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Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation.

le Polain de Waroux JB, Weerasooriya R, Anvardeen K, Barbraud C, Marchandise S, De Meester C, Goesaert C, Reis I, Scavee C - Europace (2015)

Bottom Line: However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both).Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC.Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI.

View Article: PubMed Central - PubMed

Affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium jean-benoit.lepolain@uclouvain.be.

No MeSH data available.


Related in: MedlinePlus

Average CF (g) per PV segment according to the presence or absence of ER or DC at 60 min after PVI. ER+: red stars and values; DC+: green stars and values; ER−/DC−: values in blue. LSPV, left superior pulmonary vein; RSPV, right superior pulmonary vein; LIPV, left inferior pulmonary vein; RIPV, right inferior pulmonary vein.
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EUU329F1: Average CF (g) per PV segment according to the presence or absence of ER or DC at 60 min after PVI. ER+: red stars and values; DC+: green stars and values; ER−/DC−: values in blue. LSPV, left superior pulmonary vein; RSPV, right superior pulmonary vein; LIPV, left inferior pulmonary vein; RIPV, right inferior pulmonary vein.

Mentions: Ablation strategy consisted of circumferential PV antrum ablation with PV electrical isolation as the procedural end point. After central venous access was obtained, a multipolar catheter was placed in the coronary sinus (CS). One or two transseptal punctures were performed for access into the LA. After transseptal access was obtained, boluses of intravenous heparin were given followed by a continuous infusion to maintain an activated clotting time of >300 s. Through one transseptal access, a decapolar, circular catheter was advanced into the LA via a non-steerable sheath (Fast-Cath SL-0, St Jude Medical). Directly besides this first access (one transseptal puncture) or via a second transseptal puncture (two transseptal punctures), the Tacticath (Tacticath, St Jude Medical), a 7 french, 3.5 mm open irrigated-tip ablation catheter allowing for the measurement of both the magnitude and the direction of the CF was placed in the LA. The study protocol did not allow the use of a long sheath for the Tacticath catheter. Importantly, in Brussels, only medium curves (65 cm) were used, while at Hollywood Private Hospital the Tacticath 75 cm curve catheter was used. Electroanatomic mapping (EnSite NavX, St Jude Medical) with or without image integration was used in Brussels, while computed tomography fluoroscopic overlay (Siemens iPilot) was used in Perth. Using the Tacticath, circumferential continuous point-by-point ablation lesions set was placed 1–2 cm from the PV ostia to encircle and electrically isolate the PVs. Radiofrequency energy was delivered at a pre-defined target power of 25–35 W (25 W for all posterior segments and 35 W for anterior segments) with a catheter irrigation set at 17 mL/min with 0.9% NaCl. The duration of each RF application was according to operator discretion; however, a minimum of 60 s was advised if the catheter position was stable. As the PVs were encircled, the circular catheter was used to confirm electrical isolation of each vein from the LA. Circumferential lesions around the veins were considered complete when the circular catheter no longer recorded PV potentials. The site of each RF application was recorded relative to eight pre-defined circumferential positions around the PV (superior, antero-superior, anterior, antero-inferior, inferior, postero-inferior, posterior, postero-superior) (Figure 1). For each RF application, a tag was placed on the LA shell and the following data were extracted from the Tacisys® unit: application duration, average CF, and force–time integral (FTI). Per position, the total number of RF applications, application duration, minimum CF, maximum CF, average CF and FTI, and the CF and FTI during the first application was entered into a dedicated database. In addition, the stability of the catheter (estimated by the jumping index: number of untouched segments between two consecutive RF applications), the total of application per vein, the average CF and FTI per vein, and the number of un-ablated segments per vein were also recorded. Importantly, the operators were blinded to the contact force data at all times. Patients in AF at the conclusion of the procedure were cardioverted back to sinus rhythm electrically to allow remapping of all PVs to confirm PV isolation in sinus rhythm.Figure 1


Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation.

le Polain de Waroux JB, Weerasooriya R, Anvardeen K, Barbraud C, Marchandise S, De Meester C, Goesaert C, Reis I, Scavee C - Europace (2015)

Average CF (g) per PV segment according to the presence or absence of ER or DC at 60 min after PVI. ER+: red stars and values; DC+: green stars and values; ER−/DC−: values in blue. LSPV, left superior pulmonary vein; RSPV, right superior pulmonary vein; LIPV, left inferior pulmonary vein; RIPV, right inferior pulmonary vein.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4447053&req=5

EUU329F1: Average CF (g) per PV segment according to the presence or absence of ER or DC at 60 min after PVI. ER+: red stars and values; DC+: green stars and values; ER−/DC−: values in blue. LSPV, left superior pulmonary vein; RSPV, right superior pulmonary vein; LIPV, left inferior pulmonary vein; RIPV, right inferior pulmonary vein.
Mentions: Ablation strategy consisted of circumferential PV antrum ablation with PV electrical isolation as the procedural end point. After central venous access was obtained, a multipolar catheter was placed in the coronary sinus (CS). One or two transseptal punctures were performed for access into the LA. After transseptal access was obtained, boluses of intravenous heparin were given followed by a continuous infusion to maintain an activated clotting time of >300 s. Through one transseptal access, a decapolar, circular catheter was advanced into the LA via a non-steerable sheath (Fast-Cath SL-0, St Jude Medical). Directly besides this first access (one transseptal puncture) or via a second transseptal puncture (two transseptal punctures), the Tacticath (Tacticath, St Jude Medical), a 7 french, 3.5 mm open irrigated-tip ablation catheter allowing for the measurement of both the magnitude and the direction of the CF was placed in the LA. The study protocol did not allow the use of a long sheath for the Tacticath catheter. Importantly, in Brussels, only medium curves (65 cm) were used, while at Hollywood Private Hospital the Tacticath 75 cm curve catheter was used. Electroanatomic mapping (EnSite NavX, St Jude Medical) with or without image integration was used in Brussels, while computed tomography fluoroscopic overlay (Siemens iPilot) was used in Perth. Using the Tacticath, circumferential continuous point-by-point ablation lesions set was placed 1–2 cm from the PV ostia to encircle and electrically isolate the PVs. Radiofrequency energy was delivered at a pre-defined target power of 25–35 W (25 W for all posterior segments and 35 W for anterior segments) with a catheter irrigation set at 17 mL/min with 0.9% NaCl. The duration of each RF application was according to operator discretion; however, a minimum of 60 s was advised if the catheter position was stable. As the PVs were encircled, the circular catheter was used to confirm electrical isolation of each vein from the LA. Circumferential lesions around the veins were considered complete when the circular catheter no longer recorded PV potentials. The site of each RF application was recorded relative to eight pre-defined circumferential positions around the PV (superior, antero-superior, anterior, antero-inferior, inferior, postero-inferior, posterior, postero-superior) (Figure 1). For each RF application, a tag was placed on the LA shell and the following data were extracted from the Tacisys® unit: application duration, average CF, and force–time integral (FTI). Per position, the total number of RF applications, application duration, minimum CF, maximum CF, average CF and FTI, and the CF and FTI during the first application was entered into a dedicated database. In addition, the stability of the catheter (estimated by the jumping index: number of untouched segments between two consecutive RF applications), the total of application per vein, the average CF and FTI per vein, and the number of un-ablated segments per vein were also recorded. Importantly, the operators were blinded to the contact force data at all times. Patients in AF at the conclusion of the procedure were cardioverted back to sinus rhythm electrically to allow remapping of all PVs to confirm PV isolation in sinus rhythm.Figure 1

Bottom Line: However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both).Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC.Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI.

View Article: PubMed Central - PubMed

Affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium jean-benoit.lepolain@uclouvain.be.

No MeSH data available.


Related in: MedlinePlus