16 results on '"Stroker, Erwin"'
Search Results
2. Pulmonary vein size is associated with reconnection following cryoballoon ablation of atrial fibrillation.
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Mugnai G, Cecchini F, Stroker E, Paparella G, Iacopino S, Sieira J, De Greef Y, Tomasi L, Bolzan B, Bala G, Overeinder I, Almorad A, Gauthey A, Sorgente A, Ribichini FL, de Asmundis C, and Chierchia GB
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- Humans, Middle Aged, Aged, Pulmonary Veins surgery, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery
- Abstract
Background: The second-generation cryoballoon (CB) has proven to be a highly effective ablative strategy in patients with symptomatic atrial fibrillation (AF). This study sought to investigate the anatomical characteristics of pulmonary veins (PVs) and the relationship between their size, ovality, and late reconnections in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias., Methods and Results: A total of 152 consecutive patients (98 males, 64.5%; mean age 64.9 ± 9.6 years) underwent a repeat ablation for recurrent atrial tachyarrhythmias after a median time of 6.5 months [IQR 11] from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 593 PVs, 134 (22.6%) showed a late PV reconnection in 95 patients (0.88 per patient), at the time of repeat ablation procedure. There was a significant difference in ovality between left- and right-sided PVs (p < 0.001). Greater diameters of left superior PV, left inferior PV, and right inferior PV ostia (both maximum and minimum) and higher index ovality were significantly associated with late PV reconnection., Conclusions: The rate of late PV reconnection after CB ablation was low (0.88 PVs/patient). Left-sided PVs were more oval than septal PVs. Larger PV dimensions and higher ovality index were significantly associated with reconnections in all PVs except for RSPV., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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3. Safety and long-term efficacy of cryoballoon ablation for atrial fibrillation in octogenarians: a multicenter experience.
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Cecchini F, Mugnai G, Iacopino S, Abugattas JP, Adriaenssens B, Al-Housari M, Almorad A, Bala G, Bisignani A, de Asmundis C, De Greef Y, Maj R, Osòrio TG, Pannone L, Schwagten B, Sieira J, Sorgente A, Stroker E, Wolf M, and Chierchia GB
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- Humans, Aged, 80 and over, Retrospective Studies, Octogenarians, Treatment Outcome, Recurrence, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Pulmonary Veins surgery, Cryosurgery methods, Catheter Ablation
- Abstract
Background: Cryoballoon technology (CB-A) has become a cornerstone of atrial fibrillation (AF) ablation in terms of safety and efficacy. Data regarding CB-A in octogenarians are still scarce and limited to single center experiences. The present study sought to analyze the performances of index CB-A in patients older than 80 years-old referring to 3 high-volume European centers., Methods and Results: We retrospectively enrolled 95 patients with a median age of 81 [80, 83] years. 62 (65.3%) patients presented with paroxysmal AF and 33 (33.7%) with persistent AF. Mean procedure and fluoroscopy times were 73.8 ± 25.2 and 15.3 ± 7.5 min, respectively. At 12 months and 24 months of follow-up, the overall freedom from AF was 81.1% and 66.6%, respectively. When divided for AF type, freedom from AF was higher in patients with paroxysmal AF (p = 0.007). Cryoballoon ablation was able to significantly improve AF-related symptoms as proven by the significant decrease in EHRA score during the follow-up (p < 0.0001). Phrenic nerve palsy occurred in 8 (8.5%) patients and always resolved during the procedure without affecting procedural outcome. Two major complications occurred (2.1%); one patient experienced pneumonia, successfully treated with antibiotics and non-invasive mechanical ventilation, the latter one experienced acute kidney failure secondary to urosepsis successfully treated by renal replacement therapy., Conclusions: The present study showed that CB-A is a feasible and effective procedure among octogenarians with a low complication rate. Contemporarily, CB-A can help to alleviate arrhythmia-related symptoms also among this group of subjects., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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4. Substrate mapping of the left atrium in persistent atrial fibrillation: spatial correlation of localized complex conduction patterns in global charge-density maps to low-voltage areas in 3D contact bipolar voltage maps.
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Chierchia GB, Sieira J, Vanderper A, Osorio TG, Bala G, Stroker E, Brugada P, Al Houssari M, Cecchini F, Mojica J, Overeinder I, Bisignani A, Mitraglia V, Boveda S, Paparella G, and de Asmundis C
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- Electrophysiologic Techniques, Cardiac, Heart Atria diagnostic imaging, Heart Atria surgery, Heart Rate, Humans, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
Purpose: This study aimed to investigate the spatial relationship between low-voltage areas (LVAs) in bipolar voltage mapping (BVM) and localized complex conduction (LCC)-cores in a global, non-contact, charge-density-based imaging, and mapping system (AcM)., Methods: Patients with history of index PVI for PsAF and scheduled for a repeat ablation procedure for recurrence of the same arrhythmia were enrolled between August 2018 and February 2020. All patients underwent both substrate mappings of the left atrium (LA) with the CARTO 3D map-ping system and with AcM., Results: Ten patients where included in our analysis. All presented with persistency of PVI in all veins at the moment of repeat procedure. There was no linear relationship in BVM maps between SR and CSd (correlation coefficient 0.31 ± 0.15), SR and CSp (0.36 ± 0.12) and CSd and CSp (0.43 ± 0.10). The % overlap of localized irregular activation (LIA), localized rotational activation (LRA) and Focal (F) regions with LVA was lower at 0.2 mV compared to 0.5 mV (4.97 ± 7.39%, 3.27 ± 5.25%, 1.09 ± 1.92% and 12.59 ± 11.81%, 7.8 ± 9.20%, 4.62 ± 5.27%). Sensitivity and specificity are not significantly different when comparing composite maps with different LVA cut-offs. AURC was 0.46, 0.48, and 0.39 for LIA, LRA, and Focal, respectively., Conclusion: Due to wave front direction dependency, LVAs mapped with BVM in sinus rhythm and during coronary sinus pacing only partially overlap in patients with PsAF. LCC-cores mapped during PsAF partially co-localize with LVAs., (© 2021. The Author(s).)
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- 2021
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5. Pulmonary veins anatomical determinants of cooling kinetics during second-generation cryoballoon ablation.
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Borio G, Maj R, Alessandro R, Stroker E, Sieira J, Osorio TG, Galli A, Terasawa M, Bala G, Al Housari M, Paparella G, Iacopino S, Overeinder I, Brugada P, de Asmundis C, and Chierchia GB
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- Aged, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation physiopathology, Computed Tomography Angiography, Female, Humans, Kinetics, Male, Middle Aged, Phlebography, Pulmonary Veins diagnostic imaging, Pulmonary Veins physiopathology, Retrospective Studies, Treatment Outcome, Atrial Fibrillation surgery, Cold Temperature adverse effects, Cryosurgery adverse effects, Pulmonary Veins surgery
- Abstract
Aim: The aim of the study was to investigate the role of anatomical characteristics of the pulmonary veins (PVs) determining cooling kinetics during second-generation cryoballoon ablation (CbA)., Methods and Results: we enrolled all consecutive patients who underwent CbA for symptomatic atrial fibrillation in our center from January 2019 to March 2019. All patients had complete computed tomography scans of the heart before the ablation. Anatomical characteristics were tested for prediction of a nadir temperature (NT) ≤ -48°C. Significant differences were noted among PV max diameter (20.8 ± 2.8 vs 18.5 ± 2.5 mm; P < .001); PV minimum diameter (15.2 ± 3.0 vs 13.0 ± 3.1 mm; P < .001); PV area (268.1 ± 71.9 vs 206.2 ± 58.7 mm
2 ; P < .001); PV ovality (1.4 ± 0.3 vs 1.5 ± 0.3; P = .005); and PV trunk length (27.4 ± 7.4 vs 21.3 ± 6.5 mm; P < .001). A scoring system was created by assigning one point each ranging from 0 (best anatomical combination) to 5. In the group with a score of 0, 94.0% of the CbA could reach a NT ≤ -48°C whereas with a score of 5, only 29.0% (P < .001). Left superior pulmonary vein with short trunk length and acute angle of PV branch was significantly associated with warmer NT (11.8% satisfactory CbA; P = .003). Regarding right inferior pulmonary vein, trunk length (P = .004), maximum diameter (P = .044), and transverse angle (P = .008) were independently associated with good NT., Conclusion: Anatomical PV features are associated with cooling kinetics and an anatomical score could predict lower NT during second-generation CbA. Specific characteristics were identified for inferior PV. Although heart imaging is not mandatory prior CbA, it can be a useful tool to predict cooling kinetics., (© 2020 Wiley Periodicals, Inc.)- Published
- 2020
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6. Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation.
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Conte G, Soejima K, de Asmundis C, Chierchia GB, Badini M, Miwa Y, Caputo ML, Özkartal T, Maffessanti F, Sieira J, Degreef Y, Stroker E, Regoli F, Moccetti T, Brugada P, and Auricchio A
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- Adult, Aged, Catheter Ablation methods, Cryosurgery methods, Echocardiography methods, Echocardiography standards, Echocardiography, Transesophageal methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pulmonary Veins diagnostic imaging, Pulmonary Veins surgery, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Catheter Ablation standards, Cryosurgery standards, Echocardiography, Transesophageal standards
- Abstract
Background: Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping., Methods: Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study., Results: A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months., Conclusion: Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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7. Comparison of the Incidences of Complications After Second-Generation Cryoballoon Ablation of Atrial Fibrillation Using Vitamin K Antagonists Versus Novel Oral Anticoagulants.
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Mugnai G, de Asmundis C, Iacopino S, Stroker E, Longobardi M, De Regibus V, Coutino-Moreno HE, Takarada K, Choudhury R, Abugattas de Torres JP, Storti C, Brugada P, and Chierchia GB
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- Administration, Oral, Antithrombins administration & dosage, Atrial Fibrillation complications, Belgium epidemiology, Dabigatran administration & dosage, Dose-Response Relationship, Drug, Drug Therapy, Combination, Factor Xa Inhibitors administration & dosage, Female, Follow-Up Studies, Humans, Incidence, Intraoperative Period, Italy epidemiology, Male, Middle Aged, Prognosis, Pyrazoles administration & dosage, Pyridines administration & dosage, Pyridones administration & dosage, Retrospective Studies, Rivaroxaban administration & dosage, Stroke epidemiology, Stroke etiology, Survival Rate trends, Thiazoles administration & dosage, Time Factors, Ablation Techniques adverse effects, Anticoagulants administration & dosage, Atrial Fibrillation therapy, Cryosurgery adverse effects, Postoperative Complications epidemiology, Stroke prevention & control, Vitamin K antagonists & inhibitors
- Abstract
Data evaluating the impact of the periprocedural administration of novel oral anticoagulants (NOACs) on complications in the setting of pulmonary vein (PV) isolation using cryoballoon (CB) is limited. In the present study, our aim was to analyze procedural characteristics and incidence of complications in those patients who underwent CB ablation for atrial fibrillation and the impact of NOACs on adverse events compared with vitamin K antagonists (VKAs). Consecutive patients with drug resistant atrial fibrillation who underwent PV isolation by CB as index procedure were retrospectively included in our analysis. In group I, 290 of 454 patients (63.9%) received VKAs (warfarin: n = 222 and acenocoumarol: n = 68), and in group II, 164 of 454 patients (36.1%) were treated with NOACs (rivaroxaban: n = 71; dabigatran: n = 60; and apixaban: n = 33). Age was significantly higher in the group II (62.8 ± 9.7 vs 58.6 ± 11.3; p <0.001). During the study period, 454 consecutive patients (male 71%, age 60.1 ± 10.9 years) were enrolled. Major complications occurred in 9 patients (2.0%): peripheral vascular complications were observed in 6 patients (1.3% per procedure), persistent phrenic nerve palsy occurred in 2 (0.4%), and transient ischemic attacks in 1 (0.2%). In both groups, the incidence of major complications was similar (group I [VKAs]: 7 patients [2.4%] vs group II [NOACs]: 2 patients [1.2%]; p = 0.5). In conclusion, CB ablation is a safe procedure for PV isolation and is associated with low complication rates. The incidence of adverse events in PV isolation using the second-generation CB with the periprocedural administration of NOACs is not significantly different than VKA treatment., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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8. Long-term outcome after second-generation cryoballoon ablation for paroxysmal atrial fibrillation - a 3-years follow-up.
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Takarada K, Overeinder I, de Asmundis C, Stroker E, Mugnai G, de Regibus V, Moran D, Coutino-Moreno H, Abugattas JP, Choudhury R, Ruggiero D, Paparella G, Iacopino S, Brugada P, and Chierchia GB
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- Aged, Atrial Fibrillation diagnosis, Equipment Design, Equipment Failure Analysis, Female, Humans, Male, Retrospective Studies, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation instrumentation, Catheter Ablation methods, Cryosurgery instrumentation, Cryosurgery methods, Heart Conduction System surgery, Pulmonary Veins surgery
- Abstract
Background: The second-generation cryoballoon (cryoballoon Advance; CB-A) offers excellent outcomes on the mid-term follow-up. To the best of our knowledge, little is known regarding the long-term outcome after CB-A ablation for paroxysmal atrial fibrillation (AF)., Objective: The aim of the study was to evaluate the freedom from recurrence of AF during a 3-year follow-up period, among consecutive patients having undergone pulmonary vein isolation (PVI) with the CB-A for paroxysmal AF (PAF)., Methods: Consecutive patients with drug-resistant PAF who underwent PVI using CB-A as an index procedure formed the study group. Patients were evaluated with holter ECG recordings at 1, 3, 6 and 12 months and subsequent follow-up was biannual or based on the clinical status and at the physician discretion., Results: Seventy-six consecutive patients were enrolled. Of these patients, 6 were excluded because of lack of long-term follow-up. A total of 70 patients [44 male (63%); mean age 57.9 ± 14.5 years] with a mean follow-up of 38.0 ± 7.4 months were finally included. In total, 278 PVs were depicted on the pre-procedural CT scan. All PVs (100%) could be isolated with the CB-A only. The freedom from AF without antiarrhythmic drug (AADs) after a single procedure was 71.5% of patients at a mean 38.0 ± 7.4 months follow-up. If including repeat procedures, 80% of the patients were free from AF recurrence after 1.11 ± 0.32 procedures without AADs., Conclusion: The second-generation cryoballoon offers long-term freedom from PAF in 71.5% of treated patients with a single procedure without AADs on a 3-year follow-up period.
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- 2017
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9. Single 3-Minute versus Double 4-Minute Freeze Strategy for Second-Generation Cryoballoon Ablation: A Single-Center Experience.
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Ciconte G, Sieira-Moret J, Hacioglu E, Mugnai G, DI Giovanni G, Velagic V, Saitoh Y, Conte G, Irfan G, Baltogiannis G, Hunuk B, Stroker E, Brugada P, DE Asmundis C, and Chierchia GB
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- Adult, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Belgium, Cardiac Catheters, Chi-Square Distribution, Cryosurgery adverse effects, Cryosurgery instrumentation, Disease-Free Survival, Equipment Design, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Recurrence, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Cryosurgery methods
- Abstract
Introduction: Second-generation cryoballoon (CB-Adv) ablation is highly effective in achieving pulmonary vein isolation (PVI) with promising mid-term clinical outcome. However, the ideal freezing strategy is still under debate. The aim of this study was to assess the efficacy of a single 3-minute approach compared to the conventional 4-minute plus bonus application using CB-Adv., Methods and Results: One hundred and sixty patients (67% male; mean age 58.0 ± 13.3 years) underwent PVI using CB-Adv for paroxysmal atrial fibrillation (PAF). Among 160 patients, 80 received a single 3-minute approach (3-mns group), while the remaining 80 conventional 4-minute plus bonus-freeze (4-mns group). Mean procedure and fluoroscopy times were 90.6 ± 15.8 and 18.3 ± 6.9 in the 4-mns group, 75.2 ± 17.1 and 13.5 ± 8.7 in the 3-mns group (P < 0.001, respectively). First-freeze isolation rate was 91.6% in the 4- versus 90.6% in the 3-mns group (P = 0.78). Persistent phrenic nerve palsy (PNP) occurred in 6/80 (3.5%) in the 4-mns group and 4/80 in the 3-mns group (P = 0.75). The overall freedom from ATas 2 years after the procedure was 78.1% (125/160): 77.5% (62/80 patients) in the 3-mns and 78.8% (63/80 patients) in the 4-mns group (P = 0.82). In multivariate analysis, time to PVI and nadir temperature independently predicted ATa recurrences (P < 0.001)., Conclusions: CB-Adv ablation for PAF is highly effective, resulting in 78% 2-year freedom from arrhythmic recurrences. A "single 3-minute strategy" showed equal efficacy as compared to the conventional 4-minute plus bonus freeze approach at 2-year follow-up, providing shorter procedure and fluoroscopy time. Nadir temperature and time to PVI were predictors of arrhythmic recurrences. "Bonus-freeze" strategy might be unnecessary., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
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10. One-year follow-up after second-generation cryoballoon ablation for atrial fibrillation in a large cohort of patients: a single-centre experience.
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Irfan G, de Asmundis C, Mugnai G, Poelaert J, Verborgh C, Umbrain V, Beckers S, Hacioglu E, Hunuk B, Velagic V, Stroker E, Brugada P, and Chierchia GB
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- Aged, Belgium, Catheter Ablation adverse effects, Cryosurgery adverse effects, Electrocardiography, Ambulatory, Female, Follow-Up Studies, Heart Atria physiopathology, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Postoperative Complications epidemiology, Proportional Hazards Models, Pulmonary Veins surgery, Recurrence, Retrospective Studies, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Cryosurgery methods, Tachycardia epidemiology
- Abstract
Aim: The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging results. In this study, we assessed the single-procedure outcome on a 1-year follow-up period in a large sample of patients having undergone PVI for drug-resistant atrial fibrillation (AF) using the CB-Adv., Methods and Results: A total of 393 patients (122 female, 31%; mean age 57.7 ± 12.9 years) with drug-refractory AF undergoing PVI using the novel CB-Adv were enrolled. Follow-up was based on outpatient clinic visits including Holter electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. A total of 1572 pulmonary veins (PVs) were identified and successfully isolated with 1.2 ± 0.3 mean freezes. Mean procedure and fluoroscopy times were 87.1 ± 38.2 and 14.9 ± 6.1 min, respectively. At a mean follow-up of 12 months, freedom from ATas after a single procedure was achieved in 85.8% of patients with paroxysmal atrial fibrillation and in 61.3% of patients with persistent AF (persAF). Similar success rates were observed between bonus freeze and single freeze strategies, 82.5 and 81.8%, respectively (P = 0.9). Multivariate analysis demonstrated that persAF (P = 0.04) and relapses during blanking period (BP) (P < 0.0001) were independent predictors of ATas recurrences., Conclusion: Freedom from any ATa can be achieved in 81.9% of patients after a single CB-Adv procedure in a large cohort of patients. A bonus freeze does not influence the clinical outcome, and reducing the duration of the cryoapplication to 3 min offers excellent results. Persistent AF and arrhythmia recurrence during the BP are strong predictors of AF recurrence., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
- Published
- 2016
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11. Repeat Procedures After Hybrid Thoracoscopic Ablation in the Setting of Longstanding Persistent Atrial Fibrillation: Electrophysiological Findings and 2-Year Clinical Outcome.
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Velagic V, DE Asmundis C, Mugnai G, Irfan G, Hunuk B, Stroker E, Hacioglu E, Umbrain V, Beckers S, Czapla J, Wellens F, Nijs J, Brugada P, LA Meir M, and Chierchia GB
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- Action Potentials, Aged, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Atrial Flutter diagnosis, Atrial Flutter etiology, Atrial Flutter physiopathology, Catheter Ablation adverse effects, Electrocardiography, Ambulatory, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Pulmonary Veins physiopathology, Recurrence, Reoperation, Retrospective Studies, Tachycardia, Supraventricular diagnosis, Tachycardia, Supraventricular etiology, Tachycardia, Supraventricular physiopathology, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Atrial Flutter surgery, Catheter Ablation methods, Electrophysiologic Techniques, Cardiac, Pulmonary Veins surgery, Tachycardia, Supraventricular surgery, Thoracic Surgery, Video-Assisted adverse effects
- Abstract
Introduction: In order to increase success rates of invasive treatment of persistent atrial fibrillation, the hybrid approach was developed, combining video-assisted thoracoscopic epicardial procedure with conventional endocardial catheter ablation. Currently, there are no reports of electrophysiological findings and clinical outcomes of repeat procedures after the hybrid approach., Methods and Results: Out of 64 patients who were treated by hybrid ablation for persistent atrial fibrillation (AF), 14 underwent the repeat catheter ablation and were selected for this study. All 14 patients initially presented with longstanding persistent atrial fibrillation and markedly dilated atria. The hybrid procedure was performed in a single act and the mean time to redo procedure was 346 ± 227 days. In 57% of patients indication for redo procedure was regular atrial tachycardia, and the rest presented with recurrent atrial fibrillation. In 36% of patients, recovered conduction was found along the previous ablation lesions. Only 9% of pulmonary veins were reconnected (0.36 veins per patient) and 7% of box lesions were not complete. The overall success rate at 2 years follow-up after the repeat procedure, including second repeat procedure and patients taking antiarrhythmic drugs, was 64% (57% without drugs and further ablation). One case of moderate pulmonary vein stenosis was detected as a consequence of hybrid procedure., Conclusion: Hybrid atrial fibrillation ablation results in durable lesions and high rates of chronic pulmonary vein isolation even after long-term follow-up. Most of the repeat procedures after the hybrid approach are related to left atrial flutters that could be successfully treated by catheter ablation., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2016
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12. Complications in the setting of percutaneous atrial fibrillation ablation using radiofrequency and cryoballoon techniques: A single-center study in a large cohort of patients.
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Mugnai G, Irfan G, de Asmundis C, Ciconte G, Saitoh Y, Hunuk B, Velagic V, Stroker E, Rossi P, Capulzini L, Brugada P, and Chierchia GB
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- Aged, Aneurysm, False diagnosis, Arteriovenous Fistula diagnosis, Cardiac Tamponade diagnosis, Female, Humans, Male, Middle Aged, Postoperative Complications, Thromboembolism diagnosis, Aneurysm, False etiology, Arteriovenous Fistula etiology, Atrial Fibrillation surgery, Cardiac Tamponade etiology, Catheter Ablation adverse effects, Cryosurgery methods, Thromboembolism etiology
- Abstract
Background: The aim of this study was to assess the overall incidence of complications in a large sample of consecutive patients having undergone pulmonary vein (PV) isolation, evaluating also the rate of complications in radiofrequency (RF) and cryoballoon (CB) ablation technologies., Methods and Results: From January 2008 to December 2014, 1352 consecutive PV isolation procedures were performed in our center; a total amount of 1233 AF ablation procedures fulfilling inclusion criteria was finally taken into consideration for our analysis. A total of 642 procedures were performed using RF ablation technology and 591 using CB system. Serious adverse events occurred in 36 procedures (2.9%): specifically, vascular complications in 14 (1.1%); cardiac tamponade in 13 (1.0%); a thromboembolic event in 4 (0.3%); and atrial-esophageal fistula, PV intramural hematoma, retroperitoneal hematoma, pleural hematoma and persisting phrenic nerve palsy all occurred in 1 patient individually (0.1%). No deaths related to the procedure occurred. The complication rate did not significantly differ in the RF and CB groups (respectively, 3.6% vs 2.2%; p=0.1). Complication rates considerably decreased over the study period from 4.67% in 2008 to 1.55% in 2014. Interestingly, each 1-point increase in the CHA2DS2-VASc score was found to increase by 51% the likelihood of a serious adverse event., Conclusions: The incidence of serious adverse events following AF ablation procedures was 2.9%. Vascular complications were the most frequent complication followed by tamponade and thromboembolic events. The rate of complications considerably decreased over time. CHA2DS2-VASc score was found to be associated with higher risk of complications., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
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13. Repeat Procedures After Hybrid Thoracoscopic Ablation in the Setting of Longstanding Persistent Atrial Fibrillation: Electrophysiological Findings and 2-Year Clinical Outcome
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Velagic, Vedran, de Asmundis, Carlo, Mugnai, Giacomo, Irfan, Ghazala, Hunuk, Burak, Stroker, Erwin, Hacioglu, Ebru, Umbrain, Vincent, Beckers, Stefan, Jens, Czapla, Wellens, Francis, Nijs, Jan, Brugada, Pedro, La Meir, Mark, Chierchia, Jean-Baptiste, Cardio-vascular diseases, Clinical sciences, Faculty of Medicine and Pharmacy, Supporting clinical sciences, Anesthesiology research group, Critical Care, Cardiac Surgery, and Surgical clinical sciences
- Subjects
pulmonary vein reconnection ,Atrial Fibrillation ,radiofrequent ablation ,cardiovascular system ,thoracoscopic video-assisted epicardial ablation ,left atrial flutter ,hybrid procedure - Abstract
In order to increase success rates of invasive treatment of persistent atrial fibrillation, the hybrid approach was developed, combining video-assisted thoracoscopic epicardial procedure with conventional endocardial catheter ablation. Currently, there are no reports of electrophysiological findings and clinical outcomes of repeat procedures after the hybrid approach. Methods and Results Out of 64 patients who were treated by hybrid ablation for persistent atrial fibrillation (AF), 14 underwent the repeat catheter ablation and were selected for this study. All 14 patients initially presented with longstanding persistent atrial fibrillation and markedly dilated atria. The hybrid procedure was performed in a single act and the mean time to redo procedure was 346 ± 227 days. In 57% of patients indication for redo procedure was regular atrial tachycardia, and the rest presented with recurrent atrial fibrillation. In 36% of patients, recovered conduction was found along the previous ablation lesions. Only 9% of pulmonary veins were reconnected (0.36 veins per patient) and 7% of box lesions were not complete. The overall success rate at 2 years follow-up after the repeat procedure, including second repeat procedure and patients taking antiarrhythmic drugs, was 64% (57% without drugs and further ablation). One case of moderate pulmonary vein stenosis was detected as a consequence of hybrid procedure. Conclusion Hybrid atrial fibrillation ablation results in durable lesions and high rates of chronic pulmonary vein isolation even after long-term follow-up. Most of the repeat procedures after the hybrid approach are related to left atrial flutters that could be successfully treated by catheter ablation.
- Published
- 2016
14. One Year Incidence of Atrial Septal Defect after PV Isolation: A Comparison Between Conventional Radiofrequency and Cryoballoon Ablation
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Mugnai, Giacomo, Sieira, Juan, Ciconte, Giuseppe, Hervas, Marta Soriano, Irfan, Ghazala, Saitoh, Yukio, Hunuk, Burak, Stroker, Erwin, Velagic, Vedran, Wauters, Kristel, Tondo, Claudio, Molon, Giulio, de Asmundis, Carlo, Brugada, Pedro, Chierchia, Jean-Baptiste, Clinical sciences, and Cardio-vascular diseases
- Subjects
Medicine(all) ,cryoballoon ,Atrial Fibrillation ,RADIOFREQUENCY ,iatrogenic septal defect - Abstract
BackgroundTransseptal (TS) catheterization is needed to access the left heart during pulmonary vein isolation (PVI) procedures. In the radiofrequency (RF) ablation procedure, left atrial access is commonly achieved with a double TS puncture; cryoballoon (CB) ablation usually requires only a single TS puncture. Our aim was to compare the incidence of iatrogenic septal defect (IASD) between double transseptal conventional RF and CB ablation. Methods and ResultsIndividuals having undergone PVI as index procedure by RF or CB ablation and a subsequent transesophageal echocardiography examination during postablation follow-up in our center were consecutively included. A total of 127 patients formed the study group (92 males; mean age 60 11 years). IASD was present in 17 patients (13.4%) after a mean follow-up time of 11.6 months. The incidence of IASD at 1-year follow-up following PVI was significantly higher in the CB ablation group compared with the RF ablation group (22.2% vs 8.5%; P = 0.03). Mean IASD diameter was larger in the CB group (0.60cm x0.50 cm vs 0.44 cm x 0.35 cm) without statistical significance. Only left to right atrial shunt was observed. No adverse events were recorded in these patients during the follow-up. Conclusionsthe incidence of IASD at 1-year follow-up following CB ablation procedure for PVI is significantly higher with respect to RF procedures. Although no adverse clinical events were recorded in patients with persistence of IASD, more detailed echocardiographic examinations might be advised in all individuals exhibiting this finding.
- Published
- 2015
15. One-year follow-up after second-generation cryoballoon ablation for atrial fibrillation in a large cohort of patients: a single-centre experience.
- Author
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Irfan, Ghazala, Asmundis, Carlo de, Mugnai, Giacomo, Poelaert, Jan, Verborgh, Christian, Umbrain, Vincent, Beckers, Stefan, Hacioglu, Ebru, Hunuk, Burak, Velagic, Vedran, Stroker, Erwin, Brugada, Pedro, Chierchia, Gian-Battista, and de Asmundis, Carlo
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PULMONARY veins ,AMBULATORY electrocardiography ,ATRIAL fibrillation ,CATHETER ablation ,CLINICAL trials ,CRYOSURGERY ,HEART atrium ,LONGITUDINAL method ,MULTIVARIATE analysis ,SURGICAL complications ,TACHYCARDIA ,TIME ,DISEASE relapse ,TREATMENT effectiveness ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,KAPLAN-Meier estimator ,SURGERY - Abstract
Aim: The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging results. In this study, we assessed the single-procedure outcome on a 1-year follow-up period in a large sample of patients having undergone PVI for drug-resistant atrial fibrillation (AF) using the CB-Adv.Methods and Results: A total of 393 patients (122 female, 31%; mean age 57.7 ± 12.9 years) with drug-refractory AF undergoing PVI using the novel CB-Adv were enrolled. Follow-up was based on outpatient clinic visits including Holter electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. A total of 1572 pulmonary veins (PVs) were identified and successfully isolated with 1.2 ± 0.3 mean freezes. Mean procedure and fluoroscopy times were 87.1 ± 38.2 and 14.9 ± 6.1 min, respectively. At a mean follow-up of 12 months, freedom from ATas after a single procedure was achieved in 85.8% of patients with paroxysmal atrial fibrillation and in 61.3% of patients with persistent AF (persAF). Similar success rates were observed between bonus freeze and single freeze strategies, 82.5 and 81.8%, respectively (P = 0.9). Multivariate analysis demonstrated that persAF (P = 0.04) and relapses during blanking period (BP) (P < 0.0001) were independent predictors of ATas recurrences.Conclusion: Freedom from any ATa can be achieved in 81.9% of patients after a single CB-Adv procedure in a large cohort of patients. A bonus freeze does not influence the clinical outcome, and reducing the duration of the cryoapplication to 3 min offers excellent results. Persistent AF and arrhythmia recurrence during the BP are strong predictors of AF recurrence. [ABSTRACT FROM AUTHOR]- Published
- 2016
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16. Procedural Safety and Efficacy for Pulmonary Vein Isolation with the Novel Polarx™ Cryoablation System: A Propensity Score Matched Comparison with the Arctic Front™ Cryoballoon in the Setting of Paroxysmal Atrial Fibrillation.
- Author
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Mojica, Joerelle, Lipartiti, Felicia, Al Housari, Maysam, Bala, Gezim, Shuichiro Kazawa, Miraglia, Vincenzo, Monaco, Cinzia, Overeinder, Ingrid, Strazdas, Antanas, Ramak, Robbert, Paparella, Gaetano, Sieira, Juan, Capulzini, Lucio, Sorgente, Antonio, Stroker, Erwin, Brugada, Pedro, De Asmundis, Carlo, and Chierchia, Gian-Battista
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PULMONARY veins , *CRYOSURGERY , *ATRIAL fibrillation , *PROPENSITY score matching , *GALVANIC isolation - Abstract
Background. The novel Polarx™ cryoablation system is currently being studied for atrial fibrillation (AF) ablation. To the best of our knowledge, no study comparing the novel cryoablation system with the standard Arctic Front™ cryoballoon is available in today's literature. This study aims to compare Polarx™ and Arctic Front™ cryoballoon in terms of safety and efficacy. Methods. From a total cohort of 202 patients who underwent pulmonary vein (PV) isolation for paroxysmal AF through cryoablation, a population of 30 patients who used Polarx™ were compared with 30 propensity-score matched patients who used Arctic Front™. Results. Pulmonary vein occlusion and electrical isolation were achieved in all (100%) veins with a mean number of 1.09 ± 0.3 occlusion per vein using Polarx™ and 1.19 ± 0.5 occlusion per vein using Arctic Front™ (p = 0.6). Shorter procedure and fluoroscopy time were observed with Polarx™ group (60.5 ± 14.23 vs 73.43 ± 13.26 mins, p = 0.001; 12.83 ± 6.03 vs 17.23 ± 7.17 mins, p = 0.01, respectively). Lower cumulative freeze duration per vein was also observed with Polarx™ (203.38 ± 72.03 vs 224.9 ± 79.35 mins, p = 0.02). There was no significant difference in isolation time between the two groups (34.47 ± 21.23 vs 34.18 ± 26.79 secs, p = 0.9). Conclusion. The novel Polarx™ cryoablation system showed similar efficacy in vein occlusion and isolation and safety profile when compared to Arctic Front™ cryoablation system. Procedure time, fluoroscopy time, and cumulative freeze duration were significantly lower with Polarx™ cryoablation system. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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