Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation
Background Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Objective This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. Methods This single-center, prosp...
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| creator | Wong, Kelvin C.K., MB BChir, MRCP Jones, Michael, MBBS, FRACP Qureshi, Norman, MB BChir, MRCP Sadarmin, Praveen P., MBBS, MRCP De Bono, Joe, D Phil, MRCP Rajappan, Kim, MD, MRCP Bashir, Yaver, BMBCh, DM, FRCP Betts, Timothy R., MD, FRCP |
| description | Background Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Objective This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. Methods This single-center, prospective, randomized controlled trial included patients undergoing ablation for atrial fibrillation. After circumferential pulmonary vein isolation and roof line ablation, mitral isthmus ablation was performed during left atrial appendage pacing using an irrigated ablation catheter (endocardium: maximum power: 40/50 W, maximum temperature: 48°C; CS: maximum power: 25/30 W, maximum temperature: 48°C). An air-filled 40 × 10-mm percutaneous transluminal angioplasty balloon (Opta Pro, Cordis Europa, LJ Roden, The Netherlands) was used to occlude the CS on the epicardial aspect of the ablation line. Left coronary and CS angiography were performed before and after the procedure. Results Forty-six patients were studied. The balloon was successfully positioned in the distal CS in 20 of 23 patients (87%). Mitral isthmus block was achieved in 41 of 46 patients (91%). According to intention-to-treat analysis, there was significant reduction in the need for epicardial CS ablation (48% vs. 83%, P = .01) in the CS occlusion group but no difference in acute success rate. Secondary analysis showed reduction in mean total ablation time (9.4 ± 5.5 vs. 13.3 ± 4.6 minutes, P |
| doi_str_mv | 10.1016/j.hrthm.2011.01.042 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_869406727</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1547527111001342</els_id><sourcerecordid>869406727</sourcerecordid><originalsourceid>FETCH-LOGICAL-c413t-33aca3dd94f2606de61d5d5b326b4eda3e6fedef43f3620ebbb80a9c0d8cc7b83</originalsourceid><addsrcrecordid>eNqFkV9rFTEQxUNR7B_9BAXZN5_2dibZze59UNBiW6Eg2PocssksN9fspiZZod_erLf60BdhIAP5nTPMGcbOETYIKC_2m13Mu2nDAXEDpRp-xE6wbWUt-g5frH3T1S3v8JidprQH4FsJ4hU75iiw7UV7wr590t6HMFfBGL8kt3ZjlXdUWZey9pUJMcw6PlbJzUuqRm2cd1lnStXkcixE4XZT-dKD17kYvGYvR-0TvXl6z9j3q8_3lzf17dfrL5cfb2vToMi1ENpoYe22GbkEaUmibW07CC6HhqwWJEeyNDZiFJIDDcPQg94asL0x3dCLM_bu4PsQw8-FUlaTS4a81zOFJalebhuQHe8KKQ6kiSGlSKN6iG4qSykEtWap9upPlmrNUkGphhfV2yf_ZZjI_tP8Da8A7w8AlS1_OYoqGUezIesimaxscP8Z8OGZ3ng3O6P9D3qktA9LnEuAClXiCtTdes71mogAKIrBb_GknV8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>869406727</pqid></control><display><type>article</type><title>Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Wong, Kelvin C.K., MB BChir, MRCP ; Jones, Michael, MBBS, FRACP ; Qureshi, Norman, MB BChir, MRCP ; Sadarmin, Praveen P., MBBS, MRCP ; De Bono, Joe, D Phil, MRCP ; Rajappan, Kim, MD, MRCP ; Bashir, Yaver, BMBCh, DM, FRCP ; Betts, Timothy R., MD, FRCP</creator><creatorcontrib>Wong, Kelvin C.K., MB BChir, MRCP ; Jones, Michael, MBBS, FRACP ; Qureshi, Norman, MB BChir, MRCP ; Sadarmin, Praveen P., MBBS, MRCP ; De Bono, Joe, D Phil, MRCP ; Rajappan, Kim, MD, MRCP ; Bashir, Yaver, BMBCh, DM, FRCP ; Betts, Timothy R., MD, FRCP</creatorcontrib><description>Background Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Objective This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. Methods This single-center, prospective, randomized controlled trial included patients undergoing ablation for atrial fibrillation. After circumferential pulmonary vein isolation and roof line ablation, mitral isthmus ablation was performed during left atrial appendage pacing using an irrigated ablation catheter (endocardium: maximum power: 40/50 W, maximum temperature: 48°C; CS: maximum power: 25/30 W, maximum temperature: 48°C). An air-filled 40 × 10-mm percutaneous transluminal angioplasty balloon (Opta Pro, Cordis Europa, LJ Roden, The Netherlands) was used to occlude the CS on the epicardial aspect of the ablation line. Left coronary and CS angiography were performed before and after the procedure. Results Forty-six patients were studied. The balloon was successfully positioned in the distal CS in 20 of 23 patients (87%). Mitral isthmus block was achieved in 41 of 46 patients (91%). According to intention-to-treat analysis, there was significant reduction in the need for epicardial CS ablation (48% vs. 83%, P = .01) in the CS occlusion group but no difference in acute success rate. Secondary analysis showed reduction in mean total ablation time (9.4 ± 5.5 vs. 13.3 ± 4.6 minutes, P <.02) and mean CS ablation time (1.5 ± 2.8 vs. 3.4 ± 2.7 minutes, P <.05) in patients who had CS occlusion. Conclusion Balloon occlusion of the CS during mitral isthmus ablation is feasible and safe. It significantly reduces ablation time and the need for CS ablation to achieve mitral isthmus block. The results support the hypothesis that heat sink is one of the obstacles to successful mitral isthmus ablation.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2011.01.042</identifier><identifier>PMID: 21315835</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Atrial fibrillation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - therapy ; Balloon Occlusion - methods ; Cardiovascular ; Catheter Ablation - methods ; Coronary Angiography ; Coronary sinus ; Coronary Sinus - surgery ; Electrocardiography ; Female ; Follow-Up Studies ; Heat sink ; Humans ; Male ; Middle Aged ; Mitral isthmus ; Prospective Studies ; Pulmonary Veins - surgery ; Radiofrequency ablation ; Treatment Outcome</subject><ispartof>Heart rhythm, 2011-06, Vol.8 (6), p.833-839</ispartof><rights>Heart Rhythm Society</rights><rights>2011 Heart Rhythm Society</rights><rights>Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-33aca3dd94f2606de61d5d5b326b4eda3e6fedef43f3620ebbb80a9c0d8cc7b83</citedby><cites>FETCH-LOGICAL-c413t-33aca3dd94f2606de61d5d5b326b4eda3e6fedef43f3620ebbb80a9c0d8cc7b83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527111001342$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21315835$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Kelvin C.K., MB BChir, MRCP</creatorcontrib><creatorcontrib>Jones, Michael, MBBS, FRACP</creatorcontrib><creatorcontrib>Qureshi, Norman, MB BChir, MRCP</creatorcontrib><creatorcontrib>Sadarmin, Praveen P., MBBS, MRCP</creatorcontrib><creatorcontrib>De Bono, Joe, D Phil, MRCP</creatorcontrib><creatorcontrib>Rajappan, Kim, MD, MRCP</creatorcontrib><creatorcontrib>Bashir, Yaver, BMBCh, DM, FRCP</creatorcontrib><creatorcontrib>Betts, Timothy R., MD, FRCP</creatorcontrib><title>Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Objective This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. Methods This single-center, prospective, randomized controlled trial included patients undergoing ablation for atrial fibrillation. After circumferential pulmonary vein isolation and roof line ablation, mitral isthmus ablation was performed during left atrial appendage pacing using an irrigated ablation catheter (endocardium: maximum power: 40/50 W, maximum temperature: 48°C; CS: maximum power: 25/30 W, maximum temperature: 48°C). An air-filled 40 × 10-mm percutaneous transluminal angioplasty balloon (Opta Pro, Cordis Europa, LJ Roden, The Netherlands) was used to occlude the CS on the epicardial aspect of the ablation line. Left coronary and CS angiography were performed before and after the procedure. Results Forty-six patients were studied. The balloon was successfully positioned in the distal CS in 20 of 23 patients (87%). Mitral isthmus block was achieved in 41 of 46 patients (91%). According to intention-to-treat analysis, there was significant reduction in the need for epicardial CS ablation (48% vs. 83%, P = .01) in the CS occlusion group but no difference in acute success rate. Secondary analysis showed reduction in mean total ablation time (9.4 ± 5.5 vs. 13.3 ± 4.6 minutes, P <.02) and mean CS ablation time (1.5 ± 2.8 vs. 3.4 ± 2.7 minutes, P <.05) in patients who had CS occlusion. Conclusion Balloon occlusion of the CS during mitral isthmus ablation is feasible and safe. It significantly reduces ablation time and the need for CS ablation to achieve mitral isthmus block. The results support the hypothesis that heat sink is one of the obstacles to successful mitral isthmus ablation.</description><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Balloon Occlusion - methods</subject><subject>Cardiovascular</subject><subject>Catheter Ablation - methods</subject><subject>Coronary Angiography</subject><subject>Coronary sinus</subject><subject>Coronary Sinus - surgery</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heat sink</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral isthmus</subject><subject>Prospective Studies</subject><subject>Pulmonary Veins - surgery</subject><subject>Radiofrequency ablation</subject><subject>Treatment Outcome</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV9rFTEQxUNR7B_9BAXZN5_2dibZze59UNBiW6Eg2PocssksN9fspiZZod_erLf60BdhIAP5nTPMGcbOETYIKC_2m13Mu2nDAXEDpRp-xE6wbWUt-g5frH3T1S3v8JidprQH4FsJ4hU75iiw7UV7wr590t6HMFfBGL8kt3ZjlXdUWZey9pUJMcw6PlbJzUuqRm2cd1lnStXkcixE4XZT-dKD17kYvGYvR-0TvXl6z9j3q8_3lzf17dfrL5cfb2vToMi1ENpoYe22GbkEaUmibW07CC6HhqwWJEeyNDZiFJIDDcPQg94asL0x3dCLM_bu4PsQw8-FUlaTS4a81zOFJalebhuQHe8KKQ6kiSGlSKN6iG4qSykEtWap9upPlmrNUkGphhfV2yf_ZZjI_tP8Da8A7w8AlS1_OYoqGUezIesimaxscP8Z8OGZ3ng3O6P9D3qktA9LnEuAClXiCtTdes71mogAKIrBb_GknV8</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Wong, Kelvin C.K., MB BChir, MRCP</creator><creator>Jones, Michael, MBBS, FRACP</creator><creator>Qureshi, Norman, MB BChir, MRCP</creator><creator>Sadarmin, Praveen P., MBBS, MRCP</creator><creator>De Bono, Joe, D Phil, MRCP</creator><creator>Rajappan, Kim, MD, MRCP</creator><creator>Bashir, Yaver, BMBCh, DM, FRCP</creator><creator>Betts, Timothy R., MD, FRCP</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation</title><author>Wong, Kelvin C.K., MB BChir, MRCP ; Jones, Michael, MBBS, FRACP ; Qureshi, Norman, MB BChir, MRCP ; Sadarmin, Praveen P., MBBS, MRCP ; De Bono, Joe, D Phil, MRCP ; Rajappan, Kim, MD, MRCP ; Bashir, Yaver, BMBCh, DM, FRCP ; Betts, Timothy R., MD, FRCP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-33aca3dd94f2606de61d5d5b326b4eda3e6fedef43f3620ebbb80a9c0d8cc7b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - therapy</topic><topic>Balloon Occlusion - methods</topic><topic>Cardiovascular</topic><topic>Catheter Ablation - methods</topic><topic>Coronary Angiography</topic><topic>Coronary sinus</topic><topic>Coronary Sinus - surgery</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heat sink</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral isthmus</topic><topic>Prospective Studies</topic><topic>Pulmonary Veins - surgery</topic><topic>Radiofrequency ablation</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Kelvin C.K., MB BChir, MRCP</creatorcontrib><creatorcontrib>Jones, Michael, MBBS, FRACP</creatorcontrib><creatorcontrib>Qureshi, Norman, MB BChir, MRCP</creatorcontrib><creatorcontrib>Sadarmin, Praveen P., MBBS, MRCP</creatorcontrib><creatorcontrib>De Bono, Joe, D Phil, MRCP</creatorcontrib><creatorcontrib>Rajappan, Kim, MD, MRCP</creatorcontrib><creatorcontrib>Bashir, Yaver, BMBCh, DM, FRCP</creatorcontrib><creatorcontrib>Betts, Timothy R., MD, FRCP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Kelvin C.K., MB BChir, MRCP</au><au>Jones, Michael, MBBS, FRACP</au><au>Qureshi, Norman, MB BChir, MRCP</au><au>Sadarmin, Praveen P., MBBS, MRCP</au><au>De Bono, Joe, D Phil, MRCP</au><au>Rajappan, Kim, MD, MRCP</au><au>Bashir, Yaver, BMBCh, DM, FRCP</au><au>Betts, Timothy R., MD, FRCP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>8</volume><issue>6</issue><spage>833</spage><epage>839</epage><pages>833-839</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Objective This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. Methods This single-center, prospective, randomized controlled trial included patients undergoing ablation for atrial fibrillation. After circumferential pulmonary vein isolation and roof line ablation, mitral isthmus ablation was performed during left atrial appendage pacing using an irrigated ablation catheter (endocardium: maximum power: 40/50 W, maximum temperature: 48°C; CS: maximum power: 25/30 W, maximum temperature: 48°C). An air-filled 40 × 10-mm percutaneous transluminal angioplasty balloon (Opta Pro, Cordis Europa, LJ Roden, The Netherlands) was used to occlude the CS on the epicardial aspect of the ablation line. Left coronary and CS angiography were performed before and after the procedure. Results Forty-six patients were studied. The balloon was successfully positioned in the distal CS in 20 of 23 patients (87%). Mitral isthmus block was achieved in 41 of 46 patients (91%). According to intention-to-treat analysis, there was significant reduction in the need for epicardial CS ablation (48% vs. 83%, P = .01) in the CS occlusion group but no difference in acute success rate. Secondary analysis showed reduction in mean total ablation time (9.4 ± 5.5 vs. 13.3 ± 4.6 minutes, P <.02) and mean CS ablation time (1.5 ± 2.8 vs. 3.4 ± 2.7 minutes, P <.05) in patients who had CS occlusion. Conclusion Balloon occlusion of the CS during mitral isthmus ablation is feasible and safe. It significantly reduces ablation time and the need for CS ablation to achieve mitral isthmus block. The results support the hypothesis that heat sink is one of the obstacles to successful mitral isthmus ablation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21315835</pmid><doi>10.1016/j.hrthm.2011.01.042</doi><tpages>7</tpages></addata></record> |
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| subjects | Atrial fibrillation Atrial Fibrillation - physiopathology Atrial Fibrillation - therapy Balloon Occlusion - methods Cardiovascular Catheter Ablation - methods Coronary Angiography Coronary sinus Coronary Sinus - surgery Electrocardiography Female Follow-Up Studies Heat sink Humans Male Middle Aged Mitral isthmus Prospective Studies Pulmonary Veins - surgery Radiofrequency ablation Treatment Outcome |
| title | Balloon occlusion of the distal coronary sinus facilitates mitral isthmus ablation |
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