272 results on '"Knecht, Sébastien"'
Search Results
252. Rescue retrograde coronary venous ethanol ablation of ventricular tachycardia storm in a patient with Lamin A/C cardiomyopathy: a case report.
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De Smet MAJ, Tavernier R, Duytschaever M, Knecht S, and le Polain de Waroux JB
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Background: Left ventricular (LV) summit arrhythmias account for up to 14% of LV arrhythmias. The ablation of LV summit arrhythmias is challenging, as testified by the fact that radiofrequency (RF) catheter ablation failure is frequent. Retrograde coronary venous ethanol infusion has been proposed as an alternative approach for the ablation of LV summit arrhythmias., Case Summary: A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrythmias., Discussion: Ablation of LV summit arrythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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253. Early atrial fibrillation recurrence post catheter ablation: Analysis from insertable cardiac monitor in the era of optimized radiofrequency ablation.
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De Becker B, El Haddad M, De Smet M, François C, Tavernier R, le Polain de Waroux JB, Duytschaever M, and Knecht S
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- Humans, Male, Female, Middle Aged, Follow-Up Studies, Aged, Time Factors, Treatment Outcome, Retrospective Studies, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Catheter Ablation methods, Recurrence, Electrocardiography, Ambulatory methods, Electrocardiography, Ambulatory instrumentation
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Background: Early recurrence of atrial tachyarrhythmia (ERAT) is associated with ablation-induced proarrhythmogenic inflammation; however, existing studies used intermittent monitoring or nonoptimized radiofrequency (RF) applications (noncontiguous or without ablation index target value)., Objective: The purpose of this study was to investigate the relationship between ERAT and late recurrence based on insertable cardiac monitor (ICM) data., Methods: We compiled data from Close-To-Cure and Close Maze studies, which enrolled patients who underwent RF ablation for paroxysmal or persistent atrial fibrillation (AF). All patients were implanted with an ICM 2-3 months before ablation., Results: We studied 165 patients (104 with paroxysmal AF, 61 with persistent AF). Over the 1-year follow-up period, 41 of the patients experienced late recurrence. The risk of late recurrence was higher in patients experiencing ERAT (hazard ratio [HR] 6.2; 95% confidence interval [CI] 3.0-13.0), with negative and positive predictive values of 90.5% and 45.7%, respectively. Median burden of AF during the blanking period was significantly higher in patients with late recurrence (7.9% [0.0%-99.6%]) compared to those without recurrence (0.0% [0.0%-6.0]; P <.001). For each 1% increase in AF burden during the blanking period, late recurrence increased by 4.6% (HR 1.046; 95% CI 1.035-1.059). The best tradeoff for predicting AF from ERAT occurrence was AF burden of 0.6% and last ERAT at 64 days., Conclusion: In patients ablated for paroxysmal and persistent AF with a durable RF lesion set and implanted with a continuous monitoring device, postablation early AF recurrence and burden significantly predict late recurrence. The post-AF ablation blanking period should be reduced to 2 months., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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254. Procedural performance and outcome after pulsed field ablation for pulmonary vein isolation: comparison with a reference radiofrequency database.
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De Becker B, El Haddad M, De Smet M, François C, Tavernier R, le Polain de Waroux JB, Knecht S, and Duytschaever M
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Aims: Pulsed field ablation (PFA) is a promising ablation technique for pulmonary vein isolation (PVI) with appealing advantages over radiofrequency (RF) including speed, tissue selectivity, and the promise of enhanced durability. In this study, we determine the procedural performance, efficacy, safety, and durability of PFA and compare its performance with a dataset of optimized RF ablation., Methods and Results: After propensity score matching, we compared 161 patients who received optimized RF-guided PVI in the PowerPlus study (CLOSE protocol) with 161 patients undergoing PFA-guided PVI for paroxysmal or persistent atrial fibrillation (AF; pentaspline basket catheter). The median age was 65 years with 78% paroxysmal AF in the PFA group (comparable characteristics in the RF group). Pulsed field ablation-guided PVI was obtained in all patients with a procedure time of 47 min (vs. 71 min in RF, P < 0.0001) and a fluoroscopy time of 15 min (vs. 11 min in RF, P < 0.0001). One serious adverse event [transient ischaemic attack] occurred in a patient with thrombocytosis (0.6 vs. 0% in RF). During the 6-month follow-up, 24 and 27 patients experienced a recurrence with 20 and 11 repeat procedures in the PFA and the RF groups, respectively ( P = 0.6 and 0.09). High-density mapping revealed a status of 4 isolated veins in 7/20 patients in the PFA group and in 2/11 patients in the RF group (35 vs. 18%, P = 0.3)., Conclusion: Pulsed field ablation fulfils the promise of offering a short and safe PVI procedure, even when compared with optimized RF in experienced hands. Pulmonary vein reconnection is the dominant cause of recurrence and tempers the expectation of a high durability rate with PFA., Competing Interests: Conflict of interest: M.D. received speaker fees from Biosense Webster not related to this work. The other authors report no conflict of interest to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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255. Esophageal Ulceration in a Large Contemporary Patient Cohort Undergoing Radiofrequency PVI With Maximal Preventive Measures.
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De Smet MAJ, Wielandts JY, De Becker B, François C, Tavernier R, le Polain de Waroux JB, Knecht S, and Duytschaever M
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- Humans, Esophageal Diseases etiology, Atrial Fibrillation complications, Atrial Fibrillation surgery
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- 2023
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256. Interaction between left bundle branch area pacing lead and defibrillator lead: A case report.
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François C, De Becker B, De Smet M, Knecht S, Duytschaever M, Tavernier R, and le Polain de Waroux JB
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Competing Interests: Pr. Jean-Benoit le Polain de Waroux reports nonsignificant speaker fees and honoraria for proctoring and teaching activities from Medtronic, Boston Scientific, Abbott, and Biotronik. Clara François, Benjamin De Becker, Maarten De Smet, Sébastien Knecht, Mattias Duytschaever, and René Tavernier report no conflict of interests.
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- 2023
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257. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery.
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Almorad A, O'Neill L, Wielandts JY, Gillis K, De Becker B, Nakatani Y, De Asmundis C, Iacopino S, Pambrun T, Marc M, Jaïs P, Haïssaguerre M, Duytschaever M, Chierchia JB, Derval N, and Knecht S
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Aims: Atrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery., Methods: Sixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2)., Results: After the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) ( p = 0.3). After 62 (48-84) months of follow-up and 2 (2-2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm ( p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs ( p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred., Conclusion: Long-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Almorad, O'Neill, Wielandts, Gillis, De Becker, Nakatani, De Asmundis, Iacopino, Pambrun, Marc, Jaïs, Haïssaguerre, Duytschaever, Chierchia, Derval and Knecht.)
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- 2022
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258. Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury.
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Halbfass P, Wielandts JY, Knecht S, Le Polain de Waroux JB, Tavernier R, De Wilde V, Sonne K, Nentwich K, Ene E, Berkovitz A, Mueller J, Lehmkuhl L, Reichart A, Lüsebrink U, Duytschaever M, and Deneke T
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- Aged, Esophagus injuries, Humans, Male, Middle Aged, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Pulmonary Veins surgery, Radiofrequency Ablation
- Abstract
Aims: Very high-power short-duration (vHPSD) via temperature-controlled ablation (TCA) is a new modality to perform radiofrequency pulmonary vein isolation (PVI), conceivably at the cost of a narrower safety margin towards the oesophagus. In this two-centre trial, we aimed to determine the safety of vHPSD-based PVI with specific emphasis on silent oesophageal injury., Methods and Results: Ninety consecutive patients with atrial fibrillation (AF) underwent vHPSD-PVI (90 W, 3-4 s, TCA) using the QDOT MICRO catheter, in conjunction with the nGEN (Bad Neustadt, n = 45) or nMARQ generator (Bruges, n = 45). All patients underwent post-ablation oesophageal endoscopy. Procedural parameters and complications were recorded. A subgroup of 21 patients from Bad Neustadt underwent cerebral magnetic resonance imaging (cMRI) to detect silent cerebral events (SCEs). Mean age was 67 ± 9 years, 59% patients were male, and 66% patients had paroxysmal AF. Pulmonary vein isolation was obtained in all cases after 96 ± 29 min. No steam pop, cardiac tamponade, stroke, or fistula was reported. None of the 90 patients demonstrated oesophageal ulceration (0%). Charring was not observed in the nMARQ cohort (0% vs. 11% in the nGEN group). In 5 out of 21 patients (24%), cMRI demonstrated SCE (exclusively nGEN cohort)., Conclusion: Temperature-controlled vHPSD catheter ablation allows straightforward PVI without evidence of oesophageal ulcerations or symptomatic complications. Catheter tip charring and silent cerebral lesions when using the nGEN generator have led to further modification., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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259. Atrial fibrillation ablation in patients with hypertrophic cardiomyopathy: do not throw in the towel too fast!
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O'Neill L, Duytschaever M, and Knecht S
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- Humans, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic diagnosis, Cardiomyopathy, Hypertrophic surgery, Catheter Ablation
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- 2021
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260. Biosense Webster's QDOT Micro™ radiofrequency ablation catheter.
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Wielandts JY, Almorad A, Hilfiker G, Gillis K, Haddad ME, Vijgen J, Berte B, Le Polain de Waroux JB, Tavernier R, Duytschaever M, and Knecht S
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- Catheters, Humans, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation, Pulmonary Veins surgery
- Abstract
The QDOT Micro™ catheter (Biosense Webster, Inc., CA, USA) is a new radiofrequency ablation catheter based on the SmartTouch SF™ (Biosense Webster, Inc.). It combines diffuse external irrigation with six thermocouples located within the outer metal shell and three additional microelectrodes in a 3.5 mm-tip contact force radiofrequency catheter. This article focuses on the different characteristics of the catheter, which incorporates the ability of high power delivery, irrigation flow control based on temperature sensing through the six thermocouples and the generation of microelectrograms. An outline of its performance in preclinical and clinical setting is presented, showing promising results, especially concerning procedural efficiency and short-term safety. Additional studies need to confirm long-term effectiveness, and durability studies should evaluate whether superiority on a lesion quality level can be achieved.
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- 2021
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261. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation.
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Lycke M, Kyriakopoulou M, El Haddad M, Wielandts JY, Hilfiker G, Almorad A, Strisciuglio T, De Pooter J, Wolf M, Unger P, Vandekerckhove Y, Tavernier R, de Waroux JEP, Duytschaever M, and Knecht S
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- Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Recurrence, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Pulmonary Veins surgery
- Abstract
Aims: Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability., Methods and Results: Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1-3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence., Conclusion: The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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262. A fishbone revealed.
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Wielandts JY, le Polain de Waroux JB, Knecht S, and Duytschaever M
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- 2021
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263. Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study.
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Kyriakopoulou M, Strisciuglio T, El Haddad M, De Pooter J, Almorad A, Van Beeumen K, Unger P, Vandekerckhove Y, Tavernier R, Duytschaever M, and Knecht S
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- Cardiac Catheters, Electrophysiologic Techniques, Cardiac, Female, Heart Conduction System physiopathology, Humans, Male, Middle Aged, Organ Size, Recurrence, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Catheter Ablation methods, Heart Atria pathology, Heart Atria physiopathology, Pulmonary Veins surgery
- Abstract
Aims: We sought to evaluate the efficacy and the safety of a simple technique for stabilizing the ablation catheter during anterior pulmonary vein (PV) encirclement in patients ablated for paroxysmal atrial fibrillation. This consisted of bending the ablation catheter in the left atrium, creating a loop that was cautiously advanced together with the long sheath at the ostium and then within the left superior PV. The curve was then progressively released to reach a stable contact with the anterior part of the left PVs., Methods and Results: Eighty consecutive patients (age 64 ± 11 years, left atrial diameter 43 ± 8 mm) undergoing 'CLOSE'-guided PV isolation were prospectively randomized into two groups depending on whether the loop technique was used or not. When using the loop technique, the encirclement of the left PVs was shorter [20 min (interquartile range, IQR 17-24) vs. 26 min (IQR 18-33), P < 0.01] with a high rate of first pass isolation [(100%) vs. (97%), P = 0.9] and adenosine proof isolation [(93%) vs. (95%), P = 0.67]. Most specifically, at the anterior part of the left PVs, there were less dislocations [0 (IQR 0-0) vs. 1 (IQR 0-4), P < 0.001], radiofrequency duration was shorter (272 ± 85 s vs. 378 ± 122 s, P < 0.001), force-time integral was higher [524 gs (IQR 427-687) vs. 398 gs (IQR 354-451), P < 0.001], average contact force was higher [20 g (IQR 13-27) vs. 11g (IQR 9-16), P < 0.001], and impedance drop was higher [12 Ω (IQR 9-19) vs. 10 Ω (IQR 7-14), P < 0.001]., Conclusion: This study describes a simple technique to facilitate catheter stability at the anterior part of the left PVs, resulting in more efficient left PV encirclement without compromising safety., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
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264. Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications.
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Wolf M, El Haddad M, De Wilde V, Phlips T, De Pooter J, Almorad A, Strisciuglio T, Vandekerckhove Y, Tavernier R, Crijns HJ, Knecht S, and Duytschaever M
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- Adult, Aged, Echocardiography, Endosonography, Female, Humans, Iatrogenic Disease, Male, Middle Aged, Atrial Fibrillation surgery, Catheter Ablation, Esophagoscopy, Esophagus injuries, Pulmonary Veins surgery
- Abstract
Background: The incidence of endoscopically detected esophageal lesions after pulmonary vein isolation (PVI) is as high as 18%. Intraesophageal temperature rise (ITR) during ablation is a predictor of esophageal injury., Objective: The purpose of this study was to describe an ablation strategy aiming to enclose the pulmonary veins with contiguous, stable, and optimized radiofrequency applications (referred to as CLOSE-PVI). We evaluated esophageal and periesophageal injury with endoscopy in patients revealing ITR during CLOSE-PVI., Methods: Eighty-five patients with ITR during CLOSE-PVI underwent endoscopy of the esophagus (with ultrasound in 38 patients). PVI consisted of contact force (CF)-guided encircling of the veins using 35-W applications, respecting strict criteria of intertag distance (≤6 mm) and ablation index (AI; 550 arbitrary unit [au] anterior wall, 400 au posterior wall, 300 au if ITR >38.5°C)., Results: Endoscopy was performed 9 ± 4 days after PVI. At the posterior wall, median power was 35 W [interquartile range (IQR) 35-35], application time 18 ± 5 seconds, CF 13 ± 6g, and AI 403 ± 38 au. A median of 5 applications [IQR 4-7] per patient over a length of 21.8 ± 6.8 mm resulted in ITR >38.5°C (median 39.9°C, IQR 39.2°C-41.2°C, range 38.6°C-50.0°C). For these applications, median power was 35 W [IQR 30-35], application time 14 ± 3 seconds, CF 12 ± 5g, and AI 351 ± 38 au. The incidence of esophageal erythema/erosion on endoscopy was 1 of 85 (1.2%) and of ulceration was 0 of 85 (0%). The incidence of mediastinal or esophageal injury on ultrasound was 0 of 38 (0%)., Conclusion: The occurrence of esophageal or periesophageal injury after CLOSE-PVI is markedly low (1.2%). Absence of esophageal ulceration in patients with ITR suggests that this strategy of delivering contiguous, relatively high-power, and short-duration radiofrequency applications at the posterior wall is safe., (Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2019
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265. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the 'CLOSE'-protocol.
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Phlips T, Taghji P, El Haddad M, Wolf M, Knecht S, Vandekerckhove Y, Tavernier R, and Duytschaever M
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- Action Potentials, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Cardiac Catheters, Catheter Ablation adverse effects, Catheter Ablation instrumentation, Databases, Factual, Electrocardiography, Ambulatory, Female, Heart Rate, Humans, Male, Middle Aged, Postoperative Complications etiology, Progression-Free Survival, Pulmonary Veins physiopathology, Recurrence, Risk Factors, Time Factors, Transducers, Pressure, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery
- Abstract
Aims: We have recently shown that a contact force (CF)-guided ablation protocol respecting region-specific criteria of lesion contiguity and lesion depth ('CLOSE' protocol) is associated with high incidence of acute durable pulmonary vein (PV) isolation (PVI) and a high single-procedure arrhythmia-free survival at 1 year. In the present study, we compared efficiency, safety, and efficacy of 'CLOSE'-guided PVI to conventional CF-guided PVI (CONV-CF)., Methods and Results: Fifty consecutive paroxysmal atrial fibrillation (AF) patients underwent PV encircling using a CF-sensing catheter targeting an interlesion distance (ILD) ≤6 mm and ablation index (AI) ≥400 and ≥550 at posterior and anterior wall ('CLOSE' group). Results were compared to the last 50 patients undergoing 'CONV-CF'. All patients underwent adenosine testing after PVI. Arrhythmia recurrence was defined as any atrial tachyarrhythmia (ATA) >30 s on Holter at 3, 6, and 12 months. Clinical characteristics did not differ. Contact force variability was comparable in between both groups (proportion of applications with intermittent contact 2% in 'CLOSE' vs. 1% in CONV-CF, P = 0.67). In the 'CLOSE' group, procedure time and radiofrequency (RF) time per circle were shorter (respectively 149 ± 33 min vs. 192 ± 42 min, P < 0.0001 and 18 ± 4 min vs 28 ± 7.5 min, P < 0.0001) and incidence of adenosine-proof isolation was higher (97% vs. 82%, P < 0.001). No complications were observed in the 'CLOSE' group, one tamponade in the 'CONV-CF' group. At 12 months, single-procedure freedom from ATA was 94% in 'CLOSE' vs. 80% in 'CONV-CF' group (P < 0.05). In both groups, the majority of reconnections at repeat were associated with either ILD > 6 mm and/or AI < 400/550 (100% vs. 83%, P = 0.99)., Conclusion: 'CLOSE'-guided PVI improves procedural and 1 year outcome in CF-guided PVI while shortening procedure time. Improvement cannot be explained by differences in CF variability and is most likely due to the strict application of criteria for contiguity and ablation index. A randomized controlled trial is needed to exclude the possible contribution of a learning curve.
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- 2018
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266. Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions: the ALINE study.
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Wolf M, El Haddad M, Fedida J, Taghji P, Van Beeumen K, Strisciuglio T, De Pooter J, Lepièce C, Vandekerckhove Y, Tavernier R, Duytschaever M, and Knecht S
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- Action Potentials, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Catheter Ablation adverse effects, Female, Heart Atria physiopathology, Heart Rate, Humans, Male, Middle Aged, Mitral Valve physiopathology, Prospective Studies, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Heart Atria surgery, Mitral Valve surgery
- Abstract
Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions., Methods and Results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35 W) respecting strict criteria of contiguity (inter-lesion distance ≤ 6 mm) and indirect lesion depth assessment (ablation index ≥550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo- and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median follow-up of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred., Conclusion: Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo- and epicardial RF lesions to be blocked.
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- 2018
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267. Multicentre evaluation of non-invasive biatrial mapping for persistent atrial fibrillation ablation: the AFACART study.
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Knecht S, Sohal M, Deisenhofer I, Albenque JP, Arentz T, Neumann T, Cauchemez B, Duytschaever M, Ramoul K, Verbeet T, Thorsten S, Jadidi A, Combes S, Tavernier R, Vandekerckhove Y, Ernst S, Packer D, and Rostock T
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- Action Potentials, Aged, Atrial Fibrillation physiopathology, Body Surface Potential Mapping instrumentation, Disease-Free Survival, Europe, Feasibility Studies, Female, Heart Rate, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Pulmonary Veins physiopathology, Recurrence, Reproducibility of Results, Risk Factors, Tachycardia, Supraventricular diagnosis, Tachycardia, Supraventricular etiology, Tomography, X-Ray Computed, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Body Surface Potential Mapping methods, Catheter Ablation adverse effects, Pulmonary Veins surgery
- Abstract
Aims: Non-invasive electrocardiogram (ECG) mapping allows the activation of the entire atrial epicardium to be recorded simultaneously, potentially identifying mechanisms critical for atrial fibrillation (AF) persistence. We sought to evaluate the utility of ECG mapping as a practical tool prior to ablation of persistent AF (PsAF) in centres with no practical experience of the system., Methods and Results: A total of 118 patients with continuous AF duration <1 year were prospectively studied at 8 European centres. Patients were on a median of 1 antiarrhythmic drug (AAD) that had failed to restore sinus rhythm. Electrocardiogram mapping (ECVUE™, CardioInsight, USA) was performed prior to ablation to map AF drivers (local re-entrant circuits or focal breakthroughs). Ablation targeted drivers depicted by the system, followed by pulmonary vein (PV) isolation, and finally left atrial linear ablation if AF persisted. The primary endpoint was AF termination. Totally, 4.9 ± 1.0 driver sites were mapped per patient with a cumulative mapping time of 16 ± 2 s. Of these, 53% of drivers were located in the left atrium, 27% in the right atrium, and 20% in the anterior interatrial groove. Driver-only ablation resulted in AF termination in 75 of the 118 patients (64%) with a mean radiofrequency (RF) duration of 46 ± 28 min. Acute termination rates were not significantly different amongst all 8 centres (P = 0.672). Ten additional patients terminated with PV isolation and lines resulting in a total AF termination rate of 72%. Total RF duration was 75 ± 27 min. At 1-year follow-up, 78% of the patients were off AADs and 77% of the patients were free from AF recurrence. Of the patients with no AF recurrence, 49% experienced at least one episode of atrial tachycardia (AT) which required either continued AAD therapy, cardioversion, or repeat ablation., Conclusion: Non-invasive mapping identifies biatrial drivers that are critical in PsAF. This is validated by successful AF termination in the majority of patients treated in centres with no experience of the system. Ablation targeting these drivers results in favourable AF-free survival at 1 year, albeit with a significant rate of AT recurrence requiring further management., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email: journals.permissions@oup.com.)
- Published
- 2017
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268. Ventricular tachycardia ablation through two Mitralclips®.
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Fedida J, Sohal M, and Knecht S
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- Action Potentials, Coronary Artery Bypass, Electrophysiologic Techniques, Cardiac, Heart Rate, Humans, Mitral Valve diagnostic imaging, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular physiopathology, Treatment Outcome, Catheter Ablation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery, Tachycardia, Ventricular surgery
- Published
- 2017
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269. Is Mapping of Complex Fractionated Electrograms Obsolete?
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Sohal M, Choudhury R, Taghji P, Louw R, Wolf M, Fedida J, Vandekerckhove Y, Tavernier R, Duytschaever M, and Knecht S
- Abstract
Atrial fibrillation is the most common clinically encountered arrhythmia and catheter ablation has emerged as a viable treatment option in drug-refractory cases. Pulmonary vein isolation is widely regarded as the cornerstone for successful outcomes in paroxysmal AF given that the pulmonary veins are a frequent source of AF triggering. Ablation strategies for persistent AF are less well defined. Mapping and ablation of complex fractionated electrograms (CFAEs) is one strategy that has been proposed as a means of modifying the atrial substrate thought to be critical to the perpetuation of AF. Results of clinical studies have proved conflicting and there are now strong data to suggest that pulmonary vein isolation alone is associated with outcomes comparable to those of pulmonary vein isolation plus CFAE ablation. Several studies have demonstrated that the majority of CFAEs are passive phenomena and therefore not critical to the perpetuation of AF. Conventional mapping technologies (using a bipolar or circular mapping catheter) lack the spatiotemporal resolution to identify mechanisms of AF persistence. The development of wide-field mapping techniques allows simultaneous acquisition of activation data over large areas. This strategy has the potential to better identify regions critical to AF perpetuation, and preliminary data suggest that ablation outcomes are improved when guided by these techniques. While mapping and ablation of all CFAEs is almost certainly obsolete, better identification of regions responsible for AF persistence has the potential to improve outcomes in ablation of persistent AF.
- Published
- 2015
- Full Text
- View/download PDF
270. Does diffuse irrigation result in improved radiofrequency catheter ablation? A prospective randomized study of right atrial typical flutter ablation.
- Author
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Ramoul K, Wright M, Sohal M, Shah A, Castro-Rodriguez J, Verbeet T, and Knecht S
- Subjects
- Adult, Aged, Aged, 80 and over, Catheter Ablation instrumentation, Female, Fluoroscopy, Humans, Male, Middle Aged, Operative Time, Therapeutic Irrigation methods, Atrial Flutter surgery, Cardiac Catheters, Catheter Ablation methods
- Abstract
Aims: Recent developments of open irrigated catheters have sought to create uniform cooling of the entire ablating electrode. The aim of this randomized study was to assess whether the diffuse irrigation of the Coolflex(®) (CF) catheter results in improved short-term procedural benefits in patients undergoing ablation of right atrial typical flutter., Methods and Results: Sixty consecutive patients (age 62 ± 13) with typical atrial flutter were prospectively randomized to ablation of the cavotricuspid isthmus (CTI) using either a standard 3.5 mm tip ablation catheter with six distal irrigation channels (6C) (30 patients) or a 4 mm tip fully irrigated ablation catheter (CF) (30 patients). There were no significant differences seen between procedures performed with the diffusely irrigated CF catheter and the standard six-channel irrigated-tip catheter. This concerned the total procedural duration RF duration, fluoroscopic duration, the total amount of irrigation fluid, and the occurrence of steam pop., Conclusions: The use of a diffuse irrigation at the ablation catheter tip does neither facilitate lesion formation nor reduce the amount of irrigation during RF ablation for typical right atrial flutter using recommended flow and power settings., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
271. Pulmonary vein isolation using a circular, open irrigated mapping and ablation catheter (nMARQ): a report on feasibility and efficacy.
- Author
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Zellerhoff S, Daly M, Lim HS, Denis A, Komatsu Y, Jesel L, Derval N, Sacher F, Cochet H, Knecht S, Yiem S, Hocini M, Haïssaguerre M, and Jaïs P
- Subjects
- Equipment Design, Equipment Failure Analysis, Feasibility Studies, Female, Humans, Male, Middle Aged, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Body Surface Potential Mapping instrumentation, Catheter Ablation instrumentation, Heart Conduction System surgery, Pulmonary Veins surgery, Therapeutic Irrigation instrumentation
- Abstract
Aims: Pulmonary vein isolation (PVI) is the mainstay of interventional treatment of paroxysmal atrial fibrillation (PAF). We report on the feasibility and efficacy of a novel, open-irrigated mapping and radiofrequency (RF) ablation catheter., Methods and Results: Thirty-nine consecutive patients (pts; age 60 ± 10 years, 8 females) suffering from drug-refractory PAF referred for PVI were included in this prospective study. Pulmonary vein isolation was performed with the use of a novel 10-pole circular, open-irrigated mapping and ablation catheter (nMARQ, Biosense Webster). Outcome parameters were the acute success rate in establishing complete PVI and the rate of sustained sinus rhythm (SR) during follow-up (FU). Ten patients underwent a repeat procedure for recurrent AF. Ninety-eight percent of the PVs could be acutely isolated using solely the nMARQ catheter by applying a mean total of 10.0 ± 4.6 min of RF energy. The mean total procedure duration was 86 ± 29 min, and the mean fluoroscopy time was 22.2 ± 6.5 min, respectively. Transient reconnection provoked by adenosine was observed in 10 of 24 patients, most frequently in the right superior PV. Cardiac tamponade related to transseptal puncture occurred in one patient. Reconnected PVs could be identified as a source of recurrent AF in 9 of 10 patients undergoing a repeat procedure. Single and multiple procedure success rates during a mean FU of 140 ± 75 days were 66 and 77%, respectively., Conclusion: Irrigated multi-electrode RF ablation is fast and effective, providing a high rate of isolated PVs without the need of touch-up lesions. Success rates were comparable with other techniques with a low complication rate. Recurrences of AF were mainly due to recovered pulmonary vein/left atrium conduction., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2014
- Full Text
- View/download PDF
272. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint.
- Author
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O'Neill MD, Wright M, Knecht S, Jaïs P, Hocini M, Takahashi Y, Jönsson A, Sacher F, Matsuo S, Lim KT, Arantes L, Derval N, Lellouche N, Nault I, Bordachar P, Clémenty J, and Haïssaguerre M
- Subjects
- Aged, Atrial Fibrillation physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Reoperation, Treatment Outcome, Atrial Fibrillation therapy, Catheter Ablation
- Abstract
Aims: Catheter ablation of long-lasting persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. Whether arrhythmia termination during ablation is associated with an improved clinical outcome is controversial., Methods and Results: In this prospective study, 153 consecutive patients (56 +/- 10 years) underwent catheter ablation of persistent AF (25 +/- 33 months) using a stepwise approach with the desired procedural endpoint being AF termination. Repeat ablation was performed for patients with recurrent AF or atrial tachycardia (AT) after a 1 month blanking period. A minimum follow-up of 12 months with repeated Holter monitoring was performed. Atrial fibrillation was terminated in 130 patients (85%). There was a lower incidence of AF in those patients in whom AF was terminated during the index procedure compared with those who had not (5 vs. 39% P < 0.0001, mean follow-up 32 +/- 11 months). Seventy-nine patients underwent repeat procedures: 64/130 in the termination group (6 AF, 58 AT) and 15 in the non-termination group (9 AF, 7 AT). After repeat ablation, sinus rhythm was maintained in 95% in whom AF was terminated compared with 52% in those in whom AF could not be terminated., Conclusion: Procedural termination of long-lasting AF by catheter ablation alone is associated with an improved outcome.
- Published
- 2009
- Full Text
- View/download PDF
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