Invasive management of atrial tachycardias using a novel lattice-tip catheter combining high-density mapping and dual ablation properties: initial real-world experience.
Atrial tachycardia
Electroanatomical mapping
Focal pulsed field ablation
High-density mapping
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
07 Oct 2024
07 Oct 2024
Historique:
received:
03
08
2024
accepted:
27
09
2024
medline:
8
10
2024
pubmed:
8
10
2024
entrez:
7
10
2024
Statut:
aheadofprint
Résumé
Invasive management of atrial tachycardias(ATs) requires proper diagnosis of the mechanism followed by elimination of the responsible substrate. A novel lattice-tip catheter with both high-density mapping and dual ablation properties(radiofrequency-RF/pulsed field ablation-PFA) has been recently introduced for catheter ablation of atrial fibrillation. We present the first study to assess its performance in the management of ATs (diagnostic and therapeutic). Patients with documented ATs were selected. Activation mapping was used for the establishment of the AT mechanism. Confirmation with entrainment was performed, whenever appropriate. Accuracy of the activation mapping in diagnosis, acute ablation efficacy, and procedural characteristics were the study endpoints. Twenty patients were included (12 cavotricuspid isthmus-dependent atrial flutters, 5 mitral flutters, 2 roof flutters, and 2 focal ATs). Proper diagnosis was established by activation mapping in all cases. The mean mapping time was 7.85 ± 3.06 min with 296.82 ± 150.9 mean mapping points/minute. The mean ablation time was 54.25 ± 42.97 s. Conversion to sinus rhythm during ablation was achieved in all cases with the exception of a roof flutter that converted to mitral flutter and a case of a parahisian AT in which ablation was not attempted. Patients that received ablation did not experience any arrhythmia recurrence in a mean follow up of 4.14 ± 0.91 months. No major or minor complications occurred. The lattice-tip catheter and its dedicated electroanatomical mapping system provided sufficiently detailed activation mapping for the diagnosis of the AT mechanism. The delivered lesions were highly effective acutely, with no adverse events. However, limitations exist and should be acknowledged.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive management of atrial tachycardias(ATs) requires proper diagnosis of the mechanism followed by elimination of the responsible substrate. A novel lattice-tip catheter with both high-density mapping and dual ablation properties(radiofrequency-RF/pulsed field ablation-PFA) has been recently introduced for catheter ablation of atrial fibrillation. We present the first study to assess its performance in the management of ATs (diagnostic and therapeutic).
METHODS
METHODS
Patients with documented ATs were selected. Activation mapping was used for the establishment of the AT mechanism. Confirmation with entrainment was performed, whenever appropriate. Accuracy of the activation mapping in diagnosis, acute ablation efficacy, and procedural characteristics were the study endpoints.
RESULTS
RESULTS
Twenty patients were included (12 cavotricuspid isthmus-dependent atrial flutters, 5 mitral flutters, 2 roof flutters, and 2 focal ATs). Proper diagnosis was established by activation mapping in all cases. The mean mapping time was 7.85 ± 3.06 min with 296.82 ± 150.9 mean mapping points/minute. The mean ablation time was 54.25 ± 42.97 s. Conversion to sinus rhythm during ablation was achieved in all cases with the exception of a roof flutter that converted to mitral flutter and a case of a parahisian AT in which ablation was not attempted. Patients that received ablation did not experience any arrhythmia recurrence in a mean follow up of 4.14 ± 0.91 months. No major or minor complications occurred.
CONCLUSION
CONCLUSIONS
The lattice-tip catheter and its dedicated electroanatomical mapping system provided sufficiently detailed activation mapping for the diagnosis of the AT mechanism. The delivered lesions were highly effective acutely, with no adverse events. However, limitations exist and should be acknowledged.
Identifiants
pubmed: 39375296
doi: 10.1007/s10840-024-01928-2
pii: 10.1007/s10840-024-01928-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Markowitz SM, Thomas G, Liu CF, et al. Atrial tachycardias and atypical atrial flutters: mechanisms and approaches to ablation. Arrhythm Electrophysiol Rev. 2019;8(2):131–7. https://doi.org/10.15420/aer.2019.17.2 .
doi: 10.15420/aer.2019.17.2
pubmed: 31114688
pmcid: 6528065
Reddy VY, Anter E, Rackauskas G, et al. Lattice-tip focal ablation catheter that toggles between radiofrequency and pulsed field energy to treat atrial fibrillation: a first-in-human trial. Circ Arrhythm Electrophysiol. 2020;13(6):e008718. https://doi.org/10.1161/CIRCEP.120.008718 .
doi: 10.1161/CIRCEP.120.008718
pubmed: 32383391
Reddy VY, Peichl P, Anter E, et al. A focal ablation catheter toggling between radiofrequency and pulsed field energy to treat atrial fibrillation. JACC Clin Electrophysiol. 2023;9(8 Pt 3):1786–801. https://doi.org/10.1016/j.jacep.2023.04.002 .
doi: 10.1016/j.jacep.2023.04.002
pubmed: 37227340
Tohoku S, Bordignon S, Schaack D, et al. Initial real-world data on catheter ablation in patients with persistent atrial fibrillation using the novel lattice-tip focal pulsed-field ablation catheter. Europace. 2024;26(6):euae129. https://doi.org/10.1093/europace/euae129 .
doi: 10.1093/europace/euae129
pubmed: 38916275
pmcid: 11197047
Reddy VY, Neužil P, Peichl P, et al. A lattice-tip temperature-controlled radiofrequency ablation catheter: durability of pulmonary vein isolation and linear lesion block. JACC Clin Electrophysiol. 2020;6(6):623–35. https://doi.org/10.1016/j.jacep.2020.01.002 .
doi: 10.1016/j.jacep.2020.01.002
pubmed: 32553211
Anter E, Mansour M, Nair DG, et al. Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nat Med. 2024;30(8):2303–10. https://doi.org/10.1038/s41591-024-03022-6 .
doi: 10.1038/s41591-024-03022-6
pubmed: 38760584
pmcid: 11333282
Kapur S, Barbhaiya C, Deneke T, Michaud GF. Esophageal injury and atrioesophageal fistula caused by ablation for atrial fibrillation. Circulation. 2017;136(13):1247–55. https://doi.org/10.1161/CIRCULATIONAHA.117.025827 .
doi: 10.1161/CIRCULATIONAHA.117.025827
pubmed: 28947480
Baccillieri MS, Rizzo S, De Gaspari M, et al. Anatomy of the cavotricuspid isthmus for radiofrequency ablation in typical atrial flutter. Heart Rhythm. 2019;16(11):1611–8. https://doi.org/10.1016/j.hrthm.2019.05.030 .
doi: 10.1016/j.hrthm.2019.05.030
pubmed: 31150815
Wittkampf FH, van Oosterhout MF, Loh P, et al. Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis. Eur Heart J. 2005;26(7):689–95. https://doi.org/10.1093/eurheartj/ehi095 .
doi: 10.1093/eurheartj/ehi095
pubmed: 15637084
Del Monte A, Della Rocca DG, Pannone L, et al. Coronary vasospasm during isthmus pulsed field ablation with wide area focal catheter. Circ Arrhythm Electrophysiol. 2024. https://doi.org/10.1161/CIRCEP.124.012923 .
Zhang C, Neuzil P, Petru J, et al. Coronary artery spasm during pulsed field vs radiofrequency catheter ablation of the mitral isthmus. JAMA Cardiol. 2024;9(1):72–7. https://doi.org/10.1001/jamacardio.2023.4405 .
doi: 10.1001/jamacardio.2023.4405
pubmed: 38019505
Miller JM, Tanawuttiwat T. Atrial tachycardias after ablation of atrial fibrillation: a better mousetrap? JACC Clin Electrophysiol. 2021;7(7):950–2. https://doi.org/10.1016/j.jacep.2021.06.008 .
doi: 10.1016/j.jacep.2021.06.008
pubmed: 34294392
Urbani A, Tohoku S, Bordignon S, et al. Durable LAA isolation combining pulsed field ablation and radiofrequency linear lesions in a patient with a therapy refractory left atrial appendage tachycardia. J Interv Card Electrophysiol. 2024. https://doi.org/10.1007/s10840-024-01862-3 .