Electrophysiological efficacy of Epicor high-intensity focused ultrasound

Alberto Pozzoli, Stefano Benussi, Federico Anzil, Maurizio Taramasso, Ylenia Adelaide Privitera, Domenico Cianflone, Paolo Della Bella, Ottavio Alfieri

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking of electrical conduction across the ablation lines. Epicor high-intensity focused ultrasound (HIFU) ablation has been credited with a variable clinical efficacy. The aim of this work is to ascertain the electrophysiological (EP) efficacy of such lesions, by assessing pulmonary vein isolation (PVI) after open chest HIFU ablation, in the clinical setting. Methods: Ten consecutive mitral patients (mean age: 57 ± 10 years) with paroxysmal AF undergoing concomitant ablation with the Epicor ablation system (St. Jude Inc.®, Minneapolis, MN, USA) were enrolled for EP assessment. During surgery, pairs of additional temporary wires were positioned on the right PVs (RPVs) and on the roof of the left atrium (RLA), before epicardial ablation. Exit block (no capture during PV pacing) of RPV and of RLA was assessed before, after ablating and immediately after closure of the chest, in order to check the correct positioning of the wires. EP assessment was repeated before discharge and at 3 weeks. Results: Baseline RPV pacing threshold (PT) was 3.5 ± 2 mA (range 1.5-8), of RLA 1.73 ± 1.1 mA (range 0.7-4.3 mA). PVI was not reached any time after HIFU ablation. At the pre-discharge EP study, the absence of isolation was observed in all cases. At 3 weeks, the PTs were 6.8 ± 5.8 mA on RPV (range 2-16) and 6.4 ± 5.3 mA (range 1-19) on RLA. All patients were discharged in sinus rhythm. CONCLUSIONS: PVI was not achieved after Epicor HIFU ablations, up to 3 weeks after surgery.

Original languageEnglish
Article numberezr270
Pages (from-to)129-134
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume42
Issue number1
DOIs
Publication statusPublished - Jul 2012

Fingerprint

High-Intensity Focused Ultrasound Ablation
Heart Atria
Pulmonary Veins
Atrial Fibrillation
Thorax

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Conduction block
  • HIFU ablation
  • High-intensity focused ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Electrophysiological efficacy of Epicor high-intensity focused ultrasound. / Pozzoli, Alberto; Benussi, Stefano; Anzil, Federico; Taramasso, Maurizio; Privitera, Ylenia Adelaide; Cianflone, Domenico; Bella, Paolo Della; Alfieri, Ottavio.

In: European Journal of Cardio-thoracic Surgery, Vol. 42, No. 1, ezr270, 07.2012, p. 129-134.

Research output: Contribution to journalArticle

Pozzoli, Alberto ; Benussi, Stefano ; Anzil, Federico ; Taramasso, Maurizio ; Privitera, Ylenia Adelaide ; Cianflone, Domenico ; Bella, Paolo Della ; Alfieri, Ottavio. / Electrophysiological efficacy of Epicor high-intensity focused ultrasound. In: European Journal of Cardio-thoracic Surgery. 2012 ; Vol. 42, No. 1. pp. 129-134.
@article{054238f57a124f608b5e85e45ca12c87,
title = "Electrophysiological efficacy of Epicor high-intensity focused ultrasound",
abstract = "Objectives: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking of electrical conduction across the ablation lines. Epicor high-intensity focused ultrasound (HIFU) ablation has been credited with a variable clinical efficacy. The aim of this work is to ascertain the electrophysiological (EP) efficacy of such lesions, by assessing pulmonary vein isolation (PVI) after open chest HIFU ablation, in the clinical setting. Methods: Ten consecutive mitral patients (mean age: 57 ± 10 years) with paroxysmal AF undergoing concomitant ablation with the Epicor ablation system (St. Jude Inc.{\circledR}, Minneapolis, MN, USA) were enrolled for EP assessment. During surgery, pairs of additional temporary wires were positioned on the right PVs (RPVs) and on the roof of the left atrium (RLA), before epicardial ablation. Exit block (no capture during PV pacing) of RPV and of RLA was assessed before, after ablating and immediately after closure of the chest, in order to check the correct positioning of the wires. EP assessment was repeated before discharge and at 3 weeks. Results: Baseline RPV pacing threshold (PT) was 3.5 ± 2 mA (range 1.5-8), of RLA 1.73 ± 1.1 mA (range 0.7-4.3 mA). PVI was not reached any time after HIFU ablation. At the pre-discharge EP study, the absence of isolation was observed in all cases. At 3 weeks, the PTs were 6.8 ± 5.8 mA on RPV (range 2-16) and 6.4 ± 5.3 mA (range 1-19) on RLA. All patients were discharged in sinus rhythm. CONCLUSIONS: PVI was not achieved after Epicor HIFU ablations, up to 3 weeks after surgery.",
keywords = "Arrhythmia, Atrial fibrillation, Conduction block, HIFU ablation, High-intensity focused ultrasound",
author = "Alberto Pozzoli and Stefano Benussi and Federico Anzil and Maurizio Taramasso and Privitera, {Ylenia Adelaide} and Domenico Cianflone and Bella, {Paolo Della} and Ottavio Alfieri",
year = "2012",
month = "7",
doi = "10.1093/ejcts/ezr270",
language = "English",
volume = "42",
pages = "129--134",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "1",

}

TY - JOUR

T1 - Electrophysiological efficacy of Epicor high-intensity focused ultrasound

AU - Pozzoli, Alberto

AU - Benussi, Stefano

AU - Anzil, Federico

AU - Taramasso, Maurizio

AU - Privitera, Ylenia Adelaide

AU - Cianflone, Domenico

AU - Bella, Paolo Della

AU - Alfieri, Ottavio

PY - 2012/7

Y1 - 2012/7

N2 - Objectives: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking of electrical conduction across the ablation lines. Epicor high-intensity focused ultrasound (HIFU) ablation has been credited with a variable clinical efficacy. The aim of this work is to ascertain the electrophysiological (EP) efficacy of such lesions, by assessing pulmonary vein isolation (PVI) after open chest HIFU ablation, in the clinical setting. Methods: Ten consecutive mitral patients (mean age: 57 ± 10 years) with paroxysmal AF undergoing concomitant ablation with the Epicor ablation system (St. Jude Inc.®, Minneapolis, MN, USA) were enrolled for EP assessment. During surgery, pairs of additional temporary wires were positioned on the right PVs (RPVs) and on the roof of the left atrium (RLA), before epicardial ablation. Exit block (no capture during PV pacing) of RPV and of RLA was assessed before, after ablating and immediately after closure of the chest, in order to check the correct positioning of the wires. EP assessment was repeated before discharge and at 3 weeks. Results: Baseline RPV pacing threshold (PT) was 3.5 ± 2 mA (range 1.5-8), of RLA 1.73 ± 1.1 mA (range 0.7-4.3 mA). PVI was not reached any time after HIFU ablation. At the pre-discharge EP study, the absence of isolation was observed in all cases. At 3 weeks, the PTs were 6.8 ± 5.8 mA on RPV (range 2-16) and 6.4 ± 5.3 mA (range 1-19) on RLA. All patients were discharged in sinus rhythm. CONCLUSIONS: PVI was not achieved after Epicor HIFU ablations, up to 3 weeks after surgery.

AB - Objectives: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking of electrical conduction across the ablation lines. Epicor high-intensity focused ultrasound (HIFU) ablation has been credited with a variable clinical efficacy. The aim of this work is to ascertain the electrophysiological (EP) efficacy of such lesions, by assessing pulmonary vein isolation (PVI) after open chest HIFU ablation, in the clinical setting. Methods: Ten consecutive mitral patients (mean age: 57 ± 10 years) with paroxysmal AF undergoing concomitant ablation with the Epicor ablation system (St. Jude Inc.®, Minneapolis, MN, USA) were enrolled for EP assessment. During surgery, pairs of additional temporary wires were positioned on the right PVs (RPVs) and on the roof of the left atrium (RLA), before epicardial ablation. Exit block (no capture during PV pacing) of RPV and of RLA was assessed before, after ablating and immediately after closure of the chest, in order to check the correct positioning of the wires. EP assessment was repeated before discharge and at 3 weeks. Results: Baseline RPV pacing threshold (PT) was 3.5 ± 2 mA (range 1.5-8), of RLA 1.73 ± 1.1 mA (range 0.7-4.3 mA). PVI was not reached any time after HIFU ablation. At the pre-discharge EP study, the absence of isolation was observed in all cases. At 3 weeks, the PTs were 6.8 ± 5.8 mA on RPV (range 2-16) and 6.4 ± 5.3 mA (range 1-19) on RLA. All patients were discharged in sinus rhythm. CONCLUSIONS: PVI was not achieved after Epicor HIFU ablations, up to 3 weeks after surgery.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Conduction block

KW - HIFU ablation

KW - High-intensity focused ultrasound

UR - http://www.scopus.com/inward/record.url?scp=84871697404&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871697404&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezr270

DO - 10.1093/ejcts/ezr270

M3 - Article

C2 - 22253374

AN - SCOPUS:84871697404

VL - 42

SP - 129

EP - 134

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

M1 - ezr270

ER -