Temperature-Controlled Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Atrial Fibrillation
| Autor: | Stepan Kralovec, Petr Neuzil, Srinivas Dukkipati, Jin Iwasawa, Katerina Mzourkova, Jacob S. Koruth, Jan Petru, Vivek Y. Reddy, Libor Dujka |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Radiofrequency ablation Swine medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Pulmonary vein law.invention 03 medical and health sciences Electrocardiography Young Adult 0302 clinical medicine law Heart Conduction System Internal medicine Atrial Fibrillation medicine Animals Humans 030212 general & internal medicine Prospective Studies Thrombus Aged business.industry Temperature Atrial fibrillation Equipment Design Middle Aged medicine.disease Ablation Catheter Treatment Outcome Pulmonary Veins Cardiology Catheter Ablation Atrial Ablation Female Cardiology and Cardiovascular Medicine Nuclear medicine business Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 70(5) |
| ISSN: | 1558-3597 |
| Popis: | Saline irrigation improved the safety of radiofrequency (RF) ablation, but the thermal feedback for energy titration is absent.To allow temperature-controlled irrigated ablation, a novel irrigated RF catheter was designed with a diamond-embedded tip (for rapid cooling) and 6 surface thermocouples to reflect tissue temperature. High-resolution electrograms (EGMs) from the split-tip electrode allowed rapid lesion assessment. The authors evaluated the preclinical and clinical performance of this catheter for pulmonary vein (PV) isolation.Using the DiamondTemp (DT) catheter, pigs (n = 6) underwent discrete atrial ablation in a temperature control mode (60°C/50 W) until there was ∼80% EGM amplitude reduction. In a single-center clinical feasibility study, 35 patients underwent PV isolation with the DT catheter (study group); patients were planned for PV remapping after 3 months, regardless of symptomatology. A control group included 35 patients who underwent PV isolation with a standard force-sensing catheter.Porcine lesion histology revealed transmurality in 51 of 55 lesions (92.7%). In patients, all PVs were successfully isolated; no char or thrombus formation was observed. Compared with the control group, the study cohort had shorter mean RF application duration (26.3 ± 5.2 min vs. 89.2 ± 27.2 min; p 0.001), shorter mean fluoroscopic time (11.2 ± 8.5 min vs. 19.5 ± 6.8 min; p 0.001), and lower acute dormant PV reconduction (0 of 35 vs. 5 of 35; p = 0.024). At 3 months, 23 patients underwent remapping: 39 of 46 PV pairs (84.8%) remained durably isolated in 17 of these patients (73.9%).This first-in-human series demonstrated that temperature-controlled irrigated ablation produced rapid, efficient, and durable PV isolation. (ACT DiamondTemp Temperature-Controlled and Contact Sensing RF Ablation Clinical Trial for Atrial Fibrillation [TRAC-AF]; NCT02821351). |
| Databáze: | OpenAIRE |
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