Automated rhythm-based control of radiofrequency ablation close to the atrioventricular node: Preclinical, animal, and first-in-human testing.

Autor:	Hooks DA; School of Medicine, University of Otago, Wellington, New Zealand; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France. Electronic address: darren.hooks@ccdhb.org.nz., Dubois R; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France., Meillet V; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France., Nicot J; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France., Berte B; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Yamashita S; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Mahida S; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Sellal JM; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Frontera A; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Denis A; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Sacher F; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Derval N; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Crozier I; Cardiology Department, Canterbury District Health Board, Christchurch, New Zealand., Melton I; Cardiology Department, Canterbury District Health Board, Christchurch, New Zealand., Haissaguerre M; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France., Jais P; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2021 May; Vol. 18 (5), pp. 734-742. Date of Electronic Publication: 2020 Oct 20.
DOI:	10.1016/j.hrthm.2020.10.014
Abstrakt:	Background: The risk of heart block during radiofrequency ablation of atrioventricular (AV) nodal reentrant tachycardia and septal accessory pathways is minimized by rapidly ceasing ablation in response to markers of risk, such as atrioventricular dissociation, fast junctional rhythm, PR interval prolongation, or 2 consecutive atrial or ventricular depolarizations. Currently this is done manually. Objectives: The objectives of this study were to build and test a control system able to monitor cardiac rhythm and automatically terminate ablation energy when required. Methods: The device was built from off-shelf componentry. Preclinical testing involved real-time input of electrogram/electrocardiogram data from 209 ablation procedures (20 patients) over slow (n = 19) and fast (n = 1) AV nodal pathways. The device response speed was compared with the human response speed. The device's ability to prevent heart block was tested in 5 sheep. First-in-human testing was then performed in 12 patients undergoing AV nodal reentrant tachycardia ablation. Results: Risk conditions necessitating shutoff of ablation (200 total; 111 preclinical and 89 first-in-human) were detected by the device with 100% sensitivity and 94% specificity, automatically terminating ablation while still allowing successful ablation in all patients. Device shutoff of ablation was always faster than human response (median difference 1.24 seconds). In each of 5 sheep, 40 consecutive attempts to cause heart block by ablating over the His bundle were unsuccessful because of automatic shutoff in response to rhythm change. Conclusion: Automated shutoff of ablation close to the AV node in response to markers of the risk of heart block is feasible with high accuracy as well as faster response than human response. The system may improve the safety of ablation near the AV node by preventing heart block. (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu