RESUMEN
BACKGROUND: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively. RESULTS: Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile. CONCLUSION: Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.
RESUMEN
Background: Better contact force (CF) and catheter stability (CS) during atrial fibrillation (AF) ablation are associated with higher success rate. Changes in CF and CS are observed during respiratory movements and cardiac contraction. Previous studies have suggested that rapid atrial pacing (RAP) and high-frequency, low-tidal-volume ventilation (HFLTV) independently or in combination improve CS and CF and quality of lesions. Data from a body weight-adjusted HFLTV strategy associated with RAP in AF high-power, short-duration (HPSD) ablation are still lacking. Objective: This study aimed to compare the results of HPSD AF ablation using simultaneous weight-adjusted HFLTV and RAP and standard ventilation (SV) protocol. Methods: This was a prospective, nonrandomized study with 136 patients undergoing de novo ablation were divided into 2 groups: 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). The ablation used 50 W, CF of 5 to 10 g and 10 to 20 g, and 40 mL/min flow rate on the posterior and anterior left atrial walls, respectively. Results: There were no procedure-related complications. In group A, left atrial and total ablation times were 53.5 ± 8.3 minutes and 67.4 ± 10.1 minutes, respectively. Radiofrequency time was 19.7 ± 5.7 minutes, radioscopy time was 3.4 ± 1.8 minutes, 62 (88.6%) patients had first-pass isolation, 23 (33.3%) patients had elevation of luminal esophageal temperature, and 7 (10%) patients had recurrence. In group B, left atrial time was 56.7 ± 10.8 minutes, total ablation time was 72.4 ± 11.5 minutes, radiofrequency time was 22.4 ± 6.2 minutes, radioscopy time was 3.6 ± 3 minutes, 58 (87.9%) patients had first-pass isolation, and 20 (30.3%) patients had luminal esophageal temperature elevation. Conclusion: Weight-adjusted HFLTV with RAP in comparison with SV and intrinsic sinus rhythm in HPSD ablation is safe with no CO2 retention. The approach produced significantly reduced radiofrequency, left atrial, and total ablation times and better CF and local impedance drop indexes.
RESUMEN
INTRODUCTION: Atrial fibrillation (AFib) ablation is alternative treatment to drugs. Literature suggests that use of contact force (CF) catheter with higher power for short periods is effective and safe. METHODS/RESULTS: Retrospectively analyzed 76 patients undergoing the first ablation. Third five patients-group A: 27 (77%) paroxysmal AFib (PAFib) and 8 (23%) persistent AFib (PersAFib) who underwent ablation at the power of 30 W-17 mL/minute flow with a CF of 10-30 g for 30 seconds. Fourty one patients-group B: 28 (68.3%) PAFib and 13 (31.70%) PersAFib underwent ablation using 45 W on posterior wall with CF of 8/15 g, as well as 50-W anterior wall with CF of 10/20 g-35 mL/minute flow for 6 seconds. Pulmonary vein isolation in both groups and ablated. For patients not in the sinus, we performed cardioversion before ablation. No complications. Group A: Left atrial time 110 ± 29 minutes, total 148 ± 33.6 minutes, radiofrequency time (RF) 4558 ± 1998 seconds, X-ray 8.5 ± 3.5 minutes, and elevation of esophageal temperature (ET) in 26 (74.3%). group B: Left atrial time 70.7 ± 18.5 minutes ( P < .00001), total 106 ± 23 minutes ( P < .00001), RF 1909 ± 675.8 seconds ( P < .00001), X-ray 8.8 ± 6.6 minutes ( P = .221) and elevation of ET in 21 (51.20% - P = .0578). In 6 and 12 months follow-up, we had 9 (25.71%) and 11 (31.42%) recurrences in group A and 5 (12.19%) and 7 (17.07%) in group B ( P = .231 at 6 and P = .14 at 12 months), respectively. CONCLUSIONS: HPSD was safe, useful, and efficient compared with CT, and reduced procedural time and total RF time. HPSD may reduce esophageal injury because of lower heating rate and it may reduce the recurrence of atrial tachyarrythmias.