New technology offers significant potential benefits to patients undergoing catheter ablation for atrial fibrillation
THE Blackrock Clinic has become the first hospital in Ireland to use a novel ultra-cold curvilinear catheter ablation system to treat patients with atrial fibrillation.
Atrial fibrillation, or also known as AF, is an irregular and often rapid heart rhythm. It is the most common sustained cardiac arrhythmia with a growing prevalence.
When undetected and untreated, AF in some patients can lead to potential complications including stroke or heart failure. Furthermore, AF is associated with a small reduction in longevity and an associated increased incidence of dementia.
A key component of catheter ablation of AF is electrical isolation of the pulmonary veins from the left atrium. Conventional catheter ablation of AF is achieved by thermal (radiofrequency) or cryothermal energy. Cryo-balloons have been used for many years. They can achieve low temperatures in the heart muscle and isolate the pulmonary veins.
Recently, a novel technology has been developed to achieve much lower temperatures (well below minus 120°C) in the targeted heart muscle to achieve pulmonary vein isolation.
This novel technology (iCLAS – Adagio, CA, USA) uses nitrogen near its liquid-vapour critical point. It is a freezing source delivered through a curvilinear ablation element. The configuration and orientation of the curvilinear element in the heart is controlled by an exchangeable stylet and a deflectable sheath.
Professor David Keane, director of the cardiac electrophysiology service at the Blackrock Clinic spoke about the device
He explained there are advantages of the novel system. They include the efficiency of the ultra-cold ablation system, the flexibility and subsequent conformability of the curvilinear ablation element. This is to adopt to the patient’s atrial anatomy. It is as well as the incorporation of a warming balloon to protect the oesophagus.
Catheter ablation of atrial fibrillation works best in patients with early disease. Therefore, it is more effective in patients with paroxysmal AF and is considerably less effective in patients with long-standing persistent AF.
A sub-analysis of the largest randomised trial of AF ablation indicated no prognostic benefit of AF ablation in patients over 75 years of age. In this older cohort the only indication for ablation would be for the relief of symptoms not relieved by medication.
In contrast, for selected patients under 75 years of age AF ablation can be associated with a significant improvement in outcome over a five year follow-up period.
Prior to consideration of ablation, patients with AF need to be assessed for anticoagulation. This is as well as control of risk factors contributing to AF. This is including smoking cessation, weight management, exercise, alcohol consumption and blood pressure management.
Professor Keane and the team at Blackrock Clinic carried out the first procedure using iCLAS in February.
The hospital’s CEO James O’Donoghue said that this demonstrated Blackrock’s ongoing commitment to making industry-leading technology available to Irish patients at the earliest opportunity.
“There are indicators suggesting that the number of people who develop AF will increase significantly in coming years. So, Irish patients need to know that the best possible care is available to them.
“Once again, Blackrock Clinic is proud to be the first Irish hospital to make this available. Our talented and dedicated staff will continue to provide world-class cardiology care and treatment long into the future,” O’Donoghue said.
“This novel technology comes at an exciting time for cardiac electrophysiology (EP), with the further development of new technology such as pulse field ablation (PFA) which is also due to start in Blackrock Clinic this year. So, to support these new technologies, the hospital is currently building a third dedicated EP cath lab which will be in operation by November of this year.”
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