We discontinued all antiarrhythmic drugs for, at least, 5 half‐lives, and no patient received oral amiodarone before ablation. Moreover, antiarrhythmic drugs were not resumed after ablation. We used the NavX System (St. Jude Medical Inc., St. Paul, MN) for ablation. The esophageal temperature monitoring system (SensiTherm, St. Jude Medical, Inc.) was used to provide intra‐esophageal temperature feedback. Sheath introducers were inserted through the right femoral vein under sedation. We performed the trans‐septal procedure and advanced three 8‐F SL0 sheaths (St. Jude Medical, Inc.) or two 8‐F SL0 sheaths and a steerable sheath (Agilis, St. Jude Medical, Inc.) into the left atrium. After the trans‐septal puncture, a single bolus of 5000 U of heparin was administered. A continuous infusion with heparinized saline was performed to maintain an activated clotting time of 300‐350 seconds. Pulmonary vein isolation was performed with 3D mapping and guidance using two 7‐F decapolar circular catheters (Lasso and Libero), which were positioned at the ipsilateral pulmonary vein ostia. The procedure was completed with cavotricuspid isthmus ablation. Each radiofrequency application was performed for 30‐50 s, the temperature was limited to 42°C and power to 30 W. We used the maximum power of 25 W while delivering energy to sites near the esophagus.
Agilis
Manufactured by Abbott
Sourced in United States, Sao Tome and Principe
The Agilis is a lab equipment product by Abbott. It is designed to automate various laboratory processes, enabling efficient and consistent handling of samples and reagents. The core function of the Agilis is to streamline and standardize laboratory workflows, but a detailed description of its intended use is not available.
Automatically generated - may contain errors
Lab products found in correlation
Sensitherm, by Abbott (2 mentions)
Ensite navx, by Abbott (2 mentions)
Flexcath advance, by Medtronic (2 mentions)
Navx system, by Abbott (1 mentions)
8 f sl0 sheaths, by Abbott (1 mentions)
Inquiry optima, by Abbott (1 mentions)
Daig sl1, by Abbott (1 mentions)
Ensite navx velocity, by Abbott (1 mentions)
Soundstar, by Johnson & Johnson (1 mentions)
Uhs 20, by Biotronik (1 mentions)
Thermocool smarttouch sf, by Johnson & Johnson (1 mentions)
Carto 3, by Johnson & Johnson (1 mentions)
Sl0 sheath, by Abbott (1 mentions)
Pentaray, by Johnson & Johnson (1 mentions)
Vizigo, by Johnson & Johnson (1 mentions)
Selectsecure, by Medtronic (1 mentions)
Carto system, by Johnson & Johnson (1 mentions)
Navistar thermocool, by Johnson & Johnson (1 mentions)
Ensite navx system, by Abbott (1 mentions)
Hd grid, by Abbott (1 mentions)
22 protocols using agilis
1
Pulmonary Vein Isolation with Esophageal Monitoring
2
Pulmonary Vein Isolation via Transseptal Approach
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In contrast to the phased RF ablation groups, access to the left atrium (LA) was achieved by performing two separate transseptal punctures (TSP). A non-steerable sheath (Daig SL1; St. Jude Medical, St. Paul, Minnesota, USA) for advancing the diagnostic circular decapolar catheter (Inquiry Optima; St. Jude Medical), and a deflectable long sheath (Agilis; St. Jude Medical) for the ablation catheter were placed in the LA. Management of anticoagulation including ACT measurements and heparin dosage were identical with the phased RF groups. After selective, simultaneous angiography of the ipsilateral PVs and acquisition of the individual three-dimensional anatomy of the LA (Ensite NavX Velocity; St. Jude Medical, with image integration), antral circumferential RF ablation around ipsilateral PVs using a 4 mm open-tip irrigated catheter (IBI Therapy Coolpath Duo; St. Jude Medical) was performed. Maximum power was set to 30W, going selectively up to 40W if PVI could not be achieved, especially at the anterior ridge border of the lateral PVs. Temperature was limited to 43°C. Irrigation was adjusted manually between 17 and 30 mL/min. Electrical cardioversion was performed if the patient remained in AF after PVI.
3
Mapping Pulmonary Vein Potentials
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A steerable 8Fr sheath was used for LA mapping (Agilis, St. Jude Medical, St. Paul, MN, USA). A 7Fr decapolar circular mapping catheter (Biosense Webster, Palo Alto, CA, USA) was advanced into the RSPV-LA junction for recording of PV potentials. Recordings were obtained in sinus rhythm and during pacing. Electroanatomical mapping of the LA, RSPV-LA junction, CS, and right atrium adjacent to the RSPV was conducted. The atrial electrogram from CS 1–2 was used as reference. Bipolar voltage of endocardial target tag-points before and after irradiation was compared.
4
Amiodarone Pretreatment for Transseptal Puncture
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This study was performed in six 60–75 kg Topigs Norsvin pigs. The animals were given amiodarone 1200 mg/day starting 7 days before the procedure. The animals were sedated, intubated, and anaesthetized according to a standardized protocol.4 (link) A patch electrode (7506, Valley Lab Inc., Boulder, CO, USA) was placed on a shaven area at the lower back and served as indifferent electrode. Intravenous heparin was administered to maintain an activated clotting time of >350 s. Under fluoroscopic guidance, via the right femoral vein, transseptal puncture was performed using a deflectable sheath (Agilis, St. Jude Medical, Minnetonka, MN, USA). Using a Swan-Ganz catheter, the cardiac output was measured and stored during the experiments.
5
Pulmonary Vein Isolation with Thermal Monitoring
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CA was performed using an open irrigated-tip ablation catheter (IBI Therapy Cool Path Duo or IBI Therapy Cool Flex) and a circular mapping catheter (IBI Inquiry Optima), which were positioned in the left atriumafter double trans-septal puncture under fluoroscopic guidance. A steerable sheath (Agilis, St. Jude Medical) was used in all procedures to support manipulation and stability of the ablation catheter. The geometry of the left atrium was reconstructed using a 3D mapping system (Ensite NavX, St. Jude Medical). Wide area circumferential pulmonary vein isolation was carried out with the irrigated-tip catheter with a maximal power of 35 W and a maximal temperature of 43°C. The course of the oesophagus was identified using a SensiTherm (St. Jude Medical) thermal probe. Radio frequency (RF) delivery was terminated and continued with decreased power whenever the oesophageal temperature exceeded 39°C. Complete isolation of all pulmonary veins was thoroughly verified by the circular catheter. Besides pulmonary vein isolation, additional ablation lesions such as LA linear lesion (LA roof line and mitral isthmus line) and ablation of regions with complex fractionated electrograms were placed in case AF could not be electrically cardioverted after pulmonary vein isolation.
6
Catheter Ablation for Atrial Fibrillation
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After confirming the anatomic position of the esophagus by asking patients to swallow contrast medium, all patients underwent the catheter ablation procedure in the fasting state under local anesthesia and conscious sedation with dexmedetomidine and thiamylal. Respiratory management devices, such as a nasal airway device and adaptive servo ventilation, were used at the operator’s discretion. A 6-Fr, double-decapolar, steerable catheter (BeeAT; Japan Lifeline, Tokyo, Japan) was inserted into the coronary sinus via the right internal jugular vein. An 8-Fr SoundStar ultrasound catheter (Biosense Webster) was inserted into the right atrium (RA) via the right femoral vein and the anatomy of the LA was mapped using the CartoSound module in the CARTO3 system. After transseptal puncture under intracardiac echocardiography, 2 8.5-Fr long sheaths (SL0; St. Jude Medical, St. Paul, MN, USA) were inserted into the LA. In patients with persistent AF, an 8.5-Fr deflectable sheath (Agilis; St. Jude Medical) was used at the operator’s discretion. Patients were injected with 3,000 units heparin before the transseptal puncture, with an addition 5,000 units heparin immediately after the transseptal puncture, followed by repetitive injection of 1,000–2,000 units heparin to maintain an activated clotting time >300 s during the procedure.
7
Porcine Electrophysiology Mapping Procedure
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The experimental setup has been described before12 (link)–14 (link). Briefly, landrace pigs (n = 9, 54 ± 6 kg) were fasted overnight, premedicated with midazolam and ketamine, intubated and mechanically ventilated. Anaesthesia was continued with sevoflurane, fentanyl, midazolam, pancouronium and ketamine.
Sheaths were introduced into both carotid arteries, internal jugular veins and femoral veins. A quadripolar stimulation catheter was positioned in the high right atrium (Response 6F, St. Jude Medical, Saint Paul, MN, USA), a decapolar reference catheter (6 F Dynamic Tip Steerable Catheter, Bard Electrophysiology, Lowell, MA, USA) in the coronary sinus and a steerable sheath (Agilis, St. Jude Medical, Lowell, MN, USA) with a quadripolar mapping catheter (Thermocool, Biosense Webster, Johnson & Johnson, Irvine, CA, USA) first in the right atrium and subsequently in the left atrium after transseptal puncture. Pacing was performed over the quadripolar stimulation catheter in the RA and the quadripolar mapping catheter in the LA using an external stimulator (UHS20, Biotronik, Germany).
Sheaths were introduced into both carotid arteries, internal jugular veins and femoral veins. A quadripolar stimulation catheter was positioned in the high right atrium (Response 6F, St. Jude Medical, Saint Paul, MN, USA), a decapolar reference catheter (6 F Dynamic Tip Steerable Catheter, Bard Electrophysiology, Lowell, MA, USA) in the coronary sinus and a steerable sheath (Agilis, St. Jude Medical, Lowell, MN, USA) with a quadripolar mapping catheter (Thermocool, Biosense Webster, Johnson & Johnson, Irvine, CA, USA) first in the right atrium and subsequently in the left atrium after transseptal puncture. Pacing was performed over the quadripolar stimulation catheter in the RA and the quadripolar mapping catheter in the LA using an external stimulator (UHS20, Biotronik, Germany).
8
Catheter Ablation for Perimitral Atrial Tachycardia
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All procedures were performed under general anesthesia. In the majority of patients, the procedure was performed under uninterrupted anticoagulation. Using trans-septal access guided by transesophageal echocardiography, catheters were inserted into the left atrium via irrigated sheaths (SL0 sheath and Agilis; St Jude Medical Inc., St Paul, MN, USA). 3D-electroanatomical mapping of the left atrium was performed using a navigation system (CARTO3™; Biosense Webster Inc., Diamond Bar, CA, USA) and a duo decapolar electrode catheter (Pentaray®; Biosense Webster Inc., Diamond Bar, CA, USA). A contact force catheter with an advanced irrigated porous tip (ThermoCool Smarttouch SF™; Biosense Webster Inc., Diamond Bar CA, USA) was used for ablation. Irrigating rate during ablation was 15 ml/min. 3D-electroanatomical mapping was performed after identification of P-waves on the surface electrocardiogram. The end of the window of interest was set at the end of the P-wave [12] . Atrial signal on the CS electrograms was used as the reference signal. Diagnosis of PMAT was established by activation mapping and entrainment. The ablation strategy involved MI ablation and pulmonary vein isolation (PVI) for patients that underwent a first procedure, or when reconnection was observed for patients that underwent a second or a third procedure.
9
Mapping and Ablation of Atrial Tachycardia
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Electrophysiological study and mapping with the Rhythmia system was performed as described previously. [2] (link)[3] (link)[4] (link)8 (link) Antiarrhythmic medications were discontinued >5 half-lives before ablation with the exception of amiodarone. A steerable decapolar catheter was introduced within the coronary sinus (CS). If patients were in sinus rhythm (SR) at the beginning of the procedure, AT was induced with burst pacing regardless of reconduction or block of previous pulmonary vein (PV) or linear lesions. ATs were mapped with the Orion multipolar basket catheter with support from a steerable long sheath (Agilis; St. Jude Medical or Zurpaz; Boston Scientific). An activation map was created under standard automatic beat acceptance criteria based on (1) cycle length (CL) variation, (2) activation time difference variations between the CS electrograms, (3) catheter motion, (4) electrogram stability, (5) catheter tracking quality, and (6) respiration gating. Although the dense scar threshold was nominally set at 0.03 mV as a confidence mask parameter, it was manually lowered to be as close as possible to the noise threshold, to allow visualization of the entire circuit. [2] (link)[3] (link)[4] (link)8 (link) Nonstandard Abbreviations and Acronyms WHAT THE STUDY ADDS?
10
Atrial Fibrillation Ablation Procedure
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All patients underwent an AF ablation procedure in a fasting state under local anesthesia and conscious sedation with dexmedetomidine and thiamylal. Respiratory management devices, such as a nasal airway device and adaptive servo-ventilation, were used at the operator’s discretion. A 6Fr, double-decapolar, steerable catheter (BeeAT; Japan Lifeline Co., Tokyo, Japan) was inserted into the coronary sinus via the right internal jugular vein. An 8 Fr Carto SoundStar® was inserted into the right atrium via the right femoral vein, and the LA-3D geometry was created by the CartoMerge™ module, which was thereafter integrated with the 3D LA CT image. Under ICE guidance, the transseptal puncture was performed and an 8.5Fr long sheath (SL0; St. Jude Medical, St. Paul, MN, SA) and an 8.5Fr steerable sheath (Agilis; St. Jude Medical or VIZIGO, Biosense Webster) were inserted into the LA. For anticoagulation during the procedure, 3000 units of heparin were injected before and 5000 units just after the transseptal puncture, followed by repetitive administration of 1000–2000 units of heparin to maintain an activated clotting time > 300 s during the procedure. No esophageal temperature monitoring was done in this study.
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