Entropy at the right atrium as a predictor of atrial fibrillation recurrence outcome after pulmonary vein ablation.

Atrial fibrillation (AF) recurrence rates after successful ablation procedures are still high and difficult to predict. This work studies the capability of entropy measured from intracardiac recordings as an indicator for recurrence outcome. Intra-atrial recordings from 31 AF patients were registered previously to an ablation procedure. Four electrodes were located at the right atrium (RA) and four more at the left atrium (LA). Sample entropy measurements were applied to these signals, in order to characterize different non-linear AF dynamics at the RA and LA independently. In a 3 months follow-up, 19 of them remained in sinus rhythm, whereas the other 12 turned back to AF. Entropy values can be associated to a proarrhythmic indicator as they were higher in patients with AF recurrence (1.11±0.15 vs. 0.91±0.13), in persistent patients (1.03±0.19 vs. 0.96±0.15), and at the LA with respect to the RA (1.03±0.23 vs. 0.89±0.15 for paroxysmal AF patients). Furthermore, entropy values at the RA arose as a more reliable predictor for recurrence outcome than at the LA. Results suggest that high entropy values, especially at the RA, are associated with high risk of AF recurrence. These findings show the potential of the proposed method to predict recurrences post-ablation, providing additional insights to the understanding of arrhythmia.

La ablación de taquicardia intranodal con sistema de navegación remota Stereotaxis® precisa menores parámetros de temperatura y potencia por mejoría del contacto tisular / Ablation of atrioventricular nodal reentrant tachycardia using remote magnetic guidance (Stereotaxis®) requires lower temperature and power settings because of improved local contact

Introducción y objetivos. La navegación magnética remota con sistema Stereotaxis® supone una nueva forma de ablación que podría aumentar la estabilidad del catéter. Quisimos evaluar si la posible mejoría del contacto tisular obliga a modificar los parámetros convencionales de radiofrecuencia. Métodos. Se comparó a 19 pacientes sometidos a ablación de taquicardia intranodal con catéter remoto de 4 mm con 18 pacientes con procedimiento convencional (4 mm, 60-65 °C, 50 W). Evaluamos la energía de radiofrecuencia necesaria para conseguir la no inducibilidad de más de un eco nodal. Resultados. El primer catéter remoto presentó carbonización tras las primeras aplicaciones con parámetros habituales. Así, redujimos la energía (50 °C, 40 W) en el resto. No hubo diferencias en número de aplicaciones entre grupo remoto y control (mediana, 6 [rango intercuartílico, 11] frente a 8,5 [9]). Aplicaciones ≤ 5 s suelen deberse a desplazamiento del catéter. Sólo 4 pacientes del grupo remoto tuvieron aplicaciones ≤ 5 s frente a 11 controles (p = 0,041). La ablación remota fue igual de efectiva, y se realizó con menores temperaturas y potencias medias (media ± DE, 46 ± 2 frente a 50 ± 4 °C; p < 0,001; y 29 [14] frente a 50 [7] W; p < 0,001), pero sin diferencias en energía total aplicada. Con el catéter remoto se registró menor amplitud de impedancias entre aplicaciones (media ± DE, 10,4 ± 7,6 frente a 19,3 ± 15,4 Ω; p = 0,035) y una tendencia a menor amplitud de temperaturas, lo que indica más estabilidad entre aplicaciones. No se produjeron complicaciones. Conclusiones. En nuestra serie inicial, el uso de navegación remota en la ablación de taquicardia intranodal fue efectiva y segura. La mejoría del contacto tisular disminuye desplazamientos involuntarios del catéter y parece que se necesita disminuir la potencia de radiofrecuencia para evitar la carbonización del catéter (AU)

Introduction and objectives. The Stereotaxis® remote magnetic navigation system provides a new approach to ablation that could increase catheter stability. The aim was to determine whether improved tissue contact necessitates a change in traditional radiofrequency ablation parameters. Methods. The study compared ablation of atrioventricular nodal reentrant tachycardia (AVNRT) using remote navigation (4-mm catheter) in 19 patients with conventional ablation in 18 patients (4-mm catheter, temperature 60-65oC, power 50 W). The radiofrequency energy needed to ensure that no more than a single nodal echo beat could be induced was measured. Results. Charring was observed with traditional parameters on the first applications of the remotely navigated catheter. Hence, the energy was subsequently reduced (to 50oC and 40 W). There was no difference in the number of applications between remote navigation and conventional groups (median: 6 vs 8.5; interquartile range [IQR]: 11 vs 9). Applications lasting ≤5 s were usually due to catheter dislodgment. Only 4 patients in the remote group had applications ≤5 s compared with 11 in the conventional group (P=.041). Ablation using remote navigation was equally effective and required lower temperatures and powers (mean [SD] temperature: 46 oC (2oC) vs 50oC (4oC), P < .001; median [IQR] power: 29 [14] W vs 50 [7] W, P < .001), with no difference in total energy delivered. With remote navigation, the range of impedance values between applications was less (mean [SD]: 10.4 [7.6] ¿ vs 19.3 [15.4] ¿; P=.035) and the temperature variation tended to be less, suggesting greater stability between applications. There were no complications. Conclusions. In this initial series, remote magnetic navigation was safe and effective in AVNRT ablation. Improved tissue contact reduced catheter dislodgment and necessitated a reduction in radiofrequency energy to avoid charring (AU)

Ablation of atrioventricular nodal reentrant tachycardia using remote magnetic guidance (stereotaxis) requires lower temperature and power settings because of improved local contact.

INTRODUCTION AND OBJECTIVES: The Stereotaxis(R) remote magnetic navigation system provides a new approach to ablation that could increase catheter stability. The aim was to determine whether improved tissue contact necessitates a change in traditional radiofrequency ablation parameters. METHODS: The study compared ablation of atrioventricular nodal reentrant tachycardia (AVNRT) using remote navigation (4-mm catheter) in 19 patients with conventional ablation in 18 patients (4-mm catheter, temperature 60-65 degrees C, power 50 W). The radiofrequency energy needed to ensure that no more than a single nodal echo beat could be induced was measured. RESULTS: Charring was observed with traditional parameters on the first applications of the remotely navigated catheter. Hence, the energy was subsequently reduced (to 50 degrees C and 40 W). There was no difference in the number of applications between remote navigation and conventional groups (median: 6 vs. 8.5; interquartile range [IQR]: 11 vs. 9). Applications lasting