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Journal of Interventional Cardiac... Jun 2024
Topics: Atrial Fibrillation; Humans; Pulmonary Veins; Catheter Ablation; Precision Medicine
PubMed: 38319499
DOI: 10.1007/s10840-024-01757-3 -
JACC. Cardiovascular Interventions Jul 2022
Topics: Angioplasty, Balloon; Humans; Mediastinitis; Pulmonary Artery; Pulmonary Veins; Treatment Outcome
PubMed: 35863807
DOI: 10.1016/j.jcin.2022.04.008 -
Journal of Interventional Cardiac... Jan 2022Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated...
PURPOSE
Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors.
METHODS
The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure.
RESULTS
Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found.
CONCLUSION
Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 33570717
DOI: 10.1007/s10840-021-00944-w -
Journal of Interventional Cardiac... Jun 2021Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary...
PURPOSE
Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF.
METHODS
Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography.
RESULTS
In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e') velocity (E/e' > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17-3.55, 1.05-3.39, 1.72-7.67, and 1.34-4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity.
CONCLUSION
Female sex, lower BMI, absence of hypertension, and higher E/e' were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.
Topics: Atrial Fibrillation; Catheter Ablation; Female; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 32468323
DOI: 10.1007/s10840-020-00779-x -
Pediatric Cardiology Dec 2018Pulmonary vein stenosis (PVS) is still a frustrating disease with extremely high mortality, especially in children with multiple severe PVS. Hybrid pulmonary vein...
Pulmonary vein stenosis (PVS) is still a frustrating disease with extremely high mortality, especially in children with multiple severe PVS. Hybrid pulmonary vein stenting (HPVS) is a rescue treatment for recurrent and malignant PVS. The aim of this study is to share our successful experience with intraoperative HPVS for recurrent PVS after total anomalous pulmonary venous connection (TAPVC) repair in infant. Six patients were identified between 2013 and January 2018, who were diagnosed with recurrent PVS and underwent HPVS in the operating room. The mean age at the time of the HPVS was 10.3 ± 2.7 months (range 7-14 months) and the mean body weight was 7.9 ± 2.6 kg (range 4.1-10.5 kg). Prior pulmonary vein surgery had been performed on average 2.7 times (range 2-3) in all patients. We used a bare-metal stent (BMS) of 6-8 mm diameter in 15 veins of five patients and a drug-eluting coronary stent (DES) in two veins of one patient. All patients had undergone several elective further pulmonary vein in-stent balloon dilatations or another stent insertion after HPVS. Over a mean follow-up of 17.3 ± 13.7 months (range 6-44 months), all patients maintained patency of stents although two patients died due to respiratory failure not associated with PVS. HPVS is a useful treatment modality for recurrent PVS patient that could save the life and achieve longer freedom from restenosis than repetitive surgical pulmonary vein widening only. Even though the prognosis of severe multiple PVS is very poor, planned HPVS could be a good palliation in this patients group.
Topics: Female; Follow-Up Studies; Humans; Infant; Male; Pulmonary Veins; Retrospective Studies; Scimitar Syndrome; Stenosis, Pulmonary Vein; Stents; Treatment Outcome; Vascular Surgical Procedures
PubMed: 30105463
DOI: 10.1007/s00246-018-1944-2 -
Circulation Journal : Official Journal... Nov 2023Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the...
BACKGROUND
Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI.Methods and Results: A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient.
CONCLUSIONS
Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.
Topics: Humans; Atrial Fibrillation; Stenosis, Pulmonary Vein; Cross-Sectional Studies; Pulmonary Veins; Cryosurgery; Treatment Outcome; Catheter Ablation; Lasers
PubMed: 37258224
DOI: 10.1253/circj.CJ-23-0048 -
International Journal of Cardiology Sep 2020
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins
PubMed: 32320787
DOI: 10.1016/j.ijcard.2020.04.037 -
Journal of Cardiovascular Magnetic... Dec 2022Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including...
BACKGROUND
Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.
METHODS
CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes.
RESULTS
Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen's kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day.
CONCLUSION
Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.
Topics: Humans; Stenosis, Pulmonary Vein; Pulmonary Veins; Catheter Ablation; Constriction, Pathologic; Predictive Value of Tests; Atrial Fibrillation; Lung; Magnetic Resonance Spectroscopy
PubMed: 36503589
DOI: 10.1186/s12968-022-00904-x -
Journal of Cardiovascular Medicine... Jun 2018Pulmonary vein stenosis (PVS) is a well recognized complication as a consequence of pulmonary vein isolation. In the current study, we sought to analyze potential...
AIMS
Pulmonary vein stenosis (PVS) is a well recognized complication as a consequence of pulmonary vein isolation. In the current study, we sought to analyze potential anatomical and intraprocedural predictors of PVS during second-generation cryoballoon ablation, particularly focusing on the impact of freeze duration and number of cryoapplications.
METHODS
Fifty-four patients who underwent cryoballoon ablation for atrial fibrillation were included retrospectively in this study. All patients underwent cardiac-enhanced multidetector computed tomography both before and after the ablation. The exclusion criteria were any contraindications for the procedure, including the presence of an intracavitary thrombus, uncontrolled heart failure and contraindications to general anesthesia.
RESULTS
Mild (25-50%) PVS was only detected in one vein (0.4%) and neither moderate (50-75%) nor severe (>75%) PVS were found. Twenty-five pulmonary veins (12%) exhibited slight narrowing of the diameter (less than 25%). In the univariate analysis, a longer duration of cryoapplication and a larger pulmonary vein ostium preprocedure diameter and area were independently associated with pulmonary vein narrowing [odds ratio (OR): 1.004; confidence interval (CI): 1.001-1.008, P = 0.016; OR: 1.250, CI: 1.090-1.434, P = 0.001 and OR: 1.006; CI: 1.002-1.011, P = 0.006] respectively.
CONCLUSION
Longer duration of cryoablation, an increased number of applications per vein and larger pulmonary vein ostia are associated with a higher risk of pulmonary vein diameter and area reduction. These findings might suggest to lower the dosing to a single and shorter application if isolation is attained, to reduce the possibility of future pulmonary vein narrowing.
Topics: Aged; Atrial Fibrillation; Cryosurgery; Female; Humans; Male; Middle Aged; Multidetector Computed Tomography; Postoperative Complications; Pulmonary Veins; ROC Curve; Recurrence; Retrospective Studies; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 29601309
DOI: 10.2459/JCM.0000000000000646 -
Trends in Cardiovascular Medicine Oct 2019Second-generation cryoballoon ablation has emerged as an effective and practical approach for the treatment of atrial fibrillation. It gained the overall interest of the... (Review)
Review
Second-generation cryoballoon ablation has emerged as an effective and practical approach for the treatment of atrial fibrillation. It gained the overall interest of the electrophysiology community due to its excellent success rates, and reproducible clinical outcomes comparable to the point-by-point radiofrequency technique. This technology offers several advantages including a fast learning curve and shorter procedure times making this device widely adopted in many EP-laboratories as an alternative strategy to conventional point-by-point radiofrequency ablation. As compared to its predecessor, the improved technical performances of the second-generation cryoballoon translated into favorable clinical outcomes, which are maintained in long-term follow-up. However, the ideal cryo-application duration and the adequate number of freeze-thaw cycles are not well established and predictors of durable electrical isolation are poorly known. This review provides some practical advices for a successful ablation using the second-generation cryoballoon.
Topics: Action Potentials; Atrial Fibrillation; Cryosurgery; Heart Rate; Humans; Pulmonary Veins; Recurrence; Risk Factors; Treatment Outcome
PubMed: 30552043
DOI: 10.1016/j.tcm.2018.11.009