Agustín Bortone1, Philippe Lagrange2, Bruno Cauchemez3, Cyril Durand4, Pierre Dieuzaide5, Sébastien Prévot5, Alexis Mechulan5, Thomas Pambrun6,7, Ruairidh Martin7, Pauline Parlier8, Alexandre Masse8, Eloi Marijon9, Jean-Paul Albenque10. 1. Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France. agubene@hotmail.com. 2. Département de Rythmologie, Clinique St Pierre, Perpignan, France. 3. Service de Rythmologie, Clinique Ambroise Paré, Neuilly sur Seine, France. 4. Département de Rythmologie, Infirmerie Protestante, Lyon, France. 5. Département de Rythmologie, Hôpital Privé Clairval, Marseille, France. 6. Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France. 7. LYRIC Institute/INSERM 1045, University Hospital Haut-Leveque, Bordeaux, France. 8. Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France. 9. Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France. 10. Département de Rythmologie, Clinique Pasteur, Toulouse, France.
Abstract
PURPOSE: Elimination of the negative component of the unipolar atrial electrogram is a reliable indicator of the creation of a transmural lesion. Contact-force (CF) sensing technology has the potential to increase the durability of pulmonary vein isolation (PVI). In the present multicenter study, we assessed the 2-year sinus rhythm (SR) maintenance rate in patients with paroxysmal atrial fibrillation (PAF) after PVI guided by these two approaches. METHODS: Two hundred fifteen consecutive PAF patients (62.1 ± 10.1 years, 65 women) were prospectively enrolled. All patients underwent PVI under CARTO guidance according to a systematic contiguous "point-by-point" approach, using radiofrequency energy, and a CF externally irrigated ablation catheter with the goal of at least 10g (ideally 20g) of force. The ablation endpoint of each individual lesion was elimination of the negative component of the unipolar atrial signal. The procedural endpoint was PVI with bidirectional block. RESULTS: All PVs were successfully isolated. After 30 min of waiting time, 35 patients (16%) had PV reconnection and in all of them, the PVs were re-isolated. Two years after a single ablation procedure, 187 patients (87%) remained arrhythmia free, without anti-arrhythmic drugs. Of the 28 patients presenting with AF recurrence, 25 had PV reconnection and underwent repeat PVI while in the remaining 3 patients, all four PVs were isolated and extra-PV triggers were identified. There were six groin hematomas and one transient ischemic attack. CONCLUSIONS: Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.
PURPOSE: Elimination of the negative component of the unipolar atrial electrogram is a reliable indicator of the creation of a transmural lesion. Contact-force (CF) sensing technology has the potential to increase the durability of pulmonary vein isolation (PVI). In the present multicenter study, we assessed the 2-year sinus rhythm (SR) maintenance rate in patients with paroxysmal atrial fibrillation (PAF) after PVI guided by these two approaches. METHODS: Two hundred fifteen consecutive PAF patients (62.1 ± 10.1 years, 65 women) were prospectively enrolled. All patients underwent PVI under CARTO guidance according to a systematic contiguous "point-by-point" approach, using radiofrequency energy, and a CF externally irrigated ablation catheter with the goal of at least 10g (ideally 20g) of force. The ablation endpoint of each individual lesion was elimination of the negative component of the unipolar atrial signal. The procedural endpoint was PVI with bidirectional block. RESULTS: All PVs were successfully isolated. After 30 min of waiting time, 35 patients (16%) had PV reconnection and in all of them, the PVs were re-isolated. Two years after a single ablation procedure, 187 patients (87%) remained arrhythmia free, without anti-arrhythmic drugs. Of the 28 patients presenting with AF recurrence, 25 had PV reconnection and underwent repeat PVI while in the remaining 3 patients, all four PVs were isolated and extra-PV triggers were identified. There were six groin hematomas and one transient ischemic attack. CONCLUSIONS: Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.
Authors: Dipen C Shah; Hendrik Lambert; Hiroshi Nakagawa; Arne Langenkamp; Nicolas Aeby; Giovanni Leo Journal: J Cardiovasc Electrophysiol Date: 2010-09
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: Daniel Steven; Vivek Y Reddy; Keiichi Inada; Kurt C Roberts-Thomson; Jens Seiler; William G Stevenson; Gregory F Michaud Journal: Heart Rhythm Date: 2009-11-12 Impact factor: 6.343
Authors: Rukshen Weerasooriya; Paul Khairy; Jean Litalien; Laurent Macle; Meleze Hocini; Frederic Sacher; Nicolas Lellouche; Sebastien Knecht; Matthew Wright; Isabelle Nault; Shinsuke Miyazaki; Christophe Scavee; Jacques Clementy; Michel Haissaguerre; Pierre Jais Journal: J Am Coll Cardiol Date: 2011-01-11 Impact factor: 24.094
Authors: Chan-Il Park; Heiko Lehrmann; Cornelius Keyl; Reinhold Weber; Jochen Schiebeling; Juergen Allgeier; Patrick Schurr; Ashok Shah; Franz-Josef Neumann; Thomas Arentz; Amir S Jadidi Journal: J Cardiovasc Electrophysiol Date: 2014-04-02