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Irrigated DiamondTemp catheter and return to ablation under temperature control. First Polish experience with DiamondTemp catheter in pulmonary vein isolation

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Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
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2021
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vol. 4
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issue 2
44-51
EN
We present the first Polish experience with ablation performed using DiamondTemp catheter. The study was conducted with 3 male patients diagnosed with atrial fibrillation (AF). In the first 2 patients typical transseptal punctures were performed, followed by mapping with the Advisor catheter and EnSite-Precision system. One patient had a residual atrial septal leak, therefore ablation without fluoroscopy was attempted. High-power, short-duration ablation under temperature control was performed around pulmonary vein (PV) ostia. The power was 49-53 W, the temperature was 45-48 ͦC. Duration of procedures/fluoroscopy were: 146/8.9, 177/5.9, 132/0.0 min. In the reference group, 10 recent AF identical ablation procedures performed with traditional equipment resulted in 143.0±27.0/6.0±4.4 min. Duration of DiamondTemp applications were 14.7, 32.7, 30.8 min (reference group 37.3 ± 11.4 min). Procedural endpoints were achieved in all but one patient with incomplete isolation of the low segment of the right inferior PV. There were no procedural complications noted. In conclusion, the DiamondTemp saline-irrigated catheter is safe and effective for high-power short-duration ablation in patients with AF. Furthermore, this technology makes it possible to complete the procedure without fluoroscopy. However these findings must be confirmed in larger group of patients.
2
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Cardioneuroablation in neurocardiogenic syncope – hype or hope?

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Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
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2022
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vol. 5
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issue 1
47-52
EN
We are presenting the ablation of parasympathetic ganglia in the atria as a new method of treatment of vasovagal and other neurocardiogenic syncope. This method, shifting the balance of the autonomic nervous system in the sympathetic direction, is directed to the immediate cause of syncope which is excessive activation of the vagus nerve. Its effectiveness in the annual observation is within 80-100%. This method offers a great chance to improve the quality of life in patients with reflex syncope what have not been prevented by conventional treatment.
3
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High-power and short-duration ablation with the Qdot+ algorithm for pulmonary vein isolation and the right superior ganglion plexus ablation without fluoroscopy

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Koźluk E., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
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2021
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vol. 4
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issue 2
10-17
EN
In this report we present pulmonary vein and posterior box isolation together with the right superior ganglion plexus ablation using the Qdot Micro catheter without fluoroscopy. We describe different possibilities of this new technology for catheter ablation. The main advantages of this catheter to potentially increase ablation safety and effectiveness are discussed. Specifically, the possibility to perform high-density mapping with the lowest available distance between points. Furthermore, the possibility to decrease the risk of collateral tissue damage and to improve atrial linear lesions contiguity, transmurality and durability due to the dominance of resistive heating supported by the feedback temperature control. Finally, the possibility to shorten the procedure and fluoroscopy duration due to the high shortening of application duration to 4 seconds only.
4
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First experience with left atrial arrhythmia ablation using a bidirectional steerable transseptal sheath (Vizigo) visible in the CARTO system as a method to reduce fluoroscopy

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Koźluk E., Łojewska K., Hiczkiewicz J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 2
18-21
EN
In this report we present ablations of complex left atrial arrhythmias in 3 male patients using the bi-directional steerable transseptal sheath (Visigo) which is visualizable by the 3D electro-anatomical system. Ablations of complex left atrial (LA) arrhythmias were performed in 3 patients. In the first 2 patients typical transseptal punctures were performed, followed by mapping with the LassoNav catheter and PVI (one patient also had isolation of the posterior segment). The last patient had a residual atrial septal leak, therefore ablation without fluoroscopy was attempted. An anatomical map of the right atrium was made. The ablation catheter and the Vizigo sheath were introduced into the LA through the leak in the septum. LA, pulmonary veins and 3 tachycardia loops were mapped. Lines were made in the roof of LA, in the mitral isthmus and within the atrial septum, restoring the sinus rhythm. Times of procedures/fluoroscopy were: 185, 185, 205min / 5.5; 3.8 and 0min. In the group of the last 10 previous ablations, these times were respectively: 209±48min/5,6±1,8 min. We conclude that the Vizigo sheath reduces the risk of electrode and sheath dislocation into the right atrium and the need for fluoroscopic verification during maneuvers performed with the sheath. It is also a step towards simpler left atrial ablation without the use of fluoroscopy.
5
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Difference in demand for analgesic and sedative medication according to the type of catheter ablation for atrial fibrillation

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Koźluk E., Rzechorzek W., Piątkowska A., Rodkiewicz D., Opolski G.
European Journal of Translational and Clinical Medicine
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2021
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vol. 4
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issue 1
35-42
EN
Background: Our aim was to determine if there is a difference in demand for analgesic and sedative medication according to the type of catheter ablation for atrial fibrillation (AF). Material and methods: We collected data from protocols of 1144pts, who underwent ablation of AF. We excluded 275pts, at most due to electrocardioversion during the procedure. We divided them into 4 groups: cryoballoon ablation group (CB, n = 101), single-point radiofrequency ablation group (RFth-, n = 541), single-point radiofrequency ablation group with thermocool catheter (RFth+, n = 156) and Multielectrode Pulmonary Vein Ablation Catheter group (PVAC, n = 71). We used fentanyl and midazolam for pain control. The dose was adjusted by the operator, accord-ing to patients’ request. Results: The median dose of fentanyl 0.04 mg (0.00-0.08) and midazolam 1.00 mg (0.00-2.00) in CB group was lower than in other groups (p < 0.001). The median dose of fentanyl 0.12 mg (0.08-0.17) was lower in RFth- than in in RFth+ group: 0.15 mg (0.1-0.2) (p < 0.001). The demand for analgesia was higher when PVAC was used, with median dose of fentanyl 0.15 mg (0.1-0.2) (p < 0.0024). Conclusions: The demand for analgesic/sedative medication was lower among patients who underwent CB. Among those who underwent RF ablation it was higher in groups with thermocool and multielectrode catheters.
6
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Periprocedural decrease in tumor necrosis factor alpha is a risk factor for atrial fibrillation recurrence after ablation

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Szczerba E., Koźluk E., Januszkiewicz Ł., Lisicka M., Nowak J., Kondracka A., Majstrak J., Rodkiewicz D., Piątkowska A., Kiliszek M., Opolski G.
European Journal of Translational and Clinical Medicine
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2022
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vol. 5
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issue 2
16-23
EN
Background Concentration of tumor necrosis factor alpha (TNF-alpha) might be useful in selecting patients with paroxysmal atrial fibrillation (PAF) who will benefit the most from pulmonary vein isolation. Material and methods We performed prospective cohort study among patients with PAF who had sinus rhythm prior to undergoing either radiofrequency ablation or cryoablation procedure. Blood samples were collected at the start of the procedure and 16-24 h after. TNF-alpha concentrations were measured. Follow-up data was obtained during a structured telephone interview and 24-hour ECG Holter monitoring 12 months after the ablation procedure. Results Thirty seven patients were enrolled. After 12-month follow-up 27 patients maintained sinus rhythm, 8 had recurrence of AF and 2 were lost to follow-up. There was no significant correlation between TNF-alpha concentrations in any of the samples and the recurrence of arrhythmia (for pre-procedural samples: 1.75 pg/ml vs 1.74 pg/ml; p=0.72; for post-procedural samples: 1.49 pg/ml vs 1.79 pg/ml; p=0.16). In patients who had a recurrence of AF, we observed a decrease in the periprocedural TNF-alpha concentration (-0.12 pg/ml vs 0.05 pg/ml; p=0.05). Conclusions Neither pre- nor post-procedural TNF-alpha concentrations are predictive of ablation outcome in patients with PAF. We observed a decrease in the periprocedural TNF-alpha concentration in patients who had AF recurrence.
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