Author + information
- Received July 30, 2018
- Revision received January 15, 2019
- Accepted January 17, 2019
- Published online March 18, 2019.
- Hiro Yamasaki, MD∗ (, )
- Kazutaka Aonuma, MD,
- Yasutoshi Shinoda, MD,
- Yuki Komatsu, MD,
- Keita Masuda, MD,
- Naoaki Hashimoto, MD,
- Eikou Sai, MD,
- Fumi Yamagami, MD,
- Yuta Okabe, MD,
- Yasuaki Tsumagari, MD,
- Yuichi Hanaki, MD,
- Hiroaki Watanabe, MD,
- Takeshi Machino, MD,
- Kenji Kuroki, MD,
- Yukio Sekiguchi, MD,
- Akihiko Nogami, MD and
- Masaki Ieda, MD
- ↵∗Address for correspondence:
Dr. Hiro Yamasaki, Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
Objectives This study sought to determine the feasibility of a novel simplified ablation protocol targeting only the pulmonary vein antrum using the radiofrequency hot-balloon catheter in patients with paroxysmal atrial fibrillation.
Background Radiofrequency hot-balloon (RHB) catheter has been recently introduced into clinical practice for pulmonary vein isolation (PVI). The authors hypothesized that a novel simplified ablation protocol targeting only the PV antrum with energy application for a longer time (single-shot technique) could be an alternative approach to achieve PVI, while avoiding unnecessary energy application at the PV ostium.
Methods A total of 61 consecutive paroxysmal atrial fibrillation patients (age 64.1 ± 10.9 years, 48 male) who underwent antrum RHB-PVI were enrolled. Energy applications were performed following the pre-specified protocol only targeting the PV antrum. If the PVI was not achieved after 2 energy applications using the RHB, a touch-up ablation was performed.
Results Of 241 PV, including 3 left common PV, 194 (80%) were isolated exclusively using the RHB. The target PVI average per group of 15 consecutive procedures improved from 75% (initial 15) to 89% (last 16) of patients. The injected volume was greatest in the right superior PV (13.1 ± 2.0 ml) and the smallest in the left inferior PV (10.8 ± 1.1 ml), and 23 PV (9.5%) required over 15 ml (estimated balloon diameter of 30 mm). Periprocedural complications were noted in 3 patients (4.9%), but phrenic nerve injury was not observed. Sinus rhythm maintenance at 12-month follow-up was achieved in 57 patients (93%).
Conclusions A novel simplified antrum RHB-PVI appears to be a feasible technique for the treatment of paroxysmal atrial fibrillation.
- antrum pulmonary vein isolation
- learning curve
- paroxysmal atrial fibrillation
- phrenic nerve injury
- radiofrequency hot-balloon ablation
Dr. Yamasaki has received a consultant fee from Toray Industries, Inc. Dr. Aonuma has received a grant from and belongs to the endowed department of Toray Industries, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 30, 2018.
- Revision received January 15, 2019.
- Accepted January 17, 2019.
- 2019 American College of Cardiology Foundation
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