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  1. Article ; Online: Bradyarrhythmia in a marathonist: Cardiac vagal denervation as alternative treatment.

    Neto, Micaela / Cavaco, Diogo / Lovatto, Carlos / Costa, Francisco / Carmo, Pedro / Morgado, Francisco / Scanavacca, Mauricio / Adragão, Pedro

    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology

    2023  Volume 42, Issue 3, Page(s) 277.e1–277.e7

    Abstract: Although not routinely used, cardioneuroablation or modulation of the cardiac autonomic nervous system has been proposed as an alternative approach to treat young individuals with enhanced vagal tone and significant atrioventricular (AV) disturbances. We ...

    Abstract Although not routinely used, cardioneuroablation or modulation of the cardiac autonomic nervous system has been proposed as an alternative approach to treat young individuals with enhanced vagal tone and significant atrioventricular (AV) disturbances. We report the case of a 42-year-old athlete with prolonged ventricular pauses associated with sinus bradycardia and paroxysmal episodes of AV block (maximum of 6.6 s) due to enhanced vagal tone who was admitted to our hospital for pacemaker implantation. Cardiac magnetic resonance and stress test were normal. Although he was asymptomatic, safety concerns regarding possible neurological damage and sudden cardiac death were raised, and he accordingly underwent electrophysiological study (EPS) and cardiac autonomic denervation. Mapping and ablation were anatomically guided and radiofrequency pulses were delivered at empirical sites of ganglionated plexi. Modulation of the parasympathetic system was confirmed through changes in heart rate and AV nodal conduction properties associated with a negative cardiac response to atropine administration. After a follow-up of nine months, follow-up 24-hour Holter revealed an increase in mean heart rate and no AV disturbances, with rare non-significant ventricular pauses, suggesting that this technique may become a safe and efficient procedure in this group of patients.
    MeSH term(s) Male ; Humans ; Adult ; Bradycardia/surgery ; Treatment Outcome ; Heart ; Atrioventricular Block ; Denervation ; Catheter Ablation/methods
    Language Portuguese
    Publishing date 2023-01-21
    Publishing country Portugal
    Document type Case Reports
    ZDB-ID 632718-7
    ISSN 2174-2030 ; 0870-2551 ; 0304-4750
    ISSN (online) 2174-2030
    ISSN 0870-2551 ; 0304-4750
    DOI 10.1016/j.repc.2023.01.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 2865: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Comparison of outcomes with low-power long duration versus high-power short duration of ablation: the role of the acute change in sinus rhythm after the ablation as a predictor of long-term success.

    Vassallo, Fabricio / Meigre, Lucas Luis / Cunha, Christiano / Serpa, Eduardo / Simoes, Aloyr / Lovatto, Carlos / Gasparini, Dalbian / Corcino, Lucas / Schmidt, Andre

    Heart and vessels

    2022  Volume 37, Issue 10, Page(s) 1749–1756

    Abstract: Different results are described after atrial fibrillation ablation and multiple predictors of recurrence are well established. Evaluate and analyze if heart rate increase (HRI) during a first atrial fibrillation (AF) ablation with low-power long-duration ...

    Abstract Different results are described after atrial fibrillation ablation and multiple predictors of recurrence are well established. Evaluate and analyze if heart rate increase (HRI) during a first atrial fibrillation (AF) ablation with low-power long-duration (LPLD) and subsequently with high-power short-duration (HPSD) can impact. Retrospectively analyzed 340 consecutive patients (pts) undergoing first AF ablation. There were 158 pts in LPLD group: 113 (71.5%) paroxysmal AF with ablation with a power of 30/20 w, on anterior and posterior left atrial (LA) wall, respectively, and contact force of 10-30g for 30 s. There were 182 pts in HPSD group: 106 (58.2%) paroxysmal AF, who underwent ablation with 45/50 w, contact force of 8-15g/10-20g and 35 mL/min flow rate on anterior and posterior left atrial wall, respectively. Median follow-up was 32 ± 16 months. Success was observed in 94 (59.5%) patients in LPLD and 152 (83.5%) in HPSD, in LPLD group we documented a median HRI of 4.3 bpm (8%), compared to preablation heart rate, while a higher HRI in HPSD group of HRI 13.5 bpm (27.2%) was noted. Heart rate increase was associated with a higher success rate in both ablation techniques and independently showed an important impact on the success rate after AF ablation. HPSD compared to LPLD showed a higher proportion of HRI and also demonstrated a superiority in maintaining sinus rhythm at a long-term follow-up.
    MeSH term(s) Atrial Fibrillation/diagnosis ; Atrial Fibrillation/surgery ; Catheter Ablation/adverse effects ; Catheter Ablation/methods ; Humans ; Pulmonary Veins/surgery ; Recurrence ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-04-16
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 89678-0
    ISSN 1615-2573 ; 0910-8327 ; 0935-736X
    ISSN (online) 1615-2573
    ISSN 0910-8327 ; 0935-736X
    DOI 10.1007/s00380-022-02066-3
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    Zs.A 2049: Show issues Location:
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  3. Article ; Online: Incidental parasympathetic cardiac denervation during atrial fibrillation ablation using high power short duration: a marker of long-term success.

    Vassallo, Fabricio / Corcino, Lucas / Cunha, Christiano / Serpa, Eduardo / Lovatto, Carlos / Simoes, Aloyr / Carloni, Hermes / Hespanhol, Dalton / Gasparini, Dalbian / Barbosa, Luiz Fernando / Schmidt, Andre

    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

    2023  

    Abstract: Background: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration ( ... ...

    Abstract Background: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively.
    Results: Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile.
    Conclusion: Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.
    Language English
    Publishing date 2023-09-29
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1329179-8
    ISSN 1572-8595 ; 1383-875X
    ISSN (online) 1572-8595
    ISSN 1383-875X
    DOI 10.1007/s10840-023-01653-2
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    Zs.A 5214: Show issues Location:
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  4. Article ; Online: Reduced esophageal heating in high-power short-duration atrial fibrillation ablation in the contact force catheter era.

    Vassallo, Fabricio / Meigre, Lucas Luis / Serpa, Eduardo / Cunha, Christiano Lemos / Carloni, Hermes / Simoes, Aloyr / Amaral, Dalton / Lovatto, Carlos

    Pacing and clinical electrophysiology : PACE

    2021  Volume 44, Issue 7, Page(s) 1185–1192

    Abstract: Background:  Atrial fibrillation (AF) ablation is alternative treatment to medical therapy. Most feared complication is atrioesophageal fistula METHODS: Observational, retrospective analysis of consecutive 355 patients undergoing first AF ablation. Low- ... ...

    Abstract Background:  Atrial fibrillation (AF) ablation is alternative treatment to medical therapy. Most feared complication is atrioesophageal fistula METHODS: Observational, retrospective analysis of consecutive 355 patients undergoing first AF ablation. Low-power long-duration (LPLD) group contained 158 patients, with 121 (76.58%) having paroxysmal AF who underwent ablation with power 20/30W (anterior and posterior left atrial wall), 17 mL/min flow, and a contact force of 10-30 g for 30 s. High-power short-duration group (HPSD) contained 197 patients, with 113 (57.36%) having paroxysmal AF who underwent ablation at 45/50W of power with a contact force of 8-15 g/10-20 g and a 35 mL/min flow rate for 6-8 s on the anterior and the posterior left atrial wall, respectively. Both groups had pulmonary veins isolated and atrial flutter was ablated when needed. For patients not in sinus rhythm, cardioversion was performed before ablation RESULTS: There were no complications. LPLD group: Left atrial time 118.74 min, total 145.32 min, radiofrequency time 4317.99s, X-ray 13.42 min, and elevation of luminal esophageal temperature (LET) in 132 (84.53%) patients. HPSD group: Left atrial time 72.16 min, total 93.76 min, radiofrequency time 1511.29s, X-ray 7.6 min, and LET elevation in only 75 (38.07%) patients. A markedly higher rate of first-pass isolation was observed in HPSD compared to LPLD, 77.16% versus 13.29%, respectively. Recurrence occurred in 64 (40.50%) and 32 (16.24%) in 28.45 and 22.35 months in LPLD and HPSD patients, respectively. In LPLD, 10 patients were submitted to endoscopy, and one (10%) had mild erythema and in HPSD, 13 performed the endoscopy, with two (15.38%) patients showing mild erythema CONCLUSION: HPSD technique compared to the LPLD technique showed significant reduced radiofrequency and fluoroscopy times, higher rate of first-pass isolation, lower recurrence rate, and esophageal temperature elevation and may also have a protective effect avoiding incidental esophageal injury due to these findings.
    MeSH term(s) Atrial Fibrillation/surgery ; Catheter Ablation ; Esophagus ; Female ; Hot Temperature ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
    Language English
    Publishing date 2021-06-14
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 424437-0
    ISSN 1540-8159 ; 0147-8389
    ISSN (online) 1540-8159
    ISSN 0147-8389
    DOI 10.1111/pace.14286
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    Zs.A 1466: Show issues Location:
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    Zs.MO 399: Show issues

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  5. Article ; Online: Comparison of high-power short-duration (HPSD) ablation of atrial fibrillation using a contact force-sensing catheter and conventional technique: Initial results.

    Vassallo, Fabricio / Cunha, Christiano / Serpa, Eduardo / Meigre, Lucas Luis / Carloni, Hermes / Simoes, Aloyr / Hespanhol, Dalton / Lovatto, Carlos Volponi / Batista, Walter / Serpa, Renato

    Journal of cardiovascular electrophysiology

    2019  Volume 30, Issue 10, Page(s) 1877–1883

    Abstract: Introduction: Atrial fibrillation (AFib) ablation is alternative treatment to drugs. Literature suggests that use of contact force (CF) catheter with higher power for short periods is effective and safe.: Methods/results: Retrospectively analyzed 76 ... ...

    Abstract Introduction: Atrial fibrillation (AFib) ablation is alternative treatment to drugs. Literature suggests that use of contact force (CF) catheter with higher power for short periods is effective and safe.
    Methods/results: Retrospectively analyzed 76 patients undergoing the first ablation. Third five patients-group A: 27 (77%) paroxysmal AFib (PAFib) and 8 (23%) persistent AFib (PersAFib) who underwent ablation at the power of 30 W-17 mL/minute flow with a CF of 10-30 g for 30 seconds. Fourty one patients-group B: 28 (68.3%) PAFib and 13 (31.70%) PersAFib underwent ablation using 45 W on posterior wall with CF of 8/15 g, as well as 50-W anterior wall with CF of 10/20 g-35 mL/minute flow for 6 seconds. Pulmonary vein isolation in both groups and ablated. For patients not in the sinus, we performed cardioversion before ablation. No complications. Group A: Left atrial time 110 ± 29 minutes, total 148 ± 33.6 minutes, radiofrequency time (RF) 4558 ± 1998 seconds, X-ray 8.5 ± 3.5 minutes, and elevation of esophageal temperature (ET) in 26 (74.3%). group B: Left atrial time 70.7 ± 18.5 minutes ( P < .00001), total 106 ± 23 minutes ( P < .00001), RF 1909 ± 675.8 seconds ( P < .00001), X-ray 8.8 ± 6.6 minutes ( P = .221) and elevation of ET in 21 (51.20% - P = .0578). In 6 and 12 months follow-up, we had 9 (25.71%) and 11 (31.42%) recurrences in group A and 5 (12.19%) and 7 (17.07%) in group B ( P = .231 at 6 and P = .14 at 12 months), respectively.
    Conclusions: HPSD was safe, useful, and efficient compared with CT, and reduced procedural time and total RF time. HPSD may reduce esophageal injury because of lower heating rate and it may reduce the recurrence of atrial tachyarrythmias.
    MeSH term(s) Action Potentials ; Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Cardiac Catheterization/adverse effects ; Cardiac Catheterization/instrumentation ; Cardiac Catheters ; Catheter Ablation/adverse effects ; Catheter Ablation/instrumentation ; Equipment Design ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Pulmonary Veins/physiopathology ; Pulmonary Veins/surgery ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors ; Transducers, Pressure ; Treatment Outcome
    Language English
    Publishing date 2019-08-22
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/jce.14110
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