Abstract
Catheter ablation for atrial fibrillation (AF) is a common treatment strategy in patients with drug-resistant, symptomatic AF. In patients with paroxysmal and short-standing persistent AF, pulmonary vein isolation (PVI) is often enough to prevent recurrence of atrial tachyarrhythmia (ATA). Point-by-point encircling of the PVs with radiofrequency (RF) applications, together with cryoballoon ablation, have been the mainstay strategies for the last 10 to 20 years. Each of these strategies, however, suffers from the delicate balance between preventing PV reconnection, on the one hand (toward more energy), and preventing (mainly esophageal) complications (toward less energy), on the other. The CLOSE protocol was developed as an RF ablation strategy that would result in the safe creation of durable isolation leading to improved outcomes. Basically, the aim of the protocol is to enclose the pulmonary veins with stable, contiguous (intertag distance, ITD ≤ 6 mm) and optimized lesions (35 Watts, W, RF applications up to ablation index targets of ≥400 and ≥550 at the posterior and anterior wall). In this review, we describe the background of the CLOSE protocol and the studies from the St Jan Bruges research group on procedural performance, efficacy, and safety of the CLOSE protocol in (a) single-center prospective PILOT study (CLOSE-PILOT), (b) a single-center prospective study with continuous rhythm monitoring (CLOSE to CURE), (c) a database of systematic esophageal endoscopic studies, (d) a multicenter prospective study (VISTAX), and (e) the CLOSE database (comprising > 400 patients). We also discuss the results of the randomized POWER-AF study comparing conventional CLOSE to high power CLOSE (up to 50 W). Finally, we discuss the performance, safety, and efficacy of the CLOSE protocol in light of the emerging changes in the field of catheter ablation being ultra-short high-power ablation and electroporation.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia worldwide
Database of 500 endoscopies, we observed an ulceration rate of 1.4% (Figure 3). This low ulceration rate after CLOSE-pulmonary vein (PV) isolation (PVI) compares favorably to prior studies reporting a likelihood of esophageal ulceration up to 9.3% after catheter ablation [10]
Left atrial (LA) linear lesion formation is a technique that electrophysiologists use for the ablation of persistent AF and LA macro re-entrant tachycardia
Summary
AF is a complex arrhythmia and may be classified into paroxysmal, persistent, long-standing persistent, or permanent AF, depending on its duration and mode of termination [1]. Management of AF requires a structured, patient-centered approach. Since Haïssaguerre et al stipulated the importance of pulmonary vein (PV) triggers and drivers in the pathogenesis of AF in the late 1990s, PV isolation (PVI) has become the cornerstone of the treatment for patients with paroxysmal and persistent AF [2]. PVI aims at isolating the PVs with durable transmural lesions. PVI can be obtained using point by point radiofrequency energy delivery around the ostia of the pulmonary veins (PVs) or with cryoballoon technology. The need for a standardized, safe, and effective approach for durable isolation arose
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
