Segreti l;de simone a;schillaci v;bongiorni mg;pelargonio g;pandozi c;di cori a;stabile g;pepe m;zucchelli g;shopova g;de lucia r;ferrari c;casati f;malacrida m;solimene f.A novel local impedance algorithm to guide effective pulmonary vein isolation in af patients: preliminary experience across different ablation sites from the charisma pilot study.J cardiovasc electrophysiol; year:2020;date:2020/07/03;volume:31;issue:9;pages:2319-2327.The charisma was a prospective, single-arm, multicenter cohort study designed to describe italian clinical practice regarding the approach to the ablation of different arrhythmias.The study com plied with the declaration of helsinki, the locally appointed ethics committee approved the research protocol, and informed consent was obtained from all patients.From july 2018 to october 2018, 46 consecutive patients indicated for af ablation who underwent high-resolution mapping and ablation in five italian centers were included in our analysis.All patients were followed-up at the same hospital, from the time of the first implantation to the last follow-up visit.After completion of the baseline evaluation, patients underwent the procedure under standard clinical practice guidelines.All procedures were performed under general anesthesia or deep conscious sedation.Vitamin k antagonist treatment was uninterrupted while non-vitamin k anticoagulants were omitted on the morning of the procedure.A decapolar catheter (dynamic xt; boston scientific, marlborough, ma, usa) was used to cannulate the coronary sinus.Single or double transseptal punctures were performed under fluoroscopic guidance, after which intravenous unfractionated heparin boluses were administered to maintain an activated clotting time of >300 s; the basket mapping catheter (orion; boston scientific) and the open-irrigated ablation catheter with three miniature electrodes incorporated within the distal tip electrode (intellanav mifi oi; boston scientific) were then inserted through steerable sheaths.To analyze the impedance information, the isolation line around each pair of pvs was divided into seven distinct sections.Successful single rf ablation was defined according to a reduction signal voltage by at least 50% and the inability to capture local tissue on pacing through the ablation catheter.Unsuccessful lesions were defined as those which resulted in continued ability to capture tissue.The endpoint of ablation was pvi, as assessed by entry and exit block using the 64-pole orion catheter placed sequentially in each of the pvs.The demographic and procedural data for the 46 consecutive patients.About two-thirds of the procedures were de novo pvi (n = 30, 65.2%).As the patient cohort included patients with persistent af (n = 22, 47.8%), the mean left atrium size was relatively large: 43 +/- 5 mm.The mean procedure duration and fluoroscopy times were 182.2 +/- 60 and 19.5 +/- 5 min, respectively.About 3072 rf applications were delivered, with a mean number of 48 +/- 26 ablation spots during a mean rf duration time of 39 +/- 30 s, without any steam popping.No steam pops or major complications, including atrioesophageal fistula or tamponade, were reported during or after the procedures.At the end of the procedures, all pvs were successfully isolated in all study patients.Minor complications were reported in four patients (8.7%) after the procedure: vascular complications in two patients (one groin hematoma and one arteriovenous fistula) and pericarditis with mild pericardial effusion in two patients.Conservative treatment and medical therapy were effective in all cases, without prolongation of hospital stay.During a mean follow- up of 404 +/- 111 days, four patients (9%) suffered af/at recurrence after the blanking period, resulting in a 91% recurrence-free rate of atrial arrhythmias.
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