Wide-area antral pulmonary vein and posterior wall isolation by way of segmental nonocclusive applications using a novel radiofrequency ablation balloon.
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ABSTRACT:
SUBMITTER: Aryana A
PROVIDER: S-EPMC8377238 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
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Wide-area antral pulmonary vein and posterior wall isolation by way of segmental nonocclusive applications using a novel radiofrequency ablation balloon.
Aryana Arash A Allen Shelley L SL Di Biase Luigi L Bowers Mark R MR O'Neill Padraig Gearoid PG Natale Andrea A
HeartRhythm case reports 20210727 8
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Project description:BackgroundPersistent atrial fibrillation (AF) is associated with high recurrence rates of AF and atypical atrial flutters or tachycardia (AFT) postablation. Laser balloon (LB) ablation of the pulmonary vein (PV) ostia has similar efficacy as radiofrequency wide area circumferential ablation (RF-WACA); however, an approach of LB wide area circumferential ablation (LB-WACA) may further improve success rates.ObjectiveTo evaluate freedom from atrial tachyarrhythmia (AFT/AF) recurrence postablation using RF-WACA versus LB-WACA in persistent AF patients.MethodsThis was a retrospective multicenter study. Patients were followed for up to 24 months via office visits, Holter, and/or device monitoring. The primary endpoint was freedom from AFT/AF after a single ablation procedure. Secondary endpoints included freedom from AF, freedom from AFT, first-pass isolation of all PVs, and procedural complications.ResultsTwo hundred and four patients were studied (LB-WACA: n = 103; RF-WACA: n = 101). Patients' baseline characteristics were similar except patients in the RF-WACA group were older (64 vs. 68, p = .03). First-pass isolation was achieved more often during LBA (LB-WACA: 88% vs. RF-WACA 75%; p = .04). Procedure (p = .36), LA dwell (p = .41), and fluoroscopy (p = .44) time were similar. The mean follow-up was 506 ± 279 days. Sixty-six patients had arrhythmic events including 24 AFT and 59 AF recurrences. LB-WACA group had higher arrhythmia-free survival (p = .009) after single ablation procedures. In the multivariate Cox regression model, RF-WACA was associated with a higher recurrence of AFT compared with LB-WACA (Adjusted HR 3.16 [95% CI: 1.13-8.83]; p = .03).ConclusionsLB-WACA was associated with higher freedom from atrial arrhythmias mostly driven by the lower occurrence of AFT compared with RF-WACA.
| S-EPMC9237344 | biostudies-literature
Project description:A 73-year-old woman underwent radiofrequency hot balloon ablation (RHBA) for paroxysmal atrial fibrillation. After delivery into the left inferior pulmonary vein (LIPV), the guidewire perforated the venous wall. We injected contrast medium while the inflated balloon occluded the PV. Subsequently, bronchial-pulmonary venous fistula (BPVF) occurred and the severe hypoxia caused pulseless electrical activity (PEA). Cardiopulmonary resuscitation and intubation quickly recovered spontaneous circulation. She was initially treated by a multidisciplinary team in the intensive care unit and subsequently discharged without sequelae. Although relatively rare, there are some reports of wire perforation during RHBA and cryoballoon ablation. Some cases resolved after discontinuing anticoagulant therapy, while others required invasive procedures. This is the first case in which hypoxia, shock, and PEA were caused by wire perforation. As such complications can occur in all balloon ablation procedures, operators need to take care when using the guidewire and guide catheter. Anticoagulant therapy should be discontinued following PV perforation, if possible. Hemostasis with ventilator management is desirable. If hemostasis cannot be achieved, lung resection must be considered. Although wire perforation causing BPVF is rare, establishment of preventive measures and treatment protocols is needed. <Learning objective: The safety of radiofrequency hot balloon (RHB) ablation for paroxysmal atrial fibrillation has been established. This case report presents the rare complication of a soft J-tipped guidewire perforating the pulmonary vein (PV) without any resistance. Pulmonary venography was performed with the RHB blocking the PV, eventually causing pulseless electrical activity from hypoxia due to a bronchial-pulmonary venous fistula. Artificial ventilation management by positive end expiratory pressure after discontinuing anticoagulant therapy was effective for hemostasis and improvement of respiratory condition.>.
| S-EPMC6495061 | biostudies-literature
Project description: Not available
| S-EPMC11862143 | biostudies-literature
Project description:The muscular discontinuities at the pulmonary vein (PV)-left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment's activation pattern was classified into a "directly-activated from the LA" or "passively-activated from an adjacent PV segment" pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had "passively-activated segments". If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A "successful partial antral ablation" was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a "failed partial antral ablation" was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.
| S-EPMC8367962 | biostudies-literature
Project description:There is strong evidence in support of pulmonary vein isolation (PVI) with concomitant left atrial (LA) posterior wall (PW) isolation (PWI) for the treatment of patients with persistent atrial fibrillation (persAF). While this may be achieved using surgical and catheter-based strategies, there is growing interest in performing this approach using the cryoballoon. There are several potential advantages to this strategy. First, lesions created using the current-generation cryoballoons are typically large and durable. Second, cryoballoon ablation offers a simple technique to directly ablate and debulk the LAPW. Moreover, some consider cryoenergy a safer modality specifically with regard to collateral structures (ie, the esophagus). Based on the available data, cryoballoon PVI + PWI is associated with greater intraprocedural AF terminations and reductions in long-term AF recurrence (typically by ~20%), as compared to PVI alone in patients with persAF, but with similar rates of adverse events. As such, PVI + PWI has emerged as a significant predictor of freedom from recurrent AF (odds ratio: 3.67, 95% confidence interval: 1.44-9.34; p = 0.006) as well as all atrial arrhythmias (hazard ratio: 2.04, 95% confidence interval: 1.15-3.61; p = 0.015). Adjunct radiofrequency ablation to complete PWI is required in at least one-third of the patients, and this need is highly predicted by the LA size (significantly increased with an LA diameter > 48 mm). LAPW reconnection also seems to be associated with LA dimension, particularly an LA diameter greater than 48 mm (negative predictive value: 89.7%). Nevertheless, based on the analysis of patients who underwent repeat electrophysiology study for arrhythmia recurrences, cryoballoon PVI + PWI yields acceptable long-term durability (> 80%).
| S-EPMC8384303 | biostudies-literature
Project description:BACKGROUND AND STUDY AIMS: Gastric antral vascular ectasia (GAVE) is a known cause of gastrointestinal bleeding and chronic iron deficiency anemia. Endoscopic therapy with argon plasma coagulation (APC) is widely used for treatment of GAVE, but most patients continue to require repeated blood transfusions and multiple endoscopic procedures (refractory GAVE). We describe our initial experience regarding safety and efficacy of radiofrequency ablation (RFA) therapy in treating patients with refractory GAVE. PATIENTS AND METHODS: We prospectively enrolled seven patients with refractory GAVE who had multiple prior treatments with APC. These patients were treated with RFA (HALO90 ULTRA Ablation Catheter System; Covidien, GI Solutions, Sunnyvale, CA) at Ertan Digestive Disease Center at our tertiary University Hospital. RESULTS: Seven patients underwent a total of 12 RFA procedures for treatment of refractory GAVE. The median number of RFA procedures was 2 (Range, 1 - 3). Average pre- and post-procedural hemoglobin were 9.3 g/dL and 10.16 g/dL, respectively. Five of seven patients (71 %) were transfusion-free after the RFA treatments while two patients continued to require blood transfusions. There were no complications in this series. CONCLUSION: RFA can be an effective alternative to APC for treatment of GAVE refractory to previous endoscopic therapy. Additional studies are needed to identify which subset of patients will benefit the most with RFA treatment.
| S-EPMC4477020 | biostudies-other
Project description:AimsThe cornerstone of pulmonary vein (PV) isolation (PVI) is a wide-area circumferential ablation (WACA) resulting in an antral PVI area. Pulsed-field ablation (PFA) is a new nonthermal 'single-shot' PVI technique resulting in well-characterized posterior isolation areas. However, information on circumferential PVI area is lacking. Thus, we sought to characterize the circumferential antral PVI areas after PFA-PVI.Methods and resultsAtrial fibrillation (AF) patients underwent fluoroscopy-guided PVI with a pentaspline PFA catheter. Ultra-high-density voltage maps using a 20-polar circular mapping catheter were created before and immediately after PVI to identify and quantify (i) insufficient isolation areas per antral PV segment (10-segment model) and (ii) enlarged left atrial (LA) isolation areas (beyond the antral PV segments) per LA region (8-region model). The PFA-PVI with pre- (5469 ± 1822 points) and post-mapping (6809 ± 2769 points) was performed in 40 consecutive patients [age 62 ± 6 years, 25/40 (62.5%) paroxysmal AF]. Insufficient isolation areas were located most frequently in the anterior antral PV segments of the left PVs (62.5-77.5% of patients) with the largest extent (median ≥0.4 cm2) located in the same segments (segments 2/5/8). Enlarged LA isolation areas were located most frequently and most extensively on the posterior wall and roof region (89.5-100% of patients; median 1.1-2.7 cm2 per region).ConclusionFluoroscopy-guided PFA-PVI frequently results in insufficient isolation areas in the left anterior antral PV segments and enlarged LA isolation areas on the posterior wall/roof, which both may be extensive. To optimize the procedure, full integration of PFA catheter visualization into three-dimensional-mapping systems is needed.
| S-EPMC10103571 | biostudies-literature
Project description:ObjectivePreclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH).MethodsBetween July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66-92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8-23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially.ResultsAfter CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1-5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1-2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001).ConclusionThe interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory.Trial registration numberNCT03554330.
| S-EPMC9606506 | biostudies-literature
Project description:Intrahepatic biloma is a rare complication of radiofrequency ablation (RFA). When present, it can only be conservatively managed. Here, we report the case of a patient with hepatocellular carcinoma complicated by an intractable biloma after RFA. The biloma could not be managed via percutaneous catheter drainage and antibiotic administration for over 3 months. The intractable biloma was finally cured using percutaneous transhepatic portal vein embolization. The present case demonstrates a useful treatment option for intractable biloma after RFA.
| S-EPMC7711210 | biostudies-literature
Project description: Not available
| S-EPMC10692840 | biostudies-literature