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Journal of Interventional Cardiac Electrophysiology

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01-09-2017 | MULTIMEDIA REPORT

Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study

Authors: Agustín Bortone, Philippe Lagrange, Bruno Cauchemez, Cyril Durand, Pierre Dieuzaide, Sébastien Prévot, Alexis Mechulan, Thomas Pambrun, Ruairidh Martin, Pauline Parlier, Alexandre Masse, Eloi Marijon, Jean-Paul Albenque

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2017

Abstract

Purpose

Elimination of the negative component of the unipolar atrial electrogram is a reliable indicator of the creation of a transmural lesion. Contact-force (CF) sensing technology has the potential to increase the durability of pulmonary vein isolation (PVI). In the present multicenter study, we assessed the 2-year sinus rhythm (SR) maintenance rate in patients with paroxysmal atrial fibrillation (PAF) after PVI guided by these two approaches.

Methods

Two hundred fifteen consecutive PAF patients (62.1 ± 10.1 years, 65 women) were prospectively enrolled. All patients underwent PVI under CARTO guidance according to a systematic contiguous “point-by-point” approach, using radiofrequency energy, and a CF externally irrigated ablation catheter with the goal of at least 10g (ideally 20g) of force. The ablation endpoint of each individual lesion was elimination of the negative component of the unipolar atrial signal. The procedural endpoint was PVI with bidirectional block.

Results

All PVs were successfully isolated. After 30 min of waiting time, 35 patients (16%) had PV reconnection and in all of them, the PVs were re-isolated. Two years after a single ablation procedure, 187 patients (87%) remained arrhythmia free, without anti-arrhythmic drugs. Of the 28 patients presenting with AF recurrence, 25 had PV reconnection and underwent repeat PVI while in the remaining 3 patients, all four PVs were isolated and extra-PV triggers were identified. There were six groin hematomas and one transient ischemic attack.

Conclusions

Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF.

Clinical trial registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02520960.

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Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57:160–6.CrossRefPubMed

Otomo K, Uno K, Fujiwara H, Isobe M. Local unipolar and bipolar electrogram criteria for evaluating the transmurality of atrial ablation lesions at different catheter orientations relative to the endocardial surface. Heart Rhythm. 2010;7:1291–300.CrossRefPubMed

Bortone A, Appetiti A, Bouzeman A, Maupas E, Ciobotaru V, Boulenc JM, et al. Unipolar signal modification as a guide for lesion creation during radiofrequency application in the left atrium: prospective study in humans in the setting of paroxysmal atrial fibrillation catheter ablation. Circ Arrhythm Electrophysiol. 2013;6:1095–102.CrossRefPubMed

Bortone A, Brault-Noble G, Appetiti A, Marijon E. Elimination of the negative component of the unipolar atrial electrogram as an in vivo marker of transmural lesion creation: acute study in canines. Circ Arrhythm Electrophysiol. 2015;8:905–11.CrossRefPubMed

Shah DC, Lambert H, Nakagawa H, Langenkamp A, Aeby N, Leo G. Area under the real-time contact force curve (force-time integral) predicts radiofrequency lesion size in an in vitro contractile model. J Cardiovasc Electrophysiol. 2010;21:1038–43.CrossRefPubMed

Reddy VY, Shah D, Kautzner J, Schmidt B, Saoudi N, Herrera C, et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm. 2012;9:1789–95.CrossRefPubMed

Providência R, Marijon E, Combes S, Bouzeman A, Jourda F, Khoueiry Z, et al. Higher contact-force values associated with better mid-term outcome of paroxysmal atrial fibrillation ablation using the SmartTouch™ catheter. Europace. 2015;17:53–63.

Park CI, Lehrmann H, Keyl C, Weber R, Schiebeling J, Allgeier J, et al. Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. J Cardiovasc Electrophysiol. 2014;25:701–8.CrossRefPubMed

Arujuna A, Karim R, Caulfield D, Knowles B, Rhode K, Schaeffter T, et al. Acute pulmonary vein isolation is achieved by a combination of reversible and irreversible atrial injury after catheter ablation. Evidence from magnetic resonance imaging. Circ Arrhythm Electrophysiol. 2012;5:691–700.CrossRefPubMed

10.

Miller MA, d'Avila A, Dukkipati SR, Koruth JS, Viles-Gonzalez J, Napolitano C, et al. Acute electrical isolation is a necessary but insufficient endpoint for achieving durable PV isolation: the importance of closing the visual gap. Europace. 2012;14:653–60.CrossRefPubMed

11.

Miyazaki S, Taniguchi H, Nakamura H, Hachiya H, Ichihara N, Araki M, et al. Adenosine triphospahte test after cryothermal pulmonary vein isolation: creating contiguous lesions is essential for eliminating dormant conduction. J Cardiovasc Electrophysiol. doi:10.1111/jce.12726.

12.

Spach MS, Miller WT, Geselowitz DB, Barr RC, Kootsey JM, Johnson EA. The discontinuous nature of propagation in normal canine cardiac muscle: evidence for recurrent discontinuities of intracellular resistance that affect the membrane currents. Circ Res. 1981;48:39–54.CrossRefPubMed

13.

Spach MS, Barr RC, Serwer GS, Johnson EA, Kootsey JM. Collision of excitation waves in the dog Purkinje system. Extracellular identification Circ Res. 1971;29:499–511.PubMed

14.

Pambrun T, Roig J, Bouzeman A, Maupas E, Ciobotaru V, Boulenc JM, et al. Modification of the unipolar atrial electrogram as a local endpoint during common atrial flutter ablation. J Cardiovasc Electrophysiol. 2015; doi:10.1111/jce. 12754.

15.

Steven D, Reddy VY, Inada K, Roberts-Thomson KC, Seiler J, Stevenson WG, et al. Loss of pace capture on the ablation line: a new marker for complete radiofrequency lesions to achieve pulmonary vein isolation. Heart Rhythm. 2010;7:323–30.CrossRefPubMed

16.

Datino T, Macle L, Qi XY, Maguy A, Comtois P, Chartier D, et al. Mechanism by which adenosine restores conduction in dormant canine pulmonary veins. Circulation. 2010;121:963–72.CrossRefPubMed

17.

Pérez-Castellano N, Villacastín J, Salinas J, Vega M, Moreno J, Doblado M, et al. Epicardial connections between the pulmonary veins and left atrium: relevance for atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2011;22:149–59.PubMed

Title: Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study
Authors: Agustín Bortone
Philippe Lagrange
Bruno Cauchemez
Cyril Durand
Pierre Dieuzaide
Sébastien Prévot
Alexis Mechulan
Thomas Pambrun
Ruairidh Martin
Pauline Parlier
Alexandre Masse
Eloi Marijon
Jean-Paul Albenque
Publication date: 01-09-2017
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2017
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0264-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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