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Site localization of painful lesions during radiofrequency ablation of pulmonary veins using circular multi-electrode catheters

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Previous data showed that pain sensation was common during pulmonary vein isolation (PVI) using an 8-mm radiofrequency (RF) ablation catheter. Pain was more common in the left pulmonary veins (PVs). We characterized the location of pain during PVI using circular multi-electrode ablation catheters.

Methods

Included are all consecutive patients with atrial fibrillation (AF) who underwent PVI using the phased RF PVAC® catheter (Medtronic) or the irrigated nMARQ™ catheter (Biosense Webster) under conscious sedation between July 2011 and March 2015. Site of pain reaction was marked for each patient.

Results

A total of 251 patients (141 PVAC®, 110 nMARQ™) were studied; 214 (85 %) had at least one lesion associated with pain. Gender (r = 0.084, p = 0.186), type of AF (r = 0.048, p = 0.452), age (r = 0.078, p = 0.216), and repeat procedure (r = 0.018, p = 0.78) were not correlated with pain. There was no association between site of pain and catheter type; only 33 % of the painful PVs were also the largest ones (p = 0.5, kappa = 0.03, R = −0.083). One-year freedom from AF was similar for patients with and without painful PVs (p = 0.6). The distribution of pain was as follows: 126 (59 %) left superior PV (LSPV), 28 (13 %) left inferior, 28 (13 %) all PVs, 12 (5.6 %) right superior, 12 (5.6 %) right inferior, 18 (8.4 %) left common, and 2 (0.9 %) right common PV.

Conclusions

PVI using multi-electrode catheters more commonly caused pain sensation in LSPV. There was no influence of catheter type or PV size on pain localization. Our findings, which are similar to those using an 8-mm ablation catheter, imply that location of pain is not catheter dependent but rather a reflection of autonomic physiology.

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Acknowledgments

No financial support was received for this study.

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Authors and Affiliations

  1. Electrophysiology Unit, Cardiology Department, Barzilai Medical Center, 2 Hahistadrut Street, Ashkelon, 78306, Israel

    Avishag Laish-Farkash, Amos Katz, Ornit Cohen, Azriel Osherov, Sharon Bruocha & Vladimir Khalameizer

  2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Avishag Laish-Farkash, Amos Katz, Ornit Cohen, Azriel Osherov, Sharon Bruocha & Vladimir Khalameizer

Authors
  1. Avishag Laish-Farkash
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  2. Amos Katz
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  3. Ornit Cohen
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  4. Azriel Osherov
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  5. Sharon Bruocha
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  6. Vladimir Khalameizer
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Corresponding author

Correspondence to Avishag Laish-Farkash.

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The study protocol was approved by our institution review board and was not influenced by Medtronic or Biosense Webster companies.

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All patients provided an informed consent prior to the procedure.

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Laish-Farkash, A., Katz, A., Cohen, O. et al. Site localization of painful lesions during radiofrequency ablation of pulmonary veins using circular multi-electrode catheters. J Interv Card Electrophysiol 45, 63–69 (2016). https://doi.org/10.1007/s10840-015-0065-6

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  • DOI: https://doi.org/10.1007/s10840-015-0065-6

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