scholarly journals The role of a difference between target and actual ablation index values for first-pass point-by-point pulmonary vein isolation: results from a multicenter prospective registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
NZ Gasimova ◽  
EB Kropotkin ◽  
EA Ivanitsky ◽  
GV Kolunin ◽  
AA Nechepurenko ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Significant Proportion ◽  
Mean Values ◽  
Af Ablation ◽  
Ablation Index ◽  
Number Of Patients ◽  
Target Values ◽  
Significant Difference ◽  
First Pass ◽  
Anterior Segments

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Ministry of Science and Higher Education grant (Russian Federation President Grant) Background/Introduction. Pulmonary vein electrical isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation. The Ablation Index (AI) aims to improve the efficacy and safety of radiofrequency (RF) PVI. First-pass isolation (FPI) is an indicator of PVI acute success. Target AI is being calculated for every operator as a mean value (usually, differently for anterior and posterior left atrial (LA) segments) following several "ideal" first-pass PVI procedures. However, adherence to target values, as well as its clinical importance, are unknown. Purpose. The aim of the present study was to evaluate the difference between the target and actual AI in the real practice. Methods. This work represents data from the Prospective Multicenter AF Ablation Registry. Data were collected using a web-based system. PVI procedures were performed according to the local practice, and RF ablation settings depended on operators’ preferences. Between January 2019 and December 2020, a total of 446 patients were enrolled from 7 centers, 407 of them underwent first-time AF ablation and were included into the analysis (mean age 61 ± 9 years old; 226 (55%) males; 313 (76%) with paroxysmal AF). FPI was determined as PVI achieved after circular ablation around PVs without additional applications plus persistence of bidirectional block over a 20-minute waiting period. Therefore, patients were divided in two groups: Group 1 (FPI, n = 242) and Group 2 (non-FPI, n = 165). Results. There was a significant difference between target (the mean target AI for the anterior LA segments was 438 ± 58 and 390 ± 27 for the posterior segments) and actually achieved mean AI (406 ± 33 for anterior segments and 389 ± 34 for posterior segments) with a greater difference for anterior segments (Δ 26 (95% CI [19; 32], p = 0,0001) than for posterior (Δ 4 (95% CI [0,2; 8], p = 0,042). The number of patients with a mean actual AI lower than a target value on the anterior and posterior LA walls was 219 (54%) and 171 (42%), respectively. In the FPI group higher mean values of target AI were present (FPI 444 ± 52 for anterior and 393 ± 27 for posterior LA segments vs non-FPI 432 ± 51 (p = 0,04) and 387 ± 23 (p = 0,01), respectively). The FPI group was characterized by higher mean actual AIs on anterior segments (FPI 410 ± 36 vs non-FPI 399 ± 25, p = 0,0001). There was no difference between groups in actual AI on the posterior wall (391 ± 27 vs 386 ± 41, p = 0,1). The non-FPI group was characterized by a higher proportion of subjects with hypertension (87% vs 69%, p = 0,0001) and a lower number of subjects with central obesity (body mass index≥30 in 48% vs 57%, p = 0,04). Conclusion(s). According to our prospective multicenter data, target AI is not achieved in a significant proportion of patients during PVI. This is associated with acute PV electrical reconduction and the necessity in additional ablations. FPI can be achieved more frequently when a higher mean AI value is achieved.

scholarly journals Randomized study defining the optimum target interlesion distance in ablation index-guided atrial fibrillation ablation

EP Europace ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. 1480-1486
Author(s):  
Philipp Hoffmann ◽  
Ivan Diaz Ramirez ◽  
Gerd Baldenhofer ◽  
Karl Stangl ◽  
Lluís Mont ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Study Protocol ◽  
Randomized Study ◽  
Procedure Time ◽  
Af Ablation ◽  
Study Protocols ◽  
Ablation Index ◽  
First Pass ◽  
First Time

Abstract Aims While the CLOSE protocol proposes a maximally tolerable interlesion distance (ILD) of 6 mm for ablation index ablation index-guided atrial fibrillation (AF) ablation, a target ILD has never been defined. This randomized study sought to establish a target ILD for ablation index-guided AF ablation. Methods and results Consecutive patients scheduled for first-time pulmonary vein (PV) isolation (PVI) were randomly assigned to ablation protocols with a target ILD of 5.0–6.0 mm or 3.0–4.0 mm, with the primary endpoint of first-pass PVI. In compliance with the CLOSE protocol, the maximum tolerated ILD was 6.0 mm in both study protocols. A target ablation index of ≥550 (anterior) or ≥400 (posterior) was defined for the ‘5–6 mm’ protocol and ≥500 (anterior) or ≥350 (posterior) for the ‘3–4 mm’ protocol. The study was terminated early for superiority of the ‘3–4 mm’ protocol. Forty-two consecutive patients were randomized and 84 ipsilateral PV pairs encircled according to the study protocol. First-pass PVI was accomplished in 35.0% of the ‘5–6 mm’ group and 90.9% of the ‘3–4 mm’ group (P < 0.0001). Median ILD was 5.2 mm in the ‘5–6 mm’ group and 3.6 mm in the ‘3–4 mm’ group (P < 0.0001). In line with the distinct ablation index targets, median ablation index was lower in the ‘3–4 mm’ group (416 vs. 452, P < 0.0001). While mean procedure time was shorter in the ‘3–4 mm’ group (149 ± 27 vs. 167 ± 33min, P = 0.004), fluoroscopy times did not differ significantly (4.7 ± 2.2 vs. 5.1 ± 1.8 min, P = 0.565). Conclusion In ablation index-guided AF ablation, an ILD of 3.0–4.0 mm should be targeted rather than 5.0–6.0 mm. Moreover, the lower target ILD may allow for less extensive ablation at each given point.

scholarly journals Association between left atrial wall thickness and residual potential after pulmonary vein antral isolation in patients with atrial fibrillation receiving Ablation Index-guided ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.R Lee ◽  
E.J Lee ◽  
M.J Cha ◽  
E.K Choi ◽  
S Oh
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Wall Thickness ◽  
Left Atrial ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
Ablation Index ◽  
Significant Difference ◽  
First Pass ◽  
Residual Potential

Abstract Background For the improvement of efficacy in radiofrequency catheter ablation (RFCA) of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF), fixed target Ablation Index (AI) value has been recommended regardless of individual and regional differences of left atrial wall thickness (LAWT). Objective To evaluate the association between LAWT and residual potential (RP) after first pass encirclement of PVI in AF patients receiving AI-guided PVI. Method A total of 116 patients (29% persistent AF) undergone AF RFCA using AI-guided PVI were included. Using SmartTouch catheter or SmartTouch SF catheter (Biosense Webster Inc., CA, US), point-by-point ablation was delivered at 30–40W on the anterior/roof segments and 25–30W on the posterior/inferior/carina segments. AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments. After first encirclement of PVI was performed, RP was evaluated. LAWT was evaluated by 3-dimensional wall thickness map using computed tomographic images. LAWT values of ablation regions were graded by LAWT in each segment of PV antrum (Figure). Results Among a total of 1564 PV segments, RP was observed in 106 segments (6.8%). Left superior, inferior PV ridges and right superior PV roof segments were the most, second, and third thickest area among 14 PV segments (mean LAWT grade 5.09±1.08, 3.34±1.70, and 2.32±1.11, respectively). Mean LAWT grade was lower in segments with RP than those in without RP (2.74±1.80 vs. 2.07±1.28, p<0.001, Figure). In segments applied AI 450 (anterior/roof), segments with RP showed significantly thicker LAWT than those without RP (mean LAWT grade 3.65±2.01 vs. 2.57±1.56, p<0.001). In posterior/inferior/carina segments applied AI 350, there was no significant difference in mean LAWT between segments with and without RP (1.80±0.77 vs. 1.75±0.83, p=0.744). Conclusion Delivering same AI during PVI, thicker LAWT was associated with higher incidence of RP after first pass encirclement of PV in anterior/roof area. Tailored AI should be considered by LAWT to improve acute outcome of PVI. LAWP RP Funding Acknowledgement Type of funding source: None

scholarly journals Myocardial injury after pulmonary vein isolation: fire versus ice

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A R Morgado Gomes ◽  
N S C Antonio ◽  
S Silva ◽  
M Madeira ◽  
P Sousa ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Troponin I ◽  
Surrogate Marker ◽  
High Sensitivity ◽  
Cryoballoon Ablation ◽  
Single Shot ◽  
High Sensitivity Troponin ◽  
Ablation Index ◽  
Significant Difference

Abstract Introduction The cornerstone of atrial fibrillation (AF) catheter ablation is pulmonary vein isolation (PVI), either using point-by-point radiofrequency ablation (RF) or single-shot ablation devices, such as cryoballoon ablation (CB). However, achieving permanent transmural lesions is difficult and pulmonary vein (PV) reconnection is common. Elevation of high-sensitivity Troponin I (hsTnI) may be used as a surrogate marker for transmural lesions. Still, data regarding the comparison of hsTnI increase after PVI with RF or cryo-energy is controversial. Purpose The aim of this study is to compare the magnitude of hsTnI elevation after PVI with CB versus RF using ablation index guidance. Methods Prospective study of 60 patients admitted for first ablation procedure of paroxysmal or persistent AF in a single tertiary Cardiology Department. Thirty patients were submitted to PVI using CB and 30 patients were submitted to RF, using CARTO® mapping system and ablation index guidance. Patients with atrial flutter were excluded. Baseline characteristics were compared between groups, as well as hsTnI before and after the procedure. Results Mean age was 57.9±12.3 years old, 62% of patients were male and 77% had paroxysmal AF. There were no significant differences between groups regarding gender, age, prevalence of hypertension, dyslipidaemia, diabetes, obesity or AF type. There was also no significant difference in electrical cardioversion need during the procedure. HsTnI median value before ablation was 1.90±1.98 ng/dL. Postprocedural hsTnI was significantly higher in CB-group (6562.7±4756.2 ng/dL versus 1564.3±830.7 ng/dL in RF-group; P=0.001). Regarding periprocedural complications, there was only one case of mild pericardial effusion in RF-group associated with postablation hsTnI of 1180.0 ng/dL. Conclusions High-sensitivity Troponin I was significantly elevated after PVI, irrespective of the ablation technique. In CB-group, hsTnI elevation was significantly higher than in RF-group. This disparity may reflect more extensive lesions with cryoablation, without compromising safety. Longterm studies are needed to understand whether this hsTnI elevation is predictive of a lower AF recurrence rate. FUNDunding Acknowledgement Type of funding sources: None.

P2846Focal impulse and rotor modulation ablation versus pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (FIRMAP AF study)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Tilz ◽  
C L Lenz ◽  
P S Sommer ◽  
N Sawan ◽  
R Meyer-Saraei ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Gold Standard ◽  
Artery Aneurysm ◽  
Rf Ablation ◽  
Af Ablation ◽  
Number Of Patients

Abstract Background Based on the assumption of trigger elimination, pulmonary vein isolation (PVI) currently presents the gold standard of atrial fibrillation (AF) ablation. Recently, rapidly spinning rotors or focal impulse formation has been raised as a crucial sustaining mechanism of AF. Ablation of these rotors may potentially obviate the need for trigger elimination with PVI. Purpose This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation only with the gold standard of pulmonary vein isolation (PVI) in patients with paroxysmal AF. Methods This was a post-market, prospective, single-blinded, randomized, multi-center trial. Patients were enrolled at three centers and equally (1:1) randomized between those undergoing conventional RF ablation with PVI (PVI group) vs. those treated with FIRM-guided RF ablation without PVI (FIRM group). Data was collected at enrollment, procedure, and at 7-day, 3-month, 6-month, and 12-month follow-up visits. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. Results From February 2016 until February 2018, a total of 51 (out of a planned 170) patients (mean age 63±10.6 years, 57% male) were enrolled and randomized. Four patients withdrew from the study prior to treatment, resulting in 23 patients allocated to the FIRM group and 24 in the PVI group. Only 13 patients in the FIRM group and 11 patients in the PVI group completed the 12-month follow-up. Statistical analysis was not completed given the small number of patients. Single-procedure effectiveness (freedom from AF/atrial tachycardia recurrence after blanking period) was 52.9% (9/17) in the FIRM group and 85.7% (12/14) in the PVI group at 6 months; and 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Repeat procedures were performed in 45.8% (11/24) patients in the FIRM group and 7.4% (2/27) in the PVI group. The acute safety endpoint [freedom from procedure-related serious adverse events (SAE)] was achieved in 87% (20/23) of FIRM group patients and 100% (24/24) of PVI group patients. Procedure related SAEs occurred in three patients in the FIRM group: 1 femoral artery aneurysm and 2 injection site hematomas. No additional procedure-related SAEs were reported >7 days post-procedure. Conclusions These partial study effectiveness results reinforce the importance of PVI in paroxysmal atrial fibrillation patients and suggest that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients. Further study is needed to understand the effectiveness of adding FIRM-guided ablation as an adjunct to PVI in this patient group. Acknowledgement/Funding Abbot

P2848Electrical reconnections after pulmonary vein isolation with or without contact force-guided catheters: a comparison of the proficiency of atrial fibrillation ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Fujimoto ◽  
K Yodogawa ◽  
Y Iwasaki ◽  
M Hachisuka ◽  
R Mimuro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Contact Force ◽  
High Volume ◽  
Procedure Time ◽  
Surgical Ablation ◽  
Af Ablation ◽  
Significant Difference ◽  
The Right ◽  
Posterosuperior Segment

Abstract Background Atrial fibrillation (AF) ablation is the most commonly performed catheter ablation (CA) procedure today. The 2015 ACC/AHA/HRS Advanced Training Statement reported that the success rate of AF ablation is higher in high-volume centers than in low-volume centers. We tested whether the procedure proficiency of each operator was associated with the outcome of AF ablation, and whether the ablation outcome depended on whether contact force (CF)-guided catheters were used or not, in a high-volume center. Methods We conducted a retrospective observational study including all AF patients who underwent radiofrequency CA with or without CF support since 2016 at our hospital. The patients who underwent CA at other hospitals or underwent a balloon or surgical ablation in the first session were excluded. Each ipsilateral pulmonary vein (PV) pair was divided into 8 segments. The reconnection numbers and sites of the PV segment were evaluated in the second session. Operators were divided into the experienced group (≥100 AF cases/year, at least every 3 years) and developing group (other than the experienced group), respectively. Results Among 728 patients who underwent an initial AF ablation and were followed for 510±306 days, 131 (90 males, 65±10 years) received a second ablation procedure and were analyzed. A total of 260 and 264 PV isolations (PVI) were performed by the experienced and developing group operators in the initial ablation, respectively. Compared to the experienced group, the developing group had a longer procedure time for the PVI (35±15 vs. 28±10 min, p<0.001), higher frequency of reconnections of the PVs (73% vs. 59%, p=0.01) and higher number of reconnection gaps (2.1±2.0 vs. 1.5±2.0, p=0.02), respectively. There were no significantly differences in the number of gaps between the catheters with and without CF (1.6±2.0 vs. 1.4±2.0, p=0.65) in the experienced group, however, in the developing group a smaller total number of gaps (1.5±1.6 vs. 2.4±2.1, p=0.006) and less frequency reconnection gaps of the posterosuperior segment of the right PV (10% vs. 45%, p=0.005) were seen with catheters with CF than without. There was no significant difference in the procedure time for the PVI between catheters with and without CF. Conclusions The operator proficiency may predict the outcome after AF ablation even in high-volume centers. It is preferable to perform PVI with a CF-sensing catheter for operators without adequate proficiency. Acknowledgement/Funding JSPS KAKENHI Grant Number JP18K15865

scholarly journals Shorter interlesion distance is associated with a longer procedure time but not with poorer acute results of pulmonary vein isolation: results from a prospective ablation index registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Gasimova ◽  
EB Kropotkin ◽  
EA Ivanitsky ◽  
GV Kolunin ◽  
AA Nechepurenko ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Pulmonary Veins ◽  
Anterior Wall ◽  
Procedure Time ◽  
Af Ablation ◽  
Ablation Index ◽  
First Pass ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was supported by the Ministry of Science and Higher Education grant (Russian Federation President Grant) #MD-2314.2020.7. Background/Introduction. Radiofrequency ablation (RFA) is the mainstay of invasive management of atrial fibrillation (AF). Amongst a variety of performance indicators, interlesion distance (ILD) has a potential to become a guiding one. Uptodate clinical AF RFA protocols suggest that ILD has to be less than 6 mm, however the research is still lacking in regard to its actual targeted value. Purpose. The aim of the research is to study a relationship between ILD and first-pass isolation (FPI) in ablation-index guided AF ablation procedures. Methods. This was a prospective observational multicenter study. Data were derived from the web-based system. Pulmonary veins (PV) isolation procedures were performed according to the local practice, and RFA settings depended on operators’ preferences. A total of 446 patients were enrolled, 407 of them underwent first-time AF ablation, data on ILD available in 322 subjects (177 (55%) males, mean age 62 ± 9 years old, 259 (80%) with paroxysmal AF). A mean ILD was calculated manually in each case as a sum of all ILDs divided by number of ablation tag points. FPI was considered in cases when no additional applications were required for bidirectional PV block following creation of a one circle around ipsilateral PVs and after a 20-min waiting period. Patients were divided into two groups according to ILD (Group 1 ILD≤ 4 mm, 163 patients and Group 2 ILD &gt; 4m, 159 patients) post-procedurally. Results.  The mean procedure time was 102 ± 52 min, the median fluoro time was 9 min [IQR 6; 15]. The following VisiTag parameters were used: the median target ablation index 400 [IQR 400; 500] on the left atrial anterior wall and 380 [IQR 380; 400] on the posterior segments, the median minimal contact force 3g [IQR 3; 4], median minimal time per a point - 4 sec [IQR 3; 15], mean catheter stability 3 mm (ranged between 2.5 and 3 mm). In 261 (81%) cases operators used 3 mm ablation tag size, and in 19% - 2 mm. The mean ILD was 4,1 ± 1,0 mm (3,2 ± 0,5 mm in Group 1 vs 4,6 ± 0,5 mm Group 2). FPI was achieved in 189 (59%) cases. In the "ILD ≤ 4 mm" group FPI was achieved in 93 (49,2%) cases and there were 96 (50,8%) cases of durable FPI in the "ILD &gt;4 mm" group (χ2 = 2,4, p = 0,124). The mean procedure time was 111 ± 46 min and 100 ± 35 min in Group 1 and 2 (p = 0,01), respectively. The mean fluoro time was 13 ± 4 min and 11 ± 4 min in Group 1 and 2 (p = 0,08), respectively Conclusion(s). The results of our multicenter study suggest that shortening of the distance ≤4 mm has no effect on the achievement of first-pass PV isolation, but required more procedure and relatively more X-ray exposure time.

scholarly journals Radiofrequency pulmonary vein isolation using catheter dragging technique guided by grid annotation vs. point-by-point technique guided by Ablation Index: a randomized controlled trial

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M.J Mulder ◽  
M.J.B Kemme ◽  
L.H.G.A Hopman ◽  
A.M.D Hagen ◽  
P.M Van De Ven ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Statistical Significance ◽  
Controlled Study ◽  
Private Company ◽  
Randomized Controlled ◽  
Ablation Index ◽  
Target Values ◽  
Grid Points

Abstract Background Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is an important treatment option in symptomatic atrial fibrillation (AF) patients. Ablation Index (AI) has recently attracted considerable interest as a guide for PVI procedures and combines contact force, RF application time and ablation power into a single metric. A limitation of ablation strategies guided by AI is the impossibility to use a catheter dragging technique. Although comparative studies are sparse, ablation using a catheter dragging technique may shorten procedural duration and improve PVI durability by creating uninterrupted linear ablation lesions. These ablation lesions can be visualized by a grid (grid annotation), which may provide valuable information on both lesion depth and lesion contiguity. We compared an AF ablation approach guided by grid annotation, with a point-by-point AI annotation approach in a single-center randomized study. Methods Eighty-eight patients with paroxysmal or persistent AF were randomized 1:1 to undergo RF-PVI guided by either grid annotation or AI annotation. In the grid annotation arm, ablation was visualized using automatic generation of 1mm3 grid points projected on the electroanatomic map, with grid points coloring red after 15 seconds of ablation while meeting predefined stability and contact force criteria. Ablation was performed aiming for a continuous circle of red grid points. In the AI annotation arm, ablation was visualized using automatically generated lesion tags with a diameter of 3 mm. AI target values were set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Ablation lesions were created in a point-by-point fashion, aiming for a maximum interlesion distance of 6 mm. All study participants were followed up for 12 months after PVI using out-patient clinic visits, ECGs, 24-hour Holter monitoring and a mobile-based one-lead ECG device to assess heart rhythm when symptoms suggestive of an arrhythmia occurred. Results The primary endpoint of procedure time was not different between the two randomization arms (grid annotation 71±19 min, AI annotation 72±26 min, p=0.765, Figure 1A). RF time was significantly longer in the grid annotation arm compared with the AI annotation arm (49±8 min vs. 37±8 min, respectively, p&lt;0.001). Neither fluoroscopy time or radiation dose were different between the randomization arms. All patients completed 12 months of follow-up and recurrent atrial tachyarrhythmias were observed in 29 patients (33%). Recurrence of any atrial tachyarrhythmia was documented in 10 patients (23%) in the grid annotation arm compared with 19 patients (42%) in the AI annotation arm, which did not reach statistical significance by log-rank test (p=0.074, Figure 1B). Conclusions Findings from this randomized controlled study suggest that grid annotation may provide an alternative approach for RF-PVI using AI, allowing for ablation with the catheter dragging technique. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Biosense Webster, Inc. Figure 1

Pulmonary vein isolation using ablation index vs. CLOSE protocol with a surround flow ablation catheter

EP Europace ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Benjamin Berte ◽  
Gabriella Hilfiker ◽  
Federico Moccetti ◽  
Thomas Schefer ◽  
Vanessa Weberndörfer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Atrial Tachycardia ◽  
Ablation Catheter ◽  
Ablation Index ◽  
First Pass ◽  
Procedure Duration

Abstract Aims Pulmonary vein isolation (PVI) using ablation index (AI) incorporates stability, contact force (CF), time, and power. The CLOSE protocol combines AI and ≤6 mm interlesion distance. Safety concerns are raised about surround flow ablation catheters (STSF). To compare safety and effectiveness of an atrial fibrillation (AF) ablation strategy using AI vs. CLOSE protocol using STSF. Methods and results First cluster was treated using AI and second cluster using CLOSE. Procedural data, safety, and recurrence of any atrial tachycardia (AT) or AF &gt;30 s were collected prospectively. All Classes 1c and III anti-arrhythmic drugs (AAD) were stopped after the blanking period. In total, all 215 consecutive patients [AI: 121 (paroxysmal: n = 97), CLOSE: n = 94 (paroxysmal: n = 74)] were included. Pulmonary vein isolation was reached in all in similar procedure duration (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) and similar radiofrequency time (CLOSE: 36 ± 11 vs. AI: 37 ± 8 min; P = 0.4) but first pass isolation was higher in CLOSE vs. AI [left veins: 90% vs. 80%; P &lt; 0.05 and right veins: 84% vs. 73%; P &lt; 0.05]. Twelve-month off-AAD freedom of AF/AT was higher in CLOSE vs. AI [79% (paroxysmal: 85%) vs. 64% (paroxysmal: 68%); P &lt; 0.05]. Only four patients (2%) without recurrence were on AAD during follow-up. Major complications were similar (CLOSE: 2.1% vs. AI: 2.5%; P = 0.87). Conclusion The CLOSE protocol is more effective than a PVI approach solely using AI, especially in paroxysmal AF. In this off-AAD study, 79% of patients were free from AF/AT during 12-month follow-up. The STSF catheter appears to be safe using conventional CLOSE targets.

Abstract 2754: Pulmonary Vein Isolation Using Irrigated vs. Conventional 4-mm Tip Catheters- Do Short and Long-Term Outcomes Differ?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ganesh S Kamath ◽  
Harikrishna Makani ◽  
Jorge Silva Enciso ◽  
Sunil Kumar ◽  
Suneet Mittal ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Clinical Investigation ◽  
Study Cohort ◽  
Radiofrequency Energy ◽  
Entire Study ◽  
Number Of Patients ◽  
Significant Difference ◽  
Initial Procedure ◽  
Short And Long Term

Open saline-irrigated tip ablation catheters have largely supplanted standard 4 mm tip ablation catheters for pulmonary vein isolation (PVI) of atrial fibrillation (AF), based on the assumption that the procedure is safer and more efficacious. However, outcomes after procedures that use identical techniques but different radiofrequency ablation catheters have not been compared. We studied 432 consecutive patients (age 57 ± 11 yrs) with AF (duration 7.9 ± 6.1 yrs) who underwent PVI; 320 (74 %) using a conventional 4 mm catheter and 112 (26 %) using an open irrigated tip catheter. Segmental PVI targeting the earliest LA-PV activation for all PVs in each patient was used for all patients regardless of catheter for the entire study cohort. Radiofrequency energy was delivered for ≥60 secs at each target site. The pts in the 2 groups were similar with respect to age, gender and duration of AF. All 432 pts had successful complete PVI. There was no significant difference in the total number of lesions delivered per PV in the conventional 4 mm group and the irrigated tip group (Table ) at the initial procedure. Following a single procedure, 227/ 320 (71%) patients in the conventional 4 mm and 75/112 (67%) in the irrigated group were AF-free on no antiarrhythmic drug at 12 mos (p=0.43). The number of patients who required repeat procedures was similar in the conventional group (57/320, 18%) and the irrigated tip group (22/112, 20%) (p=0.66). Serious complications were also similar (2.2% vs. 1.0 %, p=0.21) Contrary to conventional wisdom, the safety and 12 month efficacy of PVI for management of AF was similar for the two types of ablation catheters. These data suggest that PVI cohorts derived from differing ablation techniques can be combined for purposes of clinical investigation. Longer term outcomes may differ and should be studied as well.

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