 300 ml/min. Syringe-filling time (22 catheters in 16 patients) was plotted against adequacy of dialysis. The mean time to fill a 20-ml syringe was 2.2 sec, with a range of 1.0-4.7 sec. The mean time to fill syringes for catheters with adequate dialysis was 1.7 {+-} 0.5 sec, and for inadequate catheters, it was 2.8 {+-} 0.8 sec. These differences are statistically significant (p < 0.001). Using a filling time of greater than or equal to 2 sec as a threshold gives the highest sensitivity (100%) for predicting inadequate dialysis while maintaining high specificity (75%). To achieve a specificity of 100%, a 3-sec cutoff would be necessary, but would lead to a sensitivity of only 20%. A simple and objective aspiration technique can be performed at the time of tunneled dialysis catheter placement/manipulation to reasonably predict adequacy of subsequent dialysis.

  18. Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012).

    PubMed

    Ferrero de Loma-Osorio, Ángel; Díaz-Infante, Ernesto; Macías Gallego, Alfonso

    2013-12-01

    This article presents the findings of the 2012 Spanish Catheter Ablation Registry. Data were collected in 2 ways: retrospectively using a standardized questionnaire, and prospectively using a central database. Each participating center selected its own preferred method of data collection. Seventy-four Spanish centers voluntarily contributed data to the survey. A total of 11 042 ablation procedures were analyzed, averaging 149 (103) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2842; 25.7%), cavotricuspid isthmus (n=2485; 23%), and accessory pathways (n=1999; 18%). Atrial fibrillation was the fourth most common substrate treated (n=1852; 17%), representing a slight increase. The number of ventricular arrhythmia ablation procedures was similar to that of 2011, but there was a decrease in procedures for ventricular tachycardia associated with postinfarction scarring. The overall success rate was 94.9%, major complications occurred in 1.9%, and the overall mortality rate was 0.04%. Data from the 2012 registry show that the number of ablations performed continued to increase. Overall, they also show a high success rate and a low number of complications. Ablation of complex substrates continued to increase, particularly in the case of atrial fibrillation. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. Left septal atrial tachycardia after open-heart surgery: relevance to surgical approach, anatomical and electrophysiological characteristics associated with catheter ablation, and procedural outcomes.

    PubMed

    Adachi, Toru; Yoshida, Kentaro; Takeyasu, Noriyuki; Masuda, Keita; Sekiguchi, Yukio; Sato, Akira; Tada, Hiroshi; Nogami, Akihiko; Aonuma, Kazutaka

    2015-02-01

    Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery. This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th-75th percentile, 3.6-4.2 versus 2.3; 1.6-2.6 mm; P=0.006) and broader area of low voltage (<0.3 mV) in the septum than patients with nonseptal AT (82; 76-89 versus 31; 28%-36%; P=0.02). Repeated gradual prolongations of the tachycardia cycle length without change of the septal circuit were observed in all patients with septal AT (70; 63-100 versus 15; 10-40 ms; P=0.0008). Although ablation terminated all ATs, recurrence of targeted ATs was more frequent in patients with left septal AT during 30-month follow-up (71 versus 0%; P=0.001). Left septal AT after open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT. © 2014 American Heart Association, Inc.

  20. Multi-sequence magnetic resonance imaging integration framework for image-guided catheter ablation of scar-related ventricular tachycardia

    NASA Astrophysics Data System (ADS)

    Tao, Qian; Milles, Julien; van Huls van Taxis, Carine; Reiber, Johan H. C.; Zeppenfeld, Katja; van der Geest, Rob J.

    2012-02-01

    Catheter ablation is an important option to treat ventricular tachycardias (VT). Scar-related VT is among the most difficult to treat, because myocardial scar, which is the underlying arrhythmogenic substrate, is patient-specific and often highly complex. The scar image from preprocedural late gadolinium enhancement magnetic resonance imaging (LGE- MRI) can provide high-resolution substrate information and, if integrated at the early stage of the procedure, can largely facilitate the procedure with image guidance. In clinical practice, however, early MRI integration is difficult because available integration tools rely on matching the MRI surface mesh and electroanatomical mapping (EAM) points, which is only possible after extensive EAM has been performed. In this paper, we propose to use a priori information on patient posture and a multi-sequence MRI integration framework to achieve accurate MRI integration that can be accomplished at an early stage of the procedure. From the MRI sequences, the left ventricular (LV) geometry, myocardial scar characteristics, and an anatomical landmark indicating the origin of the left main coronary artery are obtained preprocedurally using image processing techniques. Thereby the integration can be realized at the beginning of the procedure after acquiring a single mapping point. The integration method has been evaluated postprocedurally in terms of LV shape match and actual scar match. Compared to the iterative closest point (ICP) method that uses high-intensity mapping (225+/-49 points), our method using one mapping point reached a mean point-to-surface distance of 5.09+/-1.09 mm (vs. 3.85+/-0.60 mm, p<0.05), and scar correlation of -0.51+/-0.14 (vs. -0.50+/-0.14, p=NS).

  1. The optimal range of international normalized ratio for radiofrequency catheter ablation of atrial fibrillation during therapeutic anticoagulation with warfarin.

    PubMed

    Kim, Jin-Seok; Jongnarangsin, Krit; Latchamsetty, Rakesh; Chugh, Aman; Ghanbari, Hamid; Crawford, Thomas; Yokokawa, Miki; Good, Eric; Bogun, Frank; Pelosi, Frank; Morady, Fred; Oral, Hakan

    2013-04-01

    Uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation is associated with a lower risk of periprocedural complications than when warfarin is temporarily discontinued. However, the optimal international normalized ratio (INR) levels during RFA have not been defined. In this retrospective analysis, RFA was performed in 1133 consecutive patients (mean age, 61±10 years) with paroxysmal (550) or persistent atrial fibrillation (583). Patients were grouped based on the INR on the day of RFA. There was a quadratic relationship between the INR and bleeding and vascular complications (P<0.001). Complications were less prevalent when INR was ≥2.0 and ≤3.0 (5% [31/572]) than when INR was <2.0 (10% [49/485]; P=0.004) and >3.0 (12% [9/76]; P=0.03). The prevalence of pericardial tamponade (1%) was similar at all INRs. From the quadratic model, the optimal range of INR was calculated as 2.1 to 2.5. INRs<2.0 and >3.0 were associated with a >2-fold increase in complications, with a further steep rise beyond an INR>3.5. Concomitant clopidogrel use was associated with a significant increase in complications at all INRs (odds ratio=3.1; ±95% confidence interval, 1.4-7.4). Unfractionated heparin requirements to maintain a therapeutic activated clotting time during RFA was reduced by 50% in patients with an INR>2.0. The optimal INR range during uninterrupted periprocedural anticoagulation using warfarin is narrow. Therefore, INR levels should be carefully monitored in preparation for RFA of atrial fibrillation.

  2. Efficacy and Safety of Radiofrequency Catheter Ablation of Tachyarrhythmias in 123 Children Under 3 Years of Age.

    PubMed

    Jiang, H E; Li, Xiao-Mei; Li, Yan-Hui; Zhang, Yan; Liu, Hai-Ju

    2016-08-01

    The risk-benefit ratio of radiofrequency catheter ablation (RFCA) in infants and toddlers remains controversial. Experience with RFCA in these patients is limited. This work is intended to describe the efficacy and safety of RFCA in children under 3 years of age with tachycardia complicated by drug resistance, drug intolerance, or tachycardia-induced cardiomyopathy. We retrospectively reviewed data from 123 consecutive children under 3 years of age (mean, 2.3 ± 0.8 years; weight, 13.6 ± 2.8 kg) with tachycardia complicated by drug resistance, drug intolerance, or tachycardia-induced cardiomyopathy; the children underwent an electrophysiology study between 1994 and 2014 at our center. Fifteen children had congenital heart disease, and 27 children were under 1 year of age. Among the 109 children who underwent RFCA, acute success rate (no inducible arrhythmia before procedure completion), 2-year rate of symptomatic tachyarrhythmia recurrence, and complication rate were assessed. Among the 123 children studied, 76.4% had atrioventricular reentrant tachycardia, 5.7% had atrioventricular nodal reentrant tachycardia, 2.4% had focal atrial tachycardia, 6.5% had atrial flutter, and 4.1% had idiopathic left ventricular tachycardia. For RFCA, the acute success rate was 94.5%, and the 2-year recurrence rate was 6.8%, without any major complications. RFCA appears to be an effective and safe therapeutic option in selected small children with tachycardia resistant to conventional medical management, tachycardia complicated by drug intolerance, or tachycardia-induced cardiomyopathy. © 2016 Wiley Periodicals, Inc.

  3. [Radiofrequency catheter ablation for ventricular premature beats of left coronary cusp under the guidance of 3-dimensional mapping system].

    PubMed

    Wang, Hong; Hong, Lang; Zhou, Yuan-feng; Lai, Heng-li; Chen, Zai-hua; Qiu, Yun

    2012-04-10

    To explore the efficacy and safety of radiofrequency catheter ablation (RCA) for ventricular premature beats originating from left coronary sinus under the guidance of 3-dimensional mapping system (CARTO). A total of 15 patients with premature ventricular contractions (PVCs) originating from left coronary sinus underwent CARTO-guided RCA. Anatomical structures were constructed and three-dimension (3D) electrical activation sequence was plotted for left ventricle and aortic sinus. The distance of earliest activation point of PVCs and origin of left coronary artery were surveyed after left coronary arteriography. The electrocardiogram (ECG) results showed that R-wave was upward in leads II, III and avF, QRS waves in lead I was mainly of rS, rs and rsr types, QS type in lead avL, RS, Rs and rS type in lead V(1), RS type in lead V(3) and absence of S wave in lead V(5)/V(6). Intraoperative mapping detected the earliest activation point on the posterior-inferior origin of left coronary artery (LMCA) ostium (n = 7), on the anterio-inferior of LMCA ostium (n = 3) and on the inferior of LMCA ostium (n = 5). The earliest activation point (local activation time) was shorter 86 - 120 ms than surface electrocardiogram QRS wave, discharge melting on the earliest activation point and nearby succeeded. PVCs disappeared, PVCs failed to be induced under similar preoperative conditions (aleudrin intravenous) and no complication occurred intraoperatively and postoperatively. The CARTO-guided RCA is a safe and effective in the treatment of PVCs originating from left coronary sinus.

  4. Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: an evaluation using magnetic resonance angiography.

    PubMed

    Jayam, Vinod K; Dong, Jun; Vasamreddy, Chandrasekhar R; Lickfett, Lars; Kato, Ritsushi; Dickfeld, Timm; Eldadah, Zayd; Dalal, Darshan; Blumke, David A; Berger, Ronald; Halperin, Henry R; Calkins, Hugh

    2005-07-01

    Catheter ablation to achieve pulmonary vein (PV) isolation has become an increasingly used treatment strategy for patients with atrial fibrillation (AF). The purpose of this study was to evaluate the impact of segmental isolation of PVs on volume of left atrium and its relation to the decrease in the size of the pulmonary veins. Gadolinium enhanced Magnetic Resonance Angiography (MRA) was performed in 51 AF patients before and 6 approximately 8 weeks post PV isolation, using cooled radio-frequency (RF) energy. Three-dimensional reconstruction with maximum intensity projections and multiplanar reformations was performed. Oblique coronal projections were used to measure the ostial size of PVs. Three orthogonal dimensions of LA chamber were measured and computed to assess the volume of the left atrium. The mean LA volume decreased by 15.7% after ablation (p<0.001). The mean PV ostial diameter decreased by 11%, from 18.3+/-0.8 mm to 16.7+/-1.0 mm (p=0.005). Moderate PV stenosis was noted in two veins out of the 192 veins analyzed. There was a significant correlation between changes in the size of PV ostium to that of the LA. Catheter ablation of AF using a segmental PV isolation approach results in a significant reverse remodeling in the left atrium. Significant stenosis of PVs appears to be rare after the segmental isolation procedure.

  5. Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration.

    PubMed

    Rivera, Santiago; Ricapito, Maria de la Paz; Tomas, Leandro; Parodi, Josefina; Bardera Molina, Guillermo; Banega, Rodrigo; Bueti, Pablo; Orosco, Agustin; Reinoso, Marcelo; Caro, Milagros; Belardi, Diego; Albina, Gaston; Giniger, Alberto; Scazzuso, Fernando

    2016-04-01

    Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency. Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03). Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias. © 2016 American Heart Association, Inc.

  6. Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation.

    PubMed

    Narui, Ryohsuke; Matsuo, Seiichiro; Isogai, Ryota; Tokutake, Kenichi; Yokoyama, Kenichi; Kato, Mika; Ito, Keiichi; Tanigawa, Shin-Ichi; Yamashita, Seigo; Tokuda, Michifumi; Inada, Keiichi; Shibayama, Kenri; Miyanaga, Satoru; Sugimoto, Kenichi; Yoshimura, Michihiro; Yamane, Teiichi

    2017-06-01

    Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation. This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients). Peripheral oxygen saturation was continuously monitored via pulse oximetry throughout the procedure. A spontaneous dissociated pulmonary vein activity after pulmonary vein isolation occurred more frequently in group M than in group D (29.1 vs 15.7%, P < 0.01). Adenosine-induced dormant pulmonary vein conduction was more frequently observed in group M than in group D (19.2 vs 13.0% P = 0.01). There were no significant differences in the incidence of non-pulmonary vein triggers between groups M and D (15.2 vs 11.1%, P = 0.53). The atrial fibrillation recurrence rate following the single procedure did not differ between the two groups (29.0 vs 26.5%, in groups M and D, P = 0.85). Although deep sedation reduced the incidence of a dissociated pulmonary vein activity and dormant pulmonary vein conduction following pulmonary vein isolation, it did not affect the recurrence rate for atrial fibrillation after the procedure.

  7. Predictors of non-pulmonary vein ectopic beats initiating paroxysmal atrial fibrillation: implication for catheter ablation.

    PubMed

    Lee, Shih-Huang; Tai, Ching-Tai; Hsieh, Ming-Hsiung; Tsao, Hsuan-Ming; Lin, Yenn-Jiang; Chang, Shih-Lin; Huang, Jin-Long; Lee, Kun-Tai; Chen, Yi-Jen; Cheng, Jun-Jack; Chen, Shih-Ann

    2005-09-20

    The purpose of this study was to investigate the predictor of non-pulmonary vein (PV) ectopic beats initiating paroxysmal atrial fibrillation (PAF). Non-PV ectopic beats can initiate PAF in some patients and play an important role in the recurrence of PAF after PV isolation. Information on the predictors of non-PV ectopic beats initiating PAF is unknown. This study included 293 patients (215 men and 78 women, age 60 +/- 14 years) with clinically documented drug-refractory PAF. Of the 94 patients with non-PV ectopic beats initiating PAF, 38 (40%) patients had superior vena cava (SVC) ectopic beats and 32 (34%) had left atrial posterior free wall (LAPFW) ectopic beats. In a univariate analysis, only female gender was related to the presence of non-PV (p = 0.016) and SVC ectopic beats (p = 0.012). Right atrial enlargement (p = 0.005) and left atrial enlargement (p < 0.001) were related to the presence of LAPFW ectopic beats. In a multivariate analysis, female gender (p = 0.043; odds ratio 2.00, 95% confidence interval [CI] 1.02 to 3.92) and left atrial enlargement (p = 0.007; odds ratio 2.34, 95% CI 1.27 to 4.32) could predict the presence of non-PV ectopic beats. Subgroup analysis showed that female gender could predict the presence of SVC ectopic beats (p = 0.039; odds ratio 2.14, 95% CI 1.04 to 4.43). In contrast, left atrial enlargement could predict the presence of LAPFW ectopic beats (p = 0.002; odds ratio 3.89, 95% CI 1.62 to 9.38). The location of non-PV ectopic beats initiating PAF can be predicted by both gender and left atrial enlargement.

  8. Clinical Utility of Atrial Electromechanical Conduction Time Measured with Speckle Tracking Echocardiography after Catheter Ablation in Patients with Atrial Fibrillation: A Validation Study with Electroanatomical Mapping.

    PubMed

    Fujii, Akira; Inoue, Katsuji; Nagai, Takayuki; Nishimura, Kazuhisa; Uetani, Teruyoshi; Suzuki, Jun; Funada, Jun-Ichi; Okura, Takafumi; Higaki, Jitsuo; Ogimoto, Akiyoshi

    2016-09-01

    Our recent report demonstrated that atrial electromechanical conduction time (EMT-ε) measured with speckle tracking echocardiography could predict cardiac events in patients with pathological left ventricular hypertrophy. This study aimed to validate EMT-ε by comparison with electroanatomical mapping and to investigate the clinical utility of EMT-ε in patients with atrial fibrillation (AF) undergoing catheter ablation. Forty-six patients with preserved LV ejection fraction (LVEF ≥ 50%) undergoing pulmonary vein isolation (PVI) for AF were studied. Atrial electrical conduction delay was determined by measuring atrial electrical activation time (EAT) using three-dimensional electroanatomical mapping just after PVI. Echocardiographic parameters were acquired within 24 hours and at 6 months after PVI. The study also included 10 control subjects. AF patients had a larger left atrial (LA) volume index (LAVI) and more prolonged EMT-ε compared with control subjects. According to the validation study, EAT was closely related to EMT-ε and a', and this association was independent of LAVI and the presence of persistent AF (EMT-ε: R(2) = 0.342, P < 0.0001, a': R(2) = 0.337, P < 0.0001). At 6 months after PVI, LAVI and EMT-ε were significantly improved. During continued follow-up beyond 6 months (total follow-up, 26 ± 12 months), the EMT-ε shortening at 6 months after PVI was significantly greater in AF-free patients than patients with AF recurrence. This study suggested that the EMT-ε could be a useful echocardiographic marker of LA electromechanical abnormalities in patients with AF. © 2016, Wiley Periodicals, Inc.

  9. Catheter Ablation of Ventricular Tachycardia/Fibrillation in a Patient with Right Ventricular Amyloidosis with Initial Manifestations Mimicking Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

    PubMed Central

    Chung, Fa-Po; Lin, Yenn-Jiang; Kuo, Ling

    2017-01-01

    Differentiating arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) from other cardiomyopathies is clinically important but challenging. Although the modified Task Force Criteria can facilitate diagnosis of ARVD/C according to clinical manifestations, histopathological examination plays a pivotal role in excluding other diseases that can mimic ARVD/C. Here, we report a patient with amyloidosis that initially presented similarly to ARVD/C. The diagnosis was confirmed by endomyocardial biopsy, and catheter ablation eliminated the ventricular tachyarrhythmias through an epicardial approach. PMID:28382086

  10. Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre- and post-procedural comparison with the Simplicity catheter system and the EnligHTN multi-electrode renal denervation catheter.

    PubMed

    Templin, Christian; Jaguszewski, Milosz; Ghadri, Jelena R; Sudano, Isabella; Gaehwiler, Roman; Hellermann, Jens P; Schoenenberger-Berzins, Renate; Landmesser, Ulf; Erne, Paul; Noll, Georg; Lüscher, Thomas F

    2013-07-01

    Catheter-based renal nerve ablation (RNA) using radiofrequency energy is a novel treatment for drug-resistant essential hypertension. However, the local endothelial and vascular injury induced by RNA has not been characterized, although this importantly determines the long-term safety of the procedure. Optical coherence tomography (OCT) enables in vivo visualization of morphologic features with a high resolution of 10-15 µm. The objective of this study was to assess the morphological features of the endothelial and vascular injury induced by RNA using OCT. In a prospective observational study, 32 renal arteries of patients with treatment-resistant hypertension underwent OCT before and after RNA. All pre- and post-procedural OCT pullbacks were evaluated regarding vascular changes such as vasospasm, oedema (notches), dissection, and thrombus formation. Thirty-two renal arteries were evaluated, in which automatic pullbacks were obtained before and after RNA. Vasospasm was observed more often after RNA then before the procedure (0 vs. 42%, P < 0.001). A significant decrease in mean renal artery diameter after RNA was documented both with the EnligHTN (4.69 ± 0.73 vs. 4.21 ± 0.87 mm; P < 0.001) and with the Simplicity catheter (5.04 ± 0.66 vs. 4.57 ± 0.88 mm; P < 0.001). Endothelial-intimal oedema was noted in 96% of cases after RNA. The presence of thrombus formations was significantly higher after the RNA then before ablation (67 vs. 18%, P < 0.001). There was one evidence of arterial dissection after RNA with the Simplicity catheter, while endothelial and intimal disruptions were noted in two patients with the EnligHTN catheter. Here we show that diffuse renal artery constriction and local tissue damage at the ablation site with oedema and thrombus formation occur after RNA and that OCT visualizes vascular lesions not apparent on angiography. This suggests that dual antiplatelet therapy may be required during RNA.

  11. Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre- and post-procedural comparison with the Simplicity® catheter system and the EnligHTN™ multi-electrode renal denervation catheter

    PubMed Central

    Templin, Christian; Jaguszewski, Milosz; Ghadri, Jelena R.; Sudano, Isabella; Gaehwiler, Roman; Hellermann, Jens P.; Schoenenberger-Berzins, Renate; Landmesser, Ulf; Erne, Paul; Noll, Georg; Lüscher, Thomas F.

    2013-01-01

    Aims Catheter-based renal nerve ablation (RNA) using radiofrequency energy is a novel treatment for drug-resistant essential hypertension. However, the local endothelial and vascular injury induced by RNA has not been characterized, although this importantly determines the long-term safety of the procedure. Optical coherence tomography (OCT) enables in vivo visualization of morphologic features with a high resolution of 10–15 µm. The objective of this study was to assess the morphological features of the endothelial and vascular injury induced by RNA using OCT. Methods and results In a prospective observational study, 32 renal arteries of patients with treatment-resistant hypertension underwent OCT before and after RNA. All pre- and post-procedural OCT pullbacks were evaluated regarding vascular changes such as vasospasm, oedema (notches), dissection, and thrombus formation. Thirty-two renal arteries were evaluated, in which automatic pullbacks were obtained before and after RNA. Vasospasm was observed more often after RNA then before the procedure (0 vs. 42%, P < 0.001). A significant decrease in mean renal artery diameter after RNA was documented both with the EnligHTN™ (4.69 ± 0.73 vs. 4.21 ± 0.87 mm; P < 0.001) and with the Simplicity® catheter (5.04 ± 0.66 vs. 4.57 ± 0.88 mm; P < 0.001). Endothelial-intimal oedema was noted in 96% of cases after RNA. The presence of thrombus formations was significantly higher after the RNA then before ablation (67 vs. 18%, P < 0.001). There was one evidence of arterial dissection after RNA with the Simplicity® catheter, while endothelial and intimal disruptions were noted in two patients with the EnligHTN™ catheter. Conclusion Here we show that diffuse renal artery constriction and local tissue damage at the ablation site with oedema and thrombus formation occur after RNA and that OCT visualizes vascular lesions not apparent on angiography. This suggests that dual antiplatelet therapy may be required during RNA

  12. Long-term follow-up after catheter ablation for atrioventricular nodal reentrant tachycardia: a comparison of cryothermal and radiofrequency energy in a large series of patients

    PubMed Central

    Knops, Paul; Janse, Petter; Kimman, Geert; Van Belle, Yves; Szili-Torok, Tamas; Jordaens, Luc

    2010-01-01

    Background Radiofrequency (RF) catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is highly successful but carries a risk for inadvertent atrioventricular block. Cryoablation (cryo) has the potential to assess the safety of a site before the energy is applied. Purpose The aim of this study was to evaluate the long-term efficacy and safety of cryothermal ablation in a large series of patients and compare it to RF. Methods All consecutive routinely performed AVNRT ablations from our centre between 1999 and 2007 were retrospectively analysed. Results In total, 274 patients were elegible: 150 cryoablations and 124 RF. Overall procedural success was 96% (262/274), and equal in both groups, but nine patients were crossed to another arm. Mean fluoroscopy time was longer in the group treated with RF (27 ± 22 min vs. cryo 19 ± 15 min; p = 0.002). Mean procedure time was not different (RF 138 ± 71 min vs. cryo 146 ± 60 min). A permanent pacemaker was necessary in two RF patients. The questionnaire revealed a high incidence of late arrhythmia related symptoms (48%), similar in both groups, with improved perceived quality of life. The number of redo procedures for AVNRT over 4.3 ± 2.5-years follow-up was not statistically different (11% after cryo and 5% after RF). Conclusions Our data confirm that cryo and RF ablation with 4-mm tip catheters for AVNRT are equally effective, even after long-term follow-up. PMID:21153914

  13. Feasibility, efficacy, and safety of radiofrequency ablation of atrial fibrillation guided by monitoring of the initial impedance decrease as a surrogate of catheter contact.

    PubMed

    Reichlin, Tobias; Lane, Christopher; Nagashima, Koichi; Nof, Eyal; Chopra, Nagesh; Ng, Justin; Barbhaiya, Chirag; Tadros, Tomas; John, Roy M; Stevenson, William G; Michaud, Gregory F

    2015-04-01

    The initial impedance decrease during radiofrequency (RF) ablation is an indirect marker of catheter contact and lesion formation. We aimed to assess feasibility, efficacy, and safety of an ablation approach guided by initial impedance decrease. A total of 25 patients with paroxysmal AF had point-by-point, wide antral pulmonary vein (PV) isolation. RF applications were aborted if a decrease of at least 5 Ω did not occur in the first 10 seconds; otherwise, ablation was continued for at least 20 seconds. Power was 30 Watts and reduced to 15-25 Watts on the posterior wall. A total of 28% of RF applications were terminated because of inadequate impedance decrease. The remaining lesions showed a median decrease of 7.6 Ω (IQR 5.0-10.7) at 10 seconds and median duration of RF lesions was 38 seconds. Note that, 100 PVs were isolated with 49 rings. PVI occurred before anatomic completion of the ablation ring of adequate lesions in 39/49 (80%) and concurrent with ring completion in 7/49 (14%). Additional lesions were required in 3/49 (6%) rings. After PVI, additional lesions were required to eliminate dormant conduction in 2/47 (4%) and pace-capture on the ablation line in 24/49 vein pairs (49%). During short-term follow-up, 3 nonfatal esophageal injuries and 2 late pericardial effusions occurred. During a mean follow-up of 431 ± 87 days, 21/25 patients (84%) remained free of recurrent symptomatic atrial arrhythmias. PVI guided by initial impedance decrease is feasible and results in PVI concurrent with or before completion of the ablation ring in 94% of patients. Single procedure efficacy after one year of follow-up was 84%. Near-term complications suggest that deeper lesions are created, indicating that further reduction of RF-power and duration is warranted. © 2015 Wiley Periodicals, Inc.

  14. Transbaffle catheter ablation of atrial re-entrant tachycardia within the pulmonary venous atrium in adult patients with congenital heart disease.

    PubMed

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Schneider, Heike E; Paul, Thomas

    2016-07-01

    Catheter ablation of atrial re-entrant tachycardia in patients after atrial switch procedure for transposition of the great arteries or with a Fontan circulation is technically challenging if the critical part of the re-entry circuit is located within the pulmonary venous atrium (PVA). We report our experience in transbaffle access (TBA) to the PVA for ablation of atrial re-entrant tachycardia focusing on technical details. In eight patients, six after Mustard procedure and two with a Fontan circulation, endocardial mapping of atrial re-entrant tachycardia revealed the critical part of the re-entry circuit within the PVA. A total of 10 ablation procedures were performed. Detailed angiographic assessment of the anatomy of the systemic and pulmonary venous atria was performed prior to baffle puncture. Transbaffle access was successfully established with a standard transseptal needle in 9 of 10 procedures. No major complications occurred. At the end of the procedure and the removal of the transseptal sheath, there was no residual shunt in any patient. Transbaffle access to the PVA for ablation of atrial re-entrant tachycardia is feasible, less invasive than alternative approaches and can be safely applied in patients after Mustard procedure or with a Fontan circulation. However, the rigidity of prosthetic material may preclude baffle puncture at least in a subset of those patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  15. Catheter ablation for atrial fibrillation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Part II.

    PubMed

    Chen, Jian; Dagres, Nikolaos; Hocini, Melece; Fauchier, Laurent; Bongiorni, Maria Grazia; Defaye, Pascal; Hernandez-Madrid, Antonio; Estner, Heidi; Sciaraffia, Elena; Blomström-Lundqvist, Carina

    2015-11-01

    The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey collecting patient-based data on current clinical practices during atrial fibrillation (AF) ablation. The participating centres were asked to prospectively enrol consecutive patients during a 6-week period (from September to October 2014). A web-based case report form was employed to collect information of patients and data of procedures. A total of 455 eligible consecutive patients from 13 countries were enrolled (mean age 59 ± 10.8 years, 28.8% women). Distinct strategies and endpoints were collected for AF ablation procedures. Pulmonary vein isolation (PVI) was performed in 96.7% and served as the endpoint in 91.3% of procedures. A total of 52 (11.5%) patients underwent ablation as first-line therapy. The cryoballoon technique was employed in 31.4% of procedures. Procedure, ablation, and fluoroscopy times differed among various types of AF ablation. Divergences in patient selection and complications were observed among low-, medium-, and high-volume centres. Adverse events were observed in 4.6% of AF ablation procedures. In conclusion, PVI was still the main strategy for AF ablation. Procedure-related complications seemed not to have declined. The centre volume played an important role in patient selection, strategy choice, and had impact on the rate of periprocedural complication.

  16. High Incidence of Low Catheter-Tissue Contact Force at the Cavotricuspid Isthmus During Catheter Ablation of Atrial Flutter: Implications for Achieving Isthmus Block.

    PubMed

    Kumar, Saurabh; Morton, Joseph B; Lee, Geoffrey; Halloran, Karen; Kistler, Peter M; Kalman, Jonathan M

    2015-08-01

    Recurrent atrial flutter following cavotricuspid isthmus (CTI) ablation remains a significant problem. The prevalence of low contact force (CF) during CTI ablation using standard tools is unknown. Our aim was to characterize the prevalence of low CF applications when experienced operators performed CTI ablation using "traditional" markers of contact blinded to CF me