Bie, J.C. de (Jippe Christiaan) (2021) High Definition (HD) Grid guided ablative treatment for drug-resistant Atrial Fibrillation. thesis, Medicine.
Full text available on request.Abstract
Background information - Atrial Fibrillation (AF) is the most common cardiac arrhythmia seen worldwide, with a growing prevalence as the population grows older. Therapeutic steps towards the treatment of this arrhythmia can be taken in a wide variety of options. Extensive trials have shown that most patients with AF who undergo therapy for rate control benefit equally from rhythm control. Nonetheless, some patients do not endure AF well and require additional treatment in the form of ablative therapy. Ablation for AF is a rapidly evolving field, varying from surgical Cox-MAZE procedures to more localized ablative lesions. Comparing success rates of ablative therapy for different arrhythmias, the success rate for AF ablation is 63-75% and arguably one of the lower ones. In 2018 a new catheter was released, the High Definition Grid (HDG) catheter with a grid-patterned electrode configuration for HD wave bipolar registration in any directionality of the splines. Alongside, limited clinical data (n=99) was provided, showing the difference between a 10-pole circular mapping catheter (CMC10), a CMC20, and the Advisor HDG mapping catheter. The 10 and 20 pole CMCs showed an average of 36-39% of gaps in patients who underwent pulmonary vein isolation (PVI), compared with almost 82% of gaps revealed by the HDG system. Methods - The department of cardiology of Isala Hospital, Zwolle, the Netherlands, set up a study to evaluate its value and virtues. The study population consisted of 251 participants, of which 69% were diagnosed with Paroxysmal AF (PAF) and 31% with either Persistent (PersAF) or Longstanding persistent AF (LSPAF). Over 53% of the study population had an ablative procedure prior to the study procedure. Follow-up was recorded up to 6 months after the procedure. Outcomes were measured by the number of recurrences (after three months), re-do procedures, and complication rate. Results - For the PAF and PersAF group, recurrences were seen in respectively 27.7% and 41% of cases. The number of recurrences does not necessarily signify a failed procedure; a part of the patients with recurrence were now able to tolerate their arrhythmia. The percentage of patients that opted for a re-do procedure in PAF and PersAF were 15% and 24%, respectively. Serious complications such as cardiac tamponade, sudden onset of iatrogenic arrhythmia, or otherwise procedure-related incidents were 8% in the PAF group and, consequently, 1.3% in the PersAF group. Conclusion - Comparing the outcomes to literature, the HDG catheter shows to be an effective method of ablation. However, additional research is required to show that it surpasses other tools used for ablation.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Elvan, dr. A. and Ramdjan, dr. T.T.T.K. and Daniels, F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 03 Jan 2022 11:10 |
| Last Modified: | 03 Jan 2022 11:10 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2923 |
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