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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
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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
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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
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Abstract
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Isolation of pulmonary veins with duty-cycled circular multipolar catheter: benefit of using the GOLD catheter
Session:
CO10 - Arritmologia
Speaker:
Pedro Silvério António
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Silvério António; Nuno Cortez Dias; GUSTAVO SILVA; Tatiana Guimarães; Afonso Nunes Ferreira; Ana Rita Francisco; Sílvia Sobral; Ana Bernardes; Céu Barreiros; Joana Quaresma; Luis Alves Carpinteiro; Fausto José Pinto; João Rodrigues De Sousa
Abstract
<p><strong>Introduction</strong>: The PVAC® (Medtronic) <em>duty-cycled</em> circular multi-polar catheter has been developed to provide pulmonary vein isolation (PVI) in a practical, guidewire-guided manner under fluoroscopic control, without the use of electroanatomical mapping systems. The catheter underwent technological improvements (PVAC-GOLD®), with modification of the <em>loop</em> angulation and use of gold electrodes, aimed at improving its efficiency and safety.</p> <p><strong>Objectives</strong>: To evaluate the safety and efficacy of PVAC-GOLD® catheter ablation and to compare it with the first generation of the PVAC® catheter.</p> <p><strong>Methods</strong>: Prospective observational study of patients with AF refractory to antiarrhythmic therapy, submitted to the first PVI procedure with circular multipolar catheter. Acute success was determined by obtaining isolation of each of the pulmonary veins, demonstrating bidirectional blockade. The fluoroscopy time, duration of the procedure and complication rate were compared according to the catheter used: PVAC® versus PVAC-GOLD®.</p> <p><strong>Results</strong>: A total of 281 patients (69.8% males, 58 ± 12 years) were evaluated, of which 91 were treated with PVAC® (32.3%) and 190 with PVAC-GOLD® (67.7% after July 2014). There was persistent AF in 23.1% and persistent long-term AF in 15.7%. Two-way blockade was achieved in 99.5% of pulmonary veins (738/742) with PVAC-GOLD®, and 92.3% (288/312) with PVAC®. The duration of the procedure was lower among the patients treated with PVAC-GOLD® [105 (90-145) vs. 195.5 (143-245) min; P <0.001], as well as the fluoroscopy time [15.5 (12-23) vs. 43 (32.4-54.5) min; P <0.001]. There were major complications in 2.5% of cases, more frequently in vascular access, statistically significant in relation to PVAC® (X<sup>2</sup> = 5.3%, p = 0.02). No patient presented tamponade, but one stroke occurred in each of the groups (0.7%). The overall success rate at 36 months after 1st ablation was 74.8% and 67.1% with PVAC-GOLD® and PVAC, respectively (p = NS). The success rate after multiple ablations was 93.5% and 75.3% with PVAC-GOLD® and PVAC, respectively (Long Rank = 3.4%, p = 0.06).</p> <p><strong>Conclusion</strong>: The new multi-polar PVAC-GOLD® catheter may provide added value in AF ablation, with a tendency for greater efficacy, faster and reducing the need for radiation exposure. Although it is a generally safe technique, it is necessary to monitor the risk of stroke.</p>
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