Key result
Low intensity collimated ultrasound-guided robotic ablation achieved acute pulmonary vein isolation in 98% of veins and 79.6% freedom from atrial arrhythmia recurrence at 12 months.
Why the study?
Existing AF catheter ablation methods are technically challenging or have limited ability to accommodate variable patient anatomy to achieve durable PV isolation.
Does low intensity collimated ultrasound-guided anatomic mapping and robotic ablation safely and effectively achieve pulmonary vein isolation and prevent recurrent atrial arrhythmias in patients with paroxysmal atrial fibrillation?
Does low intensity collimated ultrasound-guided anatomic mapping and robotic ablation safely and effectively achieve pulmonary vein isolation and prevent recurrent atrial arrhythmias in patients with paroxysmal atrial fibrillation?
A novel low-intensity collimated ultrasound-guided robotic ablation system demonstrates feasibility, safety, and efficacy for pulmonary vein isolation in a first-in-human study of paroxysmal atrial fibrillation.
May support novel robotic LICU ablation for paroxysmal AF; leaves open randomized efficacy comparisons versus standard approaches.
BACKGROUND: Catheter ablation for atrial fibrillation (AF) using point-by-point radiofrequency energy or single-application one-shot balloons is either technically challenging or have limited ability to accommodate variable patient anatomy to achieve acute and durable pulmonary vein (PV) isolation. A novel ablation system employs low intensity collimated ultrasound (LICU)-guided anatomic mapping and robotic ablation to isolate PVs. In this first-in-human, single-center, multioperator trial, VALUE trial (VytronUS Ablation System for Treatment of Paroxysmal Atrial Fibrillation; NCT03639597) in patients with paroxysmal atrial fibrillation, this LICU system was evaluated to determine its safety, effectiveness in PV isolation, and freedom from recurrent atrial arrhythmias. METHODS: In the enrolled 52 patients with paroxysmal atrial fibrillation, ultrasound M-mode-based left atrial anatomies were successfully created, and ablation was performed under robotic control along an operator-defined lesion path. The LICU system software advanced over the course of the study: the last 13 patients were ablated with enhanced software. RESULTS: Acute PV isolation was achieved in 98% of PVs-using LICU-only in 77.3% (153/198) of PVs and requiring touch-up with a standard radiofrequency ablation catheter in 22.7% (45/198) PVs. The touch-up rate decreased to 5.8% (3/52) in patients undergoing LICU-ablation with enhanced software. Freedom from atrial arrhythmia recurrence was 79.6% (39/49 patients) at 12 months or 92.3% (12/13 patients) with the enhanced software. Major adverse events occurred in 3 patients (5.8%): one had transient diaphragmatic paralysis, one vascular access complication, and one had transient ST-segment elevation from air-embolism, without sequelae. CONCLUSIONS: In this first-in-human study, low- intensity collimated ultrasound-guided anatomic mapping and robotic ablation allows PV isolation with good chronic safety; PV isolation success is improving with device enhancements. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03639597.
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Turagam et al. (2020) studied paroxysmal atrial fibrillation (n=52). Low intensity collimated ultrasound (LICU)-guided anatomic mapping and robotic ablation was evaluated on Acute pulmonary vein isolation. Low intensity collimated ultrasound-guided robotic ablation achieved acute pulmonary vein isolation in 98% of veins and 79.6% freedom from atrial arrhythmia recurrence at 12 months.
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