Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation

James K. Gabriels; Xiaohan Ying; Subhanik Purkayastha; Eric Braunstein; Christopher F. Liu; Steven M. Markowitz; Stavros Mountantonakis; George Thomas; Bruce Goldner; Jonathan Willner; Rajat Goyal; James E. Ip; Bruce B. Lerman; Jane Carter; Nicola Bereanda; Meghann M. Fitzgerald; Diana Anca; Apoor Patel; Jim W. Cheung

doi:10.1016/j.jacep.2022.10.030

Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation

James K. Gabriels, Xiaohan Ying, Subhanik Purkayastha, Eric Braunstein, Christopher F. Liu, Steven M. Markowitz, Stavros Mountantonakis, George Thomas, Bruce Goldner, Jonathan Willner, Rajat Goyal, James E. Ip, Bruce B. Lerman, Jane Carter, Nicola Bereanda, Meghann M. Fitzgerald, Diana Anca, Apoor Patel, Jim W. Cheung

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

BACKGROUND: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).

OBJECTIVES: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.

METHODS: We conducted a multicenter, prospective controlled study of 128 patients (mean age 63 ± 11 years; 37% women) with paroxysmal atrial fibrillation undergoing PVI. Patients underwent PVI under general anesthesia using serial 4-minute runs of apneic oxygenation (apnea group; n = 64) or using standard ventilation settings (control group; n = 64). Procedural data, arterial blood gas samples, catheter position coordinates, and ablation lesion characteristics were collected.

RESULTS: Baseline characteristics between the 2 groups were similar. Catheter stability was significantly improved in the apnea group, as reflected by a decreased mean catheter displacement (1.55 ± 0.97 mm vs 2.25 ± 1.13 mm; P < 0.001) and contact force SD (4.9 ± 1.1 g vs 5.2 ± 1.5 g; P = 0.046). The percentage of lesions with a mean catheter displacement >2 mm was significantly lower in the apnea group (22% vs 44%; P < 0.001). Compared with the control group, the total ablation time to achieve PVI was reduced in the apnea group (18.8 ± 6.9 minutes vs 23.4 ± 7.8 minutes; P = 0.001). There were similar rates of first-pass PVI, acute PV reconnections and dormant PV reconnections between the two groups.

CONCLUSIONS: A novel strategy of performing complete PVI during apneic oxygenation results in improved catheter stability and decreased ablation times without adverse events. (Radiofrequency Ablation of Atrial Fibrillation Under Apnea; NCT04170894).

Original language	English (US)
Pages (from-to)	497-507
Number of pages	11
Journal	JACC: Clinical Electrophysiology
Volume	9
Issue number	4
DOIs	https://doi.org/10.1016/j.jacep.2022.10.030
State	Published - Apr 2023

Keywords

apnea
atrial fibrillation
catheter stability
radiofrequency catheter ablation
Prospective Studies
Humans
Middle Aged
Male
Apnea/surgery
Catheter Ablation/adverse effects
Female
Aged
Pulmonary Veins/surgery
Atrial Fibrillation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.jacep.2022.10.030

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Gabriels, J. K., Ying, X., Purkayastha, S., Braunstein, E., Liu, C. F., Markowitz, S. M., Mountantonakis, S., Thomas, G., Goldner, B., Willner, J., Goyal, R., Ip, J. E., Lerman, B. B., Carter, J., Bereanda, N., Fitzgerald, M. M., Anca, D., Patel, A., & Cheung, J. W. (2023). Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation. JACC: Clinical Electrophysiology, 9(4), 497-507. https://doi.org/10.1016/j.jacep.2022.10.030

Gabriels, JK, Ying, X, Purkayastha, S, Braunstein, E, Liu, CF, Markowitz, SM, Mountantonakis, S, Thomas, G, Goldner, B, Willner, J, Goyal, R, Ip, JE, Lerman, BB, Carter, J, Bereanda, N, Fitzgerald, MM, Anca, D, Patel, A & Cheung, JW 2023, 'Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation', JACC: Clinical Electrophysiology, vol. 9, no. 4, pp. 497-507. https://doi.org/10.1016/j.jacep.2022.10.030

@article{594b06cf50054560bfde86bf47e21ec8,

title = "Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation",

abstract = "BACKGROUND: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).OBJECTIVES: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.METHODS: We conducted a multicenter, prospective controlled study of 128 patients (mean age 63 ± 11 years; 37% women) with paroxysmal atrial fibrillation undergoing PVI. Patients underwent PVI under general anesthesia using serial 4-minute runs of apneic oxygenation (apnea group; n = 64) or using standard ventilation settings (control group; n = 64). Procedural data, arterial blood gas samples, catheter position coordinates, and ablation lesion characteristics were collected.RESULTS: Baseline characteristics between the 2 groups were similar. Catheter stability was significantly improved in the apnea group, as reflected by a decreased mean catheter displacement (1.55 ± 0.97 mm vs 2.25 ± 1.13 mm; P < 0.001) and contact force SD (4.9 ± 1.1 g vs 5.2 ± 1.5 g; P = 0.046). The percentage of lesions with a mean catheter displacement >2 mm was significantly lower in the apnea group (22% vs 44%; P < 0.001). Compared with the control group, the total ablation time to achieve PVI was reduced in the apnea group (18.8 ± 6.9 minutes vs 23.4 ± 7.8 minutes; P = 0.001). There were similar rates of first-pass PVI, acute PV reconnections and dormant PV reconnections between the two groups.CONCLUSIONS: A novel strategy of performing complete PVI during apneic oxygenation results in improved catheter stability and decreased ablation times without adverse events. (Radiofrequency Ablation of Atrial Fibrillation Under Apnea; NCT04170894).",

keywords = "apnea, atrial fibrillation, catheter stability, radiofrequency catheter ablation, Prospective Studies, Humans, Middle Aged, Male, Apnea/surgery, Catheter Ablation/adverse effects, Female, Aged, Pulmonary Veins/surgery, Atrial Fibrillation",

author = "Gabriels, {James K.} and Xiaohan Ying and Subhanik Purkayastha and Eric Braunstein and Liu, {Christopher F.} and Markowitz, {Steven M.} and Stavros Mountantonakis and George Thomas and Bruce Goldner and Jonathan Willner and Rajat Goyal and Ip, {James E.} and Lerman, {Bruce B.} and Jane Carter and Nicola Bereanda and Fitzgerald, {Meghann M.} and Diana Anca and Apoor Patel and Cheung, {Jim W.}",

year = "2023",

month = apr,

doi = "10.1016/j.jacep.2022.10.030",

language = "English (US)",

volume = "9",

pages = "497--507",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier",

number = "4",

}

TY - JOUR

T1 - Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation

AU - Gabriels, James K.

AU - Ying, Xiaohan

AU - Purkayastha, Subhanik

AU - Braunstein, Eric

AU - Liu, Christopher F.

AU - Markowitz, Steven M.

AU - Mountantonakis, Stavros

AU - Thomas, George

AU - Goldner, Bruce

AU - Willner, Jonathan

AU - Goyal, Rajat

AU - Ip, James E.

AU - Lerman, Bruce B.

AU - Carter, Jane

AU - Bereanda, Nicola

AU - Fitzgerald, Meghann M.

AU - Anca, Diana

AU - Patel, Apoor

AU - Cheung, Jim W.

PY - 2023/4

Y1 - 2023/4

N2 - BACKGROUND: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).OBJECTIVES: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.METHODS: We conducted a multicenter, prospective controlled study of 128 patients (mean age 63 ± 11 years; 37% women) with paroxysmal atrial fibrillation undergoing PVI. Patients underwent PVI under general anesthesia using serial 4-minute runs of apneic oxygenation (apnea group; n = 64) or using standard ventilation settings (control group; n = 64). Procedural data, arterial blood gas samples, catheter position coordinates, and ablation lesion characteristics were collected.RESULTS: Baseline characteristics between the 2 groups were similar. Catheter stability was significantly improved in the apnea group, as reflected by a decreased mean catheter displacement (1.55 ± 0.97 mm vs 2.25 ± 1.13 mm; P < 0.001) and contact force SD (4.9 ± 1.1 g vs 5.2 ± 1.5 g; P = 0.046). The percentage of lesions with a mean catheter displacement >2 mm was significantly lower in the apnea group (22% vs 44%; P < 0.001). Compared with the control group, the total ablation time to achieve PVI was reduced in the apnea group (18.8 ± 6.9 minutes vs 23.4 ± 7.8 minutes; P = 0.001). There were similar rates of first-pass PVI, acute PV reconnections and dormant PV reconnections between the two groups.CONCLUSIONS: A novel strategy of performing complete PVI during apneic oxygenation results in improved catheter stability and decreased ablation times without adverse events. (Radiofrequency Ablation of Atrial Fibrillation Under Apnea; NCT04170894).

AB - BACKGROUND: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).OBJECTIVES: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.METHODS: We conducted a multicenter, prospective controlled study of 128 patients (mean age 63 ± 11 years; 37% women) with paroxysmal atrial fibrillation undergoing PVI. Patients underwent PVI under general anesthesia using serial 4-minute runs of apneic oxygenation (apnea group; n = 64) or using standard ventilation settings (control group; n = 64). Procedural data, arterial blood gas samples, catheter position coordinates, and ablation lesion characteristics were collected.RESULTS: Baseline characteristics between the 2 groups were similar. Catheter stability was significantly improved in the apnea group, as reflected by a decreased mean catheter displacement (1.55 ± 0.97 mm vs 2.25 ± 1.13 mm; P < 0.001) and contact force SD (4.9 ± 1.1 g vs 5.2 ± 1.5 g; P = 0.046). The percentage of lesions with a mean catheter displacement >2 mm was significantly lower in the apnea group (22% vs 44%; P < 0.001). Compared with the control group, the total ablation time to achieve PVI was reduced in the apnea group (18.8 ± 6.9 minutes vs 23.4 ± 7.8 minutes; P = 0.001). There were similar rates of first-pass PVI, acute PV reconnections and dormant PV reconnections between the two groups.CONCLUSIONS: A novel strategy of performing complete PVI during apneic oxygenation results in improved catheter stability and decreased ablation times without adverse events. (Radiofrequency Ablation of Atrial Fibrillation Under Apnea; NCT04170894).

KW - apnea

KW - atrial fibrillation

KW - catheter stability

KW - radiofrequency catheter ablation

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Apnea/surgery

KW - Catheter Ablation/adverse effects

KW - Female

KW - Aged

KW - Pulmonary Veins/surgery

KW - Atrial Fibrillation

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UR - http://www.scopus.com/inward/citedby.url?scp=85152406408&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2022.10.030

DO - 10.1016/j.jacep.2022.10.030

M3 - Article

C2 - 36752460

AN - SCOPUS:85152406408

SN - 2405-500X

VL - 9

SP - 497

EP - 507

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 4

ER -

Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation

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