Author + information
- Received December 24, 2019
- Revision received January 15, 2020
- Accepted January 15, 2020
- Published online June 15, 2020.
- Vivek Y. Reddy, MDa,b,∗ (, )
- Petr Neužil, MD, PhDa,
- Petr Peichl, MD, PhDc,
- Gediminas Rackauskas, MD, PhDd,
- Elad Anter, MDe,
- Jan Petru, MDa,
- Moritoshi Funasako, MDa,
- Kentaro Minami, MDa,
- Audrius Aidietis, MD, PhDd,
- Germanas Marinskis, MD, PhDd,
- Andrea Natale, MDf,
- Hiroshi Nakagawa, MD, PhDg,
- Warren M. Jackman, MDh and
- Josef Kautzner, MD, PhDc
- aDepartment of Cardiology, Homolka Hospital, Prague, Czech Republic
- bDepartment of Electrophysiology, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- cInstitute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic
- dCentre for Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University, Vilnius, Lithuania
- eHarvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- fTexas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, Texas
- gCardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
- hUniversity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- ↵∗Address for correspondence:
Dr. Vivek Y. Reddy, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Guggenheim Pavilion, Suite 280, New York, New York 10029.
Objectives This study was designed to evaluate lesion durability on invasive electrophysiologic remapping.
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.
Methods In a prospective 3-center single-arm study, paroxysmal or persistent atrial fibrillation patients underwent PVI and, as needed, linear ablation at the cavotricuspid isthmus (CTI), mitral isthmus (MI), and/or left atrial roof; no other atrial substrate was ablated. Using the lattice catheter and a custom electroanatomic mapping system, temperature-controlled (Tmax 73° to 80°C; 2 to 7 s) 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, left atrial 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 pulmonary veins (PVs) remained durably isolated in all but 1 reconnected PV—translating to durable isolation in 99.1% of PVs, or 96.3% of patients with all PVs isolated. Of 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 showed not only highly durable PVI lesion sets, but also durable contiguity of linear atrial lesions.
- atrial fibrillation
- catheter ablation
- cavotricuspid isthmus
- lesion durability
- mitral isthmus
- pulmonary vein isolation
- roof line
This study was partially supported by a research grant from Affera Inc. Dr. Reddy is a consultant with Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Autonomix, Axon, Backbeat, BioSig, Biosense-Webster, Biotronik, Boston Scientific, Cardiofocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, East End Medical, EBR, EPD, Epix Therapeutics, EpiEP, Eximo, Farapulse, Fire1, Impulse Dynamics, Javelin, Keystone Heart, LuxCath, Medlumics, Medtronic, Middlepeak, Nuvera, Philips, Stimda, Thermedical, Valcare, and VytronUS; and holds equity in Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Autonomix, Backbeat, BioSig, Circa Scientific, Corvia Medical, East End Medical, EPD, Epix Therapeutics, EpiEP, Eximo, Farapulse, Fire1, Javelin, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Middlepeak, Newpace, Nuvera, Surecor, Valcare, Vizara, and VytronUS. Dr. Kautzner has received personal fees from Bayer, Biosense Webster, Boehringer Ingelheim, Boston Scientific, EPIX, Medtronic, Merck Sharp & Dohme, Liva Nova (MicroPort CRM) and St. Jude Medical (Abbott) for participation in scientific advisory boards; and has received speaker honoraria from Bayer, Biosense Webster, Biotronik, Boehringer Ingelheim, Boston Scientific, Daiichi-Sankyo, Medtronic, Merck Sharp & Dohme, Mylan, Pfizer, ProMed sro, and St. Jude Medical (Abbott). 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. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 December 24, 2019.
- Revision received January 15, 2020.
- Accepted January 15, 2020.
- 2020 The Authors