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High-resolution mapping as an alternative for exit block testing in the presence of entrance block after high-power short-duration pulmonary vein isolation

Hochauflösendes Mapping als Alternative zum Nachweis eines Exit-Blocks bei bestehendem Entrance-Block nach Pulmonalvenenisolation in High-Power-Short-Duration-Technik

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Abstract

Background

After pulmonary vein isolation (PVI) for atrial fibrillation (AF), it is common as an endpoint to demonstrate an exit block from the pulmonary veins (PVs) in addition to an entrance block into them. By using high-resolution mapping catheters, even very small signals can be detected.

Objectives

We investigated whether additional exit block testing is still necessary when using high-resolution mapping catheters after ablation in high-power short-duration (HPSD) techniques.

Materials and methods

Overall, 114 patients with AF (average age, 65.14 ± 11.3 years; 65.8% male) undergoing radiofrequency PVI were included in the study. Ablation was performed with the HPSD technique using a fixed protocol for energy delivery of 50 W (contact force 3–20 g). Entrance and exit block were tested with a high-resolution mapping catheter. Isolation of the PVs was achieved in all patients.

Results

Capture of local PV tissue was demonstrated in all patients after PVI and exit block was present in all patients after entrance block was detected using a high-resolution mapping catheter.

Conclusion

Exit block testing in addition to the demonstration of an entrance block as an endpoint of PVI seems to have no additional benefit and might no longer be necessary when a high-resolution mapping catheter is used in HPSD ablation for PVI of AF.

Zusammenfassung

Hintergrund

Nach einer Pulmonalvenenisolation (PVI) bei Vorhofflimmern (AF) ist es als Endpunkt üblich, zusätzlich zum Nachweis eines Entrance-Blocks der Erregungsleitung in die Pulmonalvenen (PV) auch einen Exit-Block aus den PV nachzuweisen. Durch den Einsatz hochauflösender Mapping-Katheter können selbst sehr kleine Signale sicher detektiert werden.

Ziel der Arbeit

Es wurde untersucht, ob die zusätzliche Exit-Block-Testung beim Einsatz hochauflösender Mapping-Katheter nach Ablation in High-Power-Short-Duration (HPSD)-Technik noch notwendig ist.

Material und Methoden

Dazu wurden 114 Patienten mit Vorhofflimmern (Durchschnittsalter 65,14 ± 11,3 Jahre; 65,8 % männlich), bei denen eine Hochfrequenz-PVI durchgeführt wurde, in die Studie eingeschlossen. Die Ablation erfolgte in HPSD-Technik unter Verwendung eines festen Protokolls mit Energieabgaben von 50 W (Kontaktkraft 3–20 g). Entrance- und Exit-Block wurden mit einem hochauflösenden Mapping-Katheter getestet. Bei allen Patienten konnten die PV erfolgreich isoliert werden.

Ergebnisse

Durch Stimulation konnte lokales PV-Gewebe bei allen Probanden nach PVI erregt werden, und ein Exit-Block war bei allen Patienten vorhanden, nachdem ein Entrance-Block mittels hochauflösendem Mapping-Katheter nachgewiesen worden war.

Schlussfolgerung

Die Prüfung des Exit-Blocks zusätzlich zum Nachweis eines Entrance-Blocks als Endpunkt einer PVI scheint keinen zusätzlichen Nutzen zu haben und ist möglicherweise nicht mehr erforderlich, wenn ein hochauflösender Mapping-Katheter bei der HPSD-Ablation zur PVI von Vorhofflimmern eingesetzt wird.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Medizinische Klinik II - Kardiologie und Angiologie, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73430, Aalen, Germany

    Sebastian Weyand,  Matthias Beuter &  Peter Seizer

  2. Innere Medizin III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Tübingen, Germany

    David Heinzmann

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  1. Sebastian Weyand
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  4. Peter Seizer
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Correspondence to Sebastian Weyand.

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Conflict of interest

S. Weyand, M. Beuter, D. Heinzmann and P. Seizer declare that they have no competing interests.

Ethical approval was waived by the ethics committee of the Landesärztekammer Baden-Württemberg in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Weyand, S., Beuter, M., Heinzmann, D. et al. High-resolution mapping as an alternative for exit block testing in the presence of entrance block after high-power short-duration pulmonary vein isolation. Herzschr Elektrophys 33, 440–445 (2022). https://doi.org/10.1007/s00399-022-00895-3

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