Download to read offline
Convergent%20 ablation%20without%20movie
- 1. The Convergent Approachfor theTreatment of Persistent Atrial Fibrillation Bryan Piedad, MD, FACC Wellstar Medical Group
- 2. Atrial Fibrillation • Mostcommon arrhythmia worldwide • Prevalence of atrial fibrillation – 1-2 % estimated prevalence – Increasing incidence with age – Only 12 to 15% of all patients with afib are paroxysmal – Overwhelming majority of patients are persistent • Significant morbidity and mortality • Significant health care costs
- 3.
- 4. Percutaneous Ablation for AtrialFibrillation • Primary strategy in paroxysmal afib is electrical isolation of the pulmonary veins • Good success rate for paroxysmal atrial fibrillation (70 to 80%) • Low complication rate (2-4%) • Minimally invasive
- 5. Wellstar Electrophysiology • Calendaryear 2012 – 130 percutaneous ablations • Calendar year 2013 – 200 percutaneous ablations – Highest volume cryo-ablation center in the Southeast – Top 10 in the country for cryo-ablation volume – Training center for cryo-ablation – Research site for cryo-ablation
- 6. Limitations of PercutaneousAblation • Lower success rates for persistent atrial fibrillation (50% to 60%), especially with enlarged and fibrotic atria • Need for repeat ablation in up to 50% of patients – Average number of procedures is 2.3 per patient • Difficulty in delivering and confirming contiguous lesions • Extensive endocardial lesions and the risk for embolus • Potential esophageal damage and risk for esophageal- atrial fistula formation
- 7. Convergent Approach • Multi-disciplinaryapproach – Cardiac Anesthesiology – Cardiothoracic Surgery • Linear lesions via an epicardial approach • Closed chest, trans-diaphragmatic endoscopic approach – Cardiac Electrophysiology • Percutaneous EP testing and ablation (PVI and CTI ablation)
- 8.
- 9.
- 10. Percutaneous Endocardial Ablation AfterEpicardial Ablation Percutaneous Access Breakthrough Locations @ Pericardial Reflections
- 11. Study % Persistent / LongstandingAF Monitoring Level Procedure Efficacy Redos Serious Adverse Event Rate4 Allegheny CV StudyB AER 2013 N=43 86% Med 2wk Monitors 89% @ 6 mo1 NR 0% 2-Site US CV StudyA Heart Rhythm N=101 83% (Avg CHADS = 2.1) Med Reveal & Holter 79.7% @ 12 mo1 70.5% @ 12 mo1 (Survival Analysis) 6% 6% 4-Site US CV StudyB Boston AF 2012 N=115 83.5% Med 72h Holter 84% @ 11.4 mo1 77% @ 11.4 mo2 64% @ 11.4 mo3 4% 6.1% Slovenia CV StudyA,B Boston AF 2012, JCE N=50 94% High All Reveals 91% @ 1 yr1 78% @ 1 yr3 2% 10.0% OLOL CV StudyB HRS 2012 N=104 73% Med 72h Holter 92% @ 8 mo1 68% @ 8 mo3 4% 0% (5.8% > 30d) CPW CV StudyB HRS 2012 N=39 79% Med 72h Holter 94% @ 12.6 mo1 68% @ 12.6 mo3 6% 2.6% STV CV StudyB HRS 2012 N=61 88% Med 72h Holter 79% @ 11 mo1 66% @ 11 mo3 8% 3.3% 4-Site EU CV StudyD EU Journal N=73 100% High Reveals or 7d Holters 79% @ 1 yr1 4% 11.0% 2-Site CV StudyA Innovations 2011 N=65 92% Med/High Reveal or 24h Holter 88% @ 1 yr1 83% @ 1 yr3 NR 7.7% 1Efficacy = Sinus Rhythm; 2Efficacy = Sinus Rhythm & No AAD Tx; 3Efficacy = Sinus Rhythm & Off AADs, 4Safety = 30-Day Adverse Events APublished Article; BPublished/Presented Abstract; CAccepted Abstract; DSubmitted Article; EAccepted Article Published/Presented Outcomes
- 12. Summary • 1. Highlyeffective therapy for patients with persistent atrial fibrillation that still maintains a minimally invasive approach • 2. Reduction in repeat procedures • 3. Providing a new treatment option for a significant proportion of the afib population which has been somewhat “forgotten” • 4. Marketing opportunity for the health care system, cardiology, cardiac electrophysiology and CT surgery