FIRST-IN-HUMAN CASES OF CAVOTRICUSPID ISTHMUS ABLATION USING A “SINGLE-SHOT” MAP-AND-ABLATE MULTIELECTRODE SPHERICAL ARRAY PULSED FIELD OR RADIOFREQUENCY ABLATION CATHETER
Tématický okruh: Poruchy rytmu, kardiostimulace | |
| Typ: Ústní sdělení - lékařské , Číslo v programu: 332 | |
| Neužil P.1, Šedivá L.1, Petrů J.2, Škoda J.1, Funasako M.3, Janotka M.4, Hála P.1, Lekešová V.1 1 Kardiologické oddělení, Nemocnice na Homolce, Praha, 2 Nemocnice Na Homolce, Praha, 3 Kardiologie, Nemocnice Na Homolce, 4 NNH Praha | |
Introduction: CTI ablation to treat typical AFL is often performed during AF ablation. A multielectrode spherical array catheter enabling “single-shot” mapping and ablation (RFA or PFA). Objective: To assess the feasibility, safety and efficacy of CTI ablation using RFA and/or PFA. Methods: Subjects underwent CTI ablation after PVI and in some, posterior wall isolation (PWI), using the spherical array catheter (Globe, Kardium Inc) with a deflectable 16Fr sheath, under general anesthesia or deep sedation with ICE-guidance. An integrated mapping system rendered atrial anatomy and voltage. The array was positioned along the CTI, and ablation performed using PFA, RFA or dual energy (RFA-PFA; RFA next to the tricuspid valve, and PFA toward the IVC), with NTG prophylaxis and coronary angiography during PFA & PFA-RFA. Invasive remapping was at 2-5 mo. Results: The cohort (n=15; age 62±10 yrs; 27% F; LA 44.1±3.0 mm; LVEF 61.5±6.6%; CHADS-VASc 1.9±1.2) underwent CTI ablation with RFA (n=5), PFA (n=5) or RFA-PFA (n=5). Acutely success was seen for all 15 CTI lines (100%), 61 PVs (100%), and 10 PWs (100%), with a total procedure time of 127±43min. CTI block required 3.0±0.7 positions, with transpired RA ablation times of 10.8±6.6min (6.4±2.1[PFA], 12.4±4.6[RFA], 13.6±9.5[RFA-PFA]). Coronary spasm was avoided by both PFA+NTG and PFA-RFA. There were no primary safety events. Remapping revealed durable CTI block in 100%(PFA), 75%(RFA) and 50%(PFA-RFA). Durable PVI was 100% (16 of 16 PVs) for full-dose and 94% (30 of 32 PVs) for half-dose. PWI was durable in 100% (8 of 8). Conclusion: In this FIH study, the spherical array catheter safely achieved good durability for CTI ablation and for PVI/PWI, allowing coronary spasm management with either NTG prophylaxis or toggling to RFA. | |
