Author + information
- Vivek Y. Reddy, MD1,2,∗ (, )
- Petr Neužil, MD PhD1,
- Petr Peichl, MD PhD3,
- Gediminas Rackauskas, MD PhD4,
- Elad Anter, MD5,
- Jan Petru, MD1,
- Moritoshi Funasako, MD1,
- Kentaro Minami, MD1,
- Audrius Aidietis, MD PhD4,
- Germanas Marinskis, MD PhD4,
- Andrea Natale, MD6,
- Hiroshi Nakagawa, MD, PhD7,
- Warren M. Jackman, MD8 and
- Josef Kautzner, MD PhD3
- 1Department of Cardiology, Homolka Hospital, Prague, Czech Republic
- 2Department of Electrophysiology, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- 3Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic
- 4Centre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Vilnius, Lithuania
- 5Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- 6Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX
- 7Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
- 8University of Oklahoma Health Sciences Center, Oklahoma City, OK
- ↵∗Corresponding Author: Vivek Y. Reddy, MD Helmsley Electrophysiology Center Icahn School of Medicine at Mount Sinai 1190 Fifth Avenue, Guggenheim Pavilion – Suite 280 New York, NY 10029 Phone: 212-241-7114 Fax: 646-537-9691
Background The lattice-tip catheter generates a large thermal footprint during temperature-controlled irrigated radiofrequency ablation. In a first-in-human study, this catheter performed rapid point-by-point pulmonary vein isolation (PVI) and other linear atrial ablations.
Objective To evaluate lesion durability upon invasive electrophysiological remapping.
Methods In a prospective 3-center single-arm study, paroxysmal or persistent atrial fibrillation patients underwent PVI and, as needed, linear ablation at the cavo-tricuspid isthmus (CTI), mitral isthmus (MI) and/or left atrial roof; no other atrial “substrate” was ablated. Using the lattice catheter and a custom electroanatomical mapping system, temperature-controlled (Tmax 73-80°C; 2-7 sec) point-by-point ablation was performed. Patients were followed for 12 months.
Results A total of 65 patients (61.5% paroxysmal / 38.5% persistent) underwent ablation: PVI in 65, MI in 22, LA roof in 24, and CTI in 48 patients. At a median of 108 days after the index procedure, protocol-mandated remapping was performed in 27 patients. The PVs remained durably isolated in all but one reconnected PV – translating to durable isolation in 99.1% of PVs, or 96.3% of patients with all PVs isolated. Of the 47 linear atrial lesions initially placed during the index procedure, durability was observed in 10 of 11 (90.9%) MI lines, all 11 (100%) roof lines, and all 25 (100%) CTI lines. After a median follow-up of 270 days, the 12-month Kaplan-Meier estimate for freedom from atrial arrhythmias was 94.4% ± 3.2%.
Conclusions Temperature-controlled lattice-tip point-by-point ablation demonstrated not only highly durable PVI lesion sets, but also durable contiguity of linear atrial lesions.
- Atrial fibrillation
- Catheter ablation
- Pulmonary vein isolation
- Mitral isthmus
- Roof line
- Cavotricuspid Isthmus
- Lesion Durability
Funding Sources: This study was partially supported by a research grant from Affera Inc. Relationships with Industry
Drs. Reddy, Anter and Nakagawa have received research grants from Affera, Inc. Drs. Reddy, Anter and Jackman also hold stock options in Affera, Inc. Dr. Nakagawa is also a consultant to Affera, Inc. A comprehensive list of all financial disclosures (unrelated to this manuscript) is included in the Supplement. All other authors have no conflicts of interest relevant to this study.
- Received December 24, 2019.
- Revision received January 15, 2020.
- Accepted January 15, 2020.
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