Skip to main content
Erschienen in: Journal of Interventional Cardiac Electrophysiology 2/2016

19.01.2016

The importance of catheter stability evaluated by VisitagTM during pulmonary vein isolation

verfasst von: Ryudo Fujiwara, Kimitake Imamura, Yoichi Kijima, Tomoya Masano, Ryoji Nagoshi, Amane Kohzuki, Hiroyuki Shibata, Yoshiro Tsukiyama, Ryo Takeshige, Kenichi Yanaka, Shinsuke Nakano, Yusuke Fukuyama, Junya Shite

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

The recurrence rates of atrial fibrillation (Af) after ablation are still high, and repeat procedures are required in these patients. The main reason for Af recurrence is the recovery of the conduction between the pulmonary veins and left atrium. The importance of catheter stability during the pulmonary vein isolation (PVI) is not well studied.

Purpose

The purpose of this study was to evaluate the contact force (CF), stable ablation time, and power during conduction blocking lesion formation for PVI.

Methods

Thirty-two consecutive drug-refractory Af patients who underwent an initial PVI using CARTO 3 and Visitag were included. The CF, ablation time, force time integral (FTI), and ablation power were recorded by Visitag. Residual conduction gap points requiring touch-up ablation after an encircling linear ablation (R point), spontaneous reconnection points (S point), and dormant conduction points (D point) were considered as non-conduction blocking lesion points. Each ablation parameter for the non-conduction blocking lesion points was compared with the other lesion points.

Results

Twenty-one points in 16 patients were considered non-conduction blocking lesions. Ten were R, eight were S, and three were D points. The CF, ablation time, FTI, and power at the non-conduction blocking lesion points and other points were 12.0 g (7.0–21.5) and 12.0 g (9.0–16.0) (P = 0.9), 7.7 s (5.6–10.1) and 12.5 s (9.4–16.8) (P < 0.05), 103.0 g*s (62.0–174.5) and 149.0 g*s (104.0–213.0) (P < 0.05), and 30.0 W (22.5–30.0) and 30.0 W (30.0–30.0) (P = 0.06), respectively.

Conclusions

Shorter ablation time recorded in Visitag lead to non-conduction blocking lesion.
Literatur
1.
Zurück zum Zitat Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339(10), 659–666.CrossRefPubMed Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339(10), 659–666.CrossRefPubMed
2.
Zurück zum Zitat Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace, 14(10), 1385–1413.CrossRefPubMed Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace, 14(10), 1385–1413.CrossRefPubMed
3.
Zurück zum Zitat January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Jr., et al. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64(21), e1–76.CrossRefPubMed January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Jr., et al. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64(21), e1–76.CrossRefPubMed
4.
Zurück zum Zitat Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 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, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33(2), 171–257.CrossRefPubMed Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 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, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33(2), 171–257.CrossRefPubMed
5.
Zurück zum Zitat Ouyang, F., Tilz, R., Chun, J., Schmidt, B., Wissner, E., Zerm, T., et al. (2010). Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation, 122(23), 2368–2377.CrossRefPubMed Ouyang, F., Tilz, R., Chun, J., Schmidt, B., Wissner, E., Zerm, T., et al. (2010). Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation, 122(23), 2368–2377.CrossRefPubMed
6.
Zurück zum Zitat Takigawa, M., Takahashi, A., Kuwahara, T., Okubo, K., Takahashi, Y., Watari, Y., et al. (2014). Long-term follow-up after catheter ablation of paroxysmal atrial fibrillation: the incidence of recurrence and progression of atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 7(2), 267–273.CrossRefPubMed Takigawa, M., Takahashi, A., Kuwahara, T., Okubo, K., Takahashi, Y., Watari, Y., et al. (2014). Long-term follow-up after catheter ablation of paroxysmal atrial fibrillation: the incidence of recurrence and progression of atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 7(2), 267–273.CrossRefPubMed
7.
Zurück zum Zitat Cappato, R., Negroni, S., Pecora, D., Bentivegna, S., Lupo, P. P., Carolei, A., et al. (2003). Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation, 108(13), 1599–1604.CrossRefPubMed Cappato, R., Negroni, S., Pecora, D., Bentivegna, S., Lupo, P. P., Carolei, A., et al. (2003). Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation, 108(13), 1599–1604.CrossRefPubMed
8.
Zurück zum Zitat Nanthakumar, K., Plumb, V. J., Epstein, A. E., Veenhuyzen, G. D., Link, D., & Kay, G. N. (2004). Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation, 109(10), 1226–1229.CrossRefPubMed Nanthakumar, K., Plumb, V. J., Epstein, A. E., Veenhuyzen, G. D., Link, D., & Kay, G. N. (2004). Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation, 109(10), 1226–1229.CrossRefPubMed
9.
Zurück zum Zitat Ouyang, F., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H., Deger, F. T., et al. (2005). Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation, 111(2), 127–135.CrossRefPubMed Ouyang, F., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H., Deger, F. T., et al. (2005). Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation, 111(2), 127–135.CrossRefPubMed
10.
Zurück zum Zitat Verma, A., Kilicaslan, F., Pisano, E., Marrouche, N. F., Fanelli, R., Brachmann, J., et al. (2005). Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation, 112(5), 627–635.CrossRefPubMed Verma, A., Kilicaslan, F., Pisano, E., Marrouche, N. F., Fanelli, R., Brachmann, J., et al. (2005). Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation, 112(5), 627–635.CrossRefPubMed
11.
Zurück zum Zitat Kowalski, M., Grimes, M. M., Perez, F. J., Kenigsberg, D. N., Koneru, J., Kasirajan, V., et al. (2012). Histopathologic characterization of chronic radiofrequency ablation lesions for pulmonary vein isolation. Journal of the American College of Cardiology, 59(10), 930–938.CrossRefPubMed Kowalski, M., Grimes, M. M., Perez, F. J., Kenigsberg, D. N., Koneru, J., Kasirajan, V., et al. (2012). Histopathologic characterization of chronic radiofrequency ablation lesions for pulmonary vein isolation. Journal of the American College of Cardiology, 59(10), 930–938.CrossRefPubMed
12.
Zurück zum Zitat Yokoyama, K., Nakagawa, H., Shah, D. C., Lambert, H., Leo, G., Aeby, N., et al. (2008). Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circulation. Arrhythmia and Electrophysiology, 1(5), 354–362.CrossRefPubMed Yokoyama, K., Nakagawa, H., Shah, D. C., Lambert, H., Leo, G., Aeby, N., et al. (2008). Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circulation. Arrhythmia and Electrophysiology, 1(5), 354–362.CrossRefPubMed
13.
Zurück zum Zitat Reddy, V. Y., Shah, D., Kautzner, J., Schmidt, B., Saoudi, N., Herrera, C., et al. (2012). The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm, 9(11), 1789–1795.CrossRefPubMed Reddy, V. Y., Shah, D., Kautzner, J., Schmidt, B., Saoudi, N., Herrera, C., et al. (2012). The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm, 9(11), 1789–1795.CrossRefPubMed
14.
Zurück zum Zitat Neuzil, P., Reddy, V. Y., Kautzner, J., Petru, J., Wichterle, D., Shah, D., et al. (2013). Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circulation. Arrhythmia and Electrophysiology, 6(2), 327–333.CrossRefPubMed Neuzil, P., Reddy, V. Y., Kautzner, J., Petru, J., Wichterle, D., Shah, D., et al. (2013). Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circulation. Arrhythmia and Electrophysiology, 6(2), 327–333.CrossRefPubMed
15.
Zurück zum Zitat Kimura, M., Sasaki, S., Owada, S., Horiuchi, D., Sasaki, K., Itoh, T., et al. (2014). Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study. Heart Rhythm, 11(6), 984–991.CrossRefPubMed Kimura, M., Sasaki, S., Owada, S., Horiuchi, D., Sasaki, K., Itoh, T., et al. (2014). Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study. Heart Rhythm, 11(6), 984–991.CrossRefPubMed
16.
Zurück zum Zitat Natale, A., Reddy, V. Y., Monir, G., Wilber, D. J., Lindsay, B. D., McElderry, H. T., et al. (2014). Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. Journal of the American College of Cardiology, 64(7), 647–656.CrossRefPubMed Natale, A., Reddy, V. Y., Monir, G., Wilber, D. J., Lindsay, B. D., McElderry, H. T., et al. (2014). Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. Journal of the American College of Cardiology, 64(7), 647–656.CrossRefPubMed
17.
Zurück zum Zitat Wutzler, A., Huemer, M., Parwani, A. S., Blaschke, F., Haverkamp, W., & Boldt, L. H. (2014). Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up. Archives Medical Science, 10(2), 266–272.CrossRef Wutzler, A., Huemer, M., Parwani, A. S., Blaschke, F., Haverkamp, W., & Boldt, L. H. (2014). Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up. Archives Medical Science, 10(2), 266–272.CrossRef
18.
Zurück zum Zitat le Polain de Waroux, J. B., Weerasooriya, R., Anvardeen, K., Barbraud, C., Marchandise, S., De Meester, C., et al. (2015). Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation. Europace. le Polain de Waroux, J. B., Weerasooriya, R., Anvardeen, K., Barbraud, C., Marchandise, S., De Meester, C., et al. (2015). Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation. Europace.
19.
Zurück zum Zitat Park, C. I., Lehrmann, H., Keyl, C., Weber, R., Schiebeling, J., Allgeier, J., et al. (2014). Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. Journal of Cardiovascular Electrophysiology, 25(7), 701–708.CrossRefPubMed Park, C. I., Lehrmann, H., Keyl, C., Weber, R., Schiebeling, J., Allgeier, J., et al. (2014). Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. Journal of Cardiovascular Electrophysiology, 25(7), 701–708.CrossRefPubMed
20.
Zurück zum Zitat Makimoto, H., Tilz, R. R., Lin, T., Rillig, A., Mathew, S., Deiss, S., et al. (2014). Incidence and anatomical locations of catheter instability during circumferential pulmonary vein isolation using contact force. International Heart Journal, 55(3), 249–255.CrossRefPubMed Makimoto, H., Tilz, R. R., Lin, T., Rillig, A., Mathew, S., Deiss, S., et al. (2014). Incidence and anatomical locations of catheter instability during circumferential pulmonary vein isolation using contact force. International Heart Journal, 55(3), 249–255.CrossRefPubMed
21.
Zurück zum Zitat Takigawa, M., Yamada, T., Yoshida, Y., Ishikawa, K., Aoyama, Y., Yamamoto, T., et al. (2014). Patterns of pulmonary vein potential disappearance during encircling ipsilateral pulmonary vein isolation can predict recurrence of atrial fibrillation. Circulation Journal, 78(3), 601–609.CrossRefPubMed Takigawa, M., Yamada, T., Yoshida, Y., Ishikawa, K., Aoyama, Y., Yamamoto, T., et al. (2014). Patterns of pulmonary vein potential disappearance during encircling ipsilateral pulmonary vein isolation can predict recurrence of atrial fibrillation. Circulation Journal, 78(3), 601–609.CrossRefPubMed
22.
Zurück zum Zitat Takigawa, M., Kuwahara, T., Takahashi, A., Okubo, K., Takahashi, Y., Nakashima, E., et al. (2015). Simultaneous isolation of superior and inferior pulmonary veins on both the left and right sides could yield better outcomes in patients with paroxysmal atrial fibrillation. Europace, 17(5), 732–740.CrossRefPubMed Takigawa, M., Kuwahara, T., Takahashi, A., Okubo, K., Takahashi, Y., Nakashima, E., et al. (2015). Simultaneous isolation of superior and inferior pulmonary veins on both the left and right sides could yield better outcomes in patients with paroxysmal atrial fibrillation. Europace, 17(5), 732–740.CrossRefPubMed
Metadaten
Titel
The importance of catheter stability evaluated by VisitagTM during pulmonary vein isolation
verfasst von
Ryudo Fujiwara
Kimitake Imamura
Yoichi Kijima
Tomoya Masano
Ryoji Nagoshi
Amane Kohzuki
Hiroyuki Shibata
Yoshiro Tsukiyama
Ryo Takeshige
Kenichi Yanaka
Shinsuke Nakano
Yusuke Fukuyama
Junya Shite
Publikationsdatum
19.01.2016
Verlag
Springer US
Erschienen in
Journal of Interventional Cardiac Electrophysiology / Ausgabe 2/2016
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-016-0103-z

Weitere Artikel der Ausgabe 2/2016

Journal of Interventional Cardiac Electrophysiology 2/2016 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.