Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study

AbstractPurposePulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than that achieved by single-shot ablation techniques. In addition, it is associated with significant risk of oesophageal injury. The POWER-FAST pilot study evaluated the feasibility and safety of PVI by high-power short-duration (HPSD) PPRF.MethodsHPSD PPRF around the PVs was done in 48 consecutive patients with atrial fibrillation. Fifty watts was delivered until a predefined lesion index value was reached (LSI ≥ 5 or Abl-I ≥ 350) and 60 W during 7–10 s in the first 18 and last 30 patients, respectively. A control group of 47 consecutive patients who had undergone PVI before the HPSD group with conventional PPRF (30 W for 30 s) was included for reference. Echocardiography and oesophageal endoscopy wa s performed shortly after ablation in all patients.ResultsPVI of all targeted veins was achieved in 98% and 100% of patients of the conventional and HPSD groups, respectively (p = 0.59). Total radiofrequency time was 34 ± 11, 24 ± 8, and 15 ± 5 min in groups 30 W, 50 W, and 60 W (p
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research

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ConclusionsEsophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.MethodsData from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression mode...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
A new catheter solution from Junkosha represents a major step toward smaller, more flexible, and higher data capacity catheters, according to the Japanese wire and cable supplier. Tokyo-based Junkosha launched its new Multi-Filar active catheter solution at the recent MD&M Minneapolis expo. The new cables have a capacity of up to 60 power lines depending on AWG size or pitch, and are designed to provide not only increased functionality but also more signals into formerly inaccessible areas of the body, the company said. Using Junkosha’s precision-engineered PTFE lamination technolo...
Source: MDDI - Category: Medical Devices Authors: Tags: MD & M Minneapolis Components Source Type: news
This study aimed to report the procedural data and initial results of a combined ablation technique using AI ‐guided high‐power (AI‐HP; 50 W) ablation for PVI.MethodsSymptomatic AF patients were consecutively enrolled and underwent wide ‐area contiguous circumferential PVI. Contact‐force catheters were used, ablation power was set to 50 W targeting AI values (550 anterior and 400 posterior). Esophageal temperature was monitored during procedure, all patients underwent postablation esophageal endoscopy.ResultsPVI was achieved in all (n  = 50, mean age: 68 ± 9 years,...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
This study aimed to report the procedural data and initial results of a combined ablation technique using AI guided high ‐power (50W) ablation for PVI.MethodsSymptomatic AF patients were consecutively enrolled und underwent wide area contiguous circumferential PVI. Contact ‐force catheters were used, ablation power was set to 50W targeting AI values (550 anterior, 400 posterior). Esophageal temperature was monitored during procedure, all patients underwent post‐ablation Esophageal‐endoscopy.ResultsPVI was achieved in all (n=50, mean age: 68 ±9 years, female: 60%) patients, rate of first‐round PVI was 92%. ...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ CLINICAL Source Type: research
ConclusionLeft atrial posterior wall RF ablation adopting AI ≤ 350 was associated with 14% esophageal thermal injury including 3% of severe esophageal thermal ulcers. This incidence is comparable to historic control‐groups with non‐AI‐guided AF ablation.This article is protected by copyright. All rights reserved.
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ CLINICAL Source Type: research
AbstractOral anticoagulants (OA) are effective drugs for treating and preventing the formation of blood clots in patients with atrial fibrillation, mechanical heart valves and venous thromboembolism but their therapeutic effect is always counterbalanced by an increased risk of bleeding. Direct oral anticoagulants (DOACs) have brought advantages in the management of many patients, with evidence of a lower risk of intracranial bleeding in comparison to vitamin K antagonists (VKAs). However, due to the increased number of anticoagulated patients worldwide, major and life threatening OA-related bleeding is also increasing, and...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
ConclusionThe development of postoperative complications after minimally invasive Ivor Lewis esophagectomy significantly increases hospital length of stay. Performing the operation with a specialized tandem surgical team and including preoperative ischemic preconditioning of the stomach minimizes overall and anastomotic complications and facilitates on time hospital discharge as defined by a perioperative clinical pathway protocol.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Spain an 82-year-old female presented with abdominal pain Amoxicillin-Clavulanate two days after undergoing a colonoscopy. Her past medical history was remarkable for atrial fibrillation on oral anticoagulation and hypertension. She discontinued Acenocumarol 5  days prior to the endoscopy and received low-molecular-weight heparin (LMWH) as bridging therapy (last dose 24 h before the procedure). During colonoscopy, 7 small sessile polyps were removed by cold snare polypectomy. Anticoagulation (LMWH and Acenocumarol) was restarted 24 h later.
Source: Digestive and Liver Disease - Category: Gastroenterology Authors: Tags: Image of the Month Source Type: research
ConclusionThe incidence of ETL in patients undergoing left atrial posterior wall isolation is substantial. Our method of esophageal cooling did not decrease the incidence of ETL. There was a non-significant trend toward fewer severe lesions with cooling, but one cannot conclude the value of cooling from this pilot study.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
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