Incidental parasympathetic cardiac denervation during atrial fibrillation ablation using high power short duration: a marker of long-term success.

BACKGROUND: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively. RESULTS: Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile. CONCLUSION: Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.

Is Age Associated with Complications of Atrial Fibrillation Catheter Ablation?

Abstract Background Atrial fibrillation (AF) is the most frequent arrhythmia, and its prevalence increases with age. The management of AF in the elderly is challenging, as it is normally associated with comorbidities and frailty. AF catheter ablation (CA) is a safe and superior alternative to antiarrhythmic drugs (AADs) for the maintenance of sinus rhythm. Objectives To evaluate the rate of complications associated with CA for AF across different age groups. Methods A retrospective analysis of 219 patients who underwent CA for AF between 2016 and 2020 were divided into 3 age groups: less than 60 years, 60 to 70 years, and > 70 years. All the included patients underwent radiofrequency ablation using an electroanatomic mapping system. Categorical variables were evaluated with chi-square and Fisher's test, and continuous variables were evaluated by Kruskal-Wallis and post-hoc Tamhane's T2. P values less than 0.05 were considered significant. Results We found an overall total complication rate of 4.6%. The total complication rate was 3.3% in patients < 60 years of age, 5.7% in patients between 60 and 70 years, and 5.2% in patients > 70 years (p = 0.742). No deaths occurred. Conclusion There was no significant difference in the AF CA-related complications when comparing the patients by age group.

Initial Experience with Fractionation Mapping in the Identification of Vagal Ganglionated Plexus During Cardioneuroablation

This is a series case report of five symptomatic patients presented with diagnosis of sinus bradycardia, first and second degrees atrioventricular (AV) blocks, that were referred to pacemaker implantation. During the screening, a functional cause for the bradycardia and AV blocks were documented by treadmill stress test, 24-hour Holter monitoring and atropine test. After the confirmation of the diagnosis, patients were submitted to cardioneuroablation on an anatomical basis supported by a tridimensional electroanatomical fractionation mapping software. The technique and the acute and short-term results of the cardioneuroablation are described.

Reduced esophageal heating in high-power short-duration atrial fibrillation ablation in the contact force catheter era.

BACKGROUND:  Atrial fibrillation (AF) ablation is alternative treatment to medical therapy. Most feared complication is atrioesophageal fistula METHODS: Observational, retrospective analysis of consecutive 355 patients undergoing first AF ablation. Low-power long-duration (LPLD) group contained 158 patients, with 121 (76.58%) having paroxysmal AF who underwent ablation with power 20/30W (anterior and posterior left atrial wall), 17 mL/min flow, and a contact force of 10-30 g for 30 s. High-power short-duration group (HPSD) contained 197 patients, with 113 (57.36%) having paroxysmal AF who underwent ablation at 45/50W of power with a contact force of 8-15 g/10-20 g and a 35 mL/min flow rate for 6-8 s on the anterior and the posterior left atrial wall, respectively. Both groups had pulmonary veins isolated and atrial flutter was ablated when needed. For patients not in sinus rhythm, cardioversion was performed before ablation RESULTS: There were no complications. LPLD group: Left atrial time 118.74 min, total 145.32 min, radiofrequency time 4317.99s, X-ray 13.42 min, and elevation of luminal esophageal temperature (LET) in 132 (84.53%) patients. HPSD group: Left atrial time 72.16 min, total 93.76 min, radiofrequency time 1511.29s, X-ray 7.6 min, and LET elevation in only 75 (38.07%) patients. A markedly higher rate of first-pass isolation was observed in HPSD compared to LPLD, 77.16% versus 13.29%, respectively. Recurrence occurred in 64 (40.50%) and 32 (16.24%) in 28.45 and 22.35 months in LPLD and HPSD patients, respectively. In LPLD, 10 patients were submitted to endoscopy, and one (10%) had mild erythema and in HPSD, 13 performed the endoscopy, with two (15.38%) patients showing mild erythema CONCLUSION: HPSD technique compared to the LPLD technique showed significant reduced radiofrequency and fluoroscopy times, higher rate of first-pass isolation, lower recurrence rate, and esophageal temperature elevation and may also have a protective effect avoiding incidental esophageal injury due to these findings.

Changes and impacts in early recurrences after atrial fibrillation ablation in contact force era: comparison of high-power short-duration with conventional technique-FIRST experience data.

BACKGROUND OR PURPOSE: Different atrial tachyarrhythmias (AT) may be seen during follow-up after atrial fibrillation ablation. Evaluate and analyze characteristics and management of AT following first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) and its impact on late outcome. METHODS: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD with 71 and LPLD with 73 patients and no major clinical differences between the two groups. RESULTS: AT occurred in 60 patients (41.67%) in entire follow-up. HPSD 22 patients had AT: 13 during blanking period (BP) and 9 after that. LPLD: 38 patients with AT, 14 during BP and 24 after that. During BP, HPSD showed high rate of atrial flutter/tachycardia in 9 (69.23) of 13 and LPLD 4 (28.57%) of 14 patients. At 12 months' follow-up, 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD. CONCLUSIONS: HPSD ablation produced higher rates of early than late recurrence comparing to LPLD. Regular tachyarrhythmias were most common arrhythmia during BP with HPSD ablation and AF in LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months.

Long-Term Follow-Up of Cardioneuroablation to Treat Second-Degree Block After Slow Pathway Ablation.

We present the long-term follow-up of a 31-year-old woman who underwent cardioneuroablation (for atrioventricular (AV) block. Slow pathway ablation was performed in September 2017 with normal follow-up until April 2018, when the patient started noticing symptoms of palpitations at rest, and the electrocardiogram showed a Mobitz I AV block. A cardiac stress test and 24-h Holter monitoring demonstrated first- and second-degree block and normal AV conduction during times of higher heart rate. (Level of Difficulty: Advanced.).

Comparison of high-power short-duration (HPSD) ablation of atrial fibrillation using a contact force-sensing catheter and conventional technique: Initial results.

INTRODUCTION: Atrial fibrillation (AFib) ablation is alternative treatment to drugs. Literature suggests that use of contact force (CF) catheter with higher power for short periods is effective and safe. METHODS/RESULTS: Retrospectively analyzed 76 patients undergoing the first ablation. Third five patients-group A: 27 (77%) paroxysmal AFib (PAFib) and 8 (23%) persistent AFib (PersAFib) who underwent ablation at the power of 30 W-17 mL/minute flow with a CF of 10-30 g for 30 seconds. Fourty one patients-group B: 28 (68.3%) PAFib and 13 (31.70%) PersAFib underwent ablation using 45 W on posterior wall with CF of 8/15 g, as well as 50-W anterior wall with CF of 10/20 g-35 mL/minute flow for 6 seconds. Pulmonary vein isolation in both groups and ablated. For patients not in the sinus, we performed cardioversion before ablation. No complications. Group A: Left atrial time 110 ± 29 minutes, total 148 ± 33.6 minutes, radiofrequency time (RF) 4558 ± 1998 seconds, X-ray 8.5 ± 3.5 minutes, and elevation of esophageal temperature (ET) in 26 (74.3%). group B: Left atrial time 70.7 ± 18.5 minutes ( P < .00001), total 106 ± 23 minutes ( P < .00001), RF 1909 ± 675.8 seconds ( P < .00001), X-ray 8.8 ± 6.6 minutes ( P = .221) and elevation of ET in 21 (51.20% - P = .0578). In 6 and 12 months follow-up, we had 9 (25.71%) and 11 (31.42%) recurrences in group A and 5 (12.19%) and 7 (17.07%) in group B ( P = .231 at 6 and P = .14 at 12 months), respectively. CONCLUSIONS: HPSD was safe, useful, and efficient compared with CT, and reduced procedural time and total RF time. HPSD may reduce esophageal injury because of lower heating rate and it may reduce the recurrence of atrial tachyarrythmias.

Detecção de taquiarritmias atriais em portadores de marcapassos bicamerais / Detection of atrial tachyarrhythmia in dual-chamber pacemaker patients

O estudo comparou o diagnóstico de taquiarritmias atriais (TA) em portadores de marcapassos bicamerais detectadas por eletrocardiogramas de 12 derivações (ECG) realizados durante consultas clínicas e avaliações de marcapasso, com detecções de TA dos dispositivos implantados. Em uma amostra de 65 paciente, foram implantados e avaliados marcapassos bicamerais (DDDR) capazes de detectar e gravar eletrogramas atriais (EGM)...

Neuralgia do glossofaríngeo associada a síncope cardíaca refexa / Glossopharyngeal Neuralgia Associated with Cardiac Syncope

Glossopharyngeal neuralgia is an uncommon condition that has rarely been described in association with syncope. We report here 2 cases of glossopharyngeal neuralgia in elderly patients. Both were male and underwent temporary pacemaker insertion to prevent syncopal episodes. We discuss the clinical and surgical treatment of glossopharyngeal neuralgia, the role of cardiac stimulation, and the possible physiopathological mechanism of the associated cardiac disturbances