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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
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15. Valvular Heart Disease
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19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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CLEAR FILTERS
Isolation of pulmonary veins with duty-cycled circular multi-polar catheter: randomized controlled clinical trial
Session:
Posters 1 - Écran 10 - Arritmologia
Speaker:
João Rodrigues De Sousa
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
João Rodrigues De Sousa; Nuno Cortez Dias; Luis Alves Carpinteiro; GUSTAVO SILVA; Inês Gonçalves; Afonso Nunes Ferreira; Joana Quaresma; Ana Bernardes; Sílvia Sobral; Sara Neto; Céu Barreiros; Fausto José Pinto
Abstract
<p><strong>Introduction</strong>: The isolation of the pulmonary veins (PVI) is the central element in the ablation of atrial fibrillation (AF), and can be obtained with different ablation modalities. The <em>duty-cycled</em> circular multi-pole catheter PVAC® (Medtronic) allows linear application of radiofrequency energy, with the production of circumferential lesions. Conceptually, it can make ablation simpler and faster in patients with favorable anatomy.</p> <p><strong>Objectives</strong>: To evaluate the safety and efficacy of ablation with a PVAC® catheter and to compare it with the conventional technique (TCv, point-to-point, with irrigated catheter).</p> <p><strong>Methods</strong>: Clinical trial with single-blinded patients with AF refractory to antiarrhythmic therapy, randomized (1: 1) for ablation with PVAC® or TCv. The ablation strategy consisted of PVI, complemented with ablation of the cavo-tricuspid isthmus in patients with history of concomitant flutter. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by AF-free survival or any maintained supraventricular tachycardia (duration > 30seconds).</p> <p><strong>Results</strong>: 354 patients (67.5% males, 58 ± 12 years, TCv: 175, PVAC: 179) were included, of which 26.2% had persistent AF and 14.7% had long-standing persistent AF, without differences between groups. Among the PVAC treated patients, 98.3% of the pulmonary veins were isolated (620/666), similar to that of the TCv group (697/709, 93.1%). Although the complication rate was similar in both groups (PVAC: 4.9% vs. TCv: 7.8%; P = NS), the risk of hemopericardium was lower with PVAC (0% vs. 4.6%; P = 0.013). Two patients treated with PVAC developed stroke (1.13% vs. 0%; P = NS). The duration of the procedure was lower among the patients treated with PVAC [136 (100-180) vs. 230 (188-270) min; P <0.001], with no difference in fluoroscopy time [24.4 (14.5-36.8) vs. 27.1 (17.0-45.0) min]. The success rate after 1st ablation at 36 months was 68%, with no differences between groups. The success rate after multiple ablations increased to 85.8%, with no differences between groups.</p> <p><strong>Conclusion</strong>: The multipolar PVAC catheter can represent an added value in AF ablation, making the procedure simpler and faster, ensuring similar efficacy to the conventional technique and with a lower risk of cardiac tamponade. The present trial suggests the need for clinically manifested stroke risk surveillance, which may be increased with this technique.</p>
Slides
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