Risk of esophageal thermal injury during catheter ablation for atrial fibrillation guided by different ablation index

Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF) However AF recurrence after a single ablation procedure is common and often attributed to ineffective lesion delivery during PVI. In this issue of the Journal of Cardiovascular Electrophysiology, Chen et al reported their experience with 122 patients who underwent an ablation index-high power (AI-HP) strategy RF ablation for AF using 50W power, targeting AI values of 550 on the anterior left atrium (LA), 400 on the posterior wall and inter-lesion distance (ILD) 6mm. They achieved 1st pass PVI in 96.7% of cases, mean RF time was 11.5min and total procedure time was only 55.8min. All patients had 72h-Holter monitor and trans-telephonic follow up. They reported 89.4% arrhythmia free survival among patients with paroxysmal AF and 80.4% among patients with persistent AF at 15-month follow up. Sixty (49%) patients had luminal esophageal temperature (LET) >390C out of which 3 (2.5%) had asymptomatic endoscopic esophageal erosions/erythema. Four (3%) patients had clinically apparent steam pops during ablation with no adverse clinical sequela. While AI-HP guided RF ablation may be an attractive strategy for PVI that likely reduces procedure times and probably has comparable efficacy to conventional ablation settings, its safety requires further evaluation. Feedback from the ablated tissue may need to be incorporated into optimized ablation energy parameters to further improve outcomes.

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One-year outcome and durability of pulmonary vein isolation after prospective use of ablation index for catheter ablation in patients with persistent atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00880-1 ◽

2020 ◽

Author(s):

Nico Reinsch ◽

Anna Füting ◽

Jochen Buchholz ◽

Ute Ruprecht ◽

Volker Holzendorf ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Persistent Atrial Fibrillation ◽

Ablation Index ◽

One Year

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Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis

EP Europace ◽

10.1093/europace/euaa224 ◽

2020 ◽

Vol 22 (11) ◽

pp. 1659-1671

Author(s):

Adam Ioannou ◽

Nikolaos Papageorgiou ◽

Wei Yao Lim ◽

Tanakal Wongwarawipat ◽

Ross J Hunter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Meta Analysis ◽

Efficacy And Safety ◽

Ablation Index ◽

Procedural Time ◽

Force Time ◽

European Society Of Cardiology ◽

Procedural Outcomes

Abstract Aims Despite recent advances in catheter ablation for atrial fibrillation (AF), pulmonary vein reconnection (PVR), and AF recurrence remain significantly high. Ablation index (AI) is a new method incorporating contact force, time, and power that should optimize procedural outcomes. We aimed to evaluate the efficacy and safety of AI-guided catheter ablation compared to a non-AI-guided approach. Methods and results A systematic search was performed on MEDLINE (via PubMED), EMBASE, COCHRANE, and European Society of Cardiology (ESC) databases (from inception to 1 July 2019). We included only studies that compared AI-guided with non-AI-guided catheter ablation of AF. Eleven studies reporting on 2306 patients were identified. Median follow-up period was 12 months. Ablation index-guided ablation had a significant shorter procedural time (141.0 vs. 152.8 min, P = 0.01; I2 = 90%), ablation time (21.8 vs. 32.0 min, P < 0.00001; I2 = 0%), achieved first-pass isolation more frequently [odds ratio (OR) = 0.09, 95%CI 0.04–0.21; 93.4% vs. 62.9%, P < 0.001; I2 = 58%] and was less frequently associated with acute PVR (OR = 0.37, 95%CI 0.18–0.75; 18.0% vs 35.0%; P = 0.006; I2 = 0%). Importantly, atrial arrhythmia relapse post-blanking was significantly lower in AI compared to non-AI catheter ablation (OR = 0.41, 95%CI 0.25–0.66; 11.8% vs. 24.9%, P = 0.0003; I2 = 35%). Finally, there was no difference in complication rate between AI and non-AI ablation, with the number of cardiac tamponade events in the AI group less being numerically lower (OR = 0.69, 95%CI 0.30–1.60, 1.6% vs. 2.5%, P = 0.39; I2 = 0%). Conclusions These data suggest that AI-guided catheter ablation is associated with increased efficacy of AF ablation, while preserving a comparable safety profile to non-AI catheter ablation.

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Optimal ablation index parameters for radiofrequency ablation therapy of atrial fibrillation

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.3.4971 ◽

2022 ◽

Vol 38 (3) ◽

Author(s):

Xiaoru Qin ◽

Xiaofei Jiang ◽

Qiyan Yuan ◽

Guangli Xu ◽

Xianzhi He

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Posterior Wall ◽

Control Group ◽

Ablation Therapy ◽

Ablation Index ◽

Gastrointestinal Discomfort ◽

Radiofrequency Ablation Therapy

Objective: To explore the optimal ablation index (AI) parameters for radiofrequency catheter ablation (RA) for treating atrial fibrillation (AF). Method: Patients with AF (186) who underwent bilateral PVAI in the Department of Cardiology, Zhuhai People’s Hospital, Guangdong Province, from March 2018 to October 2019 and received catheter ablation as first-round treatment, were grouped according to the received AI. Control group included patients (95) who received the recommended AI ablation (350–400 for posterior wall, 400–450 for non-posterior wall). Patients in optimal AI group were ablated with optimal AI (300–330 for posterior wall, 350–380 for non-posterior wall). Results: Of 186 patients, 66 patients had paroxysmal atrial fibrillation and a mean CHA2DS2-VASc score of 2.83±1.64. Isolation rates of bilateral PVI in both groups were 91.4% and 93.6%, for patients with paroxysmal atrial fibrillation, and 81.7% and 80% for patients with persistent atrial fibrillation (P > 0.05). Left atrial function index (LAFI) decreased under the condition of sinus rhythm at the 3rd and 6th months (P < 0.05). LAFI improvement was significantly better in the optimal AI group than in the control group (P < 0.05). Rates of pain and cough during the ablation, and postoperative gastrointestinal discomfort and use of PPIs were higher in the control group (P < 0.05). Conclusion: Radiofrequency ablation of AF, guided by optimal AI combined with impedance, can minimize atrial injury, prevent atrial failure, promote the recovery of atrial function, reduces intraoperative cough, pain, and postoperative gastrointestinal discomfort and use of PPIs. doi: https://doi.org/10.12669/pjms.38.3.4971 How to cite this:Qin X, Jiang X, Yuan Q, Xu G, He X. Optimal ablation index parameters for radiofrequency ablation therapy of atrial fibrillation. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4971 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Association between ablation index and myocardial injury following radiofrequency catheter ablation for atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.218 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A De Bortoli ◽

O-G Anfinsen ◽

T Holm

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Myocardial Injury ◽

Troponin T ◽

Lesion Size ◽

Limiting Factor ◽

Af Ablation ◽

Ablation Index ◽

Target Values

Abstract Funding Acknowledgements Type of funding sources: None. Background Unpredictable lesion formation is a major limiting factor for radiofrequency catheter ablation for atrial fibrillation (AF). Ablation index (AI) emerged as a novel parameter to monitor lesion development and potentially improve clinical outcomes. Additional evidence is needed to support its use. Purpose We aimed at evaluating the relationship between AI and other lesion indicators and the release of myocardial-specific biomarkers following AF ablation. Methods Forty-six patients with similar baseline characteristics underwent a first-time radiofrequency ablation for AF and were prospectively enrolled in this study. Pulmonary vein isolation was performed by six experienced electrophysiologists with a point-by-point approach, guided by strict Visitag criteria and consistent AI target values. Myocardial-specific biomarkers troponin T and creatine kinase myocardial band were measured after 6 (TnT6 and CKMB6) and 20 hours (TnT20 and CKMB20) following sheath removal. Ablation duration, impedance drop (ID), force-time integral (FTI) and AI were registered automatically and analyzed off-line. Since biomarkers release reflect the total amount of myocardial injury, our independent variables consisted of total ablation duration, total ID, total FTI and total AI. Results 97% of total ablation duration fulfilled pre-specified Visitag criteria. Mean application duration was 20.0 ± 3.5 s, mean contact force was 15.9 ± 4.2 g, mean maximum power was 35.3 ± 1.5 W. Troponin T release was 985 ± 495 ng/L and 1038 ± 461 ng/L (p = ns) while CKMB release was 7.3 ± 2.7 mcg/L and 6.5 ± 2.1 mcg/L (p < 0.001) at 6 and 20 hours, respectively. Ablation duration, ID, FTI and AI were all significantly correlated with the release of myocardial-specific biomarkers both at 6 and 20 hours (all correlations significant at p < 0.01 level, Fig. 1). Ablation index showed the highest degree of correlation with TnT6, TnT20, CKMB6 and CKMB20 (Pearson`s R 0.69, 0.69, 0.58, 0.64 respectively, p < 0.001). Multiple regression analysis demonstrated that AI had the strongest association with TnT6, TnT20, CKMB6 and CKMB20 (beta 0.43, 0.71, 0.41 and 0.43, respectively). Conclusion Ablation index appears as the strongest lesion size indicator as measured by the release of myocardial-specific biomarkers following radiofrequency catheter ablation for AF. Abstract Figure. Scatter plots and correlations

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