Impact of ablation index settings on pulmonary vein reconnection

2021 ◽  
Author(s):  
A. Lepillier ◽  
T. Strisciuglio ◽  
E. De Ruvo ◽  
M. Scaglione ◽  
M. Anselmino ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Ablation Index ◽  
Pulmonary Vein Reconnection

scholarly journals Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation

2020 ◽  
Vol 29 ◽  
pp. 100574
Author(s):  
Mark J. Mulder ◽  
Michiel J.B. Kemme ◽  
Amaya M.D. Hagen ◽  
Luuk H.G.A. Hopman ◽  
Peter M. van de Ven ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Fibrillation Ablation ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
Pulmonary Vein Reconnection

scholarly journals High- power radiofrequency ablation guided by ablation index for pulmonary vein isolation

2020 ◽  
Author(s):  
Xuefeng Zhu ◽  
Chunxiao Wang ◽  
Jianping Li ◽  
Wenjing Li ◽  
Hongxia Chu ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Anterior Wall ◽  
Maximum Diameter ◽  
Ablation Index ◽  
Adenosine Administration ◽  
Rf Applications ◽  
Posterior Anterior ◽  
Pulmonary Vein Reconnection

Abstract Background Proposed to facilitate pulmonary vein isolation (PVI), high-power ablation may cause extracardiac damage. This study evaluated the safety and efficacy of ablation index (AI) guided high-power ablation first in an animal model and subsequently in a clinical study. Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50W, 40W and 30W; AI = 500), and in 100 consecutive patients with paroxysmal atrial fibrillation undergoing PVI (40W [last n = 50] vs. 30 W [first n = 50]; target AI = 400/500 on posterior/anterior wall, respectively). Acute PV reconnection was assessed post adenosine administration 20 minutes after ablation. Results In swine ventricular endocardial RF applications, use of 50W and 40W vs. 30W was associated with greater tissue lesion depth (5.06 ± 0.16 and 4.38 ± 0.13 mm vs. 3.95 ± 0.16 mm; P < 0.001) and smaller lesion maximum diameter (7.81 ± 0.15 and 8.42 ± 0.18 mm vs. 9.08 ± 0.15 mm; P < 0.001). Tissue necrosis caused by 50W vs. 40W and 30W was the deepest and largest (3.15 ± 0.18 mm vs. 2.71 ± 0.17 and 2.42 ± 0.13 mm; and 5.58 ± 0.18 mm vs. 5.18 ± 0.16 and 3.94 ± 0.17 mm; respectively; P < 0.001). In PVI, use of 40W vs. 30W was associated with shorter procedure time (56.54 ± 1.81 min vs. 76.55 ± 2.34 min; p < 0.001) and ablation time (35.85 ± 14.87 min vs. 51.01 ± 17.99 min; p < 0.001); lower RF energy per point (909.02 ± 354.57J vs. 1045 ± 376.60J; p < 0.001); higher first-pass PVI (87% vs. 72%; P < 0.01); lower acute PV reconnection (22% vs. 41%; P < 0.01); no complications in either group; and similar sinus rhythm maintenance at 12 months (92% vs. 84%; P = 0.22). Conclusions AI-guided high-power (40W) vs. conventional (30W) PVI was related to a reduced time for procedure and was considered safe, with diminished acute pulmonary vein reconnection.

666Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after ablation index-guided ablation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M J Mulder ◽  
M J B Kemme ◽  
L H G A Hopman ◽  
H A Hauer ◽  
G J M Tahapary ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Wall ◽  
Time Integral ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
Force Time ◽  
Pulmonary Vein Reconnection ◽  
Force Time Integral

Abstract Background/Introduction Pulmonary vein reconnection is considered a major determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Ablation Index (AI)-guided ablation allows for the creation of ablation lesions of consistent depth and may reduce the incidence of pulmonary vein reconnection after PVI. However, anatomical and imaging studies have demonstrated an important inter- and intra-patient variability of left atrial wall thickness, which can result in non-transmural ablation lesion formation in thicker segments. Purpose The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after AI-guided AF ablation. Methods Consecutive AF patients who underwent cardiac computed tomography (CT) imaging prior to AI-guided ablation between December 2017 and September 2019 were studied. AI targets were 500 for anterior/roof and 380 for posterior/inferior segments with a maximum interlesion distance of 6 mm. Occurrence of acute pulmonary vein reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were analysed offline to determine minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance for each segment according to a 16-segment model. Pulmonary vein antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units, using a previously described method. Results Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Acute reconnection (AR) occurred in 27/1152 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 17/70 (24%) patients. Anterior/roof segments were thicker than posterior/inferior segments (1.48 [1.23-1.80] vs. 1.13 [1.00-1.30] mm; p &lt; 0.01). Reconnected segments were characterised by a greater local atrial wall thickness, both in anterior/roof (1.83 [1.60-2.00] vs. 1.47 [1.20-1.80] mm; p &lt; 0.01) and posterior/inferior (1.38 [1.25-1.50] vs. 1.13 [1.00-1.27] mm; p &lt; 0.01) segments (Figure 1). Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute pulmonary vein reconnection. Conclusion Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualised AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent pulmonary vein reconnection after PVI. Abstract Figure. Impact of wall thickness on reconnection

scholarly journals Performance and Safety of Temperature- and Flow-Controlled Radiofrequency Ablation in Ablation Index–Guided Pulmonary Vein Isolation

2021 ◽  
Vol 7 (3) ◽  
pp. 408-409
Author(s):  
Alexandre Almorad ◽  
Jean-Yves Wielandts ◽  
Milad El Haddad ◽  
Sébastien Knecht ◽  
René Tavernier ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Ablation Index

Anatomic predictors of late right inferior pulmonary vein reconnection in the setting of second‐generation cryoballoon ablation

2019 ◽  
Vol 30 (11) ◽  
pp. 2294-2301
Author(s):  
Muryo Terasawa ◽  
Gian‐Battista Chierchia ◽  
Ken Takarada ◽  
Alessandro Rizzo ◽  
Riccardo Maj ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Second Generation ◽  
Cryoballoon Ablation ◽  
Inferior Pulmonary Vein ◽  
Pulmonary Vein Reconnection

Limitations of Dormant Conduction as a Predictor of Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection after Catheter Ablation

2015 ◽  
Vol 38 (5) ◽  
pp. 598-607 ◽  
Author(s):  
FRANK S. LIN ◽  
JAMES E. IP ◽  
STEVEN M. MARKOWITZ ◽  
CHRISTOPHER F. LIU ◽  
GEORGE THOMAS ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Atrial Fibrillation Recurrence ◽  
Dormant Conduction ◽  
Pulmonary Vein Reconnection
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