Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration
Backgroundwide antral pulmonary vein isolation (PVI) is effective for treating paroxysmal atrial fibrillation (PAF), although time-demanding. We investigated the impact of a standardized ablation protocol by using a bidirectional transeptal steerable sheath, high-density mapping and very high-power-...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1552340/full |
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| author | Lorenzo Gigli Alberto Preda Alessio Testoni Alessio Testoni Alessio Testoni Alexios Sotirios Kotinas Andrea Tacchetto Fabrizio Guarracini Marco Carbonaro Sara Vargiu Marisa Varrenti Giulia Colombo Roberto Menè Matteo Baroni Antonio Frontera Patrizio Mazzone |
| author_facet | Lorenzo Gigli Alberto Preda Alessio Testoni Alessio Testoni Alessio Testoni Alexios Sotirios Kotinas Andrea Tacchetto Fabrizio Guarracini Marco Carbonaro Sara Vargiu Marisa Varrenti Giulia Colombo Roberto Menè Matteo Baroni Antonio Frontera Patrizio Mazzone |
| author_sort | Lorenzo Gigli |
| collection | DOAJ |
| description | Backgroundwide antral pulmonary vein isolation (PVI) is effective for treating paroxysmal atrial fibrillation (PAF), although time-demanding. We investigated the impact of a standardized ablation protocol by using a bidirectional transeptal steerable sheath, high-density mapping and very high-power-short-duration (vHPSD) catheters on procedure timing, efficacy, and safety.Methodsconsecutive PAF patients free from previous ablations undergoing PVI alone between January 2022 and March 2023 were prospectively enrolled. The standardized workflow included general anesthesia, a single transeptal puncture trough with a bidirectional, steerable visualizable sheath introduced into the left atrium accommodated a high density, penta-spline mapping catheter and a contact force sensor ablation catheter enabled to deliver vHPSD. Procedural data and electrophysiology (EP) laboratory times were systematically collected and analyzed. The primary endpoint was any AF or atrial tachycardia recurrence at 12 and 24 month follow up.Resultsthe study cohort was composed by 138 patients (mean age was 59 ± 11 years, 38% female) and successful PVI was achieved in 100% of cases. Overall, first pass isolation (PFI) was 93%, with a LA dwell time of 32 ± 4 min. Significant complications were reported in 3% of patients. Skin-to-skin time and total EP laboratory time were 58 ± 5 min and 85 ± 7 min, respectively. The primary endpoint was achieved by 9% and 12% of cases at 12 and 24 month follow up, respectively. Upper limit skin-to-skin time and missed FPI resulted predictors of the primary endpoint.ConclusionThis standardized workflow resulted in low procedural times and arrhythmias recurrence without compromising the safety. |
| format | Article |
| id | doaj-art-e2bc81ba1a7540d4a9224d83898aa700 |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-e2bc81ba1a7540d4a9224d83898aa7002025-08-20T02:43:16ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-02-011210.3389/fcvm.2025.15523401552340Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short durationLorenzo Gigli0Alberto Preda1Alessio Testoni2Alessio Testoni3Alessio Testoni4Alexios Sotirios Kotinas5Andrea Tacchetto6Fabrizio Guarracini7Marco Carbonaro8Sara Vargiu9Marisa Varrenti10Giulia Colombo11Roberto Menè12Matteo Baroni13Antonio Frontera14Patrizio Mazzone15De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyBiosense Webster, Johnson & Johnson, Irvine, CA, United StatesJohnson & Johnson Medical S.p.A, Rome, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyDe Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, ItalyBackgroundwide antral pulmonary vein isolation (PVI) is effective for treating paroxysmal atrial fibrillation (PAF), although time-demanding. We investigated the impact of a standardized ablation protocol by using a bidirectional transeptal steerable sheath, high-density mapping and very high-power-short-duration (vHPSD) catheters on procedure timing, efficacy, and safety.Methodsconsecutive PAF patients free from previous ablations undergoing PVI alone between January 2022 and March 2023 were prospectively enrolled. The standardized workflow included general anesthesia, a single transeptal puncture trough with a bidirectional, steerable visualizable sheath introduced into the left atrium accommodated a high density, penta-spline mapping catheter and a contact force sensor ablation catheter enabled to deliver vHPSD. Procedural data and electrophysiology (EP) laboratory times were systematically collected and analyzed. The primary endpoint was any AF or atrial tachycardia recurrence at 12 and 24 month follow up.Resultsthe study cohort was composed by 138 patients (mean age was 59 ± 11 years, 38% female) and successful PVI was achieved in 100% of cases. Overall, first pass isolation (PFI) was 93%, with a LA dwell time of 32 ± 4 min. Significant complications were reported in 3% of patients. Skin-to-skin time and total EP laboratory time were 58 ± 5 min and 85 ± 7 min, respectively. The primary endpoint was achieved by 9% and 12% of cases at 12 and 24 month follow up, respectively. Upper limit skin-to-skin time and missed FPI resulted predictors of the primary endpoint.ConclusionThis standardized workflow resulted in low procedural times and arrhythmias recurrence without compromising the safety.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1552340/fullatrial fibrillation ablationparoxysmal atrial fibrillationhigh power short durationsteerable catheternear zero fluoro ablation |
| spellingShingle | Lorenzo Gigli Alberto Preda Alessio Testoni Alessio Testoni Alessio Testoni Alexios Sotirios Kotinas Andrea Tacchetto Fabrizio Guarracini Marco Carbonaro Sara Vargiu Marisa Varrenti Giulia Colombo Roberto Menè Matteo Baroni Antonio Frontera Patrizio Mazzone Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration Frontiers in Cardiovascular Medicine atrial fibrillation ablation paroxysmal atrial fibrillation high power short duration steerable catheter near zero fluoro ablation |
| title | Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| title_full | Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| title_fullStr | Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| title_full_unstemmed | Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| title_short | Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| title_sort | optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration |
| topic | atrial fibrillation ablation paroxysmal atrial fibrillation high power short duration steerable catheter near zero fluoro ablation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1552340/full |
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