Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation

Hiroshi Nakagawa, Matthias Antz, Tom Wong, Boris Schmidt, Sabine Ernst, Feifan Ouyang, Thomas Vogtmann, Richard Wu, Katsuaki Yokoyama, Deborah Lockwood, Sunny S. Po, Karen J. Beckman, D. Wyn Davies, Karl Heinz Kuck, Warren M. Jackman

Research output: Contribution to journalArticle

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Abstract

PV Antrum Isolation Using HIFU Balloon Catheter. Background: A high-intensity-focused ultrasound balloon catheter (HIFU-BC) is designed to isolate pulmonary veins (PV) outside the ostia (PV antrum). This catheter uses a parabolic CO2 balloon (behind water balloon) to focus a 20-, 25-, or 30-mm diameter ring of ultrasound forward of the balloon (parallel to catheter shaft). The purpose of this study is to test the safety and efficacy of the HIFU-BC for PV antrum isolation in patients with atrial fibrillation (AF). Methods and Results: Twenty-seven patients with paroxysmal (19 patients) or persistent (8 patients) AF were studied. Double transseptal puncture was performed for left atrial deployment of a Lasso catheter (for PV mapping) and the 14 Fr HIFU-BC. The HIFU-BC was positioned outside the PV orifice over a guidewire. HIFU energy (acoustic power 45 watts) was applied for 40 seconds with a 20-mm sonicating ring and 40 or 60 seconds with a 25-mm or 30-mm sonicating ring. No other ablation system was utilized. PV antrum isolation was attempted using HIFU-BC in 78 of 104 PVs (25/27 RSPVs, all 23 LSPVs, all 23 LIPVs, all four left common trunks and 3/27 RIPVs). HIFU-BC successfully isolated 68 (87%) of the 78PV antra with 1-26 (median 3) HIFU applications. The complications include transient bleeding from a distal branch of the left superior PV resulting from guidewire manipulation in one patient and right phrenic nerve injury in another patient. No PV stenosis (>50% narrowing) and no LA-esophageal fistula occurred. At the 12-month follow-up, 16 (59%) of the 27 patients were free of symptomatic episodes of AF (only 3 of the 16 patients were receiving antiarrhythmic medications). Conclusions: Forward-focused HIFU applications isolated PVs outside the PV ostium with elimination of AF in 16 (59%) of the 27 patients at 12 months following the single ablation procedure.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number2
DOIs
StatePublished - Feb 2007

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Patient Isolation
Pulmonary Veins
Atrial Fibrillation
Catheters
Esophageal Fistula
Phrenic Nerve
Patient Rights
Punctures
Acoustics

Keywords

  • Ablation
  • Atrial fibrillation
  • Atrium
  • Electrophysiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation. / Nakagawa, Hiroshi; Antz, Matthias; Wong, Tom; Schmidt, Boris; Ernst, Sabine; Ouyang, Feifan; Vogtmann, Thomas; Wu, Richard; Yokoyama, Katsuaki; Lockwood, Deborah; Po, Sunny S.; Beckman, Karen J.; Davies, D. Wyn; Kuck, Karl Heinz; Jackman, Warren M.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 2, 02.2007, p. 136-144.

Research output: Contribution to journalArticle

Nakagawa, H, Antz, M, Wong, T, Schmidt, B, Ernst, S, Ouyang, F, Vogtmann, T, Wu, R, Yokoyama, K, Lockwood, D, Po, SS, Beckman, KJ, Davies, DW, Kuck, KH & Jackman, WM 2007, 'Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 18, no. 2, pp. 136-144. https://doi.org/10.1111/j.1540-8167.2006.00715.x
Nakagawa, Hiroshi ; Antz, Matthias ; Wong, Tom ; Schmidt, Boris ; Ernst, Sabine ; Ouyang, Feifan ; Vogtmann, Thomas ; Wu, Richard ; Yokoyama, Katsuaki ; Lockwood, Deborah ; Po, Sunny S. ; Beckman, Karen J. ; Davies, D. Wyn ; Kuck, Karl Heinz ; Jackman, Warren M. / Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2007 ; Vol. 18, No. 2. pp. 136-144.
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abstract = "PV Antrum Isolation Using HIFU Balloon Catheter. Background: A high-intensity-focused ultrasound balloon catheter (HIFU-BC) is designed to isolate pulmonary veins (PV) outside the ostia (PV antrum). This catheter uses a parabolic CO2 balloon (behind water balloon) to focus a 20-, 25-, or 30-mm diameter ring of ultrasound forward of the balloon (parallel to catheter shaft). The purpose of this study is to test the safety and efficacy of the HIFU-BC for PV antrum isolation in patients with atrial fibrillation (AF). Methods and Results: Twenty-seven patients with paroxysmal (19 patients) or persistent (8 patients) AF were studied. Double transseptal puncture was performed for left atrial deployment of a Lasso catheter (for PV mapping) and the 14 Fr HIFU-BC. The HIFU-BC was positioned outside the PV orifice over a guidewire. HIFU energy (acoustic power 45 watts) was applied for 40 seconds with a 20-mm sonicating ring and 40 or 60 seconds with a 25-mm or 30-mm sonicating ring. No other ablation system was utilized. PV antrum isolation was attempted using HIFU-BC in 78 of 104 PVs (25/27 RSPVs, all 23 LSPVs, all 23 LIPVs, all four left common trunks and 3/27 RIPVs). HIFU-BC successfully isolated 68 (87{\%}) of the 78PV antra with 1-26 (median 3) HIFU applications. The complications include transient bleeding from a distal branch of the left superior PV resulting from guidewire manipulation in one patient and right phrenic nerve injury in another patient. No PV stenosis (>50{\%} narrowing) and no LA-esophageal fistula occurred. At the 12-month follow-up, 16 (59{\%}) of the 27 patients were free of symptomatic episodes of AF (only 3 of the 16 patients were receiving antiarrhythmic medications). Conclusions: Forward-focused HIFU applications isolated PVs outside the PV ostium with elimination of AF in 16 (59{\%}) of the 27 patients at 12 months following the single ablation procedure.",
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AU - Nakagawa, Hiroshi

AU - Antz, Matthias

AU - Wong, Tom

AU - Schmidt, Boris

AU - Ernst, Sabine

AU - Ouyang, Feifan

AU - Vogtmann, Thomas

AU - Wu, Richard

AU - Yokoyama, Katsuaki

AU - Lockwood, Deborah

AU - Po, Sunny S.

AU - Beckman, Karen J.

AU - Davies, D. Wyn

AU - Kuck, Karl Heinz

AU - Jackman, Warren M.

PY - 2007/2

Y1 - 2007/2

N2 - PV Antrum Isolation Using HIFU Balloon Catheter. Background: A high-intensity-focused ultrasound balloon catheter (HIFU-BC) is designed to isolate pulmonary veins (PV) outside the ostia (PV antrum). This catheter uses a parabolic CO2 balloon (behind water balloon) to focus a 20-, 25-, or 30-mm diameter ring of ultrasound forward of the balloon (parallel to catheter shaft). The purpose of this study is to test the safety and efficacy of the HIFU-BC for PV antrum isolation in patients with atrial fibrillation (AF). Methods and Results: Twenty-seven patients with paroxysmal (19 patients) or persistent (8 patients) AF were studied. Double transseptal puncture was performed for left atrial deployment of a Lasso catheter (for PV mapping) and the 14 Fr HIFU-BC. The HIFU-BC was positioned outside the PV orifice over a guidewire. HIFU energy (acoustic power 45 watts) was applied for 40 seconds with a 20-mm sonicating ring and 40 or 60 seconds with a 25-mm or 30-mm sonicating ring. No other ablation system was utilized. PV antrum isolation was attempted using HIFU-BC in 78 of 104 PVs (25/27 RSPVs, all 23 LSPVs, all 23 LIPVs, all four left common trunks and 3/27 RIPVs). HIFU-BC successfully isolated 68 (87%) of the 78PV antra with 1-26 (median 3) HIFU applications. The complications include transient bleeding from a distal branch of the left superior PV resulting from guidewire manipulation in one patient and right phrenic nerve injury in another patient. No PV stenosis (>50% narrowing) and no LA-esophageal fistula occurred. At the 12-month follow-up, 16 (59%) of the 27 patients were free of symptomatic episodes of AF (only 3 of the 16 patients were receiving antiarrhythmic medications). Conclusions: Forward-focused HIFU applications isolated PVs outside the PV ostium with elimination of AF in 16 (59%) of the 27 patients at 12 months following the single ablation procedure.

AB - PV Antrum Isolation Using HIFU Balloon Catheter. Background: A high-intensity-focused ultrasound balloon catheter (HIFU-BC) is designed to isolate pulmonary veins (PV) outside the ostia (PV antrum). This catheter uses a parabolic CO2 balloon (behind water balloon) to focus a 20-, 25-, or 30-mm diameter ring of ultrasound forward of the balloon (parallel to catheter shaft). The purpose of this study is to test the safety and efficacy of the HIFU-BC for PV antrum isolation in patients with atrial fibrillation (AF). Methods and Results: Twenty-seven patients with paroxysmal (19 patients) or persistent (8 patients) AF were studied. Double transseptal puncture was performed for left atrial deployment of a Lasso catheter (for PV mapping) and the 14 Fr HIFU-BC. The HIFU-BC was positioned outside the PV orifice over a guidewire. HIFU energy (acoustic power 45 watts) was applied for 40 seconds with a 20-mm sonicating ring and 40 or 60 seconds with a 25-mm or 30-mm sonicating ring. No other ablation system was utilized. PV antrum isolation was attempted using HIFU-BC in 78 of 104 PVs (25/27 RSPVs, all 23 LSPVs, all 23 LIPVs, all four left common trunks and 3/27 RIPVs). HIFU-BC successfully isolated 68 (87%) of the 78PV antra with 1-26 (median 3) HIFU applications. The complications include transient bleeding from a distal branch of the left superior PV resulting from guidewire manipulation in one patient and right phrenic nerve injury in another patient. No PV stenosis (>50% narrowing) and no LA-esophageal fistula occurred. At the 12-month follow-up, 16 (59%) of the 27 patients were free of symptomatic episodes of AF (only 3 of the 16 patients were receiving antiarrhythmic medications). Conclusions: Forward-focused HIFU applications isolated PVs outside the PV ostium with elimination of AF in 16 (59%) of the 27 patients at 12 months following the single ablation procedure.

KW - Ablation

KW - Atrial fibrillation

KW - Atrium

KW - Electrophysiology

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