The First-Pass Isolation Effect in High-Power Short-Duration Compared to Low-Power Long-Duration Atrial Fibrillation Ablation: a Predictor of Success
Keywords:
Atrial fibrillation, Atrial tachyarrhythmias, Recurrence rate, First-pass isolation, Atrial fibrillation ablationAbstract
Introduction: Different results are described after atrial fibrillation ablation and multiples predictors of recurrence are well established. Objective: Evaluate and analyze if first-pass isolation effect (FPI) during first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) can impact on late outcome. Methods: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD: 71 patients, 50 (70.42%) males, mean age 59.73 years, 52 (73.24%) hypertension, 44 (61.97%) obstructive apnea, 23 (32.39%) arterial disease, 20 (28.17%) diabetes, and 10(14.08%) stroke. CHADS2VASC2 2.57. CT: 73 patients, 50 (68.49%) males, mean age 60.7 years, 53 (72.60%) hypertension, 41 (56.16%) obstructive apnea, 28 (38.36%) arterial disease, 14 (19.17%) diabetes and 8 (10.96%) stroke. CHAD2SVASC2 2.22. Results: Recurrence occurred in 33 patients (22.92%) at 12 months follow-up, HPSD with 9 patients and LPLD with 24 patients. Higher rate of bilateral FPI were observed in HPSD patients with 62 of 71 patients comparing to 17 of 73 patients in LPLD (P < 0.00001). At the end of study 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD (P 0.0039). Conclusion: HPSD ablation produced higher rates of FPI comparing to LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months. At patients submitted to HPSD protocol ablation, FPI could predict higher rate of sinus rhythm at 12 months follow-up.
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Haïssaguerre M, Jaïs P, Shah DP, Takahashi A, Hocini M, Quiniou G, Garrigue S,
Mouroux AL, Métayer PL, Clémenty J. Spontaneous initiation of atrial fibrillation
by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339:659–666.
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G,
Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide
survey on the methods, efficacy, and safety of catheter ablation for human atrial
fibrillation. Circ Arrhythm Electrophysiol. 2010; 3:32–38.
Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS). Europace. 2007; 9:335–379.
Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SWK,
Greenstein R, Pelosi F, et al. Pulmonary vein isolation for paroxysmal and persistent
atrial fibrillation. Circulation. 2002; 105:1077–1081.
Ho SY, Sanchez-Quintana MD, Cabrera JA, Anderson RH. Anatomy of the left
atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc
Electrophysiol. 1999; 10:1525–1533.
Sánchez-Quintana D, Cabrera JA, Climent V, Farré J, Mendonça MC, Ho
SY. Anatomic relations between the esophagus and left atrium and relevance for
ablation of atrial fibrillation. Circulation. 2005; 112:1400–1405.
Ho SY, PhD; Cabrera JA, MD; Sanchez-Quintana D, MD. Left atrial anatomy
revisited. Circ Arrhythm Electrophysiol. 2012; 5:220–228.
Haines DE. The biophysics of radiofrequency catheter ablation in the heart: the
importance of temperature monitoring. PACE. March 1993; 16(2).
Panescu D, Whayne JG, Fleischman SD, Mirotznik MS, Swanson DK, Webster JG.
Three-dimensional finite element analysis of current density and temperature distributions during radio-frequency ablation. IEEE Transactions on
Biomedical Engineering. September 1995; 42(9).
Nakagawa H; Wittkampf FHM; Yamanashi WS; Pitha JV; Imai S; Campbell B;
Arruda M; Lazzara R; Jackman WM, MD. Inverse relationship between
electrode size and lesion size during radiofrequency ablation with active electrode
cooling. Circulation. 1998; 98:458–465.
Bruce GK, Bunch TJ, Milton MA, Sarabanda A, Johnson SB, Packer DL. Discrepancies between catheter tip and tissue temperature in cooled-tip
ablation: relevance to guiding left atrial ablation. Circulation. 2005; 112:954–960.
Guy DJR, Boyd A, Thomas SP, Ross DL. Increasing power versus duration
for radiofrequency ablation with a high superfusate flow: implications for pulmonary
vein ablation? PACE. 2003; 26:1379–1385.
Ullah W, McLean A, Tayebjee MH, Gupta D, Ginks MR, Haywood GA, et al. Randomized trial comparing pulmonary vein isolation using the SmartTouch catheter with or without real-time contact force data. Heart Rhythm. 2016; 13:1761–7.
Kautzner J, Neuzil P, Lambert H, Peichl P, Petru J, Cihak R, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015; 17:1229–1235.
Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SWK,
Greenstein R, Pelosi F, et al. Pulmonary vein isolation for paroxysmal and persistent
atrial fibrillation. Circulation 2002; 105:1077–1081.
Vassallo F, Cunha C, Serpa E, Meigre LL, Carloni H, Simoes A Jr., et al. Comparison of high‐power short‐duration (HPSD) ablation of atrial fibrillation using a contact force‐sensing catheter and conventional technique: Initial results. J Cardiovasc Electrophysiol. 2019; 10:1877–1883. https://doi.org/10.1111/jce.14110.
Saad E, D'Avila A, Costa IP, Aryana A, Slater C, Costa RE, et al. Very low risk of thromboembolic events in patients undergoing successful catheter ablation of atrial fibrillation with a CHADS2 score ≤ 3. A Long-Term Outcome Circulation: Arrhythmia and Electrophysiology. 2011; 4:615–621.
McLellan AJA, Kumar S, Smith C, Morton JB, Kalman JM, Kistler PM. The role of
adenosine following pulmonary vein isolation in patients undergoing catheter ablation for
atrial fibrillation: a systematic review. J Cardiovasc Electrophysiol. July 2013; 24(7):742–51.
Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T,
Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade
JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-
guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an
international, multicentre, randomised superiority trial. Lancet. 2015 Aug 15; 386
(9994):672–9.
Kuck KH, Reddy VY, Schmidt B, Natale A, Neuzil P, Saoudi N, et al. A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm. 2012; 9:18–23.
Reddy VY, Shah D, Kautzner J, Schmidt B, Saoudi N, Herrera C, et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm. 2012; 9(11):1789-1795.
Yokokawa M, Bhandari AK, Tada H, Suzuki A, Kawamura M, Ho I, Cannom
DS. Comparison of the point-by-point versus catheter dragging technique for curative
radiofrequency ablation of atrial fibrillation. PACE. 2011; 34:15–22.
Neuzil P, Reddy VY, Kautzner J, Petru J, Wichterle D, Shah D, Lambert H, Yulzari
A, Wissner E, Kuck KH. Electrical reconnection after pulmonary vein isolation is
contingent on contact force during initial treatment results from the EFFICAS I
study. Circ Arrhythm Electrophysiol. 2013; 6:327–333.
Kautzner J, Peichl P. Contact force assessment in catheter ablation of atrial
fibrillation. J Atr Fibrillation. 2014 Apr–May; 6(6):1047.
Kautzner J, Neuzil P, Peichl P, et al. Contact force, FTI and lesion continuity are
critical to improve durable PV isolation: EFFICAS 2 results (abstr). Heart Rhythm
; 9:S28.
Leite LR, Santos SN, Maia H, Henz BD, Giuseppin F, Oliverira A, Zanatta AR, Peres AK, Novakoski C, Barreto JR, Vassalo F, d’Avila A, Singh SM. Luminal
esophageal temperature monitoring with a deflectable esophageal temperature probe
and intracardiac echocardiography may reduce esophageal injury during atrial
fibrillation ablation procedures: results of a pilot study. Circ Arrhythm
Electrophysiol. 2011; 4:149–156.
Ministry of Health. MS National Agency of Sanitary Surveillance. Anvisa Resolution of the Board of Directors. DRC No. 9 of February 20, 2015.
Rickham PP. Human experimentation: code of ethics of the World Medical Association: declaration of Helsinki. Br Med J. 1964; 2:177.
Ninomiya Y, Inoue K, Ichiki H et al. Abstract 13136: First-Pass Isolation is Associated with Durability of Pulmonary Vein Isolation and Has Impact on Atrial Fibrillation Ablation Outcomes. Circulation. 2019;140:A13136.
Okamatsu H, Koyama J, Sakai Y, et al. High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in
ablation index‐guided atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2019;1–8.
Pulmonary vein isolation using ablation index vs. CLOSE protocol with a surround flow ablation catheter. Berte B, Hilfiker G, Moccetti F, Schefer T, Weberndörfer V, Cuculi F, Toggweiler S, Ruschitzka F, and Kobza R. Europace (2019) 0, 1–6.
Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, end points, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012; 9:632–696.e621.
