PURPOSE: The influence of left atrial (LA) enlargement on the efficacy of steerable sheath usage during pulmonary vein (PV) isolation is poorly understood. Here, we compared the catheter-tissue contact force (CF) and clinical outcomes between steerable and non-steerable sheaths among patients with different severities of LA enlargement. METHODS: In this prospective observational study, 90 consecutive atrial fibrillation patients scheduled for PV isolation (paroxysmal, 67 %) were enrolled and divided into tertiles of the LA volume (LA1, <124 cm3; LA2, 124 to 145 cm3; LA3, ≥146 cm3). An ipsilateral PV isolation was completed using either a steerable (n = 57) or non-steerable sheath (n = 33). RESULTS: The average CF of each ipsilateral PV was lower in the LA3 group (right 13.8 ± 5.8 g; left 9.7 ± 5.2 g) than LA1 (right 15.6 ± 6.8 g, p = 0.005; left 12.5 ± 5.6 g, p < 0.0001) or LA2 (right 15.2 ± 7.3 g, p = 0.04; left 12.6 ± 5.3 g, p < 0.0001) groups. In total, the average CF around the left PVs was significantly higher with steerable sheaths than without (12.7 ± 5.5 vs. 10.2 ± 4.9 g, p = 0.03). Subgroup analysis revealed that a tendency toward higher CF around the left PVs was observed in the LA3 group (12.3 ± 7.3 vs. 8.5 ± 3.9 g, p = 0.08) but was not in the LA1 and LA2 groups. Further, in the LA3 group, steerable sheath usage showed better clinical outcomes: shorter procedural (55 ± 29 min vs. 81 ± 39 min, p = 0.04) and fluoroscopic times (27 ± 11 min vs. 37 ± 17 min, p = 0.045) and a tendency toward a lower 1-year AF recurrence rate (39 vs. 12 %, p = 0.09). CONCLUSIONS: The beneficial effects of using steerable sheaths were more prominent in patients with severe LA enlargement.
PURPOSE: The influence of left atrial (LA) enlargement on the efficacy of steerable sheath usage during pulmonary vein (PV) isolation is poorly understood. Here, we compared the catheter-tissue contact force (CF) and clinical outcomes between steerable and non-steerable sheaths among patients with different severities of LA enlargement. METHODS: In this prospective observational study, 90 consecutive atrial fibrillationpatients scheduled for PV isolation (paroxysmal, 67 %) were enrolled and divided into tertiles of the LA volume (LA1, <124 cm3; LA2, 124 to 145 cm3; LA3, ≥146 cm3). An ipsilateral PV isolation was completed using either a steerable (n = 57) or non-steerable sheath (n = 33). RESULTS: The average CF of each ipsilateral PV was lower in the LA3 group (right 13.8 ± 5.8 g; left 9.7 ± 5.2 g) than LA1 (right 15.6 ± 6.8 g, p = 0.005; left 12.5 ± 5.6 g, p < 0.0001) or LA2 (right 15.2 ± 7.3 g, p = 0.04; left 12.6 ± 5.3 g, p < 0.0001) groups. In total, the average CF around the left PVs was significantly higher with steerable sheaths than without (12.7 ± 5.5 vs. 10.2 ± 4.9 g, p = 0.03). Subgroup analysis revealed that a tendency toward higher CF around the left PVs was observed in the LA3 group (12.3 ± 7.3 vs. 8.5 ± 3.9 g, p = 0.08) but was not in the LA1 and LA2 groups. Further, in the LA3 group, steerable sheath usage showed better clinical outcomes: shorter procedural (55 ± 29 min vs. 81 ± 39 min, p = 0.04) and fluoroscopic times (27 ± 11 min vs. 37 ± 17 min, p = 0.045) and a tendency toward a lower 1-year AF recurrence rate (39 vs. 12 %, p = 0.09). CONCLUSIONS: The beneficial effects of using steerable sheaths were more prominent in patients with severe LA enlargement.
Authors: Jason G Andrade; George Monir; Scott J Pollak; Paul Khairy; Marc Dubuc; Denis Roy; Mario Talajic; Marc Deyell; Léna Rivard; Bernard Thibault; Peter G Guerra; Stanley Nattel; Laurent Macle Journal: Heart Rhythm Date: 2014-07-25 Impact factor: 6.343
Authors: Saurabh Kumar; Joseph B Morton; Justin Lee; Karen Halloran; Steven J Spence; Alexandra Gorelik; Graham Hepworth; Peter M Kistler; Jonathan M Kalman Journal: Circ Arrhythm Electrophysiol Date: 2012-10-19
Authors: Petr Neuzil; Vivek Y Reddy; Josef Kautzner; Jan Petru; Dan Wichterle; Dipen Shah; Hendrik Lambert; Aude Yulzari; Erik Wissner; Karl-Heinz Kuck Journal: Circ Arrhythm Electrophysiol Date: 2013-03-20
Authors: Vivek Y Reddy; Dipen Shah; Josef Kautzner; Boris Schmidt; Nadir Saoudi; Claudia Herrera; Pierre Jaïs; Gerhard Hindricks; Petr Peichl; Aude Yulzari; Hendrik Lambert; Petr Neuzil; Andrea Natale; Karl-Heinz Kuck Journal: Heart Rhythm Date: 2012-07-20 Impact factor: 6.343
Authors: Kim Rajappan; Victoria Baker; Laura Richmond; Peter M Kistler; Glyn Thomas; Calum Redpath; Simon C Sporton; Mark J Earley; Stuart Harris; Richard J Schilling Journal: Europace Date: 2009-04-07 Impact factor: 5.214
Authors: Josef Kautzner; Petr Neuzil; Hendrik Lambert; Petr Peichl; Jan Petru; Robert Cihak; Jan Skoda; Dan Wichterle; Erik Wissner; Aude Yulzari; Karl-Heinz Kuck Journal: Europace Date: 2015-06-03 Impact factor: 5.214