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Phased radiofrequency ablation (PVAC), for atrial fibrillation – Acute procedural results
Abstract
http://dx.doi.org/10.1016/j.hlc.2015.06.312 312 Phased radiofrequency ablation (PVAC), for atrial fibrillation – Acute procedural results B. Wilsmore 1,∗ , W. Ahmad 1 , M. Sky 2 , M. Barlow 1 , J. Leitch 1 1 John
Hunter Hospital, Newcastle, NSW, Australia 2 Lingard Private Hospital, Newcastle, NSW, Australia Introduction: Various tools such as the Pulmonary Vein Ablation Catheter (PVAC®; Medtronic Inc.) have been developed to treat atrial fibrillation. Methods: Prospective, single operator observational registry of PVAC. The first 51 patients undergoing pulmonary vein isolation with the PVAC-Gold (second generation) were included in the analysis. Intra cardiac echocardiography (ICE) was used to guide transseptal and positioning of the PVAC catheter in 47 of 51 cases. Results: Median age was 61 years of age (range 34-84). 64% were male. 65% had paroxysmal atrial fibrillation. The average CHADS2-VASc was 1.9 (range 0-5). 48% were on warfarin, the remainder on novel oral anticoagulants. The median time (from needle-to-skin to catheters out) for ablation of paroxysmal atrial fibrillation was 78min (IQR range 61-123min), and persistent atrial fibrillation was 124min (IQR range 80189min). Median fluoroscopy time was 29min (IQR 25-35min; median skin dose 177.5mGy, IQR 25-75% 131-316). The average number of ablations per vein was 5.4. All veins were isolated with the PVAC catheter without the need for additional alternative ablation. There was one groin complication resulting in an additional night in hospital, and two femoral haematomas that did not require additional hospitalisation. All resolved without intervention, and without any long-term consequences. There were no perforations, strokes or other significant complications. No patient is more than 12 months post ablation yet and efficacy assessment will need long-term follow-up.
S243
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Conclusion: Phased RF offers an alternative safe and efficient approach to pulmonary vein isolation. http://dx.doi.org/10.1016/j.hlc.2015.06.313 313 Pouches, pectinate & prominent peaks: pitfalls during cavotricuspid isthmus radiofrequency ablation visualised under direct endoscopic visualisation W. Chik 1,2,∗ , J. Pouliopoulos 1,2 , A. Bhaskaran 1,2 , S. Thavapalachandran 1,2 , D. Ross 1,2 , S. Thomas 1,2 , P. Kovoor 1,2 , A. Thiagalingam 1,2 1 Westmead
Hospital University of Sydney, Australia 2 Hospital of the University of Pennsylvania, Philadelphia, United States of America 64-year-old woman with recurrent symptomatic cavotricuspid isthmus dependent (CTI)-atrial flutter (AFL) presented for radiofrequency ablation (RFA) after multiple DC cardioversions and failing multiple antiarrhythmic agents. The novel direct endocardial visualisation (DEV) ablation catheter was used to successfully deliver RFA under direct endocardial visualisation to create a CTI ablation line.
Full-colour endocardial visualisation endoscopic images of the complex CTI anatomy were digitally mapped using the DEV ablation catheter that incorporated a fibreoptic camera at the distal hood face. A normal saline irrigation rate of 15ml/min was delivered during visual mapping to maintain an unobstructed field of view. Ablations were performed under visualisation using a titrated power from 12 to 20W for 30 seconds with an irrigation rate at 25mls/min. In vivo images depict a highly complex and variable CTI anatomy. Dynamic CTI structures within a pressurised contracting right atrium (deep ridges, blind-looped pouches and pectinate muscles) could be appreciated through the endoscopic camera. The DEV endoscopic endocardial images Pre- and Post- creation of RFA lesions over CTI are illustrated in the
http://dx.doi.org/10.1016/j.hlc.2015.06.312 312 Phased radiofrequency ablation (PVAC), for atrial fibrillation – Acute procedural results B. Wilsmore 1,∗ , W. Ahmad 1 , M. Sky 2 , M. Barlow 1 , J. Leitch 1 1 John
Hunter Hospital, Newcastle, NSW, Australia 2 Lingard Private Hospital, Newcastle, NSW, Australia Introduction: Various tools such as the Pulmonary Vein Ablation Catheter (PVAC®; Medtronic Inc.) have been developed to treat atrial fibrillation. Methods: Prospective, single operator observational registry of PVAC. The first 51 patients undergoing pulmonary vein isolation with the PVAC-Gold (second generation) were included in the analysis. Intra cardiac echocardiography (ICE) was used to guide transseptal and positioning of the PVAC catheter in 47 of 51 cases. Results: Median age was 61 years of age (range 34-84). 64% were male. 65% had paroxysmal atrial fibrillation. The average CHADS2-VASc was 1.9 (range 0-5). 48% were on warfarin, the remainder on novel oral anticoagulants. The median time (from needle-to-skin to catheters out) for ablation of paroxysmal atrial fibrillation was 78min (IQR range 61-123min), and persistent atrial fibrillation was 124min (IQR range 80189min). Median fluoroscopy time was 29min (IQR 25-35min; median skin dose 177.5mGy, IQR 25-75% 131-316). The average number of ablations per vein was 5.4. All veins were isolated with the PVAC catheter without the need for additional alternative ablation. There was one groin complication resulting in an additional night in hospital, and two femoral haematomas that did not require additional hospitalisation. All resolved without intervention, and without any long-term consequences. There were no perforations, strokes or other significant complications. No patient is more than 12 months post ablation yet and efficacy assessment will need long-term follow-up.
S243
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Conclusion: Phased RF offers an alternative safe and efficient approach to pulmonary vein isolation. http://dx.doi.org/10.1016/j.hlc.2015.06.313 313 Pouches, pectinate & prominent peaks: pitfalls during cavotricuspid isthmus radiofrequency ablation visualised under direct endoscopic visualisation W. Chik 1,2,∗ , J. Pouliopoulos 1,2 , A. Bhaskaran 1,2 , S. Thavapalachandran 1,2 , D. Ross 1,2 , S. Thomas 1,2 , P. Kovoor 1,2 , A. Thiagalingam 1,2 1 Westmead
Hospital University of Sydney, Australia 2 Hospital of the University of Pennsylvania, Philadelphia, United States of America 64-year-old woman with recurrent symptomatic cavotricuspid isthmus dependent (CTI)-atrial flutter (AFL) presented for radiofrequency ablation (RFA) after multiple DC cardioversions and failing multiple antiarrhythmic agents. The novel direct endocardial visualisation (DEV) ablation catheter was used to successfully deliver RFA under direct endocardial visualisation to create a CTI ablation line.
Full-colour endocardial visualisation endoscopic images of the complex CTI anatomy were digitally mapped using the DEV ablation catheter that incorporated a fibreoptic camera at the distal hood face. A normal saline irrigation rate of 15ml/min was delivered during visual mapping to maintain an unobstructed field of view. Ablations were performed under visualisation using a titrated power from 12 to 20W for 30 seconds with an irrigation rate at 25mls/min. In vivo images depict a highly complex and variable CTI anatomy. Dynamic CTI structures within a pressurised contracting right atrium (deep ridges, blind-looped pouches and pectinate muscles) could be appreciated through the endoscopic camera. The DEV endoscopic endocardial images Pre- and Post- creation of RFA lesions over CTI are illustrated in the