Automated Noncontact Ultrasound Imaging and Ablation System for the Treatment of Atrial Fibrillation
| Autor: | Stepan Kralovec, William Whang, Mohit K. Turagam, Srinivas R. Dukkipati, Petr Neuzil, Danielo B. Piazza, Jan Petru, David Harari, Vivek Y. Reddy, Patrick Phillips, Ken Kakita |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Catheter ablation Young Adult Heart Conduction System Recurrence Physiology (medical) Atrial Fibrillation Humans Medicine Prospective Studies Aged Ultrasonography business.industry Atrial fibrillation Equipment Design First in human Middle Aged Ablation medicine.disease Catheter Treatment Outcome Surgery Computer-Assisted Pulmonary Veins Catheter Ablation Ultrasound imaging Female Radiology Cardiology and Cardiovascular Medicine business Radiofrequency energy Follow-Up Studies |
| Zdroj: | Circulation: Arrhythmia and Electrophysiology. 13 |
| ISSN: | 1941-3084 1941-3149 |
| Popis: | Background: Catheter ablation for atrial fibrillation (AF) using point-by-point radiofrequency energy or single-application one-shot balloons is either technically challenging or have limited ability to accommodate variable patient anatomy to achieve acute and durable pulmonary vein (PV) isolation. A novel ablation system employs low intensity collimated ultrasound (LICU)-guided anatomic mapping and robotic ablation to isolate PVs. In this first-in-human, single-center, multioperator trial, VALUE trial (VytronUS Ablation System for Treatment of Paroxysmal Atrial Fibrillation; NCT03639597) in patients with paroxysmal atrial fibrillation, this LICU system was evaluated to determine its safety, effectiveness in PV isolation, and freedom from recurrent atrial arrhythmias. Methods: In the enrolled 52 patients with paroxysmal atrial fibrillation, ultrasound M-mode–based left atrial anatomies were successfully created, and ablation was performed under robotic control along an operator-defined lesion path. The LICU system software advanced over the course of the study: the last 13 patients were ablated with enhanced software. Results: Acute PV isolation was achieved in 98% of PVs—using LICU-only in 77.3% (153/198) of PVs and requiring touch-up with a standard radiofrequency ablation catheter in 22.7% (45/198) PVs. The touch-up rate decreased to 5.8% (3/52) in patients undergoing LICU-ablation with enhanced software. Freedom from atrial arrhythmia recurrence was 79.6% (39/49 patients) at 12 months or 92.3% (12/13 patients) with the enhanced software. Major adverse events occurred in 3 patients (5.8%): one had transient diaphragmatic paralysis, one vascular access complication, and one had transient ST-segment elevation from air-embolism, without sequelae. Conclusions: In this first-in-human study, low- intensity collimated ultrasound-guided anatomic mapping and robotic ablation allows PV isolation with good chronic safety; PV isolation success is improving with device enhancements. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03639597. |
| Databáze: | OpenAIRE |
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