Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study.

BACKGROUND: Radiofrequency high-power ablation appears to be a novel concept for atrial fibrillation (AF). The ablation index (AI) value has been associated with durability of pulmonary vein isolation (PVI). OBJECTIVES: This study aimed to report the procedural data and initial results of a combined ablation technique using AI-guided high-power (AI-HP; 50 W) ablation for PVI. METHODS: Symptomatic AF patients were consecutively enrolled and underwent wide-area contiguous circumferential PVI. Contact-force catheters were used, ablation power was set to 50 W targeting AI values (550 anterior and 400 posterior). Esophageal temperature was monitored during procedure, all patients underwent postablation esophageal endoscopy. RESULTS: PVI was achieved in all (n = 50, mean age: 68 ± 9 years, female: 60%) patients, rate of first-round PVI was 92%. A total of N = 2105 AI-guided ablation lesions were analyzed. Comparing left anterior wall vs left posterior wall and right anterior wall vs right posterior wall, mean ablation time (s) per lesion was 20.5 ± 8 vs 8.6 ± 3 and 12.2 ± 4 vs 9.3 ± 3; mean contact force (g): 17.1 ± 12 vs 25.4 ± 14 and 33.7 ± 13 vs 21.0 ± 11; mean AI: 547 ± 48 vs 445 ± 55 and 555 ± 56 vs 440 ± 47 (all P < .0001). Procedure and fluoroscopy time (minute) were 55.6 ± 6.6 and 6 ± 1.7, respectively. Only one (2%) patient had a minimal esophageal lesion. During In-hospital and 1-month follow-up no major complications such as death, stroke, tamponade, or atriaesophageal fistula (AE) occurred. Preliminary 6-month follow-up showed 48 of 50 (96%) patients were free from clinical AF/atrial tachycardia recurrence. CONCLUSION: AI-HP (50 W) ablation appears to be a feasible, safe, fast, and effective ablation technique for PVI.

Predictors of Recurrence of AF in Patients After Radiofrequency Ablation.

Catheter ablation is a well-known treatment for patients with AF. Despite the growing knowledge in the field, the identification of predictors of recurrence of AF after catheter ablation is one of the primary goals and is of major importance to improve long-term results of the procedure. The aim of this article is to provide an overview of what has been published in recent years and to summarise the major predictors, helping cardiac electrophysiologists in the selection of the right candidates for catheter ablation.

Comparison of standard renal denervation procedure versus novel distal and branch vessel procedure with brachial arterial access.

OBJECTIVES: We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y-pattern), including the primary branches, and compared it to the standard procedure applied only within the main vessel. We also assessed the safety and practicality of a brachial access approach. METHODS AND RESULTS: Renal denervation was performed on 119 consecutive patients (60 ±â€¯13 years). In 68 of the patients, femoral arterial vascular approach was used and in 51 brachial. In 80 patients treated with the standard ablation, 12.0 ±â€¯3.0 total ablations (both sides) were applied while 20.4 ±â€¯3.9 total ablations were delivered for the group of 39 patients with Y-pattern denervation (P < 0.001). Technically successful renal denervation was achieved in all patients. Office blood-pressure levels at baseline were 170 ±â€¯17/93 ±â€¯10 mm Hg for the standard group and 169 ±â€¯13/96 ±â€¯9 mm Hg for the Y-pattern group. No major adverse events occurred during the procedure or in the postprocedural in-hospital period. Renal denervation was associated with significant decreases in both office and ambulatory systolic and diastolic blood pressure in both groups. The reduction in 24-hour mean ambulatory systolic blood pressure at 6 months was significantly greater (P = 0.002) for the Y-Pattern group (-22.1 ±â€¯15.4 mm Hg) compared to the Standard group (-11.8 ±â€¯16.2 mm Hg). Changes in diastolic office and ambulatory pressure were also significantly greater at 6 months in the Y-pattern ablation group. Indices of blood pressure variability improved in both groups. CONCLUSION: Renal denervation using a Y-pattern ablation strategy combined with a greater number of lesions is safe and resulted in significant greater decreases in mean 24-hour ambulatory systolic and diastolic blood pressure compared to the conventional approach in this single-centre matched cohort study. Brachial artery access was shown to be feasible and safe for renal denervation.

Recanalization and stenting of total occlusions of the renal arteries for blood pressure control in resistant to treatment hypertension.

OBJECTIVE: To evaluate whether percutaneous recanalization and stenting of totally occluded renal arteries is feasible and might be justified as effective in reducing the blood pressure (BP) in some patients with preserved collateral renal flow. PATIENTS AND METHODS: Seven consecutive patients (3 women, 4 men) at average age of 42.8 years (range, 15-67 years) with resistant hypertension, high renin activity, renal artery occlusion and preserved subsegmental flow were included. RESULTS: Endovascular recanalization was successful in 6 of 7 attempted cases. One month after the procedure the 24-h ABPM in the successfully recanalized renal CTO patients showed impressive decrease in the BP average of 138.5/81.7 mm Hg compared to 167.1/95.1 mm Hg before the procedure. Significant decrease in the drug medication was achieved. During the 6-month follow-up, two of the patients had in-stent restenosis- both successfully treated with endovascular reintervention. Secondary patency was 100% for 18 months thereafter and the BP control was excellent without medication increase. CONCLUSIONS: The recanalization of total renal artery occlusions resulted feasible and safe in the described group of patients with resistant hypertension and high plasma rennin activity. The renal artery recanalization had a positive effect on lowering the plasma renin activity and BP control.