Efficacy and Safety of Different Energy Settings for Atrial Fibrillation Ablation using the Duty-cycled Radiofrequency Ablation Catheter (PVAC)
Main Article Content
Abstract
In recent years, new ablation catheters have been developed to facilitate atrial fibrillation (AF) ablation procedures, including the multi-electrode pulmonary vein ablation catheter (PVAC), capable of using different proportions of unipolar and bipolar energy. The purpose of this study was to evaluate the acute efficacy, as well as safety, when using the two different energy settings for the PVAC catheter.
Methods and Results: Thirty-five patients with a mean age of 62 ± 7.7 years with paroxysmal (54%) or persistent AF were included in the study and randomized to 4:1 versus 2:1 bipolar/unipolar energy setting with the PVAC device. The mean number of applications with the PVAC catheter was 41 ± 10 and 51 ± 15 (p = 0.3) respectively with the 4:1 and the 2:1 setting. Touch-up with another RF ablation catheter was necessary in 3 and 7 patients respectively in the 4:1 and 2:1 group. The procedure time was 155 ± 35 and 174 ± 41minutes respectively and the total fluoroscopy time, including the time for touch-up with another catheter, was 42 ± 14 and 50 ± 17 minutes respectively with the 4:1 versus 2:1 setting. No complications were seen in any group.
Conclusion: There was no significant difference between the 4:1 and 2:1 bipolar-to-unipolar energy setting with the PVAC regarding the number of applications needed to create (PVI), the number of patients in which (PVI) could be achieved without touch-up applications, the procedure time or the fluoroscopy time.
Downloads
Article Details
Copyright (c) 2014 Lönnerholm S, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.
We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.
Peertechz accomplice with- [CC BY 4.0]
Explanation
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:
|
License Name |
Permission to read and download |
Permission to display in a repository |
Permission to translate |
Commercial uses of manuscript |
|
CC BY 4.0 |
Yes |
Yes |
Yes |
Yes |
The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.
Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, 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: 1385-413.
Boersma LV, Wijffels MC, Oral H, Wever EF, Morady F (2008) Pulmonary vein isolation by duty-cycled bipolar and unipolar radiofrequency energy with a multielectrode ablation catheter. Heart Rhythm 5: 1635-1666.
Schmidt B, Antz M, Ernst S, Ouyang F, Falk P, et al. (2007) Pulmonary vein isolation by high-intensity focused ultrasound: first-in-man study with a steerable ballon catheter. Heart Rhythm 4: 575-584.
Neumann T, Vogt J, Schumacher B, Dorszewski A, Kuniss M, et al. (2008) Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. J Am Coll Cardiol 52: 273-278.
Mulder AA, Wijffels MC, Wever EF, Boersma LV (2012) Freedom from paroxysmal atrial fibrillation after successful pulmonary vein isolation with pulmonary vein ablation catheter-phased radiofrequency energy: 2-year follow-up and predictors of failure. Europace 14: 818-825.
Beukema RP, Beukema WP, Smit JJ, Ramdat Misier AR, Delnoij PP, et al. (2010) Efficacy of multi-electrode duty-cycled radiofrequency ablation for pulmonary vein disconnection in patients with paroxysmal and persistent atrial fibrillation. Europace12: 502-507.
Mulder AA, Balt JC, Wijffels MC, Wever EF, Boersma LV (2012) Safety of pulmonary vein isolation and left atrial complex fractionated atrial electrogram ablation for atrial fibrillation with phaser radiofrequency energy and multi-electrode catheters. Europace 14: 1433-1440.
Bittner A, Monnig G, Zellerhoff S, Pott C, Kobe J, et al. (2011) Randomized study comparing duty-cycled bipolar and unipolar radiofrequency with point-by-point ablation in pulmonary vein isolation. Heart Rhythm8: 1383-1390.
Bulava A, Hanis J, Sitek D, Osmera O, Karpianus D, et al. (2010) Catheter ablation for paroxysmal atrial fibrillation: a randomized comparison between multielectrode catheter and point-by-point ablation. Pacing Clin Electrophysiol33: 1039-1046.
Malmborg H, Lönnerholm S, Blomström P, Blomström -Lundqvist C (2013) Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study. Europace 15: 1567-1573.
Wiffels MCEF, Van Oosterhout M, Boersma LVA, Werneth R, Kunis C, et al. (2009) Characterization of in vitro and in vivo lesions made by a novel multichannel ablation generator and a cicumlinear decapolar ablation catheter. J Cardiovasc Electrophysiol 20: 1142-1148.
Lau M, Hu B, Werneth R, Sherman M, Oral H, et al. (2010) A theoretical and experimental analysis of radiofrequency ablation with a multielectrode, phased, duty-cycled system. PACE 33: 1089-1100.
Wieczorek M, Hoeltgen R, Tajtaraghi S, Lawrenz W, Lukat M (2013) Pulmonary vein re-isolation for atrial fibrillation using a duty-cycle phased radiofrequency ablation: safety and efficacy of a primary 2:1 bipolar/unipolar ablation mode. J Interv Card Electrophysiol 36: 55-60.