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PVAC ablation

Fabio Dorfman, Cristiano Dietrich, Paulo Costa, Evandro Sbaraini, Rafael Abt, Dalmo Moreira, Cézar Mesas
Phased radiofrequency ablation with a single catheter technique, using a 9-electrode circumferential catheter, is a viable approach to pulmonary vein isolation for the treatment of atrial fibrillation. However, creating effective transmural lesions with such technique, while avoiding serious complications like atrioesophageal fistula, can be difficult. This case illustrates a challenging scenario, where catheter maneuvers fail to allow safe radiofrequency delivery, due to esophageal temperature rise, despite extensive navigating maneuvers...
October 2016: Journal of Atrial Fibrillation
Stefan G Spitzer, Patrick Leitz, Anke Langbein, Laszlo Karolyi, Frank Scharfe, Thomas Weinmann, Carola Rämmler, Christian Pott, Gerold Mönnig, Lars Eckardt
BACKGROUND: There is a lack of procedural and follow-up data on pulmonary vein isolation (PVI) with the second-generation pulmonary vein ablation catheter® (PVAC Gold) in patients with atrial fibrillation (AF). This study provides data on PVI procedures and 1-year follow-up results with PVAC Gold in patients with AF treated in clinical practice. METHODS AND RESULTS: Three hundred and eighty four patients with documented symptomatic paroxysmal (n=198) or persistent (n=186) AF were included in a non-randomized prospectively designed database...
April 12, 2017: International Journal of Cardiology
Christian von Bary, Thomas Deneke, Thomas Arentz, Anja Schade, Heiko Lehrmann, Sabine Fredersdorf, Dobri Baldaranov, Lars Maier, Felix Schlachetzki
INTRODUCTION: Left atrial pulmonary vein isolation (PVI) is an accepted treatment option for patients with symptomatic atrial fibrillation (AF). This procedure can be complicated by stroke or silent cerebral embolism. Online measurement of microembolic signals (MESs) by transcranial Doppler (TCD) may be useful for characterizing thromboembolic burden during PVI. In this prospective multicenter trial, we investigated the burden, characteristics, and composition of MES during left atrial catheter ablation using a variety of catheter technologies...
2017: Frontiers in Neurology
Edina Nagy-Baló, Mihran Martirosyan, Gábor Sándorfi, Orsolya Hajas, Levente Lánczi, Ervin Berényi, Lilla Ladányi, Alexandra Kiss, István Édes, Zoltán Csanádi
BACKGROUND: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported. METHODS: 27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13...
March 10, 2017: Cardiology Journal
Conn Sugihara Mbbs, Neil Barlow Mbbs, Emma Owens Mbbs, David Sallomi Mb ChB, Neil Sulke Md
Threshold testing of cardiac rhythm devices is essential to monitoring the proper functioning of such devices (1). However, the currently method of applying multiple ECG leads to the patient is burdensome and time consuming (2). We are presenting a completely new way to perform cardiac rhythm device threshold testing using pulse oximetry. Twenty patients, with varying cardiac rhythm devices and pacing modes, were enrolled and had their atrial and ventricular thresholds tested. A comparison was made between simultaneous threshold determinations via the standard EGM based method and the new pulse oximetry based method...
April 2016: Journal of Atrial Fibrillation
Antoine Lepillier, Xavier Copie, Gilles Lascault, Olivier Paziaud, Olivier Piot
PURPOSE: Catheter radiofrequency ablation (RFA) is an effective treatment for symptomatic paroxysmal atrial fibrillation (AF). It has been demonstrated that the multielectrode pulmonary vein ablation catheter (PVAC) has favourable outcomes at 6-12 months post-ablation, but there are only few studies with a long-term follow-up. METHODS: We retrospectively reviewed 77 consecutive PVAC procedures in our centre, from November 2007 to December 2012. RFA was attempted in patients with symptomatic paroxysmal AF (mean age 58...
November 22, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
P Gal, T J Buist, J J J Smit, A Adiyaman, A R Ramdat Misier, P P H M Delnoy, A Elvan
INTRODUCTION: Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation. METHODS: 50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLD(TM), Medtronic Inc...
January 2017: Netherlands Heart Journal
Robert Larbig, Ralf Dittrich, Simon Kochhaeuser, Patrick Leitz, Fatih Guener, Catharina Korsukewitz, Dirk Dechering, Christian Pott, Kristina Wasmer, Jan Schmitges, Monika Kerckhoff, Lars Eckardt, Gerold Moennig
OBJECTIVE: We had the objective to determine the impact of clinical parameters and anticoagulation status on cerebral microembolic signals (MES) during pulmonary vein isolation (PVI) for atrial fibrillation (AF). BACKGROUND: Thromboembolism and stroke are the most feared complications of PVI. MES can help to evaluate embolic burden. It is unknown whether clinical parameters have an impact on embolic risk during PVI. METHODS: In this retrospective analysis we investigated the impact of clinical parameters, including the CHADS2- and CHA2DS2-VASc-score, pulmonary vein variants and echocardiographic parameters on MES rates in patients that underwent PVI using three different ablation approaches (radiofrequency ablation (iRF), pulmonary vein ablation catheter (PVAC) with deactivated electrode pair 1 or 5 (PVAC-red) or PVAC without deactivation (PVAC-all)...
2016: PloS One
Stefan Weber, Martin Höher, Dominik Schultes
PURPOSE: Pulmonary vein isolation with radiofrequency energy is widely used as a strategy for catheter ablation of atrial fibrillation (AF). Anatomically designed catheters have been developed to increase the efficiency of AF ablation procedures. The second-generation circular ablation catheter, PVAC GOLD, was re-designed to improve energy delivery and mitigate emboli. We investigated the procedural efficiency, biophysics, and chronic efficacy of PVAC GOLD in patients with AF. METHODS: We consecutively enrolled 40 patients (60 ± 11 years) with highly symptomatic, drug refractory AF...
November 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
L M Rademakers, I Romero, T A Simmers, P H van der Voort, A M Meijer, L R Dekker
INTRODUCTION: Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48)...
July 2016: Netherlands Heart Journal
Mélèze Hocini, Cathy Condie, Mark T Stewart, Nicole Kirchhof, Jason D Foell
BACKGROUND: Long-term clinical outcomes for atrial fibrillation ablation depend on the creation of durable transmural lesions during pulmonary vein isolation and on substrate modification. Focal conventional radiofrequency (RF) ablation studies have demonstrated that tissue temperature and power are important factors for lesion formation. However, the impact and predictability of temperature and power on contiguous, transmural lesion formation with a phased RF system has not been described...
July 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Kristina Wasmer, David Krüsemann, Patrick Leitz, Fatih Güner, Christian Pott, Stephan Zellerhoff, Dirk Dechering, Julia Köbe, Philipp S Lange, Lars Eckardt, Gerold Mönnig
BACKGROUND: Left atrial tachycardias (LAT) occur in about 5% of patients after irrigated-tip circumferential antral (CA) pulmonary vein isolation (PVI). They may cause debilitating symptoms in the patient and may be very difficult to treat. OBJECTIVE: To assess the incidence of LAT after PVI with the multielectrode phased-radiofrequency pulmonary vein ablation catheter (PVAC) compared to circumferential antral PVI with an irrigated-tip catheter. METHODS: We analyzed data from our ablation database...
August 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Stephan Zellerhoff, Frank Lenze, Hansjörg Ullerich, Alex Bittner, Kristina Wasmer, Julia Köbe, Christian Pott, Lars Eckardt, Gerold Mönnig
BACKGROUND: The development of esophageal lesions following atrial fibrillation (AF) ablation has frequently been reported. Mediastinal tissue layers and the posterior wall of the left atrium are in close proximity to the site of ablation. Hence, mucosal lesions might solely represent the "tip of the iceberg." We therefore investigated patients undergoing multielectrode phased radiofrequency (RF) ablation (PVAC®, Medtronic Inc., Minneapolis, MN, USA) for symptomatic AF by radial endosonography (EUS) in conjunction with conventional endoscopy esophago-gastro-duodenoscopy (EGD) to visualize potential mediastinal injuries following pulmonary vein isolation (PVI)...
April 2016: Pacing and Clinical Electrophysiology: PACE
Avishag Laish-Farkash, Amos Katz, Ornit Cohen, Azriel Osherov, Sharon Bruocha, Vladimir Khalameizer
PURPOSE: Previous data showed that pain sensation was common during pulmonary vein isolation (PVI) using an 8-mm radiofrequency (RF) ablation catheter. Pain was more common in the left pulmonary veins (PVs). We characterized the location of pain during PVI using circular multi-electrode ablation catheters. METHODS: Included are all consecutive patients with atrial fibrillation (AF) who underwent PVI using the phased RF PVAC® catheter (Medtronic) or the irrigated nMARQ™ catheter (Biosense Webster) under conscious sedation between July 2011 and March 2015...
January 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
S J Podd, A N Sulke, C Sugihara, S S Furniss
PURPOSE: Pulmonary vein isolation (PVI) is conventionally performed using 3D electroanatomical mapping to guide point-to-point ablation. The Pulmonary Vein Ablation Catheter (PVAC)® is a phased multipolar ablation (PMRA) catheter designed for rapid PVI using radiological anatomical information. Comparison of these methods of PVI using continuous beat-to-beat monitoring was undertaken. METHODS: Fifty patients with drug-refractory, symptomatic paroxysmal atrial fibrillation (PAF) were recruited...
December 2015: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Stefan Asbach, Fabienne Schluermann, Luca Trolese, Mathias Langer, Christoph Bode, Tobias Krauss
PURPOSE: Concerning rates of pulmonary vein (PV) stenosis were reported following PV isolation (PVI) with a circular pulmonary vein ablation catheter (PVAC). As this may depend on intraprocedural imaging, we evaluated the incidence of PV stenosis in patients undergoing PVAC-PVI with continuous surveillance by intracardiac echocardiography (ICE). METHODS: Multi-slice computed tomography was performed before and 3 months after PVAC-PVI with continuous ICE surveillance in 30 patients (37 % male, 65 ± 9 years)...
October 2015: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Christian von Bary, Thomas Deneke, Thomas Arentz, Anja Schade, Heiko Lehrmann, Christoph Eissnert, Susanne Schwab-Malek, Sabine Fredersdorf, Ekrem Ücer, Dobri Baldaranov, Christina Wendl, Felix Schlachetzki
PURPOSE: Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) revealed silent cerebral events (SCEs) as an acute complication of pulmonary vein isolation (PVI). We investigated whether SCEs following PVI are associated with neuropsychological deficits observed during patients' follow-up examinations. METHODS: After PVI, 52 patients were eligible for follow-up. PVI was performed using a variety of ablation technologies (duty-cycled phased radiofrequency (RF) multipolar ablation with the Pulmonary Vein Ablation Catheter® (PVAC) in 24 patients, cooled-tip RF ablation in 23 patients, and cryoballoon ablation in five patients)...
September 2015: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
K Wasmer, P Foraita, P Leitz, F Güner, C Pott, P S Lange, L Eckardt, G Mönnig
BACKGROUND: Silent cerebral lesions with the multielectrode-phased radiofrequency (RF) pulmonary vein ablation catheter (PVAC(®)) have recently been investigated. However, comparative data on safety in relation to irrigated RF ablation are missing. METHODS AND RESULTS: One hundred and fifty consecutive patients (58 ± 12 years, 56 female) underwent first pulmonary vein isolation (PVI) for atrial fibrillation (61% paroxysmal) using PVAC(®) (PVAC). Procedure data as well as in-hospital complications were compared with 300 matched patients who underwent PVI using irrigated RF (iRF)...
January 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Gunnar Klein, Lars Lickfett, Jürgen Schreieck, Thomas Deneke, Marcus Wieczorek, J Burkowitz, Lourdes Alvarez-Ossorio, Bernd Brüggenjürgen
AIMS: The purpose of the FAST-PVI study was to compare 'traditional' ablation tools based on 'point-by-point' technology with the new 'anatomically designed' technologies in terms of procedure times and related costs for the treatment of paroxysmal atrial fibrillation. METHODS AND RESULTS: Four hundred and fifty-two consecutive ablation procedures (222 'anatomically designed', 136 Arctic Front® and 86 PVAC®) and 230 'point-by-point' ablations (100 CARTO XP and 130 NavX navigation systems) performed by nine university centres across Germany from 2006 to 2010 were evaluated retrospectively...
July 2015: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Avishag Laish-Farkash, Amos Katz, Vladimir Khalameizer
Atrial fibrillation is the most common arrhythmia and its incidence and prevalence are growing steadily. It causes increased morbidity and mortality, while keeping patients in sinus rhythm was proven to decrease mortality rate. Nevertheless, antiarrhythmic drugs are limited in efficacy and have life-threatening adverse effects, thus neutralizing their benefits. Over the last years, ablation of pulmonary vein antrum has proven to be efficient in treating patients with atrial fibrillation. It has a success rate of 60-93% and overall complication rate of 6%...
July 2014: Harefuah
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