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Electrophysiological study 6 months after Epicor™ high-intensity focused ultrasound atrial fibrillation ablation

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Abstract

Purpose

Little is presently known about the outcome of atrial lesions performed with high-intensity focused ultrasound (HIFU) for atrial fibrillation ablation. We aimed to assess endocardial atrial lesions 6 months after epicardial HIFU ablation (Epicor™) and to evaluate the benefit of a combined ablation approach.

Methods

Thirty patients (21 males, mean age 68 ± 12 years old) undergoing HIFU atrial fibrillation ablation during cardiac surgery were enrolled. Electrophysiological study (EPS) was performed 6 months after HIFU ablation, and endovascular radiofrequency was delivered in case of conduction gaps. Patients were followed up for at least 6 months after the EPS.

Results

At EPS, ten patients (38 %) had achieved complete or near-complete “box” isolation and four (15 %) had no visible lesion. Using this technology, freedom from symptomatic atrial arrhythmia at 6 months was 60 % (n = 18/30) (64 % for paroxysmal and 56 % for persistent subgroups) improving to 81 % (n = 21/26) (90 % for paroxysmal and 73 % for persistent subgroups) at 12 months after a facultative percutaneous endocardial approach was performed. Using an UltraCinch device sized below 10 improved the rate of complete lesion as assessed 6 months after surgery (58 % of complete or near-complete box isolation with UltraCinch device <10 vs 21 % when ≥11; p = 0.05).

Conclusion

Six months after HIFU ablation, only 38 % of the patients had complete or near-complete box isolation, and the recurrence rate of symptomatic atrial arrhythmia was 40 %. The latter was reduced to 19 % 6 months after complementary percutaneous approach.

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Abbreviations

AF:

Atrial fibrillation

EPS:

Electrophysiological study

HIFU:

High-intensity focused ultrasound

LA:

Left atrium

MI:

Mitral isthmus

PV:

Pulmonary vein

RF:

Radiofrequency

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Acknowledgments

The authors thank Dr. Jamil HAJJ CHAHINE and Pr. Luc CHRISTIAENS for their editorial assistance.

Conflict of interest

Frédéric Sacher and Pierre Jaïs received consulting fees and speaking honorarium from St. Jude Medical. Nicolas Derval received speaking honorarium from St. Jude Medical.

Funding

There was no grant support.

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Authors and Affiliations

  1. LIRYC, L’Institut de rythmologie et modélisation cardiaque, Avenue du Haut-Lévêque, Bordeaux Pessac Cedex, 33400, France

    Rodrigue Garcia, Frédéric Sacher, Pierre Oses, Nicolas Derval, Laurent Barandon, Arnaud Denis, Mélèze Hocini, Xavier Roques, Michel Haïssaguerre, Louis Labrousse & Pierre Jaïs

  2. Hôpital Cardiologique du Haut-Lévêque, Bordeaux Pessac Cedex, 33604, France

    Rodrigue Garcia, Frédéric Sacher, Pierre Oses, Nicolas Derval, Laurent Barandon, Arnaud Denis, Mélèze Hocini, Xavier Roques, Michel Haïssaguerre, Louis Labrousse & Pierre Jaïs

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  1. Rodrigue Garcia
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  2. Frédéric Sacher
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  3. Pierre Oses
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  7. Mélèze Hocini
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  8. Xavier Roques
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  11. Pierre Jaïs
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Corresponding author

Correspondence to Rodrigue Garcia.

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Garcia, R., Sacher, F., Oses, P. et al. Electrophysiological study 6 months after Epicor™ high-intensity focused ultrasound atrial fibrillation ablation. J Interv Card Electrophysiol 41, 245–251 (2014). https://doi.org/10.1007/s10840-014-9949-0

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  • DOI: https://doi.org/10.1007/s10840-014-9949-0

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